The Obama Agenda: Leaning left? The AMA at a crossroads
They helped derail a proposal to add national health care to the Social Security Act of 1935.
They opposed Truman’s call for universal health care, playing off the anti-Communist fervor at the time by referring to the plan as socialized medicine.
They waged war against the proposed creation of Medicare, even enlisting a well-known actor and television star to record an album entitled “Ronald Reagan Speaks Out Against Socialized Medicine.”
They played a major role in sinking “HillaryCare” in 1993, even though they had initially supported some parts of the Clinton plan.
Every time the president has tried to expand or reform health care, the members of American Medical Association (AMA) has stood in the way. In doing so, the AMA, buoyed by its status as the largest association of doctors and medical students in the United States, became a powerful, and consistently conservative voice on Capitol Hill.
However, in recent years, the AMA has seemingly turned its back on the Republicans that it used to support and depend on for votes, and has contributed, instead, to Democrats. With several high-profile announcements over the last few months, the AMA has, seemingly, cemented its shift to the left. The AMA supported the health care reform bill that recently passed the House, encouraged the military to drop its “Don’t Ask, Don’t Tell” policy, and recommended that the federal government reevaluate its classification of marijuana as a controlled substance.
The AMA, however, has resisted these ideological labels and maintained that it has always been in favor of increased access to health care. However, as health care reform reaches the finish line, the AMA finds itself at a crossroads. Its membership is declining and its message is becoming increasingly fractured as different factions are trying to pull the AMA in different directions. By angling for a seat at the bargaining table instead of playing the obstructionist role that it had become accustomed to, the AMA had hoped to shape the bill on its terms. Now, it faces accusations of selling out and betraying the fundamental principles of the organization.
Leaning Left?
During its heyday in the 1970s, the AMA counted nearly three-fourths of the nation’s physicians as members. That number has steadily decreased to the point that the AMA only represents approximately 20 percent of practicing physicians today. Nevertheless, the AMA is still the largest professional society for doctors and medical students in the United States. In 2008, the AMA reported its membership to be approximately 236,000 physicians and med students. According to the AMA’s online physician locator, which provides contact information for “virtually every licensed physician in the United States,” there are over 814,000 physicians practicing in the United States.
In an organization that large, it’s difficult to make generalizations about ideological shifts. However, the idea that the AMA is becoming more liberal is hardly a new phenomenon. In fact, according to “The Decline of the AMA,” Jeff Carlisle wrote that, as early as 2001, there were already concerns over the AMA’s leftward tilt. In 1998, the AMA threw its weight against a Washington state ballot initiative to ban racial preference programs. In 2001, the AMA criticized the Boy Scouts of America for its policy banning homosexuals from serving as scoutmasters, asserting that such actions can lead to greater suicide rates. Later that year, then-president of the AMA Richard Corlin gave a speech calling for stricter gun control.
A look at the AMA’s political donations is also enlightening. According to OpenSecrets.org, PACS and/or individuals affiliated with the AMA donated nearly $1.9 million during the 2008 election cycle with 56 percent going to Democrats. This is a stark reversal from their contributions in 2004 and 2006, when 76 percent and 67 percent of those contributions went to the Republicans, respectively. Some of the biggest beneficiaries of their support have been liberals like Senator Charles Schumer, D-N.Y., who has been one of the most outspoken supporters of a public option, Barbara Boxer, D-C.A., and Debbie Stabenow, D-M.I., as well as Congresswoman Judy Chu, D-C.A.
The AMA’s support of the House health care bill touched off some internal strife within the organization, as a group of doctors introduced a resolution rescinding the AMA’s support at last month’s meeting of the AMA’s House of Delegates in Houston. The resolution failed overwhelmingly, and according to Doctor Joshua Cohen, a headache specialist and ten-year AMA member who practices at St. Luke’s Roosevelt Hospital in New York, who was present at the meeting, the disagreement was based more in misunderstanding and miscommunication than in any deep-seated ideological divide. “Every day I get updates from AMA, but not all physicians receive these emails,’’’ Cohen said. “As a result, there’s a lack of knowledge and understanding as to why the AMA is doing what they’re doing.”
“The great thing about this meeting,’’ Cohen continued, “was that the AMA was able to explain all that to those members who hadn’t been following the process, and they understood why AMA is doing what it’s doing.”
Liberal groups haven’t exactly rushed to embrace the AMA. The Physicians for a National Health Plan (PNHP), which supports a single-payer system, has accused the AMA of being in bed with the pharmaceutical industry. “[The] AMA derives substantial funding from the pharmaceutical industry and its politics should be understood in that context,” said Dr. Laura Boylan, PNHP member and professor at NYU Medical School, in an email. “One single source of pharma funding alone, the sale of individual physician identification info, accounts for 16 percent of all AMA revenue sources.”
Indeed, according to the New England Journal of Medicine, in 2005, the AMA earned $44.5 million in revenue from the sale of doctors’ prescription information and history to pharmaceutical companies, which accounted for 16 percent of the AMA’s total revenue. In 2007, the AMA stated that they would allow doctors to withhold their information from the prescription information database, but continued to tout the benefits of inclusion, such as conducting medical research, setting up clinical trials, facilitating drug recalls.
Like the AMA, the pharmaceutical industry supports Obama’s health care reform efforts. In August, the big pharmaceutical companies cut a deal with the White House to support the bill in exchange for a pledge by the government not to use its leverage to negotiate lower prices for drugs. The AMA, for its part, adamantly denied any quid pro quo with the White House. According to an AMA spokesperson, the AMA spoke with both sides of the aisle on a variety of matters, including prescription drugs, but ultimately made their decision because they reviewed the bill and deliberated on it.
For its part, the AMA has disputed claims that it is moving towards the left. “The AMA is a bipartisan organization and represents physicians who often disagree greatly on politics, but agree on health related policy,” wrote Kristina Maletz, a medical student at Columbia University and an AMA member, in an email. “I see people claim that the AMA swings to the far right, and those that say it swings to the far left. My only conclusion from this is perhaps the AMA representation just as it was intended: representing the will of the house of medicine.”
Cohen, a self-described “life-long Democrat,” agrees with this assessment, pointing out that the AMA is a diverse body that encourages people from all over the political spectrum to join.
Cohen also points out that the AMA’s recent announcements regarding marijuana and “Don’t Ask, Don’t Tell,” are based, purely, on medical concerns. “The ‘Don't Ask Don't Tell’ policy interferes with patient confidentiality as patients cannot discuss important health matters related to their sexual orientation with physicians in the military for fear of job loss,” said Cohen. “On the issue of marijuana, many doctors believe there may be medical uses of marijuana or THC, but the current scheduling of marijuana as Schedule 1 prevents research to determine whether or not marijuana has any medical applications.”
Cohen dismisses the idea that the group is becoming more liberal, stating that the AMA’s political donations depend on its priorities. “In the early 90s, there was a lot of attention on a Patients’ Bill of Rights,’’ Cohen said “As a result there was more political affiliation along those lines and physicians supported that. In late 90s there was more focus on liability reform, which was being undertaken by Republicans. These things are cyclical.”
