When David Priver, MD, once an American Medical Association delegate, read last week that the group opposed President Barack Obama's public insurance plan option for adults under age 65, he blasted an angry e-mail to his colleagues:
". . . If nothing is done to reverse this ill-advised AMA policy, we can expect (AMA) membership to drop like a stone," wrote the San Diego obstetrician-gynecologist.
Even when learning the AMA backed off from that stance the next day, clarifying that it merely opposed any plan that forces physicians to participate or which pays Medicare rates which are too low, Priver was not appeased.
"Why make a statement like that and backtrack a day later?" Priver rhetorically asked in an interview Monday, saying he thought the move was disingenuous. "I think they really shot themselves in the foot this time."
For many physicians across the country, the AMA's initial stance severed any allegiance doctors have for the nation's largest and most powerful physicians group.
"The AMA has badly misread the sentiments of not only its members, but of physicians across the country," says Priver, former president of the San Diego County Medical Society and delegate to the California Medical Association. "Most of us don't want to be seen as obstructionists for reform. And the AMA, if they did a better job of keeping in touch with the grassroots, would have known that," Priver says.
Priver joins an increasingly vocal group of doctors who say they are defecting from the AMA.
In an article last week entitled "Dear AMA, I Quit!" in the Huffington Post, a Maryland physician said he was "disgusted" that the organization seems pre-occupied with physician reimbursement at the expense of patient care. Instead of working for patients, it seems to be "supporting the private insurance industry, which has been a driving force in creating the dysfunction(al) health care system we have today," wrote Chris McCoy, MD.
McCoy said he was reacting not just to the Thursday article in the New York Times, but also to the AMA's 12 pages of comments on health reform submitted May 11 to the Senate Finance Committee. Such a plan "threatens to restrict patient choice by driving out private insurers, which currently provide coverage for nearly 70% of Americans," the AMA wrote.
"A crowd-out of private insurers and the corresponding surge in public plan participation would likely lead to an explosion of costs that would need to be absorbed by taxpayers," according to the AMA.
McCoy said those comments indicate the AMA's position "is driven by out-dated political ideology that blindly supports private industry."
A volley of letters to the New York Times on Sunday questioned why the AMA would make such a statement before details of a public plan are understood. For some, it seems the latest AMA stance was consistent with its policies in the 1960s when it opposed the creation of Medicare and Medicaid.
"The AMA is considered by many in the medical community as out of touch and only caring about medical malpractice costs and reimbursement," said Bryan Liang, MD, of the California Western School of Law. AMA doctors, he said, tend to be older, male, more conservative, and used to "the good old days" before managed care, a time when they had more autonomy, he said.
Last week, the AMA's position on a public plan option crystallized opposition against the organization for many younger doctors who may have been sitting on the fence.
Mandy Krauthamer, MD, a primary care physician in Washington D.C., and spokeswoman for Doctors for America, a coalition of 13,000 physicians across the country who are upset with the AMA, says the organization "no longer speaks for physicians."
"We took a survey and in the first 48 hours, 2,000 of our members said they would like a public plan considered," she says. "There's healthy debate within the House of Medicine. And taking the AMA's voice as ‘the voice of all physicians' is not the way to go anymore," she said.
In reality, many doctors are not happy with Medicare or Medicaid and bridle at the obstacles put in front of them by private health insurance. But they also see their ability to do their jobs threatened by paperwork, insurance, government bureaucracy, and rising healthcare costs that all too often prompt patients to seek care too late. They are willing to give something else a try, and feel that this may be their last real chance.
The California Medical Association, which represents about one-third of California's doctors, has not yet taken a position on a public plan option, says spokesman Ned Wigglesworth. But Wigglesworth says a key concern on the West Coast is that "people in Washington should focus less on expanding coverage, which has often been a false promise, and more on expanding meaningful access to healthcare."
"Many doctors don't fully embrace either private insurance or public programs as the foundation for health system reform because they and their patients have had such problems with both," he says.
For Priver, it's important for doctors to "think over carefully the option for a public plan" and keep their place in the discussion. "We need to decide what will be the legacy we leave behind. We don't want to follow in the footsteps of the AMA. Some of us may not be happy about what's being talked about, but if you stamp your feet and walk away, you'll like the situation even less."