Dear AMA: I Quit!

Dear American Medical Association,

I recently had the opportunity to read your response to the Senate Finance Committee proposal
for health care reform, and it is clear to me that I cannot remain a
member in your organization. Please remove my name from your membership
rolls, effective immediately.

In reading the response, I was frustrated and disheartened by the
fact that you couldn't get through the second paragraph before bringing
up the issue of physician reimbursement. This merely highlights how the
AMA represents a physician-centered and self-interested perspective
rather than honoring the altruistic nature of my profession. As a
physician, I advocate first for what is best for my patients and
believe that as a physician, as long as I continue to maintain the
trust and integrity of the profession, I will earn the respect of my
community. The appropriate financial compensation for my endeavors will
follow in kind.

I encourage the AMA leadership to read Atul
Gawande's recent article describing how physician culture drives up the
cost of health care without benefiting patient outcomes
. At the
heart of this problem are physicians who have a vision of themselves as
money-generating profit centers rather than professionals serving the
public good. The AMA represents, and encourages, this mindset with its
single-focus on physician reimbursement over all other health care
reform issues.

However, the most disappointing aspect of the AMA's response to the
proposed health care reforms was the opposition to the public health
insurance option. I simply cannot support an organization that opposes
the public health insurance plan for my patients. Instead of advocating
for patients, the AMA is supporting the private insurance industry,
which has been a driving force in creating the dysfunction health care
system we have today.

But this should not have surprised me: when health care reform has
been necessary, the AMA has always stood on the wrong side of history.
The AMA opposed the creation of Medicare in the 1930s, when it was
first proposed as part of Social Security. The AMA opposed Medicare
again in the 1960s, going as far as to hire an actor named Ronald
Reagan to read a script to the AMA Auxiliary
declaring Medicare as the first step toward socialism, and concluding
with the statement that if Medicare were to become law, "One day, we
will awake to find that we have socialism.... One of these days, you
and I will to spend our sunset years telling our children, and our
children's children, what it was once like in America when men were

That was 50 years ago ... and none of that has come to pass. And yet
this year, the AMA argues that a public health insurance plan will
destroy the private insurance market. I challenge the AMA leadership to
cite a single example of an industry where involvement by the
government has lead to the elimination of private enterprise. This has
not been the case with the creation of public police forces in the
second half of the 1800's (private security companies still exist), we
have a robust system of public and private colleges existing the same
market, and bookstores still sell books despite the presence of public
libraries. A mix of public and private enterprises in the market is a
truly American solution to ensuring equal access, as well as
competition to drive quality improvement. In fact, the creation of the
public health insurance option will *increase* competition, as
demonstrated by the AMA's own studies showing that 94% of health insurance markets only have 1 or 2 providers in the market.

It would appear that the AMA's position against the public health
insurance market is driven by out-dated political ideology that blindly
supports private industry rather than a careful examination of the
facts of the current situation.

The AMA seems to be fixated on the fact that Medicare and Medicaid
payments are lower than other payers. Let's go back to the history
again: because the AMA opposed the creation of Medicare, physicians
were not represented at the table when the system was designed. As a
great policy wonk once said, "If you're not at the table, you're on the
menu." And thanks to the dismal leadership and short-sightedness of the
AMA in the 1960s, physicians were not a full partner in the creation of
Medicare. And we're still feeling the reprocussions of that today. And
yet now in 2009, the AMA is going to repeat that mistake by opposing
the public plan.

The health care system is broken, and physician leadership is needed
now more than ever to help direct the reforms that are desperately
needed. However, the AMA has not shown itself to be the organization to
provide that leadership in restoring the profession of medicine. New
physician leadership is needed to fully achieve a reformed health care
system that works for our patients and for our country.


Chris McCoy, MD