The AMA: Honest broker or wolf in sheep's clothing?

I have received lots of feedback on my earlier article involving the American Medical Association (AMA) and its history of being on the wrong side of social progress and the best interest of the American public.  The underlying theme of some of the pro AMA comments was that while the AMA may have done bad things in the distant past, today's AMA is a different organization that has been right in claiming that medicare is underfunded and restricts access to medical care for the elderly.  

 

In fairness to those readers (and to the AMA) I agree that some of the Association's current public positions are different and appear more sophisticated than they were a generation or two ago. For example, the AMA has finally come around to admitting that cigarettes are hazardous to your health and that some form of health care reform is inevitable.  But my gut tells me that the apparent changes in some of the AMA's public positions are mostly due to political realities (i.e. smoking and racial discrimination are no longer socially acceptable practices) and pressure from caring physicians who really want a better health care system designed to deliver quality care at a reasonable cost to every American.

 

Probably the most important issue facing the United States today is health care reform. While we are having this debate, it's important to know which institutions are fighting for us and which ones are fighting for their own selfish interests. While you're deciding whether or not to trust the AMA's motives in this debate, I'd like to proffer the following analogy which may help us arrive at our decision regarding the merits of the AMA's current position with respect to health care reform.  

 

Let's look at two American institutions and then decide which one most closely resembles today's AMA.  The two institutions I have selected for comparison are Big Tobacco and the Democratic Party. 

 

Big Tobacco is admittedly a pejorative term for the big three tobacco companies; Philip Morris (Altria) Reynolds American (RJR) and Lorillard. Big Tobacco currently employs five major strategies to promote the use of their product; Sponsorships, Point-of-Purchase Advertising, Promotion, Periodical Advertising and Product Placement in Movies.

 

While continuing to exploit and refine these promotional strategies, Big Tobacco is also holding itself out as a responsible corporate citizen when it comes to public health issues. Notwithstanding the fact that tobacco use is estimated to kill 443,000 Americans and costs $193 billion in lost productivity and added health care costs annually, companies like Philip Morris tout on its web-site initiatives designed to make people aware of adverse health effects of smoking. In fact, several links pose as an aid to smokers who want to quit the habit.

 

Now, at first glance, this appears to be a major change compared to 20 or 30 years ago when Big Tobacco was refusing to even acknowledge that smoking was bad for human health. But does anyone actually believe that Big Tobacco really wants its customers to quit there product? Isn't it more likely that massive lawsuits and government regulation have forced the major tobacco companies to pretend to care about public health? Take another look at the five major strategies and then tell me that Big Tobacco has fundamentally changed and is now a good corporate citizen that is sincerely interested in public health. 

 

Now, let's take a look at the evolution of the Democratic Party. Up until the mid 20th century, the Democratic Party was clearly not on the cutting edge when it came to civil rights and racial equality. For example, in 1942 Robert C. Byrd, the 91 year old current senior Senator from West Virginia briefly joined the Ku Klux Klan (he has since denounced his former racist past) and there is little doubt that Democratic President Woodrow Wilson (1913 -1921) was a white supremacist. Even progressive hero Franklin D. Roosevelt saw fit to order the internment Japanese American citizens during World War II. Finally, let's not forget that openly racist senators like Jessie Helms and Strom Thurman were once Democrats until they found a more receptive audience within the Republican Party. In fact, the Internet is full of right wing hysteria regarding the raciest history of the Democratic Party.  

 

But with the passing of the 1964 Civil Rights Act, followed by the Social Security Act of 1965, the Democratic Party took on the appearance of a truly progressive party that; for the most part, was deeply committed to promoting social justice and the well being of the average American citizen. But how do we know that the Democratic Party, unlike Big Tobacco, is sincere and not just pretending to have changed its ideology? Well, the fact that a majority of today's Democratic lawmakers, led by a black president, is advocating for a public option over the objection of a massive Industrial Health Complex should give us a hint as to the correct answer.

 

Now, back to the original question. Is today's AMA more like the Democratic Party, fundamentally different from what it was a half century ago, or, is today's AMA more like Big Tobacco? Trying to appear to be an objective voice on the side of the American public but, in reality, a wolf in sheep's clothing? 

 

Let us look at some more facts before we answer this question:

 

 

Look, the bottom line is that the American Medical Association is an institution that, like Big Tobacco, is looking out for what's best for the AMA and not what's best for you and me. Even conservative Nobel Prize winning economist Milton Friedman admitted that the AMA essentially acts as a guild which works to increase physicians' wages and fees by influencing limitations on the supply of physicians and non-physician competition. This focus on minimizing competition perfectly mirrors the agenda of the Health Care Industry. When it was politically safe for this physicians guild to take tobacco money in exchange for its endorsement of cigarette smoking, it did so without question. Today we see the results of that policy as we are witnessing the annual deaths of 443,000 Americans, most of whom became hooked on cigarettes at the time the AMA was hawking Big Tobacco's product. 

 

Despite its claimed commitment to universal coverage, the AMA has fought almost every major effort at heath care reform and still believes that Medicare is "socialized medicine". They will have a seat at the table during this crucial debate and they will adopt to whatever new legislation is passed by congress and signed into law by President Obama.  But please don't believe for a second that the AMA is looking out for your best interest because what's good for the AMA is hazardous to your health and to your wallet.