The AMA has long oppossed any federal regulation of physician payments and billing. In fact the medical establishment has rebuked outside regulation and control for over a century. We are probably the only industry to completely regulate itself on nearly every level. Maintaining this self-control has been a major priority for the medical industry throughout American hisory.
When Truman tried to establish Medi-Care it was effectively blocked until the 1960’s, primarily by the American Medical Association (AMA). There was a very public campaign comparing government insurance to socialism and communism coinciding with, and likely accelerating, cold-war sentiments. The AMA even opposed private insurance when it began to emerge in the early 1900’s. It wasn’t until the depression left many patients unable to pay for medical services that doctors began accepting insurance routinely. Anything that comes between patients and doctors has been traditionally viewed as a threat to physician autonomy, especially third parties who come between physician’s and their payments.
When congress finally passed the medicare act it did so with the AMA fighting tooth and nail, openly threatening to boycott the program. This anomosity is largely responsible for the inefficiencies and run-away costs Medi-Care and Medi-Caid are known for. Without constructive input and collaboration from the largest and most influential medical society significant flaws and run away costs were inevitable. In an attempt to appease doctors and convince them to participate in the program Medi-Care initially paid doctors almost anything they asked for, while doctors routinely doubled or tripled medical service fees when when billing Medi-Care. At first there was nothing the governement could do but pay the bills as asked because doctors were needed for the program to survive. Eventually Medi-Care began to cap payments and to set prices for physician services, so the next generation of doctors began feeling the squeeze, which has become tighter and tighter with each passing year.
At this point the AMA is still trying to close the fence when the horse has been out for 40 years. As a matter of fact, the fence was poorly constructed in teh first place becasue the AMA would not help with its construction. As a physician who cares for a substantial number of Medi-Care patients already, I would prefer the AMA focus on finding and supporting the best plan out there. The bridges built in this process may be used in the future to modify whatever program is established, over time, to better suit everyone’s needs. It is time we break the long established tradition of oppossing any program that lacks perfection.