Leaning Left? The AMA at a Crossroads

Historically, whenever a Democratic president has tried to expand or reform health care, the American Medical Association has stood in the way. But in the current debate, the AMA has supported health care reform.
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It helped derail a proposal to add national health care to the Social Security Act of 1935.

It 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.

It waged war against the proposed creation of Medicare, even enlisting a well-known actor and television star named Ronald Reagan to record an album entitled "Ronald Reagan Speaks Out Against Socialized Medicine."

And, in 1993-4, it played a crucial role in sinking HillaryCare.

Every time a Democratic president has tried to expand or reform health care, the 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.

In recent years, however, the AMA has undergone a seeming internal realignment. Instead of joining forces with Dick Armey and the tea party movement, the AMA has turned into an ally, if not yet a full-fledged member, of the liberal coalition. As old-guard members' gasped, the organization has lined up behind health care reform, called on 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.

AMA officials reject any suggestions of moving left, contending that the group makes medical, not political, policy decisions. "The AMA is a bipartisan organization and represents physicians who often disagree greatly on politics, but agree on health related policy," said Kristina Maletz, a medical student at Columbia University and an AMA member. "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."

Whatever the reasons for the shift on health care, the AMA finds itself at a crossroads. Its membership is declining, and there are divisive conflicts among those who remain in the fold. By abandoning its obstructionist strategy this in return for a seat at the bargaining table, 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 236,000 physicians and med students, roughly 20 percent of those eligible. Nevertheless, it remains the largest professional society for doctors and med students in the United States.

Conservative anxiety over the medical society's ideological drift reached a new high in 2009 with its support of Obamacare, but these fears date back to at least the 1990s. 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 their policy banning homosexuals from serving as scoutmasters, asserting that such actions can lead to greater suicide rates. In a direct assault on the right, then-president of the AMA Richard Corlin gave a 2001 speech calling for stricter gun control.

A look at the AMA's political donations reveals a substantial defection from the GOP. 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, but a bid to rescind support of the health care bill at the November AMA's House of Delegates in Houston was decisive defeated 350-167.

Despite these developments, liberal groups haven't exactly rushed to embrace the AMA. The Physicians for a National Health Plan (PNHP), which advocates advocate for 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% of all AMA revenue sources."

She's right. 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% 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 controversial pledge by the Obama administration not to use the government's buying power to leverage 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.

The AMA may be moving towards the political left, but one thing hasn't changed. According to an AMA spokesperson, as well as several AMA members, the organization that has spent decades opposing socialized medicine remains categorically opposed to a single-payer health care system. Clearly, the AMA isn't about to turn its back on its core principle.

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