AMA at a crossroad: Let basic values be our guide

As I write this, the 2009 AMA Interim Meeting of the House of Delegates has just concluded. By the time you read it, it will be another chapter in our history. An important one.

The months, weeks and days leading up to this meeting reminded me of the classic opening lines of Charles Dickens' A Tale of Two Cities.

"It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity, it was the season of Light, it was the season of Darkness, it was the spring of hope, it was the winter of despair, we had everything before us, we had nothing before us."

It's as though Dickens attended one of the health care town hall meetings in August.

A few years ago, the House of Delegates changed the format of the twice-a-year meetings to allow the Interim Meeting to focus on advocacy issues. This year, health system reform was front and center. And it should be.

Late at night on the first day of the Interim Meeting, the House of Representatives passed its version of health system reform, HR 3962.

The bill will significantly expand health insurance coverage to Americans; empower patient and physician decision-making; institute meaningful insurance market reforms; make substantial investments in quality; institute prevention and wellness initiatives; provide incentives to states that adopt certificate-of-merit and/or early-offer liability reforms; and reduce administrative burdens.

It's not the last step of the process, but it's the latest step. And the AMA House of Delegates reaffirmed its support for health system reform alternatives that are consistent with AMA policies concerning universal access, pluralism, freedom of choice and freedom of physician practice, including the right to contract privately for professional services between physician and patient.

It also outlined specific elements the AMA will actively and publicly support and oppose as the health system debate continues. The complete resolution can be found on the AMA Web site (link).

Just as crucial to health system reform is the need for Congress to include Medicare payment reform in any comprehensive health system reform legislation.

Both the House and Senate have the legislative language at hand to repeal permanently the broken physician payment formula and preserve access to care for seniors, baby boomers and military families.

One attempt at this proved disappointing, when S 1776 -- legislation by Sen. Debbie Stabenow (D, Mich.) to eliminate the flawed SGR formula -- failed to reach the Senate floor for an up-or-down vote. Later in November, the House of Representatives will take up HR 3961, their version of legislation to eliminate the SGR formula.

It's another example of the challenges facing the Federation of Medicine the AMA represents.

In 2002, during extensive AMA discussions about a shift to an "organization of organizations," the chair of the task force made this important point -- organizations and individuals vote on AMA policy, but they are not bound to follow it. However, the AMA is bound by it. As a result, unity of message does not necessarily constitute consensus about any given advocacy position.

For example, the AMA adopted policy to have an individual mandate for health insurance for those making more than 500% of the federal poverty level. This would equate to less than 10% of the person's take-home pay and, thus, be considered affordable.

Some who sit in the AMA House of Delegates disagree. We live in a free society, and people are free to express their opinion. But what message does it send to policymakers, elected leaders and the public?

As Sun Tzu wrote in his Art of War: To conquer your enemy, try to divide it among itself. Our medical profession is in a constant struggle with government and those in the private sector who control the purse strings. When they see division, it makes their efforts to manipulate the medical profession that much easier.

Our AMA policy is set by organizations that represent all physicians in America. Our Council on Legislation and our Board of Trustees try to implement that policy based on the resources available.

Yet our membership is still made up of individuals who decide annually if they again will write their checks to continue to participate. Although they do not have a direct vote on that policy, they do have a voice if they wish to attend in person and testify at the reference committees twice a year at the House of Delegates meetings. They also can register their opinions through our Member Connect surveys.

Ultimately, AMA policy may be changed if the delegates vote to do so -- with the assumption that the House of Delegates represents the AMA membership. But the feedback from some members over the last few months on AMA policy questions that premise. It's this sort of division that gives the enemies of organized medicine great comfort.

So, the AMA is at a crossroad. In a crisis, true character is revealed. Times change, situations change, technology changes, the landscape may be altered, but basic values must not.

Our ethical responsibility to our medical profession and the patients we serve will continue to be the standard that determines the AMA's action -- and we've decided on a course that is decent and civilized. It is the reason we exist: to promote the art and science of medicine and the betterment of public health. To help those everyday heroes called physicians help patients.