Why is the ama against universal health care

Legislation that would help create a single-payer health care system in California, the first of its kind in the nation, faces a crucial test in the next week. The bill — AB 1400 — must pass the full Assembly by Jan. 31, or it’s dead.

The California Nurses Association, the state’s nurses union, is leading the effort to pass AB 1400. But the state's largest association of doctors, the California Medical Association, opposes the bill.

“It will disrupt people's health care at the worst possible time,” said Ned Wigglesworth, a spokesperson for Protect California Health Care, a coalition formed to oppose AB 1400. The coalition includes the California Medical Association as a member.

“It will force all 40 million Californians into a new untested state government program and will prohibit them from being able to choose private coverage even if they want it,” he said.

In nearly all previous attempts to create a single-payer health system in the United States, the fiercest objections have come from doctors, said Dr. Micah Johnson, co-author of the book "Medicare for All: A Citizen’s Guide" and a practicing internal medicine physician in Boston.

Doctor opposition to single-payer may seem counterintuitive — but Johnson said doctors cannot help but view health reform through the lens of what's best for them as well as what's best for their patients. To the extent they're most concerned with changes to their own pay and autonomy, Johnson called doctors "double agents in the health reform debate for the last century."

Johnson spoke with KQED's April Dembosky about the history of physician opposition to single-payer.

The following interview has been edited for length and clarity.

The most striking example is Harry Truman's health care proposal in the 1940s. This is the first and really only time a sitting U.S. president gave a full-throated endorsement of a single-payer-style, truly universal national health insurance plan.

The American Medical Association were the top opponents of the plan. They hired a PR firm called Campaigns Inc. that rose to fame in California, helping to defeat a statewide universal health insurance plan. The American Medical Association put an incredible amount of money behind this at the time: $3.5 million. In today's dollars, that's about $40 million. It was the largest lobbying campaign the nation had ever seen — and it worked.

So at the beginning, the public was in support of this national health insurance plan. But then support dwindled over the years — and the vast majority of people had heard of the AMA's opposition to the plan.

When I talk to doctors who are opposed to the single-payer proposals right now, they say their top concerns are their patients.

I think doctors have been double agents in the health reform debate for the last century.

We wear two hats in these conversations. We wear the hat of medical experts, people who know a lot about what's best for patients, and we also wear a hat that's just our own personal financial interest. I think these things can often get confused and, you know, can be leveraged against each other.

In the early '60s, there was an early attempt to create a Medicare program for seniors, and back then, doctors hired actor Ronald Reagan to speak out against the idea. He said, “One of the traditional methods of imposing state-ism or socialism on a people, has been by way of medicine. It’s very easy to disguise a medical program as a humanitarian project.”

Definitely a remarkable moment in the history of health reform, and even though Medicare passed, Ronald Reagan was also elected in a landslide in 1980 and ended up presiding over the Medicare program. So we have all these ironies in health reform.

What the American Medical Association’s surprising vote on Medicare-for-all tells us about the single-payer debate.

By Dylan Scott@dylanlscott Jun 12, 2019, 11:40am EDT

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In a striking vote at its annual meeting this week, the American Medical Association’s policymaking arm nearly voted to overturn the physician group’s longstanding opposition to single-payer health care.

The House of Delegates, which sets the policy priorities and positions for the nation’s best-known medical association, voted on a resolution to reverse the organization’s opposition to single-payer. The vote failed, but narrowly: 47 percent voted to eliminate opposition to single-payer as an official policy position of the AMA, while 53 percent voted to maintain it.

We shouldn’t overinterpret one procedural vote at a professional conference, of course. But the vote does signal two important trends for the Medicare-for-all debate:

1. Single-payer continues to gain real momentum, even within the industry that would be significantly overhauled under such a system.
2. Medical industry opposition might not be as monolithic as it first appears.

The AMA has been a powerful voice against single-payer health care for decades. In the 1950s, the organization helped mobilize against a push for national health insurance, preferring private employer-based coverage. It did support the Affordable Care Act but has more recently joined the Partnership for America’s Health Care Future, a conglomeration of hospitals, drugmakers, and other industry groups that is singularly focused on opposing the new energy around Medicare-for-all.

Bob Doherty, a senior vice president for government affairs and public policy at the American College of Physicians, tweeted after the vote that such a strong showing within the AMA for single-payer “would have been unimaginable in years past.”

Bottom-line: there is a large segment of the House of Delegates who support single payer (or don’t want AMA to oppose them) or public option approaches, as well as AMA’s new policies to close coverage gaps in the #ACA. This would have been unimaginable in years past. #AMAmtg

— Bob Doherty (@BobDohertyACP) June 11, 2019

I asked Doherty what is changing within the AMA that might explain the surprisingly strong support for single-payer in this week’s vote. The group’s composition, for one, he said.

“The AMA House of Delegates has become younger and more diverse (especially many more women) over the years, reflecting the trend in who is going into medicine,” he told me. He also pointed out the rise of specialty medical societies, which tend to be more progressive, in the AMA ranks — which has undermined the long-held dominance of more conservative state medical associations.

“I also think physicians are frustrated with paperwork, preauthorizations, limited formularies, high-deductible plans, and narrow networks associated with private insurers,” Doherty added, “each with their own and conflicting rules.”

The AMA doesn’t speak for all US doctors, and its membership numbers have declined steadily over the past 75 years. But it is still seen as the most influential lobbying group advocating on behalf of America’s physicians.

One of Medicare-for-all’s great challenges is the unified industry opposition to single-payer; if that dam were to crack, even a little, that would be a significant victory for the cause. It didn’t quite happen this week, but the AMA vote suggests such a reversal isn’t entirely out of the question.

For now, the medical industry is lobbying hard against Medicare-for-all and placing its 2020 Democratic primary bets on former Vice President Joe Biden, a single-payer skeptic, to ward off the left’s crusade to overhaul the US health care system. In the near term, that may be a sound bet: Biden is leading in the polls, and Democratic voters seem to be prioritizing other issues and beating Trump over a 2021 legislative push to pass a Medicare-for-all plan.

But the winds do seem to be shifting — the House of Delegates vote is maybe the best evidence of the change yet. As Doherty tweeted: “There is a lot more support for publicly financed coverage than ever before.”

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