The AMA Neither Supports Nor Opposes the Public Plan

I didn’t really want to write about the American Medical Association at all after the president’s speech a few weeks ago.  As Harold Pollack notes in a recent blog post, “I’m struck by extent that the AMA seems stuck in a narrow interest-group model that represents a shrinking segment of the medical profession.”  But I’ve received so many emails about a recent CNN report on new AMA president Dr. J. James Rohack, that I’m writing this one post just to clarify what happened.

It’s fair to say that the AMA is in support of health care reform in a very general way.  It is not accurate to say they support a public health insurance option.  CNN got it wrong.

The official AMA position, as reported by the Daily Dose and others, was voted on at their convention in Chicago.  It supports a broad definition of “health system reform” but explicitly leaves out any mention of a public plan.  The Daily Dose article provides some fascinating context as to the parliamentary maneuvering that went on during June 17.  After the controversy of the previous two months, where the AMA seemed increasingly against a public plan and then softened that position to say they were against a public plan that forced Medicare providers to participate, the shock of the day was that they passed a resolution in support of the public plan!   But then-president Dr.  Nancy Neilsen essentially took the podium to say, “Not so fast, bub!”  She made an appeal to not peg their support of reform to one policy, and as a result they soon they passed an amendment to that resolution to punt on the question of a public plan.

This was basically a vote of “We want reform – but we’re not going to tell you what kind.”

Fast forward to the CNN interview with Dr. Rohack from July 1.  Most of his comments were strongly pro-reform, but vague on details.  The only thing he seemed die-hard against was, “expanding Medicare coverage for senior citizens into a broader general public plan” – not a shock, since the AMA has been the sworn enemy of single-payer since the days of FDR.   (For colorful commentary on the AMA’s intransigent past, check out this column by Nicholas Kristof.)  But how could they then be for a public plan similar to Medicare if they're dead-set on Medicare for All?  The confusing quote in the article which prompted the misleading headline says that the AMA supports “an ‘American model’ that includes both ‘a private system and a public system, working together.’”  But that’s not a public plan – that’s the National Health Exchange as envisioned by the House bill or the state-level Gateways envisioned by the Senate Health, Education Labor Pensions Committee.  The “private system” is the current insurance marketplace.  The “public system” is the Exchange.  Dr. Rohack makes it clear he’s looking at the Federal Employee Health Benefit Program and wonders why Congress doesn’t just expand that.  The FEHBP is the model of a transparent marketplace, but it’s all private insurance.  The public plan, if it makes it through the process, would be one option among many private options.  But the marketplace itself is not the same as the public plan.

So it was either the reporter or the editor who missed the boat on this one.  The AMA still seems to be living by the mantra of “We don’t want to get pinned down” or as Dr. Nielsen put it, “The AMA did not close doors. The AMA said we will evaluate all alternatives in keeping with our principles.” (What they’re saying in private is anyone’s guess.)

So pro-health reform in a fuzzy, hard to define way?  Sure.  Pro- an expansion of public coverage either through single-payer or a public health insurance option?  Nope.  Pro- a “level playing field” flavor of the public plan, like the one suggested by Sen. Schumer and the HELP committee?  Remains to be seen, but actions speak louder than words. I wouldn’t be singing the AMA’s praises just yet.

(Photo credit:  this lovely piece of the AMA's history with health care reform is by exakta on Flickr.)