AMA Broadens Its Social Agenda

For generations the American Medical Association, the biggest trade group for doctors in the U.S., has pretty much symbolized the entrenched health-care establishment. The AMA even popularized the term "socialized medicine" almost a century ago in its fight against national health insurance.

AMA President James Rohack talks about health overhaul on Capitol Hill in September. i i

AMA President James Rohack talks about health overhaul on Capitol Hill in September. Alex Wong/Getty Images hide caption

itoggle caption Alex Wong/Getty Images
AMA President James Rohack talks about health overhaul on Capitol Hill in September.

AMA President James Rohack talks about health overhaul on Capitol Hill in September.

Alex Wong/Getty Images

But lately the group has come out in support of health overhaul, even endorsing, somewhat controversially at first, House Democrats' bill to remake the nation's health system.

The AMA, which represents about 250,000 doctors, just wrapped up a big meeting in Houston where the members of its policy-making House of Delegates took some bold stands. In one vote, they asked the federal government to revisit the classification of marijuana as a Schedule I drug, like peyote or LSD, because that status inhibits research on its potential medical benefits.

The group also passed a resolution calling on the military to abandon its "don't ask, don't tell" policy on sexual preference because it hurts health care of gays and lesbians. Another resolution criticizes bans on same-sex marriage because they contribute to health disparities.

We caught up with Dr. James Rohack, a cardiologist who's president of the AMA, to find out more. Here are edited highlights from our conversation.

Some of the policies recently adopted by the AMA surprised us. What's going on?
In the past some have painted the AMA as an organization of "no." We oppose, we oppose, we oppose. In the 21st century, I think the AMA reflects an organization that looks to improve care and meet our mission of helping doctors help patients. We've also focused on those social issues and governmental regulations that have not allowed us to provide better care for patients.

Why did the AMA decide to endorse the House Democrats' bill?
The AMA continues to be committed to health system reform that meets our policies dealing with freedom of choice, freedom of physician practice, and universal access for patients in a pluralistic health-care system.

The AMA supports HR 3962, recognizing that it is not a perfect bill. But we also recognize that the legislative process requires something to come out of the House and the Senate before legislation can be enacted.

What sorts of thing still need to be worked out?
The ability to privately contract for services without penalty to the patient or physicians still isn't in health-care legislation. Right now, if a Medicare patient and a physician wanted to privately contract for medical care, the physician would have to leave Medicare for two years.

Before 1997, when Congress put in this ban, it happened infrequently. But it did allow for patients who did have the ability the pay the full fees a physician charges to pay those full fees.

Is there a broader issue here about Medicare's payments to doctors?
The payments haven't kept up with the cost of keeping an office open. And Congress took away the right of the physician to bill the patient for the full charge in 1997.

Since 2000, if physicians were paid under the same Medicare index as hospitals, they'd be paid 20% more than they're paid now. Many physicians now are not accepting more Medicare patients.

What led the AMA to ask the government to ease up on marijuana?
The AMA has recognized that research really needs to be done on marijuana's status. Our policy is not an endorsement of legalization. There appears to be a potent therapeutic use of the bioactive compounds in that substance but because of the way the government has scheduled that, it's very difficult to study.

The policy that was adopted is more aggressive. In the past our policy was more we encourage research. This was brought to us by our oncology colleagues, recognizing that substance was very helpful.

Finally, what's the AMA trying to accomplish with its resolutions against the military's "don't ask, don't tell" policy and bans on same-sex marriage?
What's been recognized is that for those who live in households that have same-sex partners, there are disparities in health care. And for those in the military, it's complicated because a physician who's caring for patient is going to ask about their sexual history as part of a good history and physical. If you're prohibited from asking that and our military personnel aren't able to completely confide in them, then physicians can't provide good patient care.

We're not recognizing a pro or con on the issue of gay marriage, it's just purely looking at the issue of disparities of health care—making sure that members of same-sex households have access to quality, affordable health care.



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