I was not at all surprised to read the AMA’s strong statement of support for the appointment of Representative Tom Price to be the Secretary of Health and Human Services. I was also not surprised to read articles of outrage from more progressive physicians about the AMA’s endorsement of Representative Price. I have found that uniformly the AMA’s natural position on most political issues is usually the inverse of mine. President Obama was successful in negotiating for the AMA’s weak approval of the ACA before it was passed but has the AMA ever been been a truly enthusiastic supporter of it? An article, “Why the AMA Endorses Obamacare—But Your Doctor Does Not” from 2012 outlines the diminished influence of the AMA over many of its members over the last few decades. The AMA has equivocated before in its attempts to play both ends to the middle, and so it was with its endorsement of the proposal that Price be the nominee.
The reaction to the AMA’s endorsement on November 29 was swift. By December 1, just two days later, more than 4800 physicians had signed a petition expressing their anger at the endorsement. Becker’s reported on the petition:
“We believe that in issuing this statement of support for Dr. Price, the AMA has reneged on a fundamental pledge that we as physicians have taken — to protect and advance care for our patients,” the letter reads. It is unclear from the letter if the physicians are AMA members or not. The organization has roughly 250,000 members, according to an AMA spokesman. The letter claims the organization represents about a quarter of U.S. physicians.
I was most impressed by the swift objection from the leadership of the National Physicians Alliance which was also released a statement on November 30:
“The National Physicians Alliance opposes the nomination of Dr. Tom Price to become the next Secretary of Health and Human Services (HHS). Dr. Price’s efforts to repeal the Affordable Care Act and replace it with a much less comprehensive plan would significantly jeopardize coverage for millions of our patients (20 million Americans in Exchanges) and greatly weaken current protections that prohibit insurers from denying coverage or charging exorbitant rates because of pre-existing conditions (estimated 129 million Americans with pre-existing conditions). Moreover, his support to privatize Medicare would end the healthcare guarantee for our nation’s 57 million seniors and drastically hurt our most elderly and vulnerable patients. His past policy proposals would also dismantle our health insurance safety net (Medicaid) for over 80 million low-income Americans, including children (State Children’s Health Insurance Program). Lastly, his staunch opposition to reproductive health rights makes it clear he does not trust women to make their own decisions about their health. We believe our next HHS Secretary should support the continued expansion of coverage, fight to improve, not dismantle, our current Medicare program and pursue efforts to achieve a more equitable, affordable and high quality health care system for all.
We are dismayed that other large physician organizations [the AMA] have endorsed Dr. Price without consideration of the harm his policies would inflict on our collective patients. We call on other physician organizations to put our patients’ interests first and foremost, and encourage everyone to join the National Physicians Alliance, the only physicians’ organization committed to advancing the core values of the medical profession: service, integrity and advocacy.”
Whether the 4800 signers of the protest document sent to the AMA (now up to at least 5,500, including me) were AMA or not, on the same day that impressive response became news, the AMA was backtracking and explaining their reasoning on their website and Facebook page.
We’ve been listening to the feedback from physicians and medical students in recent days — and we would like to share additional context regarding our statement on Dr. Price’s nomination for HHS Secretary.
First and foremost, we want to make one thing clear: regardless of administration or Cabinet, the AMA remains devoted to improving health insurance coverage so that patients receive timely, high-quality care, preventive services and other necessary medical treatments.
Our history with Dr. Price includes many instances of productive dialogue on topics where our policies and his are in sync, and also on topics where we differ fervently. Our support of Dr. Price is not support for his every policy position. But we do strongly support having a capable, knowledgeable physician in this leadership position. We must be realistic; the election is now over, and as happens in every election, one candidate won and now must choose his Cabinet. And as a non-partisan organization, the AMA has an obligation to work with the incoming administration and strive to find common ground.
That sounds terrific, but their statement is a whitewash compared to the succinct objections presented in the National Physicians Alliance statement that explain why so many of us are upset by the nomination of Dr. Price. Probably one of the best and most readable discussions of what Tom Price’s stated opinions are and what he has done to upset us in the past can be understood in a well written article that appeared in the Atlantic on the same day that he was endorsed by the AMA. What is chilling in the article is the description of the influence that the HHS Secretary has over how the ACA works. How the public experiences the law can be substantially changed by the administrative powers of the the Secretary without any action by Congress or the President.
The diminished influence of the AMA and its historical lack of recognizing what is best for the country and patients in general is nothing new. James Surowiecki has published an excellent article in the New Yorker recently documenting the self serving nature of the AMA, HOW DOCTORS COULD THWART HEALTH-CARE REFORM:Over the years, doctors have behaved like a classic political interest group, and they’ve been very successful at it. After a thorough review of the self serving historical positions of the AMA Surowiecki sums up the issue by saying:
Doctors, then, [as members of the AMA] have behaved like a classic political interest group, and they’ve been very successful. They are now more likely to be in the top one per cent of earners than members of any other industry. They don’t have things all their own way—there are more administrative burdens, and insurance companies and the government are more intrusive than before—but the profession has been the single biggest beneficiary of the boom in medical spending in the past four decades, and doctors’ incomes have remained relatively untouched by attempts to rein in health-care costs.
I have recently joined the National Physicians Alliance. Among other things they are the originators of the “Choosing Wisely” campaign. If you study their website you will see that they are expressly in favor of all of the progressive ideas to support the goal that we provide
Care better than we’ve seen, health better than we’ve ever known, cost we can afford,…for every person, every time…in settings that support caregiver wellness.
Their concerns do not end at our borders. They care about healthcare around the world. As their statement quoted above underscores, Tom Price’s views and the AMA’s history and current endorsement of Price stand in stark contrast to their core values.
As far back as a hundred years ago the AMA was fighting universal healthcare. The AMA was a huge critic of Roosevelt’s Social Security Act until universal healthcare for the elderly was removed. David Blumenthal and James Marone in their terrific book, The Heart of Power: Health and Politics in the Oval Office, tell the fascinating story of how Harvey Cushing, famous neurosurgeon and influential AMA member, convinced Franklin Roosevelt not to include healthcare. Cushing’s daughter was married to Roosevelt’s son and they shared grandchildren and many social occasions that gave Cushing access to Roosevelt.
When Harry Truman tried to introduce a single payer program the AMA was there to kill it. Twenty years later they fought the introduction of Medicare and Medicaid, and for the first time they did not get their way. I chuckle every now and then when I think where the practices of most physicians would be without Medicare. Even Medicaid has been a sustaining source of income for many and for many of the nation’s hospitals. The AMA’s attempt at self serving the interests of physicians is so upside down and backwards that a good rule of thumb could be if the AMA is against something, we should all be for it, and if the AMA is for something you better try to figure out what is wrong! I think that the last statement applies to their endorsement of Representative Price.
The National Physician Alliance is not the only option that concerned physicians have. One encouraging outcome of this latest clumsy move by the AMA is the emergence of another new physician organization that is much more aligned with the principles of the Quadruple Aim than the AMA is. The Clinician Action Network was the sponsor of the petition. You can still sign their petition. I first learned about the three young physicians who started it all in an article on the Doximity Website.
It is my hope that organizations like the National Physicians Alliance or the Clinical Action Network might be the origin of the movement that I was calling recently.
…It is preposterous perhaps to imagine, but those who see value in what has been accomplished need to come together in an all out coordinated effort to preserve and improve, not repeal and replace, the ACA.
History demonstrates the path for success for unlikely processes of change can sometimes lead to surprising successes. John Kotter teaches that foundational to effective change is the formation of a guiding coalition. Actually, the first step is to have a cause, but the first action is to form a large volunteer army from up, down and across the organization (or the nation) to serve as the change engine.
Could the Clinician Action Network be the group that leads the way? They seem to be off to a good start. 5000 physicians sounds like a lot of doctors until you realize that there are over 900,000 in the country. The AMA claims to have about 250,000 or a little more than 25% of all doctors in its support. We need to learn more, but I am sure that the more we learn the more we will realize that once again, as been true so many times before in history, the AMA is on the wrong side of history when it comes to the big issues that make a difference.
