President Barack Obama's nearly hour-long speech to the American Medical Association on Monday didn't contain much in the way of new policy proposals. But he made it clear that physicians may play a pivotal role in determining whether or not healthcare reform legislation moves forward smoothly in the coming months.
"I need your help, doctors," Obama said. "To most Americans you are the healthcare system. The fact is Americans—and I include myself and Michelle and our kids in this—we just do what you tell us to do … We listen to you, we trust you. And that's why I will listen to you and work with you to pursue reform that works for you."
Those comments are particularly interesting in the context of the AMA's fumbling last week over its position on the public insurance option that Obama favors.
An article in last Thursday's New York Times claimed for the first time that the nation's largest physician group opposed a government-sponsored insurance plan, and quoted a letter the AMA sent to the Senate Finance Committee that said, "The AMA does not believe that creating a public health insurance option for non-disabled individuals under age 65 is the best way to expand health insurance coverage and lower costs. The introduction of a new public plan threatens to restrict patient choice by driving out private insurers, which currently provide coverage for nearly 70% of Americans."
That's pretty strong language that could have made for an awkward visit from the president and given ammunition to opponents of the public plan.
But not so fast. Before the day had ended, AMA President Nancy Nielsen, MD, issued a clarification, saying, "Today's New York Times story creates a false impression about the AMA's position on a public plan option in health care reform legislation. The AMA opposes any public plan that forces physicians to participate, expands the fiscally-challenged Medicare program or pays Medicare rates, but the AMA is willing to consider other variations of a public plan that are currently under discussion in Congress."
So what's going on here? Why is the AMA sending mixed messages? Why did the organization immediately back away from its strong opposition to a public option?
The answer was in Obama's speech: It's because he needs your help, doctors.
A new poll from Gallup suggests that the American public trusts physicians more than any other stakeholder to recommend the right options for reforming the healthcare system. Seventy-three percent polled put their trust in physicians, compared to only 58% who are confident in Obama's recommendations.
That means physicians also have a unique power to sink healthcare reform. The AMA has a history of doing so, in fact. The AMA is credited with giving the phrase "socialized medicine" its current pejorative connotation; it campaigned against Medicare in the 1950s and 1960s, enlisting then-actor Ronald Reagan as a spokesman; and it helped defeat President Bill Clinton's attempt at healthcare reform in the 1990s, in part by endorsing House Speaker Newt Gingrich's alternative plan.
But this time may be different. Physicians need reform as much as anyone, and they have a lot to lose if the entire effort fails. Most doctors support many of the proposals that Obama mentioned on Monday—covering the uninsured, getting rid of the sustainable growth rate formula, paying more for prevention and primary care, and addressing malpractice reform. Although Obama explicitly said he wasn't in favor of caps on malpractice awards, he did tell the audience that he was willing to explore a range of ideas for dealing with malpractice issues and defensive medicine. That was the biggest applause line of the speech.
The AMA has to walk a fine line politically—it must use its influence to tweak the specifics of the reform package, but if the organization is too aggressive it risks torpedoing the entire process.
Most doctors don't want that to happen, so the AMA won't likely oppose reform as openly as in the past.