AMA: A Case Study

aniya nelson 11-27 -17 The book Fahrenheit 451 is about burning books and people betraying each other through certain problems. Fahrenheit 451 written by Ray Bradbury. It's about how they weren't allowed to have books and other situations about depending on each other because Montag stole a book and didn't tell somebody he stole a book. In Fahrenheit 451, Ray Bradbury uses betrayal in several ways to illustrate his stance on burning books through conflict, and exposition.

Falling from grace is a story about character emotions and interactions, it displays the character emotions towards each other and the situation in a complex yet simple way- allowing the reader to experience an in-depth description of characters emotions through their own chapters. Grace, Kip, Ted and Annie all show emotions towards the situation at hand.

As resistant as some states’ legislative and regulatory bodies are to grant APNs autonomy of practice, the damage being done by over-regulation is clear (Safriet, 1992). Physicians are forced into a position to either supervise the APN’s practice or be constantly consulted for approval of their practice decisions. Safriet (1992) described that in and of itself, this constant supervision may appear to patients that the APN is not competent to provide adequate or care equivalent to that of a physician. If the role of the APN is to bridge gaps in health care by relieving the medical establishment of some of the patient load by performing the same function as a physician in a primary care setting, it seems wholly unnecessary to restrain their scope of practice in those areas. This type of restrictions affect cost and patient care accessibility (Safriet, 1992). This was a problem stated in the article, however 25 years later, populations of patients remain unseen or cared for and APNs continue to be underutilized (Safriet, 1992). Rigolosi and Salmond (2014) cite the American Association of Nurse Practitioners (AANP) when they state that not utilizing nurse practitioners due to practice restrictions costs $9 billion annually in the US (p. 649).

With the Advent of the Affordable Care Act, came many changes throughout the medical industry, changes happened in hospitals, health insurance, and doctors. Doctors, more than any other group seem to be affected in a number of way, from the amount of patients, from the increased number of people with insurance plans. It also changed the way a doctor interacts with other parts of medicine. There are some questions arising from this such as; would doctors approve or disapprove of these changes along with do these changes affect the doctors' ability to practice. For the most part, there is no difference the way doctors practice or to their income, but it does have doctors utilize their abilities towards medicine rather paper pushing which could have doctors prefer the post-ACA medical community rather than before.

The AMA uses the mass media, policy formation, testimonies at legislative or agency hearings, direct and informal contact with legislators, and elections as their lobbying strategies for bill # H.R.1628 titled “American Health Care Act of 2017”. The legislative strategies they mainly use is their direct contact with legislators, because as was stated before, the AMA’s “representatives are leaders and political forces in every congressional district, every community in America.” The AMA has an extensive network of individuals, which makes it easy for them to get into contact with congressional actors. Some other strategies the AMA uses is that they support drafting regulation/shaping policy on agenda-setting, talking to journalists and using paid advertisements. In David Trumans’ book, “Basic Interests: The Importance of Interest Groups in Politics and Political Science”, spends an entire chapter describing the dynamics of access in the legislative process. For example, an important factor to keep in mind is that “The legislature as a part of the institution of government embodies, albeit incompletely, the expectations, understandings, and values prevailing in the society concerning how the government should operate.” The AMA is like that of a heavy tank on a battlefield crushing the competition (other interest groups) in US legislature. They understand that their ideas and beliefs can be implemented into legislature and can affect the way the US government operates. Another conception of Truman’s “dynamics of access” is that of “"pressure," conceived as bribery or coercion in various forms, which is scarcely the distinguishing feature of interest groups in the legislative process. Such coercion is frequently attempted, of course, and it often has an observable effect.” The AMA is known for its lobbying efforts and overall impact in the

The Patient Protection and Affordable Care Act (PPACA), also referred to as the "Affordable Care Act" or "ACA" or "Obama Care") is the major health care reform bill passed into law on March 23, 2010. The debates surrounding the PPACA have been volatile at times, and continue to be the most intense public examinations of any piece of legislation in our recent history. The affordable Care Act (Obamacare) is ripe for repeal. For the American public, there are ample reasons for dissatisfaction: higher costs; arbitrary and sometimes absurd rule-making; bureaucratization of an already overly bureaucratized sector of the economy; incompatibility with personal freedom and religious liberty; enormous spending and heavy taxation; and widely acknowledged design flaws, evident in the ACA’s hopelessly complex and unworkable subsidy schemes, boondoggle bailouts, and collapsing co-ops. Nonetheless, other ACA legal challenges were still facing the healthcare law. In December 2015, the Association of American Physicians and Surgeons (AAPS) submitted an amicus brief to the Supreme Court arguing against the constitutionality of the employer insurance mandate within the Affordable Care Act. The law contains a number of experiments designed to drive down health costs, such as Accountable Care Organizations. The whole idea is to move the system away from paying for volume and toward paying for value. We still don't know whether that will happen. But it's fair to say that reducing the cost of health care will make it easier to expand coverage. The nation’s gains in health care coverage and delivery system design over the last several years have made measurable differences in the lives of millions of Americans. There are many ways to achieve a high-performing health system. But it’s critical that the nation remain committed to this goal.

The aim of the ACA is to provide affordable health care to all Americans, but it still leaves some issues unaddressed that will impact the access to health care. Covino (n.d.), “Though the intentions of the legislation are good, the Affordable Care Act does little to improve the actual health care delivery system” (para.1, page 2). According to the American Medical Association, we are facing an increasing Physician shortage. As of 2010 we faced a shortfall of 13,700 physicians, the estimate is that number will increase to 62,900 by 2015, 91,500 by 2020, and 130,600 by 2025 (Krupa, n.d.), with primary care taking the largest impact. Health Care coverage will be of no benefit if there are no doctors to treat the patients. An example of this occurred in 2002 when Thailand’s’ “30 Bhat Scheme” added (CNN n.d.) “14 million people to the country’s health care system, resulting in long waits and subpar service” (Your health is covered, but who is going to treat you?) Several factors contribute to the physician shortage. Many physicians are reaching the age of retirement, the Association of American Medical Colleges estimates nearly 15 million physicians will be eligible for Medicare in the coming years (CNN n.d.). The increasing cost of malpractice insurance also deters many from pursuing a career in medicine, and is forcing some doctors to retire. Also contributing to the physician shortage is a lack of spots in residency programs. “In 2011, more than 7,000 were left

The first thing to think about is the fact that health care accounts for approximately 8% of the U.S. economy. The Affordable Care Act, better known as Obamacare or other unsavory names is actually in my mind making the medical field and the availability of care for patients more difficult. Regardless of its benefits to some patients, Obamacare is making things much more difficult for doctors, nurses and anyone that is part of the medical profession. It has done nothing but increase paperwork, which is the major priority, and costs have continued to rise. From what I have witnessed has done nothing to increase the quality of care. Government bureaucrats and insurance companies, not doctors, are in charge of our health care. Obamacare is all about saving money, by not spending it on patient care and where the money is spent is being directed by special interest and profit-making organizations. They are dictating the way care is provided. Basically insurance companies are in control of who lives or who dies. The law contains spending cuts to Medicare that amount to $716 billion from 2013 to 2022. The end result of course is that seniors are the group that suffers the most since they are the group that seeks and needs medical care more than any other age group. Money is the priority and not patient care as government and insurance companies have a different agenda than health care providers. Should “for-profit” insurance companies exist, or should there be only “non-profit”

Written about the structure and culture of biomedical heath care and a society that is attempting to prolong aging, Medicare funding, funding and development of research, and today’s definition of standard care, Sharon Kaufman brings to light the many dilemmas posed to the American health care system. Her ethnographic story, Ordinary Medicine: Extraordinary Treatments, Longer Lives and Where to Draw the Line reveals the booming biomedical research and clinical trials industry, the power held by Medicare and private insurance, and a rapidly changing standard of care once a medical treatment is considered reimbursable. This leads to systematic changes in the standard of care result in a massive amount of pressure being placed upon doctors, patients and families to make an ethically and medically sound decision in refusing or accepting therapy. Kaufman exposes the driving forces behind the expansion of biomedicine, society’s response to the growing industry on a personal and bureaucratic level.

Missouri currently ranks 42 in the nation for barriers that prevent APRN 's from seeing patients"(K. Iman, personal communication, May 14, 2015). It is difficult to state the positions of each legislator in Missouri. To focus in on the State Representative that represents the 118 the district where I currently reside, I contacted Ben Harris. I discussed with State Representative Ben Harris on his position on APRN’s and expanding their scope of practice in Missouri. He shared “ I really don’t know what citizens would do without the Nurse Practitioners because doctors just are not wanting to come to rural areas and practice medicine. People rely on a daily basis for these dedicated people who give care and compassion to those who need attention. Section 334.104 allows for APRNs (advanced practice registered nurses) to enter into a collaborative practice with a physician””(B. Harris, personal communication, May 15, 2015). It is apparent that Ben Harris recognizes the importance of APRN’s having the ability to practicing to the full extent.

After years of schooling and hundreds of thousands of dollars in debt, doctors aren’t even able to work on their own terms. “Consumers allegedly have a “right” to what health care providers provide, a “right” to say what will be provided, when, and at what price” (Salsman 2012). Consumers shouldn’t have a “right” to what is provided to them or how much it costs. The government controls pricing and controls who can receive care and what kind. It’s not right that those who are actually working in the medical profession that they have lost control of their businesses.

Although there have been numerous controversies as to whether or not the ACA provides greater benefit or harm, the bottom line is as more have coverage, there will be an increased number of consumers for advanced practice nurses and physicians. Even greater of an impact is the way in which reimbursement has been identified. Under this new law, hospitals and physicians are penalized for readmissions in 30 days for the same diagnosis as manifested by the Centers for Medicare & Medicaid Services (CMS) guidelines. As a result, advance practice nurses are being pushed to provide better outcomes.

Those against and those rooting for that of managed care agree that the existence of unconstrained health care on demand is declining. As health care costs push very high yearly, some say it 's time for all to comprehend that the medical healthcare industry has financial restrictions just like any other industry.

In the wake of the 2016 presidential election, concerns have been raised regarding the Republicans’ desire to repeal the Affordable Care Act, informally referred to as Obamacare. The ACA was originally enacted into law in 2010 and has been annually provisioned to expand its ability to not only improve the nation’s access to health care, but also to reform the health care delivery system. Through the ACA, private and public insurance has become more available and affordable, new health care delivery models have improved quality of care, and several workforce policies have made primary care a more desirable profession for medical students.

It is a very thin line between the two. Yes, to some extent it has. Medicine has become a business. The Hippocratic oath taken by physicians proclaims and sets forth the guiding principles for the medical profession, that of patient’s welfare, to do no harm, patient autonomy, and social justice (Antoniou et al., 2010). The inequities in healthcare of our own doing. Social justice between a physician (provider) and the unique relationship they have with their patient is best attained privately and with autonomy. Social justice has been lost due to governments, corporations, and oppressive humanitarians dictating the terms of the physician-patient relationship. This violates the Hippocratic oath and is