All Together Now: "Fuck You, AMA!"

Perhaps its time for doctors to replace lawyers as the profession we love to hate. Instead of using lawyers, let’s tell jokes like, “How many doctors does it take to stop a moving bus? Never enough.”

Fueling my rage today is the American Medical Association’s (AMA) decision to oppose any health care reform that includes a public insurance plan. This decision is nothing short of disgraceful and unmasks the AMA for what they have become – a self-interest group that first seeks to make medicine a more lucrative profession for doctors and then worries about patient care and issues related to access, costs, and equity.

In a paper sounding more like a part of a marketing campaign for capitalism than a statement from a group supposedly dedicated to providing health care, the AMA states that they oppose public options for providing insurance because

The AMA supports the insurance market reforms to create more choice and better access to affordable coverage for both individuals and small businesses.

Insurance market reforms? Are you fucking serious? These are the folks whose profits increase as our nation’s health decreases. And when was the last time you heard a physician speak well of insurance companies? I’m around doctors all the time, and all I ever hear is how insurance companies have made the provision of medical care worse for the patient and provider. They take the decision-making out of the hands of those who possess the most knowledge (physicians), instead putting them in the hands of business school trained insurance executives whose primary concern is profits, not health. Shit, at least they’re honest.

While the AMA’s latest action is extremely disheartening, it should come as no surprise to anyone who has followed the path health care has taken in the US. And in many ways, the AMA bares much of the blame, as they have been behind the wheel, driving us all closer to the edge of the cliff. Examining the AMA’s history sheds some light on the issues, as it becomes increasingly clear that this is not an organization that is dedicated to human rights, including making health care a right for all people in the United States.

When the federal government was busy at work creating Medicare in the 1930s, the AMA was just as busy, engaging in a campaign to oppose the creation of the program, then proposed as a part of Social Security. They amped up their efforts in the 1960s, hiring Ronald Reagan to pump up the crowd at a meeting of the AMA Auxiliary by warning of the impending threat of Socialism if Medicare was created. Reagan concluded his not-so-prescient address by stating 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 free.

Fast-forward to today and the landscape of health care remains under the control of that capitalist system, with for-profit insurance and pharmaceutical companies wielding virtually unrestrained power. Not surprisingly, these entities seek to increase their bottom lines and their stockholder dividends, not the number of people who have access to quality and affordable health care.

Somehow we managed to create Medicare and escape the predicted outcome of becoming the dreaded S-word. Maybe if we had become a country more concerned about the well-being of everyone, and less so about maintaining the illusion of the benefits of capitalism, the millions of Americans who are without insurance today would find themselves in a better, more humane position.

According to the most recent data, during the years 2007-2008, 86.7 million people under the age of 65 in the United States went without heath insurance for some period of time. That number represents one-third of the entire population. Clearly the private sector is doing a spectacular job in providing affordable, accessible care for all.

Of these 86.7 million, 60% were uninsured for at least 9 months, while 75% were uninsured for at least 6 months. One quarter of the 86.7 million were without insurance for the entire 2-year period, and 20 percent were without for 13-24 months. Only 5 percent were uninsured for 2 months or less.

And the numbers are even worse for racial and ethnic minority groups and those living in poverty. In 2007-2008, 55.1 percent of Latino/as, 40% percent of African Americans, and 34% of other racial and ethnic minorities went without health insurance, compared to 25.8 percent of Whites. Nearly 60% of individuals living under the poverty line went without insurance during the 2007-2008. And the poverty line is a bullshit number that doesn’t capture all folks any reasonable person would consider poor. In 2008 the federal government defined a family of four as poor if their income was $21,200 a year or less. Try telling a family of four with an income of $25,000/year that they aren’t poor. And make sure you do so in a metropolitan area where the costs of living are higher.

In indicting the AMA, I am not indicting all doctors. The AMA is an organization that speaks for its 250,000 members. Not all doctors are members, and as is the case with any organization, there are members who disagree with this and other positions the organization takes. But what about those that remain members? This issue should serve as a deal breaker to those sitting on the fence, wondering if they can be part of an organization that takes such a position on public health insurance.

A growing number of doctors have felt their philosophical belief that medicine should be about service not profits has become so far from what the AMA stands for that they have quit the organization. One such doctor, Chris McKoy, writes on The Huffington Post about quitting the organization and the factors that led him to the decision to do so.

In reflecting his belief that the AMA has become too focused on financial outcomes and profits, McKoy states, “the AMA represents a physician-centered and self-interested perspective rather than honoring the altruistic nature of my profession.”

McKoy goes further and place much of the blame of the current state of medicine at the feet of the AMA. In particular, he states his feelings regarding the AMA in aligning itself more closely with for-profit companies, not 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.

In addition to ending their affiliation with the AMA, a number of doctors who have seen their commitment to patient care at odds with the AMA have established several organizations to counter the AMA’s positions. Most notably is Physicians for a National Health Program, whose mission is the creation of single-payer national health insurance. Their site is full of useful information, including resources documenting the need for and benefits of single-payer health insurance.

The AMA can now be seen as nothing more than a lobbying arm for doctors who see practicing medicine as a means to wealth, with service as a mere possible byproduct. Their commitment to defeating public health insurance is only made worse by their lack of commitment to pro-actively advocating and advancing ideas and practices that promote health. This includes their long-standing efforts to disparage virtually all homeopathic and alternative practices and beliefs that do not fit under the umbrella of Western medicine. And their power and reach can be seen everywhere.

On June 8, Newsweek’s cover contained a picture of Oprah Winfrey with superimposed text that read, “Crazy talk: Oprah, wacky cures, and you”. The article’s basis was that Oprah and other non-medical professionals who publicize anything other than the institutionally legitimized and sanctioned means for promoting health and treating ailments and diseases are causing more harm than they are doing good.

Deepak Chopra recently wrote in response to Newsweek’s piece, which was the Newsweek norm of mediocre writing, poor research, and a limited and uncritical perspective.

Chopra has long been a vocal critic of the American medical establishment. He has been a champion of those treatments and remedies the medical community labels as alternative. In addition to their fight to minimize the possible benefits of alternative treatments, the AMA has been quiet on the need to reframe the way we view health by adopting a mindset that prioritizes wellness and prevention.

On a daily basis doctors don't deal in these things; few take courses in medical school centered on them. That's why a massive movement has arisen driven by patients themselves.

Much of the blame, as Chopra points out, can be traced to the medical community’s relationships with the pharmaceutical industry and the need to pump up bottom lines.

Denial also plays a huge part in this story. Mainstream medicine continues to downplay the enormous drawbacks of a health-care system that is addicted to drugs and surgery as the two constant drumbeats of treatment.

All this leads to large expenditures that produce little in the way of improving health outcomes. We spend more than any other nation on health care, yet our health outcomes do not see corresponding improvements because of where we spend the money.

Overall, this country's health care system is actually a "sick care" system. In 2006, $2.1 trillion were spent in the U.S. on medical care, 95% of which was spent to treat disease after it had already occurred.

In light of all of this, it is impossible for me to reconcile the dissonance and outright hypocrisy inherent in an organization that claims to prioritize health and well-being above all else while simultaneously rationalizing taking a position against single-payer health insurance. Maybe if you just keep repeating the mantra that markets and capitalism are the best means of making health care affordable and accessible I’ll eventually ignore the facts and become a follower in the cult that the AMA has created. It seems to be working for the members of the AMA.

Let the AMA know how you feel by calling (202) 789-7447. You can also submit a comment on-line here. And finally, you can mail correspondence to:

American Medical Association
515 N. State Street
Chicago, IL 60654