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Editor’s
note: The 100th annual meeting of the American Medical Association's
House of Delegates is currently meeting in Baltimore, as the Patients'
Bill of Rights debate heats up in Congress. Yesterday, the AMA's
delegates passed a resolution taking on the Boy Scouts for excluding
homosexuals. In May, Michael Catanzaro took a look at the liberal
AMA in "What's Up, Docs?"
 resident Bush
got a great deal of media attention when he ended the American Bar
Association's special role in evaluating federal judges-but a few
weeks later, the press largely overlooked Bush's slap at another
whitecollar professional group, the American Medical Association.
Bush gave his first important health-care address to the American
College of Cardiologists, even though presidents traditionally reserve
this speech for the AMA. The decision was occasioned principally
by concern about the AMAs political tilt, which has diminished the
once-revered organization's influence and damaged its reputation
for protecting the interests of doctors and patients.
Many Republicans, including those at the White House, see the AMA
leadership as just another Democratic party constituency. Not so
long ago, the AMA was a reliable GOP ally: In 1965, the AMA stood
with Republicans in denouncing Medicare as "socialized medicine,"
and in strongly resisting excessive regulation of health care; after
a brief flirtation with President Clinton's health-care overhaul
in 1993, the AMA helped Republicans crush it. But AMA leaders no
longer consider the Republican party the vehicle to advance their
interests; in fact, these interests now converge with those of the
most liberal wing of the Democratic party.
The AMA's realignment has had consequences: The association now
represents just 32 percent of American physicians, down from a peak
of nearly three-fourths in the early 19?Os. Much of the decline
stems from the increasing specialization of medicine, which has
forced doctors into specialty groups better equipped to represent
them; but another important factor is the AMA's strange alliance
with trial lawyers. The AMA and the American Trial Lawyers Association
favor legislation permitting unlimited lawsuits against HMOs. Together,
they helped defeat three GOP senators who held a different view.
As a crucial member of the "Patient Access Coalition," the AMA financed
television ads against Sens. Slade Gorton (Wash.), Spencer Abraham
(Mich.), and John Ashcroft (Mo.), all of whom opposed the AMA on
HMO liability. "Tell your senators to stand up for patients and
let America's doctors make your health-care decisions-not HMO bureaucrats,"
the ads proclaimed.
The AMA also withdrew its support from GOP congressman Ernie Fletcher
of Kentucky. In 1998, the AMA's PAC had given him the maximum $10,000
contribution-but Fletcher's contention that lawsuits would not curb
HMO abuses was a heresy it couldn't overlook.
In addition to targeting Republicans, the AMA is busy championing
left-wing causes. In 1998, AMA leaders sided with the Left in opposing
Washington State's Initiative 200, which proposed banning all forms
of state affirmative action. The organization also recently joined
the gun-control coalition known as Doctors Against Handgun Injury,
and distributed a booklet on gun safety to thousands of doctors;
Dr. Katherine Christoffel, one of the contributors to the booklet,
has compared guns to viruses that must be eradicated. But Dr. Timothy
Wheeler, president of Doctors for Responsible Gun Ownership, says
that while "this campaign is couched in terms of patient safety…it
really represents a psychological aversion to gun ownership."
The AMA is even emulating the AFLCIO by campaigning for federal
legislation to permit physicians to unionize. Some congressmen,
most of them Republicans, criticized the unionization drive as merely
an effort to increase physician reimbursement fees and boost AMA
membership; but Tom Campbell, a California Republican, and John
Conyers, a Michigan Democrat, shepherded the AMA-backed bill through
the House last June. It passed by a vote of 276 to 136.
After the bill passed, AMA board member Donald Palmisano basically
proved the Republican skeptics right by making the following boast
in an e-mail: "The gutting amendments that would have prevented
fee negotiations and would have required FTC [Federal Trade Commission]
or DOJ [Department of justice] supervision were defeated….
Finally, we need to turn this into new membership. How can someone
not join now?"
Palmisano's e-mail revealed a struggling organization, searching
for relevance and the power it once enjoyed-and it only served to
accentuate the mistrust Republicans have come to harbor against
AMA leaders. "It used to be that when Republicans on the Hill tried
to understand what doctors in their districts were thinking, they
turned to the AMA," says a Republican leadership aide. "But that's
totally changed. We simply don't believe what they say."
The AMA's search for renewed influence has pushed the 154-year-old
organization into the crucible of managed-care reform: Bashing HMOs
has become de rigueur for the AMA leadership. But while some doctors
are sympathetic, much of the AMA rank and file is not. According
to Jerald Schenken, who served on the AMA board from 1985 to 1994,
AMA leaders have "lost their place in the front" when it comes to
issues affecting doctors. "If they are to be leaders, they've got
to find a way to represent American doctors."
Suing HMOs out of existence was supposed to be the AMA's return
ticket to glory. But the AMAs pursuit of that goal has blinded it
to issues of greater import for doctors. Take, for example, malpractice
reform. According to a national survey, nearly three-fourths of
physicians think trial lawyers would be the principal beneficiaries
of HMO lawsuits. Nearly 9 in 10 doctors said they supported malpractice
reform. Even the AMA itself, until recently, consistently spoke
out against medical liability. "Although patients, physicians, and
health-care providers are most directly harmed by the present system,
society as a whole is also harmed," said Dr. Joseph Painter, then
AMA president, in his 1993 testimony before Congress. "The spiraling
costs generated by our nation's dysfunctional liability system are
home by everyone."
Yet the AMA no longer considers medical malpractice a top priority.
This year, the AMA dropped out of the Health Care Liability Alliance,
which favors attaching malpractice reform to the Patients Bill of
Rights. And over the past three years, AMA leaders rejected opportunities
to obtain significant curbs on malpractice lawsuits. The compromise
presented to them was simple: Accept restrictions on managed-care
lawsuits in exchange for capping damages in malpractice cases. But
the AMA's answer, to the shock of its rank and file, was no.
In 1998, Dennis Hastert-not yet House Speaker-chaired a managedcare
task force created by Speaker Newt Gingrich. Hastert's panel produced
a bill that did not permit lawsuits, but instead allowed patients
to participate in internal and external appeals processes if they
were denied care. That bill passed the House in July 1998, without
the AMAs support. The AMA supported instead a bill sponsored by
John Dingell of Michigan, under which patients could bypass appeals-and
go directly to court-just by alleging harm. Dingell's bill permitted
patients to sue in federal and state courts simultaneously, and
was biased toward action in state courts-where trial lawyers and
juries dominate.
The AMAs refusal to compromise infuriated Hastert. "These guys [AMA
leaders] are — as far as I'm concerned — toadies of the
Democrats," he complained in August 1998. Even Georgia Republican
Charlie Norwood, who later cosponsored Dingell's bill (and just
recently took his name off the bill in deference to President Bush),
was indignant. "Frankly, I find it unbelievable," he said. "It's
almost as if they don't know how to win."
Over the next two years, Hastert continued to work on malpractice
reform, but was rebuffed by AMA leaders. The Dingell-Norwood bill
(now called the Ganske-Dingell bill) passed the House in 1999, with
68 Republican votes. The Senate, led by majority whip Don Nickles,
passed its own version; the House-Senate conference on the bill
deadlocked for most of 2000. Nickles, who chaired the conference,
adamantly opposed new lawsuits, but eventually accepted a compromise.
The AMA, however, refused to budge.
In September 2000, Hastert asked the AMA's board members and Washington
lobbyists to submit compromise language. "At that point, everyone
thought we had reached a deal," says congressman Dave Hobson, an
Ohio Republican and a member of Hastert's task force. But incredibly,
a month later, the AMA simply sent Hastert another draft of Dingell-Norwood.
Nickles was furious. "The AMA leadership leaves something to be
desired," he said pointedly.
The AMA's single-minded drive for HMO lawsuits has long-term consequences.
Former AMA president Dr. Daniel "Stormy" Johnson defends the organization
he served for 19 years-but is concerned about the AMAs "not striking
the proper balance on the Patients Bill of Rights." He finds it
"distressing" that the AMA has alienated its "natural allies" in
the business community.
The AMA spent nearly $18 million on lobbying last year, but the
organization has little to show for it. America's doctors also have
failed to reap much benefit. "That's the great irony here," says
Mark Merritt, chief strategist for the American Association of Health
Plans. "Malpractice reform should be at the center of the health-care
debate, but it's not — because it was pushed aside by trial
lawyers." In the AMA's world, trial lawyers and gun control predominate;
like the American Bar Association, the nation's oldest physicians
group finds itself outside the circle of power, desperately searching
for a way back in.
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