The AMA, AAP, ACP, AAFP

If physicians are too busy taking care of patients to devote a lot of time to advocacy, who does this for them? That's a great question! Each specialty has an organization which represents them, and a professional membership that they can obtain. In each group, there is a specific wing dedicated to advocacy. The problem, however, is the group doesn't necessarily represent the values of their constituents 100% of the time. We all know how frustrating it can be when your elected official decides to pursue their own agenda for the sake of their professional advancement, or personal beliefs. We also know each person is also interested in job security. Unfortunately, the most vocal (and the group which donates the most money) often gets disproportionate representation. This is no different in politics or professional groups.

Since the days of Andrew Jackson (who was notorious for this practice), politicians reward those who support them. Obama is no different in this course of action, as you can see the millions of dollars in earmarks added at the last second to his bills once he became president. The AMA, AAP, ACP, AAFP, and other groups all met with Obama in the infancy of his health care reform bills. Previously, they had supported other measures (Tort reform for example), and following the meeting they publicly endorsed Obama's plans, even though the plan is not necessarily in the best interest of physicians or patients (see prior posts). Of course, going into the meetings, they had some pretty significant concerns. Do we honestly believe when we watch months of debate, that the questions were all answered in those brief meetings? I would hope not. It would be more reasonable to believe there was some incentive for changing their position.


We can see an example of incentive and reward in the pharmaceutical industry. According to Bloomberg, "two firms that received $343.3 million to handle advertising for Barack Obama’s White House run last year have profited from his top priority as president by taking on his push for health-care overhaul. This year, AKPD and GMMB received $12 million in advertising business from Healthy Economy Now, a coalition that includes the Washington-based Pharmaceutical Research & Manufacturers of America, known as PhRMA, that is seeking to build support for a health-care overhaul." Besides having already received massive compensation for their efforts in getting Obama elected, they have the potential for substantial gains if his health care plan goes into effect.

How, you ask? Allow me to explain. In medicine, there is something called a formulary. This is a list of medications the hospital has chosen as the first line agents it keeps available for use. For example, there are many competing "statins" on the market to treat cholesterol. The hospital chooses a particular drug because the hospital has worked out a deal with the distributor to get the drug at a lower cost. This helps the pharmaceutical company because its drug is chosen over other cholesterol lowering agents, and the company is banking on the number of people who will be using the medication. It helps the hospital because the drug company offers the medication at a lower cost. By "scratching Obama's back" (multiple times), the drug companies have a lot to gain. There is a good chance that the government will decide which drugs (manufactured by certain companies) a hospital can use to "control costs". Does this sound like special interest to anyone else? Oddly enough, Obama and other politicians refuse to pass legislation against pharmaceutical agencies. Instead, insurance companies are "villains" and doctors take tonsils out "for money."


What kind of incentives can Obama offer the various specialty groups? The AMA, for example, has been arguing for tort reform for nearly a decade without success. On the other hand, the current administration has been steam rolling bills through the house and senate without pause. If the specialty groups would like a different type of legislation passed, it would be plausible to assume cooperating with Obama on his most aggressive reform to date would be a good starting point. Additionally, one of the techniques to get a bill passed is to make it appear as though it is inevitable for that bill to be passed. Politicians don't like to vote on the "wrong side" because the people who maintain power passed the bill. It would make for difficult working conditions later.


It is far easier, then, to go along with the health care reform bill if:
1) it's presented as though it's going to happen anyway
2) what you're already seeking seems unable to come to fruition (tort reform)
3) current concessions or future promises are made by those in power to look "favorably" on your cause
4) you have a way to "spin" it so you still achieve success.
Keep in mind everyone has different priorities, and how we prioritize is only that. Just because we put something in a bill at the top of the list does not mean we want everything else that is included in the bill, nor does it mean we completely devalue everything else. Obama stood at a press conference recently amongst liberal Christian leaders who support his plan. They cited the need for universal health care. This is the same citation the AMA uses. Both groups believe that the uninsured are a priority, but it might not mean that they agree with the remainder of the bill. I discuss access to care in another post. First, I don't believe access to care is the primary problem. Second, I don't believe this bill adequately addresses this problem (also discussed in another post). Third, in some cases this may be a "smoke screen" or "spin" so both parties can claim "victory."

In any case, regardless if you believe Obama used the "carrot technique," these professional organizations are their own entity and do not necessarily exemplify the beliefs of their members. Personally, for every 25+ physicians I discuss the issue with, only 1 agrees with Obama's health care reform plans. Although this isn't a scientific argument, it just is to make the point that people have varying opinions - even physicians. The choice, ultimately, is in each one of us when we discuss these issues prior to congressmen voting on them in the future.