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AMA Support of Health Reform Bill Is A Milestone

The importance of the AMA's endorsement of the House of Representatives' health reform bill should not be minimized. The AMA has been fighting government efforts to establish universal coverage at least since the 1930s, when the AMA's opposition discouraged F.D.R. from pursuing reform on that front. While it's true that the AMA represents a far smaller percentage of physicians than in past decades, it remains a legitimate voice of physicians--which is why President Obama addressed the AMA convention last month.

The House legislation, which was adopted by the Ways & Means Committee today, includes a public plan option, and the AMA notably did not support that in its press release. Although former AMA President Nancy Nielsen has said that the organization does not oppose all versions of the public option, the AMA rejects any plan that would require doctors to participate as a condition of participating in Medicare or would pay them Medicare rates, as the House bill proposes. But current AMA President J. James Rohack praised the bill for authorizing "fundamental Medicare reform, including repeal of the flawed sustainable growth rate (SGR) formula" and "additional funding for primary care services, without reductions on specialty care."

There are other areas that the AMA finds praiseworthy, including insurance market reforms, a ban on pre-existing condition exclusions, an individual mandate to buy coverage, and an insurance exchange to lower the cost of individual coverage. But the elimination of the SGR, which threatens to cut Medicare payments to physicians by 21 percent next year, is a primary goal of the association. And Medicare's recent decision to shift some money from specialists to primary-care physicians also runs counter to AMA doctrine; hence the organization's support of the House bill's approach to funding primary care.

One can only guess whether the AMA believes the House's version of the public plan will fail to make it into the final legislation after the Senate has its way. But it seems clear that the organization is gambling that, with Democrats controlling Congress and the White House, it's better off backing the horse that seems sure to win instead of the alternative--essentially the status quo, which is helping no one, including doctors. And if health reform actually does expand coverage to millions of the uninsured, physicians are bound to benefit.