Guest post: AMA backs the mandate…
Guest post by Michael Halasy
AMA backs the mandate…
The AMA has its annual House of Delegates meeting last week, and boy, are they concerned. Recent evidence has suggested that they have lost 12,000 members since 2009. Much of this has been due to the AMA’s support of the PPACA. Today, the HOD voted to maintain the support of the individual mandate, (Chicago Tribune story here).
The problem with this concern is that it isn’t new. The AMA has been losing members for many years. They have also been losing money.
At one point in there history, the AMA was powerful, perhaps one of the most powerful organizations in the country. Politicians feared them. People respected them. But then, with the rampant specialization that really began in the early 1960’s, physicians started to jump ship. Many began to only belong to the rapidly rising specialty organizations, believing that they could tend to their interests as a specialty physician better.
Add to this, that the AMA chose to have battles with…..well, everyone. They fought against group practices, labeling them “communist”. They challenged the creation of HMO’s and vigorously opposed Medicare. They fought against the Doctor of Osteopathy (D.O.) profession. They challenged the creation of the Nurse Practitioner and Physician Assistant professions, and have continually challenged Podiatrists, Chiropracters, Optometrists, Psychologists, and virtually everyone NOT an M.D.
The end result was an organization that became a caricature. A cartoon. Like the boy that cried wolf, the AMA lost respect and wasted precious political capital in far too many small skirmishes that could have been negotiated instead of battled. During this time they lost a lot of members. Determining the peak of membership is difficult as the AMA does not make that public, but it seems that membership during the aughts has decreased by about 2-3% annually, with this latest decreased of 5% being the most substantial. This means that once you discount the medical students, residents, and fellows, you have at best about 19-20% of physicians represented. Once you discount retirees the number is closer to 15-16% of practicing physicians.
This is too bad, but this is a situation that they themselves created.
Michael, They seem to have been rather too interested in politics for their own good. I really don’t see why people should care what the AMA thinks about the individual mandate. That’s a legal matter and is not their area of expertise. You’d think they’d be concerned about for-profit medicine and how it could either be improved or replaced with something better.
Or they could study how pharmaceutical companies work and figure out ways to make them more responsive to patient needs. Or how about conducting effectiveness studies for different courses of treatment? How about patient education regarding things we need to know about modern medicinal treatments for various conditions–what works and what doesn’t?
I have the impression from what you’ve said that the AMA could use new goals and a new direction. Sure would be nice if they’d apply their minds to what patients need and not what political impact their positions have. I’m one of those old-fashioned patients who think medicine should have a scientific basis. Sure would be nice if doctors could rely on the AMA for good current information regarding general medicine and its various specialties. NancyO
Nancy, there are several excellent books on medieval “guilds” that protected their members interests past the point of sanity. Today’s American Medical Association has many very intelligent members, unforturnately, they will march on to annilahation crying for their “priveleges.”
The AMA is a guild. It has no more self awareness than a turtle. It will cry forever as medicine changes. It will pretend that the members are the most knowledgeable about every disease known to mankind. A specialist may know a huge amount about a tiny fraction of medical knowledge. That does not make a physician an “expert” on gambling, the stock market, politics or any other field of medical practice. They only know a tiny bit about medicine. The rest is strictly faking it.
They are swiftly approaching sorcery as a gold standard for medical care. The AMA is full of people that are actually seriously dangerous to their patients in their sheer damned self limited ignorance.
hell, interesting perspective. Thanks for writing. NancyO
Underestimation of those who shape health care designs in the nation are not a good idea although underestimation has continued for over 100 years and may continue for decades more.
The AMA still selects those who sit on panels, those who advise politicians, and those who determine rates of reimbursement and health spending. The AMA shares enormous influence with the American Hospital Association and the Association of American Medical Colleges. Health insurance executives and drug companies are not far off. Each suffers losses in some areas, but each still shapes substantial benefits for those they represent.
By a consistent focus upon concentrating health spending month after month for decade after decade, they have managed to accomplish concentrations of health spending – and in ways few understand and have a clue about.
Track the most lines of revenue and the top levels of reimbursement and see where they lead. Those in hospital and subspecialty and academic areas continue to do well even in a down economy. Investors continue to flock to these health investments. We continue to spend more and more dollars on fewer Americans.
The national health spending level continues to increase even when it further damages economic recovery,
There is evidence of even greater power, perhaps not individually but collectively. It took about 15 years to reshape Medicare and Medicaid their way, 5 years for managed care, and the most recent reforms were negated not long after they were announced. With hundreds of billions flowing in concentrated ways, it is easy to deflect small portions to continue the same designs that work for so few.
My own time in the AMA was short. As a solo rural family physician I turned to the AMA for help with primary care and rural health in the 1980s. I was the first delegate selected by the Young Physician Section to sit in the AMA House of Delegates. Suffice it to say that the AMA was not really focused on areas of importance to me or to most young physicians.
It was a great learning experience. Associations tend to take on their own course that may or may not benefit their members. Those advancing to top positions are inevitably changed by the journey to get there, as we fully understand about politicians and so many others that lose their relevance and awareness early on.
Does the AARP represent seniors or the AARP insurance interest? Which focus is best for seniors given that substantial revenues come from the insurance focus?
Does nursing leadership represent the basic RNs that make up the bulk of membership or is their focus more about academic, hospital, and subspecialty – also guided by the health policy reward system? Is nursing leadership focused on delivering the best nursing care, or are there other agendas that guide nursing associations and policies and their leaders rising to power in government such as autonomy or even perhaps displacing physicians?
There have been six different primary care sources existing or created in the US. Decades ago all resulted in more than a majority of graduates found in primary care. Their associations all represented primary care specifically during these time periods. Now only one source has a majority contribution to primary care and even family medicine is beholding to academic interests due to the training connection? Does the AAPA or the AANP represent primary care when over 60% of members are not active in primary care? Does the United States discern who is a primary care source or not? Associations are very powerful in ways not always understood by the public, by politicians, by members, or by association leaders.