The American Medical Association, the nation's largest doctors' group, is wary of President Barack Obama's call for public health insurance. It doesn't want government meddling in their jobs.
But these days, most doctors aren't members of the AMA, and just how much that body can sway Obama's health reform efforts will be a test of its once mighty clout.
Representing barely one-fourth of the nation's physicians, it's tough to call the AMA the true mouthpiece of American medicine.
Yet despite its bleeding membership and stodgy image, the AMA remains the nation's largest, most visible group of doctors. It still spends large sums of money on efforts to shape national health policy.
The group's 500-plus policy-making delegates, along with the hundreds of thousands of physicians around the country who aren't members, will be listening closely Monday when Obama comes to Chicago to explain why doctors should support his health reform plans.
"They are the only face of organized medicine. Their meeting is giving the president an opportunity to speak to physicians both organized and unorganized," said Paul Ginsburg, president of the Washington-based Center for Studying Health System Change.
Current health system is ailing
At the AMA's annual meeting in Chicago, Obama will "lay out plainly what health care reform will mean for American families and their doctors and what it won't," said White House spokesman Robert Gibbs. "He'll make clear why we can't afford to wait another year or another administration to bring down costs that are crushing families, businesses and government."
AMA's leaders agree that the nation's health system is sick. But the group has long opposed government intrusion into health care and believes reform can be achieved by revamping private health insurance plans.
Dr. Nancy Nielsen, AMA's president, says the group wants details on Obama's proposal for a public health insurance plan to compete with private plans.
In a written statement Thursday, she said the AMA "opposes any public plan that forces physicians to participate, expands the fiscally challenged Medicare program or pays Medicare rates."
But, she added, the AMA "is willing to consider other variations of a public plan that are currently under discussion in Congress."
In an interview with The Associated Press on Wednesday, Nielsen sounded more conciliatory than combative. She said AMA shares Obama's concern "that we need to have comprehensive health care reform" that offers everyone affordable, high-quality health insurance.
The AMA has long been a visible presence in Washington, lobbying mostly for things like improving Medicare payments to doctors and other pocketbook issues affecting members.
Federal Election Commission data show that between 2000 and 2008, the AMA's political action committee contributed nearly $11 million to federal candidates and committees, an FEC spokeswoman said Thursday.
Mixed track record
But the AMA's track record on shaping national health policy is mixed.
It vehemently fought the creation of Medicare and succeeded in delaying its debut decades ago. But even though "AMA was a much more powerful organization back then," it was unable to overcome overwhelming public sentiment on the need to insure the elderly, Ginsburg noted.
Public sentiment now strongly favors major health reform, so the AMA may be willing to compromise.
Dr. Aaron Carroll, director of Indiana University's Center for Health Policy and Professionalism Research, predicts the AMA "won't fight as hard as they have in the past."
Carroll co-authored a study published in Annals of Internal Medicine last year that showed broad support among U.S. physicians for government-sponsored health insurance. That report on 2,000 randomly surveyed doctors found almost 60 percent supported some form of national health insurance.
Carroll is a member of Physicians for a National Health Insurance Program, a group that favors a single-payer plan, which is opposed by the AMA. But the survey was conducted independently as part of his work at the university.
In a Thursday visit to Green Bay, Wis., to promote his health reform efforts, Obama said a single-payer plan would have some appeal. But he stressed he's not endorsing nationalized health care, and in earlier comments Obama has called that approach impractical.