If you’re an American who misses the days when you could pick a doctor out of the phone book, write a check to pay for the visit and be done with it, you may be pleased to hear that the next president’s nominee to run the nation’s health system belongs to an organization that agrees with you.
The nominee is Rep. Tom Price, R-Ga., Donald Trump’s pick as secretary of health and human services, and the organization is the Association of American Physicians and Surgeons, an Arizona-based group that promotes libertarian principles in health care — and an array of far-right conspiracy theories about many other topics. Price, an orthopedic surgeon for 20 years before entering Congress, is a member of the group, according to the health news website STAT. Another well-known doctor-politician, Sen. Rand Paul, R-Ky., has been a member; an article in the organization’s journal last year touted Dr. Ben Carson as a potential president.
AAPS confirmed Price’s membership to STAT, and its website has repeatedly touted the congressman’s association with the group. Price and the Trump transition did not respond to requests for comment from Yahoo News. To be sure, Price’s membership in the group does not imply he agrees with everything it stands for or has published in its journal. But with the previously obscure organization now poised to influence the thinking at the top levels of U.S. health care policymaking, it’s worth looking into some of the positions it has advanced over the years.
Whoever runs HHS next year will have a large say in implementing Trump’s inchoate plan to repeal, reform or replace some, most or all of Obamacare, and the choice is guaranteed to spark controversy in that respect. But Price, who has spearheaded Republican opposition to the program in Congress over the past five years, is a particularly polarizing choice, in part because he appears to favor major changes to Medicaid and Medicare — including proposals by House Speaker Paul Ryan, R-Wis., to move Medicare toward a “premium support” model, replacing its open-ended promise to pay for medical care with vouchers that recipients could use to buy their own insurance.
Sen. Patty Murray, D-Wash., the ranking Democrat on the committee that will consider Price’s nomination, sent a shot across his bows Friday with a statement that read, in part, “There’s no question that Congressman Price and I have stark differences in our views about the direction our health care system should take. I plan to ask him detailed questions about whether he would strengthen health care for families or aim to implement the partisan, deeply harmful vision President-elect Trump campaigned on and has threatened to carry out during his Presidency.” The 228,000-member American Medical Association, whose own website calls Obamacare “a tremendous step forward on the path toward meaningful health system reform,” nevertheless quickly endorsed Price, prompting an online petition from members outraged by the choice, and opposition from a liberal doctors’ group, the National Physicians Alliance, which claims 20,000 members.
But Price’s nomination has also brought some unaccustomed attention to the AAPS and its 4,000-plus members. Founded in 1943, its mission statement encompasses a commitment to “the preservation of the sanctity of the patient-physician relationship, and for safeguarding the individual rights and independence of patients and physicians.” What this means in practice is opposition to virtually any federal mandates, requirements — or reimbursements — that could interfere with that sacred relationship. In particular, it urges “non-participation” in the Social Security amendments of 1965 — also known as Medicare — “as the only legal, moral, and ethical means of concretely expressing their complete disapproval of the spirit and philosophy behind these amendments.” In an email, Jane Orient, MD, the group’s executive director, said that “most members still participate” in the programs or treat indigent patients for free or whatever they can afford to pay.
The modern conservative movement, to a considerable degree, was born in opposition to Medicare. Republicans who love to quote Ronald Reagan’s famous 1961 lament for lost American freedoms — “We are going to spend our sunset years telling our children and our children’s children, what it once was like in America when men were free” — may not even realize that the speech was a diatribe against “socialized medicine,” also known as Medicare. As late as 2010, Sue Lowden, a prominent Nevada Republican who was seeking her party’s nomination for the U.S. Senate, urged a return to an era “before we all started having health care … [In] the olden days, our grandparents, they would bring a chicken to the doctor. They would say I’ll paint your house.”
Opposition to Obamacare is, of course, mainstream Republican doctrine, as is the fear that Medicare has been stealthily bankrupting the country for the past 50 years. And certain other ideas advanced on the AAPS website — such as the notion (“for information and discussion”) that Barack Obama was hypnotizing voters into supporting him, a technique the author suggested appeared to work especially well on Jews — wouldn’t raise eyebrows among the people who had no trouble believing he was a secret Muslim born in Africa.
But AAPS has also taken on issues that are peculiar to the medical profession, and are outliers even among doctors, such as its opposition to electronic health records. This is an innovation intended to make it easier for different doctors who may be treating the same patient to share information, but which AAPS, preferring the days when medical records were kept in file cabinets under lock and key, derides as “Big Brother medical databases.”
Another AAPS bogeyman is “evidence-based medicine,” which means setting standards for care based on scientific studies, rather than whatever a doctor learned in medical school decades ago supplemented by experience. Attempts by third-party payers — also known as Medicare — to encourage adherence to an abstract standard of “best practices” is said by AAPS to encroach on the sacrosanct physician-patient relationship.
And on the hot-button issue of childhood vaccination, AAPS has staked out a position against requiring them — a position that many mainstream medical organizations find alarming. “Our children face the possibility of death or serious long-term adverse effects from mandated vaccines that aren’t necessary or that have very limited benefits,” Orient, the group’s executive director, has written, adding, “This is not a vote against vaccines. This resolution only attempts to halt blanket vaccine mandates by government agencies and school districts that give no consideration for the rights of the parents or the individual medical condition of the child.”
Mandatory vaccinations represent an interesting test of competing principles: the right of patients, or their parents, to make their own decisions about health care, weighed against the risk of an epidemic resulting from large numbers of unvaccinated children running around. It’s obvious where libertarians of the right (or, for that matter, the left) will come down on this choice. Price, himself, appears not to have taken a public position on the question, but the president-elect who appointed him has advanced the widely discredited theory that childhood vaccines are a cause of autism, though he limits his argument to “massive” doses. (“Healthy young child goes to doctor, gets pumped with massive shot of many vaccines, doesn’t feel good and changes — AUTISM. Many such cases,” Trump tweeted in 2014.)
Price’s confirmation hearings should be interesting.