Leadership
Friday, November 7 2008
Commenting on yesterday’s post, Peter wrote:
Take physicians out of the leadership in healthcare, and you get serious problems as evidenced by the current reality of healthcare in this country.
As a matter of fact, the current reality of health care in this country is largely due to physicians’ leadership over the past 100 years. No profession has done more to shape our current system than physicians, under the auspices of the American Medical Association. The AMA has fought every wave of reform, and stymied nearly every attempt to legislate a more comprehensive and equitable health care system.
For example, in 1920s a group called the CMCC advocated reform of the health care system in the US, but “the CMCC’s modest proposals for group medicine and voluntary insurance were denounced by the American Medical Association (AMA) as “socialized medicine”.*
Then, “In 1943, labor unions joined the reformer-experts of the Committee for the Nation’s Health and liberal administration officials in drafting the Wagner-Murray-Dingell bill (named for its congressional sponsors), the major health insurance legislation of the Truman era. [...]
Reformers needed all the help they could get to fight an unprecedented onslaught by the AMA. After Truman’s electoral victory in 1948, the doctors’ organization spent over $1 million on an anti-health reform public relations blitz that included advertising, television and radio spots, telegram and letter-writing campaigns, and the lobbying of legislators by their own personal physicians. Unlike reformers, AMA members successfully reached out to the grassroots with “doctor-to-patient” letters denouncing the Wagner — Murray — Dingell bill.*
Then, of course, there was the AMA’s efforts to kill Medicare in the 1960s.
Retirees disseminated “millions” of pieces of literature in an attempt to thwart AMA propaganda, and 14 000 seniors marched down the boardwalk at the 1964 Democratic Convention in Atlantic City. Americans were highly sympathetic toward the elderly as a group, which made it harder for the AMA and other opponents “to engage in open warfare” against health reform, and in July 1965 Medicare became part of the Social Security Act.*
More recently, the AMA nominally supported President Clinton’s reform proposals in the 1990s, but they never stood up for it and ultimately lobbied against it.
Far from being absent from the process that created our current system, physicians – as the AMA – have in fact been instrumental. Every time someone has claimed health care is broken, the AMA has opposed any fix. The only group able to make any headway against the AMA was seniors, and then only with large Democratic majorities in Congress and a popular Democratic President. In every other case, if politicians have made a hash of things, it’s because they were listening to the physicians.
So yes, physicians have some insight, and that should count for something. But for too long, that insight and the narrow interests it reflects have trumped any other voice, especially the voices of the people the system exists to serve. Yes, we should acknowledge some role for doctors in health care reform, but only as partners – never again as masters.
I would argue that the institution of Medicare has been largely responsible for the mess we are in by nature of its price fixing and incentivizing medical students to enter specialties versus primary care. If only the country listened to the doctors back in the 1960s instead of retirees, a group of people which wanted to receive benefits from a system even though they knew they didn’t have to put a dime into it, we wouldn’t have a federal entitlement that absorbs hundreds of billions of dollars and is still bankrupt.