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zoom RSS 米国医師会は政府後援の健康保険プランに反対/米国医療事情 オバマ政権 医療制度改革

<<   作成日時 : 2009/06/13 00:11   >>

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 米国医師会は政府後援の保険プランに反対。約25万人の会員を擁する米国最大の医師組織である。
 医師会としては、一般原則論として医療サービスは現状と同じく私的市場を通して提供されるべきであるとしている。
 オバマ大統領は選挙期間中と先週の議会への手紙で、新たな公的な健康保険オプションを要求している。ナンシー・ペロシもそのゴールを支持すると言った。公的なオプションなしに法案は議会を通過しないだろうと言う。
 上院財務委員会に提出されたコメントの中で、米国医師会は、65才以下で障害なしの個人のために公的医療保険オプションを作成することが補償の拡大とコスト低下に最も良い方法だとは思わない、という。現在約70%に補償提供している私的保険業者を追放して新たな公的プランを導入すると患者の選択を制限する恐れがある。公的プラン参加の急増により納税者負担の増加を引きおこす可能性がある。
 かつては政治的な巨獣であったが、現在もどの医療産業よりも強い影響力を持っているため、議員は可能であればいつもその意見と支持を求める。メディケア支払い削減に対しては繰り返し議会を説得して削減撤回や延期をもたらしてきた。
 2000年以来の選挙において医師会の政治活動委員会は980万ドルを議会の候補者に寄付してきた。2008年は56%民主党へ寄付したが、それ以前の4回は共和党が多かった。
 180の学会を傘下におさめる米国医師会が全ての医師を代弁しているわけではない。あるグループは単一の公共保険システムを支持している。最近特に、私的保険の管理作業に嫌気が差しているため、選択肢を探している医師がいる。
 医師会は、医師の参加を強制するようなプランは支持できない。多くの医師や医療施設は新たな患者流入を受け入れる余裕がない。従来連邦プログラムは医師の自発的な基盤に基づいて行われてきた。
 医師会にとっても医療改革は重要であり建設的な方法で議論を進めている。医療的な決定の政府による統制や保険計画への医師の義務的参加には絶対反対である。
 1993年6月13日のシカゴでのヒラリー・ロダム・クリントンのスピーチを医師会は思い起す。彼女は、医師が、医療制度改革に対する彼女の努力を支持すれば、ホワイトハウスが、医療訴訟を制限し、医師を煩わしい規則から解放する「新しい契約」を提案した。
 医師会はいくつかの点でオバマ大統領に合意する。保険を取得する余裕のある人には取得を義務化すべきである。私的なMedicare Advantage プランへの支払い削減にはオバマ氏と同じ意見である。
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 米国医師会長の緊急コメント:
画像 間違えないでほしい。無保険者をカバーする医療改革は、米国医師会の今年の最優先事項である。すべてのアメリカ人が入手可能な高品質な医療保険を得る必要がある。このNYTの記事は、医療改革立法における公的医療保険プランに対する米国医師会の立場に誤った印象を与えている。医師会は、医師に参加を強制し、財政上問題視されたメディケアプログラムを拡大するような公的な計画にはどんなものにも反対するが、現在議会で議論中の公的な計画のバリエーションは喜んで検討したい。
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Doctors’ Group Opposes Public Insurance Plan
http://www.nytimes.com/2009/06/11/us/politics/11health.html
By ROBERT PEAR
Published: June 10, 2009

画像WASHINGTON ― As the health care debate heats up, the American Medical Association is letting Congress know that it will oppose creation of a government-sponsored insurance plan, which President Obama and many other Democrats see as an essential element of legislation to remake the health care system.

The opposition, which comes as Mr. Obama prepares to address the powerful doctors’ group on Monday in Chicago, could be a major hurdle for advocates of a public insurance plan. The A.M.A., with about 250,000 members, is America’s largest physician organization.

While committed to the goal of affordable health insurance for all, the association had said in a general statement of principles that health services should be “provided through private markets, as they are currently.” It is now reacting, for the first time, to specific legislative proposals being drafted by Congress.

In the presidential campaign last year and in a letter to Congress last week, Mr. Obama called for a new “public health insurance option,” which he said would compete with private insurers and keep them honest.

Speaker Nancy Pelosi of California said Wednesday that she supported that goal. “A bill will not come out of the House without a public option,” she said Wednesday on MSNBC.

But in comments submitted to the Senate Finance Committee, the American Medical Association said: “The A.M.A. does not believe that creating a public health insurance option for non-disabled individuals under age 65 is the best way to expand health insurance coverage and lower costs. The introduction of a new public plan threatens to restrict patient choice by driving out private insurers, which currently provide coverage for nearly 70 percent of Americans.”

If private insurers are pushed out of the market, the group said, “the corresponding surge in public plan participation would likely lead to an explosion of costs that would need to be absorbed by taxpayers.”

While not the political behemoth it once was, the association probably has more influence than any other group in the health care industry. Lawmakers seek its opinion and support whenever possible. It has repeatedly persuaded Congress to cancel or postpone cuts in Medicare payments to doctors, though it has not secured a “permanent fix.”

If the doctors are too aggressive in fighting the public plan, they risk alienating Democrats whose support they need for legislation to increase their Medicare fees.

The group has historically had a strong lobbying operation, supplemented by generous campaign donations. Since the 2000 election cycle, its political action committee has contributed $9.8 million to Congressional candidates, according to data from the Federal Election Commission and the Center for Responsive Politics. Republicans got more than Democrats in the four election cycles before 2008, when 56 percent went to Democrats.

Robert Gibbs, the White House press secretary, said that in his address to the group next week, Mr. Obama would “outline the case for health care reform and make clear why we can’t afford to wait another year, or another administration, to bring down costs that are crushing families, businesses and government.”

Mr. Gibbs did not say whether Mr. Obama would discuss a public insurance plan, the most contentious issue in the debate.

The A.M.A., an umbrella group for 180 medical societies, does not speak for all doctors. One group, Physicians for a National Health Program, supports a single-payer system of insurance, in which a single public agency would pay for health services, but most care would still be delivered by private doctors and hospitals. In recent years, some doctors have become so fed up with the administrative hassles of private insurance that they are looking for alternatives.

Until now, stakeholders in the health care industry have generally muted their criticism of Democratic proposals. But as details of the legislation have emerged, the criticism has become more pointed.

America’s Health Insurance Plans, a lobby for insurers, said Tuesday that the government plan proposed by some Senate Democrats could “dismantle employer-based coverage and significantly increase costs for those who remain in private coverage.”

Under a proposal favored by many Democrats, doctors who take Medicare patients would also have to participate in the new public plan. Democrats say that requirement is needed to make sure the public plan can go into business right away with a large network of doctors.

The medical association said it “cannot support any plan design that mandates physician participation.” For one thing, it said, “many physicians and providers may not have the capability to accept the influx of new patients that could result from such a mandate.”

“In addition,” the A.M.A. said, “federal programs traditionally have never required physician or other provider participation, but rather such participation has been on a voluntary basis.”

In an interview, Dr. Nancy H. Nielsen, president of the American Medical Association, said she was delighted by Mr. Obama’s plan to address the doctors.

“Health care reform is as important to us as it is to him,” Dr. Nielsen said. “We will be engaged in discussions in a constructive way. But we absolutely oppose government control of health care decisions or mandatory physician participation in any insurance plan.”

Mr. Obama’s trip recalls a speech to the A.M.A. in Chicago on June 13, 1993, by Hillary Rodham Clinton. She proposed “a new bargain” in which the White House would limit malpractice lawsuits and free doctors from onerous rules if doctors supported her effort to overhaul the health care system.

The association agrees with Mr. Obama on some points. It says that individuals and families who can afford coverage should be required to obtain it.

Like Mr. Obama, the association wants Congress to cut payments to private Medicare Advantage plans. The White House says Medicare pays the private plans 14 percent more than it would cost the government to care for the same people in traditional Medicare.

Ron Nixon contributed reporting.

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AMA Committed to Health System Reform This Year
http://www.ama-assn.org/ama/pub/news-events/news-events/ama-responds-ny-times.shtml
For immediate release
June 11, 2009

Statement attributable to:
Nancy H. Nielsen, MD
President, American Medical Association

“Make no mistake: Health reform that covers the uninsured is AMA’s top priority this year. Every American deserves affordable, high-quality health care coverage.

“Today's New York Times story creates a false impression about the AMA's position on a public plan option in health care reform legislation. The AMA opposes any public plan that forces physicians to participate, expands the fiscally-challenged Medicare program or pays Medicare rates, but the AMA is willing to consider other variations of a public plan that are currently under discussion in Congress. This includes a federally chartered co-op health plan or a level playing field option for all plans. The AMA is working to achieve meaningful health reform this year and is ready to stand behind legislation that includes coverage options that work for patients and physicians.”

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Learn more about the AMA’s work to cover the uninsured and health reform.

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こんにちは。オバマ大統領どうやら、本気で社会変革にのりだそうとしているようです。実際に大きな社会問題である、医療保険改革のために、98兆円の財源確保をしようとしています。いくら社会改革をしようにも、善意だけで念仏を唱えていては何も変わりません。ひるがえって、日本はどうでしようか。社会問題に本格的に手をつけるような気配はみられません。日本は、本来的には経済より社会を優先してきて成功した国です。ポール・クルーグマンは、日本の経済対策は方向性は間違えていないが、投資額があまりに小さいとしています。私もそう思います。ここいらで、日本でも、年金問題、少子高齢化、医療、教育などの社会改革に対して少なくとも新たに50兆超円の対策を打っていくべきだと思います。これによって、多くの国民から社会に対する先行き不安が解消されれば、実体経済にもかなり良い影響を及ぼすものと思います。詳細は是非私のブログをご覧になってください。
http://yutakarlson.blogspot.com/2009/06/blog-post_13.html
yutakarlson
2009/06/14 11:00

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米国医師会は政府後援の健康保険プランに反対/米国医療事情 オバマ政権 医療制度改革 医師の一分/BIGLOBEウェブリブログ
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