Obama Faces Tough Audience at AMA

CHICAGO, June 15, 2009— -- It's been a long, long time since a sitting president of the United States talked face-to-face with the American Medical Association. So it's not surprising that the more than 500 AMA delegates, friends and relatives assembled here are focusing all their energies on President Barack Obama takes the podium Monday.

Obama's speech will end a 26-year long drought for presidential speeches at the AMA; Ronald Reagan addressed the delegates in 1983, the same year he proposed to freeze Medicare payments to physicians while his administration worked to cobble together a Medicare overhaul.

The freeze, and a short-lived Medicare option called part C, which covered catastrophic medical expenses, were widely considered to be flops. When President Barack Obama delivers a speech today in front of the AMA House of Delegates, it will be poignant occasion for the divisive doctors' group for a number of reasons.

The years since the Reagan speech have been tough ones for the AMA, which has seen both its membership roles and its revenues shrink. The group still describes itself as the "house of medicine" with a membership of about 236,000 physicians, but 30 percent of them are students, who pay no dues, and only about half are practicing physicians.

Moreover, the AMA has a struggled with its image. Last year it issued a formal apology for its past history of racial discrimination.

Second, it's no secret that the group has vocally opposed many healthcare legislation and overhaul efforts in the past 40 years, from the creation of Medicare to the failed reform efforts of the 1990s.

In March, Dr. Nancy Nielsen, the AMA's outgoing president, told MedPage Today that the AMA felt spurned during the Clinton administration when it wasn't invited to a single healthcare reform discussion.

Rather than sitting out that the battle over the Clinton plan, the AMA, along with insurers, launched a major offensive that some say was the main reason the reform efforts failed.

American Medical Association Weighs in on Health Care Reform

"You know, we have sometimes drawn lines in the sand that have left our AMA blamed for blocking reforms," Nielsen told the delegates during the opening session of this year's meeting.

But she promised the crowd that it is different this time around.

Nielsen called the current climate, where healthcare reform may soon be a reality, "our profession's D-Day."

"The decisions we make in the next four days will have a profound impact, and the country is watching," she said.

Indeed, many are watching to see what side the AMA eventually comes down on as more specifics on healthcare reform plans from the White House and Congress are revealed.

It's not yet clear exactly how the AMA's ideology will meld with reform efforts. For instance, the AMA has come out against a public plan option that would pay physicians at Medicare-like rates. But the group was angered last week after it felt that a New York Times article mischaracterized the group as being in all-out opposition to any variation of the current health insurance system .

"The AMA is working to achieve meaningful health reform this year and is ready to stand behind legislation that includes coverage options that work for patients and physicians, " Nielsen said in a release.

To prove the AMA's clout, Nielsen outlined in her speech some successes the group has under its belt -- such as suing United Healthcare and its database subsidiary Ingenix for allegedly understating out-of-network payments. United Healthcare settled with the AMA for $350 million.

Also, the AMA has been an instrumental force in convincing Congress to vote to stall planned cuts in the sustainable growth rate (SGR) -- the arcane formula used to calculate physicians payment.

But the AMA has had some failures too, such not being able to exert enough influence to bring about medical liability reform at the national level, and achieving a "watered down" bill on physician private contracting.

In her speech, Nielsen appeared to be hinting at a new, less adversarial role for the AMA.

"We can't keep on hating everyone all the time -- government, health plans, and sometimes even each other," she said. "It's our responsibility to try some new things and innovate in healthcare delivery."

Medical Group Sees Ideology Shift

"We're not the same AMA," Wertsch said. "It's very progressive now.

As evidence, Wertsch cites his own varied rolls at the AMA. He is not only a former president of the Wisconsin chapter and a current members of the Wisconsin delegation to the AMA, but Wertsch, who has a gay son, also chairs a task force that advises the AMA Board of Trustees on gay, lesbian, bisexual, and transgender issues in medicine.

Still, perceptions are slow to change.

Wertsch said some colleagues in Wisconsin won't join the AMA because of hard-line stances the group took on a number of major issues, notably opposing the creation of Medicare in the 1960s.

Regardless of its image problems, the AMA is riding high this week because Obama is coming to talk turkey with doctors.

"I think it's important that he is recognizing the AMA as representative of the physicians of the country," said Dr. J. Brennan Cassidy, an emergency medicine physician in Sacramento, Calif., and president-elect of the California Medical Association.

As to what the AMA wants to hear from Obama, there is little doubt that a permanent fix to the SGR formula is at the top of the delegates' wish lists.

"The SGR is a flawed formula and fixing that is an important issue," Cassidy said. Or, as Nielsen said, "It's is time to pour concrete in that hole and walk away from it."

Dr. Benjamin Shwachman, a pain specialist who is a delegate from Covina, Calif., also would like to hear how more specifics from the president on how he plans to improve access to care for those who are uninsured and underinsured.

Physicians here are also hoping for some words from Obama on his plans to reform the medical liability system.

One former past president, Dr. John Clowe, a retired family physician who practiced in New York, said he was "pleased" that Obama is speaking to the group and hopes the president will talk about "the independence of the physician to practice."

A long time AMA warrior who led battles in the 1980s against Medicare pay freezes, Clowe said flatly, "The AMA doesn't approve of government-run medicine. We want independence."

Nielsen went to some lengths to assure the delegates that president Obama does support physicians' independence to make medical decisions without influence from government.

"President Obama acknowledges that medical decisions must be made between the patient and the physician," Nielsen told AMA members. "That's where medical decisions belong, and we will fight till our last breath for that privilege."