I have a piece up today on the dismayed reaction from some doctors and doctors’ groups to the American Medical Association’s decision to endorse the House Democrats’ health-care bill. A number of them felt that AMA jumped the gun. Dr. Donald Palmisano, a former AMA president who is quoted in the piece, told me:

I believe a better negotiating technique would have been to say we are happy that you are trying to fix elements of the health-care system that have problems, and if you can fix these things and not put onerous provisions on doctors, we’ll be happy to endorse the bill. But don’t endorse it and then say we’d like to fix things as we go along.

Now there is talk that the Democrats might make a change to the bill that would lower Medicare payment rates for doctors. The NYT reports that:

The Blue Dogs said they had won agreement from Mr. Waxman to help rein in Medicare spending by giving the executive branch new power to set annual payment rates for doctors, hospitals and other health care providers, based on recommendations from an independent advisory council. Rates are now set by statutory formulas, and Congress is besieged by lobbyists pleading for bigger increases each year.

Obama referenced this change during his press conference last night:

And I’ll give you one specific example. I think that there was legitimate concern that we had not incorporated all of the measures that could reduce health-care inflation over the long term in some of the versions of health-care reform that were coming out of the committee. Well, over the last week, working with not only health- care experts but also members of Congress who are concerned about this, we actually have now gotten a commitment to incorporate an idea that has a panel of doctors and health-care experts advising on how we can get a better value for our money in Medicare.

I asked the AMA for comment on this proposed change and received the following statement from AMA president J. James Rohack:

The AMA has expressed strong concerns about the proposal to members of Congress and the Obama administration. Across the nation, dedicated physicians are working hard to provide high-quality care within a system that doesn’t work for them or the patients they care for. Physicians should be exempt from any independent body that sets Medicare payment rates to avoid double jeopardy, as physicians are the only group in the Medicare program already subject to a spending target that lowers payments if the spending target is exceeded.

AMA has “expressed strong concerns,” but it hasn’t left itself much leverage in the debate. Having already endorsed the basic contours of the Democrats’ plan, it’s unlikely that the party cares much about securing the group’s continuing endorsement.