The Treatment

The AMA Endorsement and Why It Matters

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In rapid succession, the AARP and American Medical Association (AMA) have endorsed health care reform. This is consistent with what they've said all year long. And it's important all the same.

Democrats need both groups' support, not because of their fundraising clout but because of their credibilty with the public. Older voters, in particular, take cues from the groups. When conservatives say the Democrats want to kill Medicare or, worse, kill Grandma, it helps when Democrats can respond by citing the approval of these two organizations. While it's not quite the Good Housekeeping Seal of Approval, it's as good as you're going to get in politics.

But reform advocates have worried the AMA might change its mind. The AMA had hoped health care reform would include a permanent fix of the annually scheduled, and annually postponed, reduction in Medicare physician payments under the Sustainable Growth Rate (SGR) formula. That didn't happen, because Congress wouldn't set aside the money for it and fiscal conservatives refused to finance a long-term fix purely through deficit spending. And while House Democratic leaders have pledged publicly they'd try to pass an adjustment later in the year, that's not the same as passing an adjustment today.

In addition, the AMA, like any large organization, has its own internal political dynamics. The national leadership has supported reform for a while. That's particularly true of the current president, J. James Rohack. But AMA membership tends to be relatively conservative, even more so than the physician population as a whole. And some of its state-based chapters, like the Texas Medical Association, are somewhere off in Tea Party territory. The tension between the national and state leadership has been palpable all year long. I still remember, vividly, the last time the AMA announced a health care reform endorsement on the phone. A group of rogue Texas Medical Association physicians got on the media call and started haranguing Rohack about it.

Losing the AMA would have hurt, in part, because the AARP might have followed. Given the anxiety of older voters, AARP was relying on AMA for validation from the doctors, much as the Democrats were.

But the AMA is sticking with the program. A big reason, I'm sure, is old-fashioned transactional politics: They still hope and expect some kind of help on the SGR. (My guess is that they get some sort of multi-year adjustment--i.e., fewer than ten years but longer than the usual one--that can be financed with revenue or savings elsewhere.) But I suspect Rohack and his allies also grasp that, even without the SGR fix in place, reform has benefits for physicians. It expands insurance coverage, so 30 million more people will be able to pay their bills. It boosts payments for primary care physicians, who are underpaid and in short supply. It introduces serious malpractice reforms that, although not the award caps many physicians prefer, could radically reduce the malpractice burden on doctors while simultaneously improving patient safety. And it will start to reduce the overall care of medicine, so that Medicare--the program on which so many physicians are dependent--can be on more solid financial footing.

In a media conference call this afternoon, Rohack was careful to say Congress and the president must something about the SGR this year. The support, in other words, is qualified. But qualified support is good enough.

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