What's Up, Docs? The Democratization of the AMA - American Medical Association espouses Democratic Party ideas

National Review, May 14, 2001 by Michael Catanzaro

President Bush got a great deal of media attention when he ended the American Bar Association's special role in evaluating federal judges- but a few weeks later, the press largely overlooked Bush's slap at another white-collar professional group, the American Medical Association. Bush gave his first important health-care address to the American College of Cardiologists, even though presidents traditionally reserve this speech for the AMA. The decision was occasioned principally by concern about the AMA's political tilt, which has diminished the once-revered organization's influence and damaged its reputation for protecting the interests of doctors and patients.

Many Republicans, including those at the White House, see the AMA leadership as just another Democratic party constituency. Not so long ago, the AMA was a reliable GOP ally: In 1965, the AMA stood with Republicans in denouncing Medicare as "socialized medicine," and in strongly resisting excessive regulation of health care; after a brief flirtation with President Clinton's health-care overhaul in 1993, the AMA helped Republicans crush it. But AMA leaders no longer consider the Republican party the vehicle to advance their interests; in fact, these interests now converge with those of the most liberal wing of the Democratic party.

The AMA's realignment has had consequences: The association now represents just 32 percent of American physicians, down from a peak of nearly three-fourths in the early 1970s. Much of the decline stems from the increasing specialization of medicine, which has forced doctors into specialty groups better equipped to represent them; but another important factor is the AMA's strange alliance with trial lawyers. The AMA and the American Trial Lawyers Association favor legislation permitting unlimited lawsuits against HMOs. Together, they helped defeat three GOP senators who held a different view. As a crucial member of the "Patient Access Coalition," the AMA financed television ads against Sens. Slade Gorton (Wash.), Spencer Abraham (Mich.), and John Ashcroft (Mo.), all of whom opposed the AMA on HMO liability. "Tell your senators to stand up for patients and let America's doctors make your health-care decisions-not HMO bureaucrats," the ads proclaimed.

The AMA also withdrew its support from GOP congressman Ernie Fletcher of Kentucky. In 1998, the AMA's PAC had given him the maximum $10,000 contribution-but Fletcher's contention that lawsuits would not curb HMO abuses was a heresy it couldn't overlook.

In addition to targeting Republicans, the AMA is busy championing left- wing causes. In 1998, AMA leaders sided with the Left in opposing Washington State's Initiative 200, which proposed banning all forms of state affirmative action. The organization also recently joined the gun-control coalition known as Doctors Against Handgun Injury, and distributed a booklet on gun safety to thousands of doctors; Dr. Katherine Christoffel, one of the contributors to the booklet, has compared guns to viruses that must be eradicated. But Dr. Timothy Wheeler, president of Doctors for Responsible Gun Ownership, says that while "this campaign is couched in terms of patient safety . . . it really represents a psychological aversion to gun ownership."

The AMA is even emulating the AFL-CIO by campaigning for federal legislation to permit physicians to unionize. Some congressmen, most of them Republicans, criticized the unionization drive as merely an effort to increase physician reimbursement fees and boost AMA membership; but Tom Campbell, a California Republican, and John Conyers, a Michigan Democrat, shepherded the AMA-backed bill through the House last June. It passed by a vote of 276 to 136.

After the bill passed, AMA board member Donald Palmisano basically proved the Republican skeptics right by making the following boast in an e-mail: "The gutting amendments that would have prevented fee negotiations and would have required FTC [Federal Trade Commission] or DOJ [Department of Justice] supervision were defeated . . . Finally, we need to turn this into new membership. How can someone not join now?"

Palmisano's e-mail revealed a struggling organization, searching for relevance and the power it once enjoyed-and it only served to accentuate the mistrust Republicans have come to harbor against AMA leaders. "It used to be that when Republicans on the Hill tried to understand what doctors in their districts were thinking, they turned to the AMA," says a Republican leadership aide. "But that's totally changed. We simply don't believe what they say."

The AMA's search for renewed influence has pushed the 154-year-old organization into the crucible of managed-care reform: Bashing HMOs has become de rigueur for the AMA leadership. But while some doctors are sympathetic, much of the AMA rank and file is not. According to Jerald Schenken, who served on the AMA board from 1985 to 1994, AMA leaders have "lost their place in the front" when it comes to issues affecting doctors. "If they are to be leaders, they've got to find a way to represent American doctors."