AMA About Face on Public Plan?

July 4, 2009 by Michael Ricciardelli · 5 Comments
Filed under: AMA, Proposed Legislation, Public Plan 

Janus coin

Janus coin

CNN reports that Dr. J. James Rohack, the “new president of the American Medical Association, which represents the interests of the nation’s doctors, said Wednesday the group is open to a government-funded health insurance option for people without coverage.”

And that

“Dr. J. James Rohack told CNN the AMA supports an ‘American model’ that includes both ‘a private system and a public system, working together.’”

As we posted back on June 11, 2009 the AMA had announced the day prior that it would “lobby against the inclusion of a Public Plan in health care reform legislation.”

At that time, many people made note of the AMA’s long history of opposition to “public” health measures such as Medicare and Medicaid, and as we noted in our post, “AMA to Oppose Public Plan–Again,” “at least one physician, Dr. Chris McCoy, Policy Chair for the National Physicians Alliance…publicly quit the AMA in response.”

But that was way back on June 11th , a full twenty days ago. Apparently something has changed since then? Although Dr. Rohack became president of the AMA on June 16th, under the circumstances that alone seems insufficient to account for the purported change.

Insurance & Financial Advisor Webnews describes the situation thus:

The new president of the American Medical Association appears to have confused or complicated the organization’s position on a public health insurance option during a CNN interview.

Dr. J. James Rohack, a physician in Texas who became president of the largest doctors’ group in the nation June 16, said in a live interview Wednesday (July 1) with CNN’s Tony Harris and Medical Correspondent Elizabeth Cohen that the group wants people who lack health insurance to be put into the Federal Employee Health Benefits Plan, the insurance program for federal employees and members of Congress.

“If it’s good enough for Congress, why shouldn’t it be good enough for individuals who don’t have health insurance provided by their employers,” Rohack said in the nine-minute interview.

A call for comment from the AMA was not returned.

One of the more interesting things about this apparent change of heart is that Dr. Rohack’s ascendancy to the post was preordained , so to speak . The AMA chooses it’s “president-elects” a full year in advance (the present AMA president-elect is Dr. Cecil B. Wilson, named on June 15, 2009, will take office in June, 2010 ).

According to this Reuters Press Release from June 17, 2008 announcing Dr. Rohack as the president-elect, Dr. Rohack was certainly no stranger to the inner sanctum of AMA policy decisions prior to becoming president. He did not just jump upon the scene:

“Taking a leadership role with the AMA in 2001 when he was first elected to theAMA Board of Trustees, Dr. Rohack served a one-year term as chair of the AMA Board of Trustees in 2004-2005.  He was reelected to a final four year term in 2005.”

Presumably, as one in “a leadership role” this year as both a Board of Trustees Member and as president-elect, Dr. Rohack was privy to, and part of, the AMA’s announcement (five days before he assumed the presidency) that they would “lobby against the inclusion of a Public Plan in health care reform legislation.” Therefore, his ascendancy seems insufficient to account for the change .

The question then is what could have changed in those twenty days between proclamations besides the ascendancy of Dr. Rohack? New research? A close reading of Profs Cortez, Greaney, Jost, Jacobi and Pasquale? I think not. Although reluctant to criticize for a reasoned and responsive change in direction (to reconsider carefully in the face of conflicting data is a good thing), this sudden (and unexplained) shift of direction smacks of politics and P.R. from an organization which is no stranger to either. I can’t help but find myself thinking of Tess of the d’Urbervilles when faced with her “converted” malefactor Alec:

“Don’t go on with it!” she cried passionately, as she turned away from him to a stile by the wayside, on which she bent herself. “I can’t believe in such sudden things! I feel indignant with you for talking to me like this when you know–when you know what harm you’ve done me!

I’m not sure what harm the AMA has actually done, but their repeated opposition to public options such as Medicare, Medicaid, early forms of HMO’s which sprung up in the Great Depression era, and the present Public Plan have not helped.

Keep your eyes on the spin.

Having said all that, a final note. CNN reported on

“the American Medical Association, which represents the interests of the nation’s doctors…”

Whether or not the AMA can be said to actually “represent the interests of the nation’s doctors,” is, perhaps, subject for debate. A quick google search on the AMA brings up some interesting figures: “the percentage of doctors who belonged to the organization declined from the mid-1960s on. At the height of the group’s campaign against Medicare, the AMA claimed at least 70 percent of American doctors as members. By the mid-1990s, the AMA represented only about 40 percent of American doctors.”

The 40% number of the mid-1990’s is a fond memory for the AMA. The present number for American doctor membership is closer to 22 ½ % — and that’s counting students and interns (who pay reduced yearly dues of only $20 and $45 respectively).

On June 14, 2009, Emily P. Walker, Washington Correspondent, MedPage Today reported on the present status of the AMA:

Although the group boasts close to 240,000 members, 29% are students or residents, who pay sharply discounted dues. Still more of the members are retirees, whose dues are also cut.

The AMA’s Council on Long Range Planning and Development had more specificity. It reported that there are 1,060,333 physicians and medical students in the United States and 238,977 of them AMA members.

Of those members, 20.5% are medical students, 9% are residents, and 36.5% are 56 or older. As one delegate put it, “we have a lot of students and a lot of old docs, but not a lot of practicing physicians.”

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Comments

5 Responses to “AMA About Face on Public Plan?”
  1. Julian Lieb,M.D says:
    07/04/2009 at 8:15 am

    Major innovations from an unheeded, disregarded, and unappreciated clinical researcher, no match for the Uwe’s of the world.

    INFECTION
    Lieb J. “Immunopotentiation and inhibition of herpes virus activation during therapy with lithium carbonate. Med Hypoth 1981; 7:885-890
    Lieb J. “Remission of herpes virus infection and immunopotentiation with lithium carbonate: Inhibition of prostaglandin E1 synthesis by lithium may explain its antiviral, immunopotentiating, and antimanic properties.” Proceedings of the Third World Congress of Biological Psychiatry, Stockholm. Biol Psych Perris C, Struwe G, Jansson B. (eds.) 1981 695-698
    Horrobin D, Lieb J. “A biochemical basis for the actions of lithium on behavior and on immunity: relapsing and remitting disorders of inflammation and immunity such as multiple sclerosis or recurrent herpes as manic-depression of the immune system.” Med Hypoth 1981; 7:891-905
    Lieb J. “Remission of rheumatoid arthritis and other disorders of immunity in patients taking monoamine oxidase inhibitors.” Int J Immunopharmac 1983; 5(4): 353-357
    Lieb J. “Lithium and immune function.” Med Hypoth 1987; 23:73-93
    Lieb J. “Invisible antivirals.” Int J Immunopharm 1994; 16:
    Lieb, J. “Lithium and antidepressants: inhibiting eicosanoids, stimulating immunity, and defeating microorganisms.” Medical Hypotheses (2002) 59(4), 429-432
    Lieb, J. “The immunostimulating and antimicrobial properties of lithium and antidepressants.” Journal of Infection (2004) 49(2) 88-93
    Lieb, J “Lithium and antidepressants: Stimulating immune function and preventing and reversing infection.” Medical Hypotheses (2007) 69, 8-11
    CANCER
    Lieb, J. “Antidepressants, eicosanoids and the prevention and treatment of cancer.”
    Plefa (2001) 65(5&6), 233-239
    Lieb, J. “Antidepressants, prostaglandins and the prevention and treatment of
    cancer.” Medical Hypotheses (2007) 684-689
    Lieb, J.”The multifaceted value of antidepressants in cancer therapeutics.” Editorial comment. European Journal of Cancer 44 (2) 2008 172-174
    Lieb, J.”Defeating cancer with antidepressants.” ecancermedicalscience DOI. 10.3332/eCMS.2008.88
    Were you to develop a skin infection with methicilin-resistant bacteria, you might well end up hospitalized and treated with ineffective antibiotics. Should the infection develop into necrotizing fasciitis, both of your legs could be amputated, and you would spend the rest of your life in a wheelchair and on disability. The hospital would charge in the scores, if not hundreds of thousands, for, among others, the hospitalization, surgery, laboratory tests, nursing, and medications. Were your physician an exception who diligently studies the medical literature, he would have known to administer lithium as an antibacterial antibiotic, and spare you the entire catastrophe.
    Should you develop a glioma, you would face surgery, chemotherapy, radiation, and the prospect of a lingering death, but not before the hospital billed you for scores of thousands. Were your physician a rarity who studies the medical literature, rather than relying on big pharma sponsored CME, he might have known to prescribe an antidepressant, that in targeting the mitochondria of the glioma cells while sparing healthy cells, could arrest and reverse the malignancy.
    Many years ago, Harvard physicians noted that the only solution to the healthcare crisis would be innovation that reduces utilization. Many of my articles were published in peer reviewed journals, thus calling for more peer review would be peer reviewing peer review. All you need do is access Medline or Pubmed, and enter “antidepressants” and “cancer.” With patience, you will be able to retrieve more than sixty articles attesting to the advance. In “Against Method” Paul Feyerabend warned that suppressing a paradigm in preference to one politically favored could permanently damage society.
    Sincerely,
    Julian Lieb, M.D

  2. Michael Ricciardelli says:
    07/04/2009 at 12:07 pm

    Interesting, to say the least; “…suppressing a paradigm in preference to one politically favored could permanently damage society” is well put. It struck me last night that Justice Holmes’ famous dictum regarding First Amendment freedom of speech and the “Marketplace of Ideas” is, in the health care world, well, somewhat regulated by the “marketplace.”

    I had read a report from RH Waring, School of Biosciences, University of Birmingham on the absorption of magnesium sulfate (epsom salts) through the skin (http://www.epsomsaltcouncil.org/articles/Report_on_Absorption_of_magnesium_sulfate.pdf), some evidence suggestive of abnormal sulfur metabolism affecting people with autism spectrum disorders, (Waring R.H., Klovrza L.V., “Sulphur Metabolism in Autism”. Journal of Nutritional and Environmental Medicine 10, 25-32 (2000)), and some recent news on a promising study in which the use of magnesium sulfate was shown to correlate with a lower incidence of cerebral palsy in pre-term newborns
    (http://www.nlm.nih.gov/medlineplus/podcast/transcript101408.html)

    In a news article regarding the cerebral palsy study, (http://www.medicalnewstoday.com/articles/95803.php) Study co-author, Dr John Thorp, who is McAllister distinguished professor of obstetrics and gynecology at the University of North Carolina (UNC) at Chapel Hill, said:
    “We have a cheap, widely available treatment already in hand that cuts in half the risk of babies being born with an extremely disabling disorder. That is a tremendously exciting development.”

    Cheap, very cheap. And that may be both a blessing and a curse. At a few dollars for a few pounds of the stuff it seems to suffer some in the marketplace of ideas simply because no one in the literal marketplace stands to make much money off of it. It is, it seems, a veritable orphan of of its own affordable efficacy. Which brings us to the larger question: what else of relatively unstudied promise is out there?

  3. J. James Rohack, M.D., AMA President says:
    07/08/2009 at 9:50 am

    AMA policy is formed by the AMA’s voting House of Delegates – the nation’s only democratic assembly of physicians and medical students representing all state and specialty medical societies. I shared with CNN the AMA’s new policy – which was created and voted on by our physician delegates at our annual meeting in June - that the AMA supports health system reform alternatives consistent with AMA principles of pluralism, freedom of choice, freedom of practice, and universal access for patients.

    This evolution in policy is consistent with the AMA’s strong support for health reform this year that provides high-quality health care coverage for all Americans. Our commitment is clear. Over the last few years we’ve spent $15 million dollars to call attention to the uninsured crisis and lay the groundwork for health reform that gets all Americans covered through our Voice for the Uninsured campaign.

    We don’t yet know what form a final bill will take, which is why we will carefully study all options that make the system better for America’s patients and allow physicians to provide high-quality care. The AMA will stay actively engaged to get reform this year that improves the system for patients and physicians.

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