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Physician Unrest Flares Over AMA Stand

July 16, 2009


Concerned that the American Medical Association has taken too tepid a position on Democratic healthcare reform plans, a coalition of state medical associations and specialty organizations is breaking from the country’s largest physicians’ group to mount its own push against the inclusion of a public insurance option in any overhaul bill.

Seventeen state medical associations and three specialty physicians’ groups planned a conference call late Wednesday to discuss a draft letter that would go much further than the AMA’s more measured responses to the public option.

The AMA has made clear it is not opposed to a public plan, but would resist a Medicare-like program that mandates physician participation and pays less than their costs.

The draft letter, written by members of the Medical Association of Georgia, says flatly that the physicians’ groups unequivocally oppose a government-administered insurance plan, as well as use of government-funded effectiveness tests, or “comparative effectiveness research,” to dictate which medical procedures should be eligible for coverage.

David Cook, executive director of the Georgia group, acknowledged that the AMA has expressed some concerns about legislation that would mandate physicians’ participation in a public plan. But Cook said the AMA “really doesn’t say ‘yes’ or ‘no'” to the question of slamming the door on the proposal, which President Obama pitched to the organization during its annual meeting in Chicago last month.

“We are opposed to the creation of a public option under any circumstances,” Cook said.

Once individual state medical associations have decided whether they will sign on to the Georgia group’s letter, it will be circulated on Capitol Hill “within the week,” he added.

A Republican aide familiar with the coalition’s concerns said the physicians’ groups especially worry that AMA’s position on public option language in the House’s developing legislation has been “too squishy.”

Todd Atwater, CEO of the South Carolina Medical Association, said the draft letter does not represent a break with AMA, merely a more barbed critique than the larger 245,000-member physicians’ lobby is prepared to make.

“We’re very supportive of AMA,” said Atwater. “We are not anti-AMA. But tactically, we would like them to be more forceful.”

Atwater’s group circulated a much tougher letter among its members in early June, calling a public option the first step “down the road towards indentured servitude” and hinting that physicians’ groups have been bullied into submission by congressional Democrats and the Obama administration.

“Physicians have been offered a seat at the table so long as we sit still with our hands folded in our laps and keep our mouths shut,” wrote John Black president of the South Carolina association, and Gary Delaney, the group’s chairman. “The muzzle that the Feds placed on us must be removed and the decibel level of our voices must be raised so that we are unmistakably heard.”

In addition to Georgia and South Carolina, state medical associations from New Jersey, Florida, Arkansas, Virginia and 10 other states and the District of Columbia planned to discuss the letter and consider signing it.

The Triological Society and the American Academy of Facial Plastic and Reconstructive Surgery were also invited to participate in Wednesday’s discussion, said a spokeswoman for the Georgia group.

The alliance originally was formed to advocate for physicians’ rights to offer private contracts with patients for what some call boutique care or “concierge” medicine.

It successfully advocated for language in an AMA policy position in support of federal legislation that would protect physicians from penalties or fees if they entered into private contracts to perform procedures not covered by patients’ insurance plans. The policy stand was approved by the AMA House of Delegates at last month’s meeting in Chicago.

At that meeting, Obama tried to dispel concerns that a public option threatens private insurance alternatives. “The public option is not your enemy. It is your friend,” he said.

AMA President J. James Rohack issued a statement Wednesday saying his organization stands by the policy proposals approved at that meeting. He said the AMA will advocate for what’s best for both physicians and patients.

“At our annual meeting in June, AMA physician delegates voted for AMA to support health system reform alternatives consistent with principles of pluralism, freedom of choice, freedom of practice, and universal access for patients,” Rohack said. “This evolution in policy is consistent with the AMA’s strong support for health reform this year that provides high-quality health care coverage for all Americans.”