Trumpfs Health Secretary Pick Leaves Nationfs Doctors Divided
By ROBERT PEAR
DEC. 26, 2016 - The New York Times
WASHINGTON
— When President-elect Donald J. Trump chose Representative Tom Price of Georgia
to be his health and human services secretary, the American
Medical Association swiftly endorsed the selection of one of its own, an
orthopedic surgeon who has championed the role of physicians throughout his
legislative career.
Then
the larger world of doctors and nurses weighed in on the beliefs and record of
Mr. Price, a suburban Atlanta Republican — and the split among caregivers,
especially doctors, quickly grew sharp.
gThe
A.M.A. does not speak for us,h says a petition signed by more than 5,000
doctors.
Mr.
Trump and a Republican-held Congress are considering some of the biggest changes
to the American health care system in generations: not only the repeal of the
Affordable Care Act, which is providing insurance to some 20 million people, but
also the transformation of Medicare,
for older Americans, and Medicaid,
for low-income people. Mr. Price has favored those changes.
Seven years ago, the A.M.A.fs support helped lift
President Obamafs health care proposals toward passage, and the group has backed
the law, with some reservations, since its adoption in 2010. But as Republicans
push for its dismantlement, deep disagreements within the A.M.A., which has long
wielded tremendous power in Washington, could lessen its influence.
Continue reading the main story
The concerns voiced by dissident
doctors do not appear to imperil Senate confirmation of Mr. Price, but they do
ensure that his confirmation hearings next month will be as contentious as any
held for a Trump nominee, featuring a full public examination of the new
presidentfs proposed health policies.
gDoctors are divided big time,h
said Dr. Carl G. Streed Jr., a primary care doctor at Brigham and Womenfs
Hospital in Boston and a member of the A.M.A. house of delegates, the
organizationfs principal policy-making body.
The controversy began soon after Mr. Trump announced on
Nov. 29 that he had chosen Mr. Price to head the Department of Health and Human
Services, which controls Medicare, Medicaid, the Affordable Care Actfs federal
health
insurance exchange, the National Institutes of Health, the Food and Drug
Administration and the Centers for Disease Contol and Prevention.
Within hours, the A.M.A. — the nationfs largest medical
advocacy group, which has nearly 235,000 members and calls itself gthe voice of
the medical professionh — issued a statement saying it gstrongly supportsh the
selection.
It noted Mr. Pricefs experience as a doctor, a state
legislator and a member of Congress. It praised, in particular, his support for
gpatient choice and market-based solutionsh and his efforts to reduce gexcessive
regulatory burdensh on doctors.
The enthusiasm was understandable at one level: Mr. Price
has been a member of the A.M.A. house of delegates since 2005 and was an
alternate delegate for a decade before that, according to the A.M.A. and the
Medical Association of Georgia.
gFor those who are attacking Dr. Price, I have to ask whom
you would rather have at the helm of H.H.S. — a career bureaucrat? A former
governor who views doctors as a cost center to be controlled?h said Dr. Robert
E. Hertzka of San Diego, an anesthesiologist and former president of the
California Medical Association. gTom Price may turn out to be the best friend
that physicians and patients have ever had in that role.h
Many doctors are not willing to take that chance. More
than 750 people who identify themselves as members of the A.M.A. signed a letter
to the associationfs board objecting to the endorsement.
The gunqualified supporth for Mr. Price is inappropriate,
the letter says, because he has been ga strong opponent of so much of our
clearly delineated A.M.A. policyh on issues like the Affordable Care Act, contraception
and gay rights. Some doctors also said their patients could be hurt by major
changes in Medicare and Medicaid that Mr. Price, along with other House
Republicans, has advocated.
Dr. Andrea S. Christopher, 32, an
internal medicine doctor at the veterans hospital in Boise, Idaho, said she had
decided not to renew her A.M.A. membership over the endorsement, which she
called especially upsetting to her generation of physicians.
gDr. Price has been an outspoken opponent of the
Affordable Care Act, which has done so much to address the needs of our most
vulnerable patients and reduced the uninsured rate to the lowest level on
record,h Dr. Christopher said.
Dr. Kristin M. Huntoon, a 37-year-old neurosurgery
resident at Ohio State University in Columbus, said the organizationfs support
for Mr. Price had increased the chances that the Affordable Care Act would be
dismantled — and that has put her patients at risk.
Ohio has extended Medicaid coverage to more than 600,000
people under the federal
health care law. If that expansion is reversed, Dr. Huntoon said, some
patients will not receive imaging or treatment at an early stage of their
disease, and they are more likely to arrive when tumors have spread to the
brain.
gAt that stage,h she said, gtherefs often nothing I can do
for the patient.h
Physicians have long been a focus of Mr. Pricefs
legislative efforts. He led the push to fix widely recognized flaws in
Medicarefs formula for paying doctors and supported changes in malpractice laws
that could make it easier for doctors to defend themselves. He supported changes
in Medicare that would allow doctors to get around fee limits by signing
contracts with patients. He has also backed changes in antitrust law that would
enhance doctorsf bargaining power in negotiations with insurance companies.
gPocketbook issues — the economic well-being of physicians
— may well be a factor contributing to the A.M.A.fs endorsement,h said Dr. Manan
Trivedi, a former Democratic candidate for Congress who is the president of the
National Physicians Alliance, a group of 10,000 doctors that opposes Mr. Pricefs
confirmation.
Dr. Patrice A. Harris, the chairwoman of the A.M.A.,
strongly defended the groupfs actions and suggested that Mr. Price could
surprise critics as Dr. C. Everett Koop did in the 1980s, when he was surgeon
general of the United States under President Ronald Reagan. Liberal politicians
and womenfs groups initially criticized Dr. Koop because of his opposition to abortion,
but when he stepped down after more than seven years in office, he was widely
praised for his role in fighting AIDS
and discouraging the use of tobacco.
gWe do realize that there is a diversity of opinion on Dr.
Price,h Dr. Harris said in an interview. gWe respect that diversity. We take the
concerns that have been expressed by some of our members and by physicians in
general seriously.
gOur support for Dr. Price is
based on our history with him, his extensive involvement with A.M.A.,h she
added. gHefs a longtime member, hefs a delegate. For us, he has always been
accessible. He listens, and he really knows how policies impact the delivery of
care and the physician-patient relationship.h
Phillip J. Blando, a spokesman for the Trump transition
team, said Mr. Price had been endorsed by many medical groups and was guniquely
preparedh for the job. gIf confirmed,h he said, gDr. Price will work to restore
the patient-doctor relationship and clamp down on government overreach.h
Mr. Price has introduced legislation to repeal President
Obamafs health law, including its expansion of Medicaid and subsidies for the
purchase of private insurance. He advocates tax credits to help people buy
insurance, greater use of individual health savings accounts and state-run
ghigh-risk poolsh for people with pre-existing conditions who might otherwise
have difficulty finding affordable coverage.
As a member of the House Budget Committee, and then its
chairman, he has supported proposals to shift Medicare away from its open-ended
commitment to pay for medical services and toward a fixed government
contribution for each beneficiary, which could be used for either private
insurance or traditional Medicare. Such proposals could increase costs for some
beneficiaries or limit the amount of care they receive, health policy experts
say.
Mr. Price has also backed turning Medicaid into block
grants to state governments. Critics say that states would probably respond by
restricting eligibility, cutting Medicaid benefits or reducing payments to
health care providers.
In leading efforts to repeal the presidentfs health law,
Mr. Price is pursuing a goal in opposition to the policies of the A.M.A. In a
letter to congressional leaders in 2010, Dr. J. James Rohack, who was then
president of the A.M.A., said the law took gan important step toward improving
the health of the American people,h by gextending coverage to the vast majority
of the uninsuredh and gimproving competition and choice in the insurance
marketplace.h
Dr. Samantha G. Harrington, a doctor at Cambridge Hospital
in Massachusetts, said she had canceled her A.M.A. membership because she found
its endorsement of Mr. Price gembarrassing and shameful.h
Dr. Thomas M. Gellhaus, the president of the American
Congress of Obstetricians and Gynecologists, said Mr. Price had gworked closely
with ush on many issues. But, he said in a recent letter to the congressman,
gsome of the bills you supported in Congress would not serve womenfs health
well.h
Mr. Price has supported efforts to restrict abortion and
cut off federal funds for Planned Parenthood clinics.
If confirmed, Mr. Price would be
only the third physician to serve as secretary in the 63-year history of the
Health and Human Services Department and its predecessor, the Department of
Health, Education and Welfare.