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Why the American Medical Association Opposes the Public Insurance Plan

To understand the importance -- or lack thereof -- of the American Medical Association's opposition to the public plan, you first need to understand "Operation: Coffeecup." This was the AMA's big political campaign in 1961. It came at another moment that seemed ripe for health-care reform. John F. Kennedy had begun working toward government-run health-care plans that would cover the elderly and low-income Americans. We know these plans today as Medicare and Medicaid. In 1961, however, the AMA hired Ronald Reagan to produce a recording that called them something entirely different: socialism. You can listen to it above. The recordings were sent to the "ladies auxiliary" of the AMA -- wives of doctors, essentially -- and played at informal morning coffees around the country.

Which is all to say, of course the American Medical Association is opposed to the public plan. It has opposed all public plans proposed by all presidents in all contexts. The AMA opposed national health care as proposed by Harry Truman ("all forms of security, compulsory security, even against old age and unemployment, represent a beginning invasion by the state into the personal life of the individual, represent a taking away of individual responsibility, a weakening of national caliber, a definite step toward either communism or totalitarianism"), and Medicare and Medicaid as envisioned by John F. Kennedy. And it will oppose the public plan now.

And the group is not necessarily wrong to do so. The AMA represents the interests -- which it tends to define as the profits -- of doctors. That gives it a slightly different perspective on the American health-care system. Judged as a health-care system, it's pretty bad, primarily because it's so expensive. But judged as a mechanism for funneling profits toward various actors in the medical industry, it's pretty good, primarily because it's so expensive. Things that would make it cheaper -- like a public plan -- will inevitably cut into the profits of doctors. And the AMA doesn't want that.

Which is all fair enough. But I think it would be useful for folks to ask themselves whether they really think America would be better off without Medicare and Medicaid and if they really think that the point of health reform should be to protect the profit margins of the medical industry. The AMA has one set of interests to protect, and taxpayers have another. And sometimes, the two will diverge.

It's also worth saying, of course, that the AMA is not the only game in town. Take the National Physicians Alliance. It's a newer, smaller, younger association of doctors. It sees the interests of doctors as inseparable from the interests of patients. It supports a public plan. Or check out Physicians for a National Health Care Plan, which see the interests of doctors as irreconcilable with the interests of insurers. It's for single-payer. As Jon Cohn notes, the American Academy of Family Physicians and the American Pediatrics Association tends to be more liberal, and it'll be interesting to see where they fall on the public plan.

Who's right? Hard to say. But all of these groups are representing a different version of the interests of doctors. Patients, of course, have a different set of interests to protect.

By Ezra Klein  |  June 11, 2009; 12:03 PM ET
Categories:  Health Reform  
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Comments

I think the angle you portray here ("OF COURSE the AMA is opposed to the public plan . . .") needs to be played up and the AMA's influence played down. The NY Times's story, for instance, captures none of the history and prospective you deliver here, and thus, my reading of the story was "Oh no! If the doctors don't get on board, whatever will we do!?!"

Call me lily-livered. Haha.

Posted by: pbasso_khan | June 11, 2009 12:29 PM | Report abuse

Only something like 30% of MDs are in the AMA. I'm pretty sure AMA membership mainly surgeons -- the people who rake in the big bucks from overtreatment. The bad guys in Atul Gawande's article.

It's a mistake to think they represent the interest of doctors broadly, let alone the health and welfare of the public.

Posted by: chrismealy | June 11, 2009 12:32 PM | Report abuse

One of my best friends is a doctor. On some occasion, a politician came to speak to him and a number of his colleagues, and started spouting up AMA lines. This politician was apparently quite surprised to discover that real-life doctors don't, in fact, necessarily or even often agree with the AMA.

Politicians deal with limited information and the people they interact with are highly non-representative of the general population, so it's easy for them to come to false conclusions about popular sentiment. It's distressing that this seems to have so much impact on policy choices.

Posted by: davestickler | June 11, 2009 1:12 PM | Report abuse

Of course the AMA opposes the plan because if their self interest.

Likewise because of politician's self interest countries with socialized medicine do not limit spending in a rational way based on cost benefit but because of the they just squeeze the providers.

In most stories that we hear people are not angry with their insurance companies because they pay for too much over treatment, but because the refuse to pay for some care.

Posted by: jwogdn | June 11, 2009 1:14 PM | Report abuse

whoa, you are so "reasonable" about the role of AMA it kinda transcends morality. I understand projecting the aura of a balanced assessment is smart politics, but liberal persons are licensed to analyze in the public interest!

Posted by: MrGoodKnight | June 11, 2009 1:30 PM | Report abuse

I'm curious as to why a public option necessarily means less profit for doctors. Seems to me that the savings to be gained by reducing the dead-weight administrative costs attributable to insurance could be parceled out in such a way as to put some towards cost savings/increased coverage and some towards increased profits for the doctors. Or does the math just not work out that way?

Posted by: gedwards1 | June 11, 2009 1:37 PM | Report abuse

to follow up on chrismealy: I realize that membership of these groups overlaps, but I'd love to know the relative strength (and lobbying/campaign donations expenses) of the various MD groups. Don't forget the National Med. Assoc. (black physicians that the AMA wouldn't let in for decades).

It WILL hurt that the AMA is again fighting against reform. Somebody needs to organize the anti-AMA groups into something that is an effective counterweight.

Also, do the MDs vote on policy positions, or is this solely the responsibility of some executive group at the AMA?

Posted by: JimPortlandOR | June 11, 2009 1:52 PM | Report abuse

JimPortlandOR, this will blow your mind:

http://www.opensecrets.org/lobby/top.php?indexType=s

You can look up the other groups on that site. They barely register.

Posted by: chrismealy | June 11, 2009 3:26 PM | Report abuse

Make no mistake: Health reform that covers the uninsured is AMA’s top priority this year. Every American deserves affordable, high-quality health care coverage.

Today's New York Times story creates a false impression about the AMA's position on a public plan option in health care reform legislation. The AMA opposes any public plan that forces physicians to participate, expands the fiscally-challenged Medicare program or pays Medicare rates, but the AMA is willing to consider other variations of a public plan that are currently under discussion in Congress. This includes a federally chartered co-op health plan or a level playing field option for all plans. The AMA is working to achieve meaningful health reform this year and is ready to stand behind legislation that includes coverage options that work for patients and physicians.

Dr. Nancy Nielsen
President, American Medical Association

Posted by: AmericanMedicalAssociation1 | June 11, 2009 4:26 PM | Report abuse

In other words, the AMA's position is "we'd love more business, so long as it doesn't interfere with our profit-margins."

I guess that's a reasonable position, but it definitely doesn't reflect the sentiments of the entire American medical profession.

Posted by: JPRS | June 11, 2009 6:45 PM | Report abuse

Ezra,

Although the AMA did oppose Medicare, its truly ironic because after Medicare, doctors incomes went UP, not down. Having your income subsidized by the federal government is generally a boon to any professional group.

I suspect the same thing will happen under Obama's proposed system. Ironically, Medicare was the best thing that ever happened to doctors incomes.

Posted by: platon201 | June 11, 2009 10:51 PM | Report abuse

The real reason the AMA is right to oppose more public healthcare is not because of salary/income issues, its because of control.

A universal govt healthcare system would force most doctors to essentially become federal employees. Note that its a unique position that doesnt exist for other "public service" type jobs such as policemen, firemen, teachers. All those groups have independent localities who compete with each other based on wages. A "medicare for all" type system is distinctly different.

The AMA represents a small group of doctors who are scared about being essentially forced into government employees. The irony of it is, they are already essentially that now, they just cant bear to see the act completed.

Posted by: platon201 | June 11, 2009 10:55 PM | Report abuse

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