The former AMA delegate who predicted the physician group's membership would "drop like a stone" because of statements suggesting they oppose a public plan, now says he is somewhat relieved that the group's Wednesday resolution will "at least keep them at the table" of health reform debate.
"At least they realized that the first statement was a mistake," says David Priver, a San Diego obstetrician gynecologist and California Medical Association delegate.
AMA delegates this week spent several hours in an emotional debate–one member who was there called it "knockdown, drag out"–between left wing and right wing members who disagreed over how to weigh in their voice on President Barack Obama's push for a public plan. And support for "a public option" was language that was included in the wording of one of several proposed resolutions they agreed to consider.
"It broke down between the right and the left," says Robert Hertzka, MD, a moderate California delegate to the AMA. "The right outnumber the left, but people on the left are about as loud as the people on the right," he said yesterday in an airport bound for home.
Some were concerned that not supporting a public plan "makes it seem like we like Aetna, when we just filed three lawsuits against health plans," he says.
In the end, the delegates were tired and out of time, and outgoing president Nancy Nielsen, MD, took the microphone. They all want reform, she told the crowd, but she suggested they just stick with the language in place in a previous resolution. That resolution did not include mention of a public option.
They voted, just as the delegates were about to lose the conference hall, Hertzka says.
The new resolution says the following: The organization supports "health system reform alternatives that are consistent with AMA principles of pluralism, freedom of choice, freedom of practice and universal access for patients."
"People on the left and right really felt like they had fought a war. They felt something dramatic had happened," Hertzka describes.
But other doctors are still disenchanted with the AMA for not specifically advocating a public plan as the Obama administration is pushing.
"The AMA has a large denial problem," says Joe Scherger, MD, vice president for primary care at Eisenhower Medical Center, near Palm Desert, CA. and an AMA member.
"They're not facing the huge healthcare cost problem, and that's the problem that's crippling America," says Scherger. "What is the AMA doing to respond to what is happening in McAllen TX, where a map of medical expenses finds them charging more than all but one other region of the country, apparently because physicians are giving too much care?
"Nothing," he said.
"There's nothing new in their new statement, at all," he said.
Kevin Pho, MD, who blogs from his internal medicine practice in Nashua, NH, said in an interview that younger physicians like himself, and more liberal ones in his specialty, tend to side more with the American College of Physicians than the AMA.
"The AMA only represents 30% to 35% of doctors practicing across the country," he says. "But they are still the most influential lobbying force for doctors in the country and they still hold influence and sway."
Now, he said, the AMA appears to realize that "they have to appear somewhat open to some sort of public plan because the president supports it, and if they don't they'll lose their seat at the negotiating table."
Pho says it's difficult for anyone to say how they feel about a public plan when the details of the president's proposal have not yet been revealed. In reality, the concept of a public plan may be different than anyone on the right or left side of the debate envisions today.
Priver, former president of the San Diego County Medical Society, echoes his comment. "They've got to start spelling out the details. I don't know whether they're holding up for a reason, or whether spelling out these details would mean more anxiety."