Just the other day, I was skimming through the FM dial as I drove my rental car from Hattiesburg to the airport in Jackson, following a combined ACP Mississippi/Louisiana chapter meeting. Along with the Sunday morning preachers and stale classic rock, I came across a broadcast that caught my attention: Someone (I never heard the name) was ranting about the American Medical Association's support for health care reform. His gist was that the AMA "sold out" doctors by supporting enactment of "ObamaCare" in order to protect its "monopoly" on the CPT coding system.
He also accused the AMA of trying to "gag" physicians from telling patients about how they would be harmed by the legislation, echoing a Wall Street Journal op-ed that accuses the AMA of "now trying to silence doctors who oppose it." (In fact, the AMA didn't try to gag anyone, but expressed concern about a Florida urologist who put up a sign telling patients who voted for President Obama to go "elsewhere" for their care.)
This is just one of the many barbs directed at the AMA for its decision to support enactment of the Patient Protection and Affordable Care Act (PPACA). There is no doubt that some doctors are angry, very angry, at the AMA. A blog search comes up with dozens of posts about how the AMA has betrayed doctors. It is almost as if the AMA has become the devil incarnate in some doctors' minds.
There is a remarkable degree of incoherence in the criticisms. Many people who decry Harry Reid's "backroom" deals to get the legislation passed apparently see no contradiction in blasting the AMA for not negotiating its own deal to get tort reform passed or the SGR repealed.
Some say that AMA "sold out" doctors - but then say they got nothing in return. Which is it? Some criticize the AMA for being too cozy with primary care at the expense of other specialists, others for being too close to specialists at the expense of primary care. Which is it? The AMA-financed RUC, which recommends relative values to the CMS and other payers, is a favorite whipping boy, even though the PPACA requires HHS to establish a process, outside of the RUC, to review the accuracy of relative values. (This wasn't one of the provisions in the law that the AMA favored, but AMA ended up supporting the overall legislation, nonetheless.)
It is interesting that some disgruntled internists will cut ACP more slack than the AMA. While in Hattiesburg, an ACP member politely told me he had torn up his AMA membership card in protest, but that he continued to support ACP, even though he disagrees with the ACP’s support for the PPACA.
I am glad, of course, that many internists who disagree with ACP's position on health reform remain loyal to the organization. And although it isn't my job to defend the AMA, I am bothered that the invective directed at the AMA always assigns the worst possible motivations behind the association’s actions. It isn't a case of just disagreeing with the AMA's stances, but of assuming that the AMA was motivated by crass and venal self-interest or by a cynical political agenda that put its own leaders' interests above its physician members.
This does not square with the people I know who are in the leadership of the AMA. People like Cecil Wilson, MD, MACP, the incoming President of the AMA, a private practice internist from Winter Park, Florida (and former chair of the ACP Board of Regents), one of the most principled physicians I know. Or Jim Rohack, MD, FACP, the outgoing AMA President, and Nancy Nielsen, MD, FACP, past-president of the AMA--all doctors of character and principle. Or the AMA staff in Washington, who work tirelessly to represent AMA members' interests in Washington. The AMA didn't get everything it wanted - who did? - but it did its best to represent its members' interests and the policies given to it by its House of Delegates.
The critics of the AMA might entertain this thought: Maybe, just maybe, the AMA supported health care reform because getting 95% of all Americans covered was the right thing to do.
I think it the AMA showed enormous character, courage and leadership by supporting the final bill, even as it knew that physicians and the public were divided and that they would likely lose some members as a result.
Today's question: What do you think about the AMA's actions on health reform?