While some prominent physician groups at the national level like the American Medical Association have suggested that the typical doctor on net would be better off if Congress’s health care legislation were to pass—mainly because of all the changes in Medicare payment methodology—those groups have generally failed to acknowledge a number of the critical issues. Based on the provisions of the House health care bill (H.R. 3200), here are the simple facts:

• As millions of Americans are moved from private insurance to public coverage, with the introduction of a Medicare-like public plan and a massive Medicaid expansion, once reform is fully implemented annual reimbursements to doctors could fall by $31.7 billion.

• Although the typical physician could be better off –as the AMA contends–if reform included a replacement of sustainable growth rate (SGR) formula- the formula for updating Medicare physician payment- the House legislation could reduce physicians’ annual net incomes by $9.3 billion, or roughly $13,117 per doctor.

• Even if the SGR were replaced and physicians at the national level would on average see their net annual income increase under the reform, there would still be significant variations at the state level. That said, groups like the American Medical Association at the federal level might not be looking out for its state affiliates or actual doctors on the ground in some areas of the country. For example, if reform with a “robust” public option were to pass Congress and receive President Obama’s blessing, physicians in Maine could see their net annual income decline by $271.7 million, with an average loss in income of $55,692 per physician.

Would doctors in Maine really care to know that if the AMA plays its card right with health care reform, on average, at the national level their counterparts might potentially come out ahead on the other side? It’s doubtful. But that’s how top-down “change” imposed by Washington works. It always works that way when the “change agents” are in the business of securing more power and control.