Recent New Yorker article, I read, “The Fight Within the American Medical Association“ What I found interesting is the AMA’s history in support and lack of it for better healthcare. It is going both ways while slowly advancing towards Single Payer. Out of necessity, the AMA has started to move closer to the reality of a Single Payer plan. Why now? Commercial healthcare insurance companies and Medicare Advantage are calling the shots on what care will be given to a patient. Much of this is done via fax, adding to cost, and delaying care. Doctors are losing autonomy. In today’s healthcare market, doctors have to associate with a group of doctors or become a part of an ACO. A single practicing doctor is a rarity. Interesting (edited for
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Recent New Yorker article, I read, “The Fight Within the American Medical Association“
What I found interesting is the AMA’s history in support and lack of it for better healthcare. It is going both ways while slowly advancing towards Single Payer. Out of necessity, the AMA has started to move closer to the reality of a Single Payer plan.
Why now?
Commercial healthcare insurance companies and Medicare Advantage are calling the shots on what care will be given to a patient. Much of this is done via fax, adding to cost, and delaying care. Doctors are losing autonomy. In today’s healthcare market, doctors have to associate with a group of doctors or become a part of an ACO. A single practicing doctor is a rarity.
Interesting (edited for clarity) factoid(s).
The A.M.A., and physicians are no longer the most dominant force in health politics. Many of the most consequential negotiations over the Affordable Care Act involved the pharmaceutical, ACOs. and insurance industries. All of which command formidable lobbying operations. Doctors were not in the driver’s seat of changes.
The rise of these power centers is another explanation for the profession’s openness to greater government involvement. Having replaced hospital as entities, the newbies here are the ACOs being collections of hospitals, clinics, etc.
Single Payer
Even with the AMA’s diminishing influence, the prospect of the A.M.A. moving toward the single-payer camp is tantalizing for progressives. The A.M.A. influence has been targeting legislation having spent four hundred and sixty-two million dollars on lobbying. The amount exceeded only by the expenditures of the U.S. Chamber of Commerce, the National Association of Realtors, and the American Hospital Association.
Single-payer proponents in decades past discovered to their chagrin, physicians can exert a broader influence. “There’s a cultural authority there,” Jacob Hacker, a professor of political science at Yale stated. “If physicians are really on the side of a much more just health-care system, I think that can move the needle.”
Decades of a Changes
In 1917, the A.M.A. endorsed compulsory health insurance. The endorsement quickly faced a countering revolt from the state societies, whose members feared a drop in wages, and reversed course. The same year, a California referendum proposed the establishment of a state-run health-insurance system. A group of California physicians, the League for the Conservation of Public Health, launched an opposition campaign based on fears of German infiltration.
The argument being, “What is Compulsory Social Health Insurance?“ And their answer being, it is a dangerous device, invented in Germany, announced by the German Emperor from the throne. Announced, the same year he started plotting and preparing to conquer the world.” The measure was overwhelmingly defeated.
In 1932, an editorial in the Journal of the American Medical Society denounced a proposal for government-backed voluntary health insurance as “an incitement to revolution.”
In 1949, Gallup found that fifty-nine per cent of Americans supported Harry Truman’s plan for a payroll-tax-financed, government-run insurance system. The A.M.A. charged each member an extra twenty-five dollars to finance a lobbying campaign. In the end, support for the proposal fell to twenty-four per cent.
Of the defeat of his insurance plan, Truman in his memoirs wrote how troubling it was to him. More so, then other defeats during his Presidency. Stating,
“there are a lot of people in Congress who jump when the American Medical Association cracks the whip,”
In 1961, actor Ronald Reagan spoke in response to a different government proposal calling it socialized medicine (Medicare). The A.M.A. produced a recording, “Ronald Reagan Speaks Out Against Socialized Medicine.”
The future President Reagan warning listeners;
“Subsidizing medicine would curtail Americans’ freedom. Pretty soon your sons will not be deciding when he’s in school, where he will go or what he will do for a living. He will wait for the government to tell him.”
Physicians “had a lot of cultural authority.” They were not shy about using their community contacts to shift public opinion.
In 1993, the Clinton Administration sought the A.M.A.’s support for its health-care initiative. Hillary Clinton flew to Chicago to speak at its annual meeting. Her speech was greeted with a mix of warmth and wariness. Some smaller organizations backed the plan, some opposed it, and the A.M.A. largely sat out the fight.
In 2008, the A.M.A. signals support for the Obama Administration’s health-care proposals. This was including the individual mandate for health insurance. At the last minute, a bloc of conservative physicians were successful in passing a measure rescinding A.M.A. support for the individual mandate. Leadership prevented the proposal from taking effect by tabling it until the next meeting. Organized medicine had become a house divided.
A 2016 poll found thirty-five per cent of doctors considering themselves Democrats. Twenty-seven per cent were identifying as Republicans. Fifty-six per cent were supporting single-payer health care.
The Leverage?
Since 1998, the A.M.A. spent four hundred and sixty-two million dollars on lobbying to influence Congress. An amount exceeded only by the expenditures of the U.S. Chamber of Commerce, the National Association of Realtors, and the American Hospital Association. And, as single-payer proponents in decades past discovered to their chagrin, physicians can exert a broader influence. “There is a cultural authority there,” Jacob Hacker, a professor of political science at Yale stated.
“If physicians are really on the side of a much more just health-care system, I think that can move the needle.”
In 2021, healthcare has advanced to being 18% of GDP.