Why the American Medical Association Opposes the Public Insurance Plan

Original Link: http://voices.washingtonpost.com/ezra-klein/2009/06/why_the_american_medical_assoc.html

By Ezra Klein

To understand the importance -- or lack thereof -- of the American Medical Association's opposition to the public plan, you first need to understand "Operation: Coffeecup." This was the AMA's big political campaign in 1961. It came at another moment that seemed ripe for health-care reform. John F. Kennedy had begun working toward government-run health-care plans that would cover the elderly and low-income Americans. We know these plans today as Medicare and Medicaid. In 1961, however, the AMA hired Ronald Reagan to produce a recording that called them something entirely different: socialism. You can listen to it above. The recordings were sent to the "ladies auxiliary" of the AMA -- wives of doctors, essentially -- and played at informal morning coffees around the country.

Which is all to say, of course the American Medical Association is opposed to the public plan. It has opposed all public plans proposed by all presidents in all contexts. The AMA opposed national health care as proposed by Harry Truman ("all forms of security, compulsory security, even against old age and unemployment, represent a beginning invasion by the state into the personal life of the individual, represent a taking away of individual responsibility, a weakening of national caliber, a definite step toward either communism or totalitarianism"), and Medicare and Medicaid as envisioned by John F. Kennedy. And it will oppose the public plan now.

And the group is not necessarily wrong to do so. The AMA represents the interests -- which it tends to define as the profits -- of doctors. That gives it a slightly different perspective on the American health-care system. Judged as a health-care system, it's pretty bad, primarily because it's so expensive. But judged as a mechanism for funneling profits toward various actors in the medical industry, it's pretty good, primarily because it's so expensive. Things that would make it cheaper -- like a public plan -- will inevitably cut into the profits of doctors. And the AMA doesn't want that.

Which is all fair enough. But I think it would be useful for folks to ask themselves whether they really think America would be better off without Medicare and Medicaid and if they really think that the point of health reform should be to protect the profit margins of the medical industry. The AMA has one set of interests to protect, and taxpayers have another. And sometimes, the two will diverge.

It's also worth saying, of course, that the AMA is not the only game in town. Take the National Physicians Alliance. It's a newer, smaller, younger association of doctors. It sees the interests of doctors as inseparable from the interests of patients. It supports a public plan. Or check out Physicians for a National Health Care Plan, which see the interests of doctors as irreconcilable with the interests of insurers. It's for single-payer. As Jon Cohn notes, the American Academy of Family Physicians and the American Pediatrics Association tends to be more liberal, and it'll be interesting to see where they fall on the public plan.

Who's right? Hard to say. But all of these groups are representing a different version of the interests of doctors. Patients, of course, have a different set of interests to protect.