As I See It

Guilt by Association: The AMA Sold Us Out

By Paul S. Koch, MD, Editor Emeritus

When I finally draw up my list of the top boneheaded decisions I've made in my career, I'll get to relive some really juicy blunders. But one decision that will not be on that list, and one that I'm still happy with today, occurred 25 years ago: I quit the American Medical Association, and I have yet to regret it.

I don't even remember the details of the event that set me off. It was something about a CPT code that ophthalmology wanted and I think even our Academy asked for, but the AMA said no, we couldn't have it. That seemed like a shot across our bow, so I shot back.

“Bah, I quit!” I said, though I'm sure they didn't even notice.

Never have I been more happy with that decision than now, after learning that the AMA came out in favor of the health care “reform” bill that will radically transform the delivery of medical care, even though it lacked the major reforms that physicians needed.

By contrast, our ophthalmology organizations — our Academy and ASCRS — were forceful and vocal on our behalf all throughout the process. I am so proud of them and all the other professional societies that stood up for the needs of their members.

An Advocate for the Advocates

See, physicians look out for our patients. What we need is someone or something looking out for us: a big, powerful ally to deal with big, powerful bullies. We are not allowed to organize in the sense that we can't form a union, so we do the next best thing. We organize professional societies and pay dues and make contributions to political action committees so someone big and strong can stand up for us. The AMA is considered the granddaddy, the organization that represents all physicians.

What do we need in a new world of health care? We need tort reform. The legal climate in the country is completely nuts. It has to be changed.

We cannot even begin to discuss reducing the cost of health care without major changes in perceived liability. Cost containment? How can we cut costs when we need to perform tests and documentation for our own protection? Every medical association in the country should have made it perfectly clear — our doctors will not be part of a plan that does not resolve this issue.

Okay, so Congress tossed out a bone to silence critics. They included the chance for statewide demonstration projects to test tort reform for five years, beginning next year. That, of course, succeeds in shutting us up for six more years while nothing is resolved. They got us. It was brilliant maneuvering on their part.

We need the Medicare payment cut permanently gone. Everyone knows it's a problem, and Congress votes every so often for a temporary fix. It should have been made clear, “You want us in, SGR goes out !”

We needed to be strong. Instead, what we got were the weenies in the AMA declaring their support for the bill and expressing a hope that maybe, someday, pretty please, we'll have the chance to talk about tort reform and the Medicare SGR.

The leadership at the AMA believes that if we give the lawyers and politicians what they want, they'll respect us and one day will give us what we need. Really? They respect weakness? If they didn't give us tort reform and the SGR fix when they needed our support, why on earth would they ever give it to us when they do not need our support?

Laws and Sausages

Otto von Bismarck famously said that two things you don't want to witness being made are laws and sausages; the ingredients, laid bare, are not an inspiring sight. If only we physicians had had a cook of our own in the kitchen during the recent year-long sausage making, the result might have been a little more appetizing.

But recall that Bismarck also said that politics is the art of the possible. There was one golden moment when organized medicine — all specialties — could draw a line in the sand. Instead, our biggest and most powerful voice, the AMA, caved.

I wish I could join the Teamsters. They get respect. OM

Paul S. Koch, MD is editor emeritus of Ophthalmology Management and the medical director of Koch Eye Associates in Warwick, RI. His e-mail is: paulkoch@kocheye.com.