I am a member of the American Medical Association and chair the Delegation from the Florida Medical Association. As an advocate for the medical profession, I am very proud of the work that we do, but I also realize that much more is needed. In particular, we desperately need to address the growing disconnect between the AMA and the broader physician community. This disconnect is one of the key reasons why the AMA has struggled to attract members and live up to its potential as a voice for all physicians. An excellent summary of this ongoing problem was written by former JAMA editor George Lundberg in the Medscape article titled, “Why do so many physicians hate the AMA?”
Unfortunately, the AMA continues to take actions that may exacerbate this problem. When I read the AMA’s recent letter regarding the American Health Care Act, I was disappointed by its failure to address some of the most significant concerns of the physician community. The AMA voiced its opposition to the proposed bill on grounds that it may cause a decline in health insurance coverage. Yet, since when is promoting health insurance the AMA’s top priority? The AMA’s stated mission is to “promote the art and science of medicine for the betterment of the public health, to advance the interests of physicians and their patients, to promote public health, to lobby for legislation favorable to physicians and patients, and to raise money for medical education.”
I fail to see how promoting health insurance is the overriding objective in that mission statement. Rather, I believe the key message is that the AMA must protect the medical profession so that physicians can help America become healthy. Health and insurance are not the same thing. The AMA exists to promote the art and science of medicine for the betterment of public health, not to promote some narrow definition of public health tied inextricably to health insurance. Without physicians, there can be no health care, no health care system, and no reason for the AMA to exist.
In addition to its narrow focus on health insurance, the AMA’s statement fails to communicate the importance of having a physician-led health care system. Across health care, everyone wants to be in charge and play the role of quarterback. No one wants to play the line, defense, or special teams. Various health care professionals are now fighting to become the quarterback — except, of course, those who have realized that there is also money to be made by coaches, managers and franchise owners.
The corporatization of medicine seems to have become more important than the needs of the profession itself, and the AMA seems to be leading the way in encouraging physicians to play an undistinguished role as part of a disjointed health care team rather than serving as trusted leaders. The opinion of the physician community has become just one of many. We are no longer the quarterbacks but part of a conglomerate that fails to properly recognize the unique skillset and intense medical training that sets physicians apart from administrators and other practitioners.
This problem ties back into the AMA’s decision to focus so much of its effort on health insurance. Again, health insurance is not tantamount to health care and certainly not a guarantor of health. Health is not just the absence of disease but also the interplay of lifestyle behaviors that are literally lifesaving and life-enhancing. Unfortunately, this is not how American medicine is taught and certainly not something that can be acquired through a myopic focus on insurance.
How does insurance help a homeless person on the street who does not have food, clothing, or shelter? There are many social issues that need to be addressed to help meet the needs of all Americans. In my opinion, there are three groups of people: Those who want to be healthy and actively participate, those who are thinking about their health and are open to ideas about how to improve it, and those who are disinterested for one of many reasons. It is not the lack of resources but a lack of resourcefulness that contributes to the problems facing this last group.
In order to address the needs of these distinct groups, we need to take a stepwise approach to addressing their problems. By initially focusing on the first two groups, I believe we can improve population health, save lives, and save enough money to help those who are disengaged from the “health care system” as it currently stands.
Furthermore, as we move forward with these efforts, I believe that some of those disconnected individuals in the third group will start looking at health differently and move into the second group. In the end, there will be many more who are engaged in healthy behaviors than those who are not. This will literally save lives across the United States. It will also create jobs, help our planet, and help us find better ways to endow people with proper nutrition, healthier habits, and, as needed, high-quality medical care. This work will not be accomplished by insurers, but by a concerted effort to empower patients and restore physicians as the leaders of the health care team.
The AMA’s statement on the American Health Care Act reports that obtaining insurance for patients is AMA policy. Yes, this is one of many AMA policies but certainly not the only one. There are many policies that help physicians practice medicine and help patients. There are policies opposing scope-of-practice laws that permit non-physicians to practice medicine, policies that support fair payment for medical care, polices on easing the burden of electronic health records, a clear policy stating that physicians should lead the effort to reform our health care system, and many more.
For these reasons, I believe the AMA’s letter on the American Health Care Act was too narrowly focused and prematurely written. If the AMA is to effectively serve as a voice for physicians, it must speak more to the needs of the medical community and leave room to negotiate with elected and appointed officials. The AMA’s decision to swiftly announce opposition to a major health care reform initiative without properly reflecting on the challenges facing the medical profession is a step in the wrong direction.
Corey Howard is an internal medicine physician and chair, Florida delegation to the American Medical Association.
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