'AMA to Obama: Feh.'

[seafan]

Jonathan Cohn reports on Obama's address to the American Medical Association today. (Hat tip to Digby)


June 15, 2009

.....

"You entered this profession to be healers," Obama said, "and that’s what our health care system should let you be."

They were stirring words. And yet the audience remain decidedly unstirred. They reacted not as high-minded champions of health and the public interest, but like any other interest group, focused entirely on their narrow economic interests. Fixing malpractice. Ending the annually scheduled reduction in Medicare payments. And even then, the approval was qualified. Once Obama made clear he didn't want to cap malpractice awards, as the AMA has long desired and Republicans usually promise, the clapping stopped. A few people actually booed.

I suppose this isn't surprising. Among other things, the AMA represents an ever-shrinking portion of the physician population. And, by all appearances, it represents the profession at both its most craven and conservative. Remember, this is the organization that funded pro-tobacco candidates even as its top public health priority was to reduce smoking. And, remember, this is the org(an)ization that in 1995 endorsed Newt Gingrich's plan to savage Medicare by, among other things, forcing beneficiaries to pay more for their care. What convinced the AMA to make this deal? Chiefly, it was Gingrich's agreement to strike a provision that would have cut physician fees.

Of course, not all physicians agreed with the AMA back then. The American College of Physicians, a more liberal group, protested the cuts because of what it would mean for the elder(l)y . And the same is true today. Smaller, more liberal physician groups are lining up behind reform. They want malpractice relief and a Medicare fix, too. But they also want what's best for their patients--and their country. They want to help construct a deal, one that works for everybody.

So the question going forward is how the medical profession as a whole chooses to act. Whatever their lobbying presence in Washington, physicians have enormous influence over the public as individuals. Health reform is a complex issue; patients will be asking their doctors, whom they trust, what to think.

Physicians say they have a higher obligation than other professions, that they are healers and not just tradesmen looking to make a buck. And many really believe that, I know. Now is the time to show it.

Noteworthy historical comparison: Over at the Health Care Blog, Michael Millenson reminds us that Hillary Clinton got a rousing reception when she spoke to the AMA in 1993. But she did it by playing more to the organization's predispositions. And, of course, she ended up failing in her reform effort. So perhaps a speech with less sugarcoating bodes well for reform, even if it wasn't quite what this year's audience wanted to hear.

Just a little info on AMA's membership numbers and what percentage of practicing physicians it represents:

Physician membership in the group has decreased to lower than 19% of practicing physicians.

In 2004, the AMA reported membership totals of 244,569, which included retired and practicing physicians along with medical students, residents, and fellows. The medical school section (MSS) reported totals of 48,868 members, while the resident and fellow section (RFS) reported 24,069 members. Combined they account for almost 30% of AMA members. <3> If every other member of the AMA was a fully qualified practicing physician then the AMA would represent 19% of America's practicing physicians (There are currently approximately 900,000 practicing physicians in America).

However, MedPage Today estimates that the AMA only represents 135,300 "real, practicing physicians" as of 2005 (15.0% of the United States practicing physicians). <4> When asked about this, Jeremy Lazarus, MD, a speaker in the AMA House of Delegates, stated that membership was stable, avoiding commenting on the low overall numbers (2005 AMSA annual meeting, AMA vs. PNHP healthcare debate, Arlington, Virginia). Link

The attitude of the AMA has been a disgrace for many decades.

[mucifer]

1. I listened to it on the radio. The applause sounded pretty loud to me.