Politics & Policy

Don’t Trust the AMA

It's out of touch.

‘I was surprised, shocked, and saddened.”

That’s how Donald J. Palmisano, former president of the American Medical Association, described his reaction upon learning that the organization had endorsed the House Democrats’ health-care-reform plan. “I am a loyal member of the AMA, a lifetime member, but I believe the AMA made a serious mistake in endorsing this bill.”

He’s not the only one. The AMA’s endorsement prompted Alex Vuckovic, a private practitioner and academic psychiatrist, to tender his resignation from the group. In a letter to AMA president J. James Rohack, Vuckovic called the government-run insurance option in the Democrats’ bill “an obvious Trojan Horse designed to transform our medical-care system into a federally controlled single-payer system.”

The AMA’s endorsement also prompted a coalition of eleven state, county, and specialty medical associations to send a letter to Capitol Hill this week strongly opposing the creation of a “public option” and other aspects of the Democrats’ bill. The coalition’s letter characterized the bill as a big step toward single-payer: “We are concerned that any government plan will always have advantages that are not available to the private sector. These unfair advantages will effectively crowd out the private market leaving only a government–run option available.”

From this grassroots rebellion, the first and most obvious lesson to draw is that doctors do not speak with one voice on matters of public policy. In particular, some private practitioners complain that the AMA no longer represents their concerns. Terry H. McMillan, an ear, nose, and throat surgeon in Las Cruces, N.M., says this is why he quit paying his AMA dues years ago. “There’s been a move away from private physicians and their views to more of a community view of medicine,” he says. “That doesn’t work for me or for many of the colleagues I work with.” Instead, McMillan stays involved with his county and state medical societies, because “they’re much more involved in the day-to-day needs of practicing physicians.”

Vuckovic puts it this way: “I think AMA has become part of the whole government-medical complex.” He argues that the AMA has complacently accepted the transformation of the medical profession into a “service-delivery model, with both physician-providers and patient-customers slowly but surely becoming servants of the same paymasters: the private and public insurers.” The idea of returning medicine to a fee-for-service model has been all but abandoned in Washington, where AMA lobbyists spend most of their time.

The coalition of state groups reflects a different focus. David Cook, executive director of the Medical Association of Georgia, says, “We’re working very hard to preserve the private practice of medicine, and this bill puts the government right smack-dab in the middle of health care.” Cook’s group took the lead in organizing the coalition, which includes medical associations from South Carolina, Delaware, and the District of Columbia, plus specialty groups like the American Association of Neurological Surgeons. “Our members support what we’re doing,” Cook said. “Many have called with surprise at what the AMA did.”

The AMA’s drift away from a focus on protecting private medicine and toward an increasingly left-leaning policy orientation has not gone unnoticed. In the May 14, 2001, issue of National Review, Michael Catanzaro noted the growing number of liberal policy positions (such as gun control) embraced by the AMA — in contrast to the dwindling percentage of practicing physicians belonging to the group. There’s no hard evidence from which to infer a causal relationship one way or another, but it is nevertheless true that the AMA now represents only around 120,000 practicing physicians, or (statistics vary) between 20 and 30 percent of the national total. Regardless of why, the AMA no longer speaks for the majority of practicing doctors.

And there is another lesson to be drawn: While President Obama routinely blames “special interests” for obstructing his progress, at least as many powerful special-interest groups support his plan as oppose it. In addition to the AMA’s endorsement, Obama has cut deals with hospitals and drug companies to build support for the plan; Wal-Mart, the nation’s largest private employer, has given its blessing; and even insurance companies, which oppose the creation of a government-run insurance plan, favor the mandates that would require everyone to purchase coverage. If Obama’s effort fails, it won’t be because it lacked the support of large special-interest groups like AMA. It will be because smaller groups closer to the grassroots opposed it.

Gregory Tarasidis, a private practitioner, is the president-elect of one such group: the South Carolina Medical Association. Like Palmisano, he was surprised the AMA came out with its endorsement so early. It was “too strong, too much support, and too early in the process,” he says, and he wonders whether the group took enough time to really learn what its members thought of the legislation. “It’s a 1,000-plus page bill,” he says. “That’s difficult for anybody to digest.”

Palmisano, who now serves as a spokesman for the Coalition to Protect Patients’ Rights, says he knows “lots of people writing to me and saying they’re going to resign, that AMA doesn’t represent them anymore, but what I’m telling them is this: You shouldn’t quit AMA. You should focus on fixing the problems with the bill that’s coming out of Congress right now, then worry about fixing the problem with the AMA.” Palmisano says he did exactly that by running for president of the organization when he saw things he wanted to change.

But others think the organization is too far gone. In the end, Vuckovic’s message to the AMA was simple: “Please remove me from the membership rolls of the AMA as of today. And good luck to the next generation of Medical Service and Product Providers and their unfortunate patients.”

– Stephen Spruiell is an NRO staff reporter.

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