Health Care

A Look Inside What the Hell Happened with the AMA Today

by Tim Foley

category: Enemies Of Reform

Published June 11, 2009 @ 08:26PM PT

An article appearing in this morning’s NY Times by health politics uber-scribe Robert Pear declared “Doctors’ Group Opposes Public Insurance Plan.”  It went on to describe the objections of the American Medical Association (AMA) to the public health insurance option, the centerpiece of the health care plans being pushed by the relevant committees in Congress, in no uncertain terms.  But by the early afternoon, the AMA was releasing a “clarifying statement” along the lines of “Oh, of course we’d be OK with certain types of public plans, silly!”  So what the hell happened?

Let’s get this out of the way first.  That wasn’t a “clarifying statement.”  That was a walk back.  Yes, the article by Pear focused predominately on forcing physicians to participate in a public plan more than anything else, and forcing physicians in is a detail that’s only in one of the many variants of the public plan.  But the Pear article also uses this dead-to-rights quote as to why the AMA won’t support it:  “The introduction of a new public plan threatens to restrict patient choice by driving out private insurers, which currently provide coverage for nearly 70 percent of Americans.”  I happen to believe this is a loco argument – why are we bailing out yet another industry specifically because it can’t compete?  But this is the argument no matter what variety of public plan you’re talking about.  So "clarifying” hours later that you meant to say “the AMA is willing to consider other variations of the public plan that are currently under discussion in Congress”?

Not.  Credible.

Three theories as to what prompted this about-face.  (Keep in mind I don't know for sure -- but these hypotheses are intriguing to think about).

1.)    Dear God, what did we just do?

The AMA as an organization has been both low-key and reserved about its stance on President Obama’s push to make quality, affordable health care for all a reality.  They’ve been at the table, but they’ve been quiet about it.  And even though many doubted that they’d be good citizens throughout the process, reformers generally left them alone.
But we’re not idiots.  The AMA has been the sworn enemy of health care reform since the days of FDR, Harry Truman, and JFK, particularly any time physician reimbursement rates are involved.  They opposed Medicare – the most popular health care system operating in the country – to the death back in the 1960s.  It was reasonable to watch them with a wary eye.

Therefore, when the AMA seemed to step up to oppose a critical element of the President’s health care plan, everyone was ready to pounce – and pummel them.

• Here’s Media Matter suggesting a curious confluence between the AMA and private insurance’s lobbying efforts.
• Here’s Igor Volsky on Think Progress pointing out, “But the AMA, which has a long history of opposing the enactment of Medicare and other health reform legislation, does not speak for all doctors.”  (Igor’s right, by the way.  The AMA represents maybe 20% of physicians in this country).
• Here’s Jon Cohn pointing out the inconsistencies of their argument.
• Here’s Matt Holt on The Health Care Blog saying, “It’s a pity that as a policy wonk I can’t take them seriously.”
• Here’s Merrill Goozer summarizing, “When push came to shove, the doctors stood with the companies that absorb an inordinate amount of their time filling out forms.”
• And finally, the coup de grace, Maggie Mahar’s killer post, “The AMA Would Make Health Care Unaffordable to Many Americans.”

And there are many, many more.  By the way, there’s no question some AMA members read the newspaper and health care policy blogs.  They were probably not thrilled that their organization had just become a national punching bag.  The end result:  Holy Cow!  What did we just do?

(This is starting to be a pattern.  Ben Nelson hated the public plan, now he’s open to it.  The Blue Dogs were for the trigger, but then had to let everyone know that was a negotiating strategy.  Max Baucus says the public plan is “on the side of the table,” then last week after meeting the President, had to say it’s definitely in.  I’ll be curious to see how many more legislators and organizations have these “Wile E. Coyote running off a cliff” moments.)
2.)    So help me, I will strike you down

The most intriguing theory comes from Ezra Klein:  as we get closer to a bill, Congressional reformers and the White House are playing hardball.  “They're saying that you're either with health reform, or you're against it. And if you're against it, you can't expect to be taken care of in the final legislation. They're not going to save your seat at the table while you're trying to burn down the room. And the AMA, it seems, got the message.”

I haven’t seen this suggested by anyone but Ezra… but it’s an interesting theory.

3.)    Dude, I did not come all the way to Chicago for nothing

That’s right, the AMA convention begins this Saturday in Chicago.  On the agenda includes the usual annual business of the organization, which, judging by their agenda, will doubtlessly include a number of votes on what policies to support or not support on health care reform.  I don’t know how your annual conventions go, but if I’m attending one, I generally don’t like it when the organization published a position in the freakin’ New York Times before I even get a chance to vote on it.  To say the timing of the article suggests the leadership is nor respecting the opinions of the members is an understatement.

All of this sets up a fascinating moment on Monday when President Obama addresses the AMA Convention.  It was already highly anticipated – we know Obama’s new stump speech on health care specifically includes numerous mentions of the public plan – and now has been dialed up to eleven.

(Photo credit:  photobunny on Flickr.)