AMA Faces a Crossroads

In March, I talked with Robert Moffit, PhD, a senior fellow for domestic and economic policy at the Heritage Foundation, who insisted one of the potential losers in healthcare reform was going to be the powerful American Medical Association.

Moffit says the AMA was not a force in the healthcare debate. He says the AMA's arguments languished in Congress as it tried to overturn the sustainable growth rate (SGR) formula that governed physician Medicare payments, yet limply supported the Obama healthcare reform.

Indeed, as Congress dragged out the "doc fix" debacle, the AMA would issue statements saying that patients were the big losers and Congress needed to act. The AMA's press statements often sounded the same, with the difference being some quotes.  I thought the press releases were quite tame. Moffit thought they were weak. Moffit indicated that the AMA would pay a price for what he saw as waffling in the healthcare debate.

In late June, President Obama signed a bill that would postpone until Nov. 30 the proposed 21% cut in Medicare and TRICARE reimbursements to physicians.

After the votes in Congress, I kept thinking: where's the fallout for the AMA? Was Moffit wrong? Was this just another conservative taunt from the Heritage Foundation?

But in the aftermath of healthcare reform, there is no doubt some physicians are furious with the AMA and even some of the organization's strongest supporters say the organization must rethink its approaches as it moves ahead. In August, the Florida Medical Association is scheduled to consider a resolution to break away from the AMA. Moffit thinks it's just the beginning of political trauma for the AMA. We'll see.
The Florida Medical Association resolution says that the AMA "failed to achieve one single concession" in the healthcare reform legislation, according to The Hill, the Washington newspaper. The resolution says the AMA is "failing to lead and represent America's physicians."

The Hill didn't reach the sponsor of the resolution, Douglas M. Stevens, MD, a Fort Meyers, FLA, plastic surgeon, but I did. He confirmed the resolution, saying "in Florida physicians have seen what government sponsored healthcare is and think it's a disaster.
The AMA consistently failed us on the signature U.S. healthcare policy—and failed us miserably," He added, "I'm not clear whom the AMA is representing anymore."

 The AMA has not commented on the Florida Medical Association resolution.

 "This is definitely heavyweight stuff," Moffit says of the Florida resolution. "Doctors want to change the whole way in which they deal with Washington—different from this whole business of going along, and getting along. That's what the AMA does. We are at a watershed."

 "Florida has a huge group of doctors who serve Medicaid patients, and also serve Medicare patients," Moffit adds. "Physicians are going to be on the receiving end of basically a price controlled payment system, which limits their outcome and also limits their options.

The Florida vote may be a big deal, or it simply could be one physician's resolution that will be shouted down in a chorus of "nays." That's what basically happened in May in Texas, where a resolution to have the Texas Medical Association be removed from the AMA was discussed, Susan Rudd Bailey, MD, president of the Texas Medical Association, told me.  The group, which represents 45,000 members, quickly dispatched the idea, she says.

"I think we and the AMA have not really differed widely in our opinions about what needs to be done in health system reform," Bailey says. "The major differences have been in strategies and tactics that were used when the bill was debated in Congress."

"The biggest question is whether the AMA should have fallen on its sword over SGR. Should they have withdrawn (their support) for the rest of the bill because the SGR fix wasn't in it? They decided not to. A lot of physicians are frustrated and angry. But the AMA is a very easy scapegoat."

 "There needs to be a national organization that speaks for all physicians regardless of specialties, regardless of where they are in their careers. If the AMA fails or ceases to exist, we have to create another one like it," Bailey says.

In addition, the reach of the AMA should not be misjudged, she says. "The AMA does so much more than advocacy," she says. "If we lose the AMA, we lose all those other things as well." The AMA has about 240,000 members, representing about 20% of U.S. physicians. Critics believe it will see a cascade of lost membership in the wake of healthcare reform.

Bailey says she believes the AMA is strong, but may need to change. It may have to become a "different type of organization," she says, such as an "organization "become an organization (that represents) various organizations of physicians."

Still, the AMA has been important as a voice for physicians, Bailey says. "I think change is much better from the inside."

We're not talking Bush-Gore in Florida, but there are many political issues involved, conservatives vs. liberals in the undertow of healthcare reform, as Bailey notes.

Moffit agrees that the political undertones are strong in whatever region of the country addresses the healthcare issues and feelings about the AMA reflect that. Whatever happens with the AMA, "it can't be a 'get along and be along' organization, Moffit says. "They are only going to splinter themselves. They can't be like Caspar Milquetoast."

The Florida Medical Association's delegates are expected to vote on Stevens' resolution at their meeting Aug. 13-15 in Orlando.

Stevens says he has no idea how the vote will go on his resolution to disengage from the AMA. Whatever happens, "the discussion is what's really important," he says.