Hudson, Fla., Spine Surgeon Alfred Bonati, MD, founded the American Society of Medical Doctors in July, with money out of his own pocket. Since then, the Washington, D.C.-based organization has been busy sponsoring surveys of physician opinion, publishing white papers and taking on the AMA for endorsing the health reform bill that was passed by the House of Representatives. In this wide-ranging interview, Dr. Bonati explains why he founded the organization and he identifies the political challenges facing orthopedic surgeons and other specialists.
Q: Dr. Bonati, I think it would be fair to say that the proposed healthcare reforms from President Obama and Congressional Democrats are anathema to you. What is it about these plans that upsets youDr.Dr. Alfred Bonati: Two main goals of this legislation, to expand coverage and introduce a government-run system, would actually lower the quality of medical care, make it less efficient and, along the way, reduce reimbursements for physicians.
It appears that President Obama wants to bring medical care to the level of the general practitioner. What the GP essentially does is triage people. The GP looks at somebody, then sends them on to specialist. That is inefficient and it delays care and makes it cost more. The specialist should be seeing the patient in the first place. A patient with an eye problem, for example, should go to an ophthalmologist because the ophthalmologist has thousands of hours of training in eye care and the GP does not.
Q: I understand you went to Washington recently to share your views. What groups did you meet with?
AB: I’m a Republican, so I met with aides to Republican congressmen and with the GOP national chairman, Michael Steele. I believe they took what I had to say seriously. But the fact is that both the Republicans and the Democrats are playing games in the health reform debate. We as physicians could become a pawn of either side. But this is much too important a topic to be playing games.
Q: You commissioned a national survey of specialists to gauge their mood on health reform. What did you find out?
AB: Let me first explain that my group did not conduct this survey. It was conducted by an independent research group, WRS Opinion Research, on Aug. 7, and it went out to a nationwide sample of specialists. The survey found that 70 percent of these specialists opposed the Democrats’ health reform proposals and 66 percent believe that a government-run health plan would restrict doctors' ability to offer the best care possible. Furthermore, over 60 percent said they would not accept new patients with government insurance and 27 percent said they would not accept any patients on a government-run plan.
Q: With your opposition to the Democrats’ plan, do you think there should be any kind of health reform at all?
AB: Yes, I do. First, we need to have serious tort reform. Frivolous lawsuits amount to $20 billion in expenses. We cannot allow medicine to be defenseless. We need to set a system to evaluate screen lawsuits and remove frivolous claims from the beginning.
Second, we need to address health insurance abuses. I believe we should create a national rating system for insurance companies. It could operate through a TV channel. It would be a simple system, with codes in three colors. A green-rated insurer would have the best ratings, yellow, so-so, and red, bad. If a physician decided not to take a particular insurer, they would tell the patient, and the patient would add a rating to the review system, and that company’s accumulated rating would quickly fall.
Q: I know you prefer private insurance over a government-run plan. But it seems from what you just said that you still have some strong misgivings about private insurance. Can you talk about those concerns?
AB: We need to find some way to eliminate the constant tricks that the insurance companies play against the doctor. I’ll give you an example. If I want to do spine surgery and the MRI image that the patient brings to me is of poor quality, I will not have the necessary information to perform the surgery. So I tell my patient to go and get another MRI, but the insurance company denies that second MRI. They say the patient already has an MRI! Use the first MRI! But I have already told them that MRI is unusable! And so we go around and around and around with the insurance company. If this system is to work, they should be taking my word for it that the MRI is unusable. Why do they think I am asking for another one? For the fun of it?
Q: I see that your new organization is focusing on specialists. Is there any room in it for family physicians and other primary care physicians — or GPs, as you have been calling them?
AB: Yes. Primary care physicians are free to join, but our direction is to protect the specialists so that this country can continue offering the best medicine in the world. Many GPs come from a different point of view. They would love to have the Obama plan because it would bring patients to them. But that would harm specialty care.
Q: You were raised in an Italian family in Chile, but you obviously prefer U.S. healthcare. What is it about U.S. healthcare that you admire?
AB: People from all over the world come to the United States to get their care because American medicine is technically superior to any other system in the world. The key reason for that is our emphasis on specialists. In Europe, they rely on a system dominated by GPs, but in America, 70 percent of doctors are specialists. In this country you have this constant quest for cutting-edge treatments. This is also the goal of my own practice. I have performed more than 35,000 surgeries and have developed several patented tools for spine surgery.
Q: You oppose the House Democrats’ health reform bill, but the AMA supports it. What do you make of the AMA’s position?
AB: The AMA seems to have become an organization very much managed by politicians. They seem to have abandoned the interests of medicine and have become unrepresentative of doctors. Only a small fraction of physicians in this country are AMA members, and more and more doctors are resigning in protest of AMA policy. What you have left is a group mostly made up of GPs, internists, pediatricians, psychiatrists. The specialists are no longer represented there.
Q: Some people might say your organization is just a temporary phenomenon, rising up to oppose the Democrats’ health reform plan, then disappearing again. What do would you say to that?
AB: I would like the ASMD to become permanent. We need to fill the vacuum in representation at the AMA. First we have to get known. We’ve only been around for one and a half months. But there is a big vacuum to fill. We are in the process of creating a board representing physicians from across the country. I’m financing this with my own money for now, but we’ll need to have some long-term income. We’ll probably be asking for dues, and they will probably be at the same level as the AMA dues. I believe ASMD has a great future!
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