Home > Medical School, Medical/Health Commentary > AMSA Follies: By Reader Demand

AMSA Follies: By Reader Demand

I was originally going to abandon any effort to post the remainder of my coverage of the American Medical Students Association’s 2011 annual convention when it become clear that it would be so delayed that it could hardly be considered topical. A small number of readers have encouraged me to post the highlight anyways, using the arguments: better late than never; the events left to be blogged were the most interesting; and finally, I may as well “complete the chronicle.”

Below the cut, for those interested in how health policy was presented at the AMSA convention, are highlights from two events: a debate between Michael Cannon (Cato Institute) and Robert Zarr (American Academy of Pediatrics, Physicians for a National Health Plan); and a later event featuring Walter Tsou (immediate past president, PNHP).

The debate was something of an unfortunate affair. The topic was supposed to be about the PPACA, presumably with Cannon opposing it and Zarr favouring it. Of course, PNHP are no fans of the health reform bill either.

Mr. Cannon opened with a number of points clearly aimed at his audience: skeptical medical students (except for the one Cato fanboy sitting upfront). He presented reasons why we as (future) physicians should oppose the health reform bill:

  1. Insurance expansion doesn’t always lead to health improvement; isn’t our goal health improvement? He cited data from the first 10 years of the Medicare program showing that it didn’t save a single life.
  2. The PPACA won’t reduce costs, and won’t reduce the deficit, which will lead to more pain, more taxes, more brutal spending cuts in the future.
  3. By increasing the amount of bureaucracy, especially government bureaucracy, the health reform bill will require future physicians to spend less time caring for patients and more time lobbying and advocating. (okay, this one may not have been well-tailored to the median audience member…)
  4. If the mandate is found to be constitutional, so will any other government intrusion into areas that fall under the scope of the ever-expanding Commerce Clause.
  5. When insurers tried to point out that the act would increase premiums, Secretary Sebelius, tasked with overseeing the thicket of insurance regulations to be written, told them not so subtlely to shut up. What would happen in a government-prone system if physicians tried to speak up?
  6. Finally, he argued that the proposed Independent Payment and Advisory Board would substantially reduce the influence of physicians over health policy, and their own practices.

Dr. Zarr’s presentation seemed like a canned pro-single payer PowerPoint that he brought out in response to a speaking invitation. This led to him talking past many of the points that Mr. Cannon made. Now, I’ll be upfront and say that I don’t think that single-payer is a good idea for the US, least of all single-payer implemented on a national scale and overseen by the federal government. Though I may disagree with it, there is an intellectually honest and good-faith case to be made for it. Dr. Zarr did not make that case. His presentation was instead notable for a variety of misrepresentations and misinterpretations of data, peppered with the occasional false or naive statement. Even my pro-single payer classmates didn’t think much of his talk.

Here’s a sampling of some of the goofs he made:

  • Implying that a long hospital length-of-stay is a goal unto itself (in comparing the US to countries with longer length-of-stay).
  • Pretending that health care systems can be evaluated by looking at life expectancy at birth (a much better case could be made for life expectancy at 60 or 65).
  • Getting the statistics on comparative out-of-pocket health care spending simply wrong. 
  • Using a deceptive metric to compare Medicare to private insurance overhead
  • Finally, as with AMSA’s health policy “leaders,” Dr. Zarr continually made the erroneous conflation of “single-payer” with “universal coverage.” At least now we know where AMSA’s PNHP acolytes get it from.

The subsequent presentation from PNHP was substantively better than Dr. Zarr’s bit, but not by much. At least this one was supposed to be about single-payer financing and delivery.

  • Dr. Tsou lamented the fact that there is no “mission statement” or central control of health care spending. Someone might think he was begging the question, but then he was preaching to the choir.
  • He framed the argument for single-payer as pro-business, pro-jobs, centrist, and patriotic. 
  • When discussing the requirements for insurance plans sold on Obamacare exchanges, he completely confused actual vs. actuarial spending values. A minor quibble, perhaps, but something I would have hoped a professional financing reform activist would have grasped.
  • According to Dr. Tsou, health IT (and electronic medical records in particular) will not work except within a single-payer framework.
  • He made the assertion that in OECD countries with some private financing of health spending, “insurers act as the single payer.” The mental contortions necessary to utter that phrase did not manifest themselves physically.
  • Stepping far outside his area of expertise, Dr. Tsou launched into a bizarre diatribe in which he lamented the loss of manufacturing jobs in the US, claiming that “a country that doesn’t produce things is a second-class country,” and that “jobs follow manufacturing.” My notes also indicate that something was said about textiles. Perhaps he thinks that more of us should have gone to work in the t-shirt factories instead of entering our chosen (service sector) profession?

Also of note, Ezra Klein gave the keynote speech between these two sessions. There’s no use in my noting what was said, given that he posted it the night before the talk. The Q&A, however, revealed a curious fascination with the Canadian health care system, and a whole lot of ignorance about how it works.

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