In his highly anticipated speech to the American Medical Association, President Barack Obama said he wants the AMA onboard the healthcare reform train -- but he won't delay its departure if the AMA hesitates.
"To say it as plainly as I can, health care reform is the single most important thing we can do for America's long-term fiscal health. That is a fact," Obama said.
"In order to do that we are going to need the help of the AMA."
The historic speech in front of a group that has blocked past reform efforts was met with respect -- he was interrupted 36 times by applause, including a handful of standing ovations. But at least once -- when he said he would not back caps on jury awards in medical liability cases -- he was booed, although the booing was notably restrained given the emotional attachment the AMA has to tort reform built on caps.
"They responded positively but warily," said Dr. Michael Reichgott of New York, a delegate from Medical Education Section of the AMA. "Everybody was being very skeptical. There is a great deal of cynicism about what the government really intends to do."
And on this issue at least, the cynicism came from both sides. The Center for Justice and Democracy, which purports to advocate for injured consumers, attorneys and others, issued a letter to Obama signed by 64 survivors of medical malpractice. The letter expressed concern that "the rights of medical malpractice patients may be stripped away" as a result of the president's national health care push.
Obama told the AMA that what his administration -- the government -- intends to do is to do is enact a $1 trillion reform plan to cover nearly every United States citizen and to expand access to medical care.
After focusing on the parts of reform where agreement was a given -- coverage for preventive medicine, moving the nation from cardboard file folders for patient records to a portable electronic health record, and freeing doctors from hassles that turn them into "bean-counters and paper-pushers" rather than "healers" -- Obama turned to what has proven to be most controversial aspect of reform: the public plan.
Obama tried to sell the idea of a new public insurance plan to a group of people who have, by in large, been against it.
The president would like the government to run a Medicare-like insurance option alongside private plans, all of which would be purchased through an insurance clearinghouse called the "exchange."
But Republicans in Congress are vehemently opposed to the idea, calling it a "government takeover," that would drive private insurance companies out of business.
Some AMA members said they fear a public plan would be too much government-interference in their medical practice.
As former AMA president Dr. John Clowe, a retired family physician who practiced in New York, put it, "The AMA doesn't approve of government-run medicine. We want independence."
But Obama promised the public option was not his secret scheme to turn the U.S. system into a single-payer system.
"The public option is your friend, not your enemy," he said.
"So, when you hear the naysayers claim that I'm trying to bring about government-run health care, know this -- they are not telling the truth."
Last week the AMA began to signal its objection to a public plan, and it immediately found itself enmeshed in controversy as other organized medicine groups criticized the position.