The American Medical Association is one powerful voice on the subject, but it's far from the only one. The AMA opposes President Obama's public insurance option, which he will try to push through Congress this year. But the AMA represents only 20 percent of physicians.
Dear AMA: I quit!
With that letter, a young Mayo Clinic physician named Chris McCoy removed himself from the membership rolls of the American Medical Association this month -- and plunged himself into a roiling national debate over the future of American health care.
The cause of McCoy's ire?
The AMA's opposition to a new public insurance option as part of President Obama's plan for health-care reform.
McCoy's solo protest is just one sign of deepening fissures among America's doctors at a time when the country is hurtling toward big changes in the way it pays for and delivers health care.
Last week, Obama stood before the AMA's annual meeting in Chicago to promote his ideas on health reform. Support from the biggest, most influential physician group is thought to be crucial if Obama is to muscle a bill through Congress this year.
But with 250,000 members, the AMA represents just 20 percent of physicians, down from 75 percent in 1960.
Far from being a monolithic group, the nation's doctors reflect a spectrum of views -- based on personal experience, mission and financial self-interest -- that mirrors the way Americans in general have different hopes for health care reform.
"The AMA has stolen the headlines with Obama's visit," said Dr. Jean Silver-Isenstadt, executive director of the National Physicians Alliance, a four-year-old group that favors a public insurance plan. "But there are many physicians ... and the majority feel that our patients really can't wait anymore."
Her group, with 20,000 members, is just one of many.
Another is Physicians for a National Health Program (PNHP). It has 16,000 members and supports a single-payer system, where patients continue to see private providers but the government pays all medical bills.
"Talk to a doctor who works in a public hospital," said Dr. Scott Davies, chief of medicine at Hennepin County Medical Center and an AMA member, "and the majority would favor single-payer."
Then there's the American Medical Student Association, whose 62,000 members represent the next generation of doctors. AMSA broke off from the AMA nearly 60 years ago when the parent group opposed creation of Medicare. It supports a "robust, well-crafted public health insurance option" and, ultimately, a single-payer system, said legislative director Farheen Qurashi.
ER vs. radiologists
A study published by the Annals of Internal Medicine last year found that 59 percent of about 2,200 physicians surveyed supported national health insurance. The researchers from Indiana University found that was up from 49 percent in a 2002 survey.
Yet the results show the many faces of medicine. Doctors in lower-paid practices -- psychiatry, pediatrics, emergency medicine and internal medicine -- were most likely to support national health insurance. Those in higher-paid areas -- surgical subspecialties, anesthesiology and radiology -- were least likely.
"There's a correlation with income and the way they get their income, whether it's by doing procedures," said Dr. Oliver Fein, a professor at Weill Cornell Medical College in New York and head of PNHP.
The AMA said its policy is made through a democratic process that includes physician and medical student delegates from all state and specialty medical societies, as well as groups representing medical students and residents.
"No other physician group in the nation allows all physicians a voice in the future of medicine in our country," said AMA President Dr. J. James Rohack, a cardiologist in Texas. "Opting out simply means your voice is not heard when and where it counts."
Without the AMA platform, splinter groups often struggle to get their message out.
The same week AMA leaders were hosting Obama in Chicago, Fein was visiting the Twin Cities. At one evening event at St. Catherine's University in St. Paul, his audience barely filled a quarter of a large auditorium. Fein had more luck at Hennepin County Medical Center, the state's biggest safety net hospital, where about 80 doctors squeezed into a conference room over lunch.
Focus on reimbursement?
McCoy, a 30-year-old from Topeka, Kan., has watched the health care reform debate raptly. He just finished his residency in internal medicine at Mayo Clinic in Rochester and is starting a one-year stint as chief medical resident there.
Last week, he read the AMA's response to Senate Finance Committee proposals, which included a new public insurance option in the mold of Medicare. The AMA, which decades ago opposed creation of Medicare, said another public plan would "expand the number of years physicians will be facing [payment] cuts." It pushed instead for better regulation of private insurers so everyone has affordable coverage.
(The AMA has since softened its stance, saying it opposes a public plan that forces physicians to participate, expands Medicare or pays Medicare rates. However, it is open to other public options.)
McCoy was outraged by the focus on reimbursement.
He didn't just stew. He dashed off a letter.
The emphasis on money "highlights how the AMA represents a physician-centered and self-interested perspective rather than honoring the altruistic nature of my profession," he wrote. "As a physician, I advocate first for what is best for my patients."
McCoy notes he doesn't speak for Mayo, which has its own health policy objectives.
No political novice, he spent a year as legislative affairs director for the American Medical Student Association and is now policy chairman for the National Physicians Alliance.
McCoy posted his June 11 letter on his personal blog and Facebook page. From there it made its way -- as these things do -- onto the Huffington Post website, where it attracted more than 700 comments.
"I was really surprised and touched," he said. It shows "how frustrated patients are by the health care system and how they wished doctors were advocating for them."
For its part, the AMA said it is committed to health reforms that benefit patients and physicians and will stay the course to get all Americans coverage.
"If Dr. McCoy has strong feelings about health reform, we urge him to engage -- not quit,'' said Rohack. "No one -- not Dr. McCoy, not AMA, not even President Obama - will get everything they want from health reform, and for AMA, quitting is not an option."
Chen May Yee • 612-673-7434