Thursday, June 25, 2009

The AMA and Health Care Reform

Nick Kristof has a great op-ed today in the NY Times about the AMA and its very, very puzzling reluctance to support the "public insurance option" as part of the health insurance legislation currently working its way through congress. For those not aware, the AMA has, for the past several years, unambiguously supported the notion that all Americans deserve basic medical care. (This is a seeming departure from decades of AMA philosophy, which has been remarkably conservative on a number of issues.) However, as the rubber meets the road and legislators discuss the brass tax required to meet such a lofty goal, the AMA has settled back into its more comfortable position of opposing progressive policies and has decided to oppose any bill that includes a public plan. Their logic is priceless: "the introduction of a new public plan threatens to restrict patient choice by driving out private insurers," they note in a letter to the Senate Finance committee. That is, if we have a public option, and that option is so good that people might want to opt for it over private insurance, we should not do so because it hurts the...sit tight for this...insurers! One might have thought that the AMA was an organization representing the interests of patients, but apparently they are much more concerned for the welfare of insurers. And "welfare" is a particularly apt word.

Money quote, from President Obama's former private-practice internist Dr. David Scheiner, in criticizing the AMA: "they’ve always been on the wrong side of things. They may be protecting their interests, but they’re not protecting the interests of the American public. In the past, physicians have risked their lives to take care of patients. The patient’s health was the bottom line, not the checkbook. Today, it’s just immoral what’s going on. It’s abominable, all these people without health care."

One key point not emphasized by Kristof is that while physician membership in the AMA is dwindling (he estimates that only one in five docs are current members), and there are other physician groups such as the American College of Physicians who are supportive of a more robust public health care policy, the AMA still is regarded by most laypeople as the definitive body that speaks for America's physicians. As a consequence of the AMA's Good Houskeeping Seal of Approval, their opposition to the public finance option makes it seem like physicians as a whole are opposed to it, and while I have not seen polling data, I suspect that this is not the case. Such short-sightedness thus makes us all look bad.

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