The AMA Will Oppose M4A…Until It Doesn’t

Prior to 1965, the American Medical Association fought against the creation of Medicare, warning – correctly – that it would lead to “socialized medicine.”  The AMA and their allies in Congress depended on then-Ways and Means Committee Chairman Wilbur Mills to craft a limited, more fiscally responsible plan to head off a more gargantuan insertion of the U.S. government into all of health care.  In that, the AMA produced another chapter in a long history not of leadership, but of debridement, excising just a little more infection, and ceding a little more tissue in hopes of a firebreak.  It’s a lousy strategy for defending and promoting principle, but it’s great for organizational preservation.

After LBJ’s master win, the doctors started jacking up prices for easy government cash, prompting the AMA president to warn “that physician fees were rising faster than the cost of food and housing, and he urged members to address ‘efficiency, cost and methods of delivery’ of health services in order to preserve freedom from further government intervention  As in years past, that plea did little to ameliorate profit maximization.”  More than a half-century after warning doctors to not get too greedy for government cash, the AMA continues to support the Affordable Care Act…the legislation that made lots of extra government cash available to Big Insurance.  Consistency, or irony? 

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Now the Vichy House of Medicine is leaving a coalition fighting against Medicare For All.  Oh, to be sure they say they still oppose the full and final government takeover of all things health.  “It just wants to focus its energies on advocating for solutions, such as improving ObamaCare by making its subsidies for helping people afford coverage more generous.” 

The AMA’s Dr. James Madara:  “The American Medical Association (AMA) firmly believes that the best pathway to expand affordable, high quality health insurance coverage to all Americans is through a mix of private and public health insurance options.  We remain opposed to Medicare for All, and policies that reduce patient choice and competition, and are built on flawed financing policies.”  Reduced patient choice and competition, and flawed financing policies exactly describe the ACA which the AMA so fervently believes is mostly A-OK.  The most recent AMA delegates vote tallied 47% in favor of M4A.  This means that nearly half of the overall minority of physicians which the AMA represents, are themselves represented by those who want the government to be in charge of their lives.  That is disheartening nonetheless. 

The AMA strongly opposed government in health care for decades – until it didn’t.  After cooking up the ICD/CPT manuals scam, it bought into the “preserving and strengthening” rhetoric that led to the line of successes that included DRG’s, SGR, MACRA, MIPS, and whatever other acronym-for-failure you wish to add.  And of course, they supported the ACA.

And before it’s over, count on the AMA to swing back around and support M4A.  They’ll support it just as a so-called “public option” at first, but they will encourage all physicians to participate.  And later, they will agree, with the appropriate amount of hesitation, that it will be in the best interests of patients as a whole of the government to compel all physicians to participate.  This bunch is so full of themselves, and so unaware that they probably don’t even realize this is how it is going to play out.  And when it does, and the feds have leaned on the states to make M4A participation mandatory for licensure, the staid, thoughtful AMA will have a seat at the table, toothless, but able to advise and accept.

Pat Conrad MD

Pat Conrad is a full-time rural ER doc on the Florida Gulf Coast. After serving as a carrier naval flight officer, he graduated from the University of Florida College of Medicine, and the Tallahassee Family Medicine residency program. His commentary has appeared in Medical Economics and at AuthenticMedicine.com . Conrad’s work stresses individual freedom and autonomy as the crucial foundation for medical excellence, is wary of all collective solutions, and recognizes that the vast majority of poisonous snakebites are concurrent with alcohol consumption. 

  2 comments for “The AMA Will Oppose M4A…Until It Doesn’t

  1. September 15, 2019 at 5:36 pm

    Excellent, Dr. Conrad!
    The AMA used to say, “The voluntary way is the American Way.” No more. According to the late Francis Davis, editor of Private Practice, physicians called a special session of the House of Delegates to advocate nonparticipation in Medicare (the policy of aapsonline.org). The effort failed, narrowly, and the rules were changed to make it impossible for members to call another special session.
    AAPS got the AMA to admit to the CPT monopoly at the 1998 Chicago fly-in over the revised E&M Documentation Guidelines (https://www.jpands.org/vol23no3/orient.pdf)

  2. Thomas David Guastavino
    September 15, 2019 at 6:56 am

    Are there any physicians left that do not the see the need for a physicians union with the right to strike ?

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