When President Obama discussed health care reform with the physicians of the American Medical Association on Monday, he was speaking to a group considered one of the strongholds of opposition to reform, particularly any that includes the so-called “public option” (creating a government-sponsored insurance plan, modeled after Medicare and available to all Americans, that would expand options and reduce costs by competing with private plans on a national insurance “exchange”). The AMA has a history of opposing major changes to health care, dating back to the advent of Medicare in the 1960s, and had gone on record the week before opposing any public plan—saying, in comments sent to the Senate Finance Committee, that “the introduction of a new public plan threatens to restrict patient choice by driving out private insurers.”
It’s commonly assumed that the AMA’s stance reflects the beliefs of a majority of the nation’s physicians, many of whom do benefit from the runaway costs of health care. Wouldn’t doctors, concerned that reform would drive down costs, uniformly stand with insurance and pharmaceutical companies in defense of the status quo?
But this view is based on a belief that all doctors like the way the current system has, as President Obama put it, “taken the pursuit of medicine from a profession—a calling—into a business.”
The truth is, they don’t.
Despite its prominence and lobbying budget, it’s important to remember that the AMA doesn’t speak for all doctors—fewer than a fifth of practicing physicians, in fact, and that number appears to be dropping. Meanwhile, membership is growing in physicians’ groups that have a different perspective. Sixteen thousand doctors are members of Physicians for a National Health Program, dedicated solely to research, education, and advocacy in support of a universal, comprehensive, single-payer system.
Or, take the National Physicians Alliance. Recognizing that “some physician organizations prioritize political agendas concerned with physician compensation and malpractice over medicine and health issues,” the NPA’s mission is to “restore physicians' primary emphasis on the core values of our profession: service, integrity, and advocacy.” When the AMA came out in opposition to the public option last week, NPA policy director Dr. Chris McCoy quit—publicly. In an open letter to the AMA, he said he could no longer be a member of an organization that encouraged physicians to “have a vision of themselves as money-generating profit centers rather than professionals serving the public good.”
On Monday, a coalition including the National Physicians Alliance, The American Academy of Family Physicians, the Doctors Council, and five others released a joint statement supporting the creation of a public option, saying it would increase affordability and promote better and more collaborative care. Together, the associations represent 215,000 doctors.
Doctors for America, another of the signatory coalitions, offers a forum for physicians to express their frustrations and hopes. The voices that emerge aren’t worried about making more money, but about being good doctors:
Dr. Hamid Rabiee, California: “I want health reform that takes the profit out of health, [and] changes the health industry to health care.”
Dr. Robyn Liu, Kansas: “I want health reform that is about health and puts patients first. I want incentives that are aligned with patient health and not with performing more tests and procedures.”
Dr. Robert Patterson, Indiana. “I want health reform that allows me more time to know the patient I am serving better.”
Dr. Elizabeth Powers, Oregon: “We must measure the efficacy of any new system by the health of our entire population. Inequities based on race, socioeconomic status, insurance status, etc. must be eliminated.”
Dr. Bonnie Gifford, West Virginia: “I want health reform that removes the business model from caring.”
The AMA isn’t a monolithic bloc, either, and many voices within are speaking out for change. Though the association hasn’t wavered in its opposition to expanding a government-run system like Medicare, its policymaking group today voted to support “health system reform alternatives.” Dr. Nancy Nielson, the group’s outgoing president, says that the AMA is not categorically opposed to a public plan and encouraged members not to allow themselves to be cast as “naysayers” to reform. She also reminded the group that it should focus more on patient care and less on defense of the insurance industry.
It’s clear, though, that many doctors don’t need that reminder. Fifty-nine percent of them support a national health insurance program, according to a March poll published in the Annals of American Medicine. It’s the system that makes the most sense to doctors—and patients—of all political backgrounds, as YES! has reported. All over the country, they’re pushing for universal, fair, and public health care that values patients over profits and health over industry.
They’re the ones President Obama was talking to when he said that the pursuit of money “is not why you became doctors. That is not why you put in all those hours in the Anatomy Suite or the O.R. That is not what brings you back to a patient's bedside to check in or makes you call a loved one to say it'll be fine. You did not enter this profession to be bean-counters and paper-pushers. You entered this profession to be healers - and that's what our health care system should let you be.”
Even at the AMA, that got a standing ovation.