Does the AMA matter in the health care debate? Congress is beginning to have its doubts, despite the medical association's deep pockets and platoons of lobbyists.
It's lost its principles, some lawmakers and physicians say. Perhaps more damaging: It can't produce votes.
After a humiliating defeat in the Senate, the venerable American Medical Association faces a revolt from both its member doctors and one-time political allies as it struggles to influence an overhaul of the nation's health system.
The group had pinned its hopes on winning a $247 billion, 10-year reprieve from scheduled reimbursement cuts for physicians who treat Medicare patients in return for supporting the White House push for broader changes in health care coverage. When the pay boost was sidetracked last week in the Senate, it undercut the doctors' leverage — just as final negotiations on the broader health bill intensify.
"I can't think of a more ineffective organization when it comes to dealing with Congress," said Sen. John Cornyn, R-Texas, who has tangled with the group in the past. "The lesson I've learned ... is if you agree to fix their compensation, they will basically get in the tank with their natural adversaries."
Democrats aren't as harsh, and they still fear alienating the doctors lobby. But Senate Majority Leader Harry Reid strongly suggested the group had failed to deliver on a pledge of lining up enough votes to pass its high-priority pay rate legislation. "I had been told" they had several Republican votes, he said — votes that didn't materialize.
The AMA's president-elect, Dr. Cecil Wilson, said the group had made no such promises but merely pointed out that many GOP senators had backed similar legislation in the past. The setback followed the AMA's airing of what it said was $1 million worth of television ads in targeted states, designed to bolster support for the bill. It failed because of bipartisan concerns that it would raise federal deficits.
Wilson defended his group's lobbying strategy, saying it has done what's best for doctors and patients and fought successfully to keep its seat at the table during sensitive negotiations with President Barack Obama's team and key Democrats on the final health overhaul.
"We deliberately chose a strategy which said the best way to get health system reform in this country was for us to provide constructive leadership, to work with the people who were writing the legislation as well as the Obama administration," said Wilson, who stressed that the AMA hasn't decided yet whether to back the final health measure.
In the process, though, some doctors say the group has been willing to sacrifice what many of them consider crucial priorities: placing new restrictions on medical malpractice lawsuits and fighting any proposal that hands the government more control over how doctors practice and earn money. The AMA irked many members by deciding earlier this year to endorse a $1 trillion-plus plan by House Democrats that contained the pay raise but no malpractice limits and included the so-called public option for government-run insurance.
"The AMA is not as strong as they think they are — that's the bottom line," said Bob Feldtman, a cardiovascular surgeon in Dallas. He said the group has sacrificed crucial leverage in its intensive push for doctors' pay. "It's a sellout to whatever the Obama health care plan is," he said, "and the problem with that is, we don't know what that's going to be."
Next weekend, a dissident group of medical specialty societies and state delegations plans to try to force the AMA to drop its support for the health overhaul through a resolution that calls the legislation crafted so far "anathema to doctors and patients." The resolution, to be considered at a semiannual AMA meeting in Houston, calls on the group to oppose any deal that includes a public option, among other items, or one that doesn't contain malpractice changes.
"You always gain respect when you take a position on principle and don't try to do what's politically expedient at the moment to get a short-term gain. You always lose it when you don't," said Dr. Donald Palmisano, a former AMA president and current member who says the association has miscalculated in the health overhaul negotiations. "The short-term gain of getting more money without getting any promise of reform is not a victory."
The AMA has traditionally aligned itself with Republicans and filtered the majority of its sizable political contributions to the GOP, but last year it switched allegiances, devoting slightly more than half of the $3.3 million its political action committee spent to electing Democrats.
The organization's political giving is closely tied to the fate of doctors' pay. After Cornyn cast a procedural vote last year against legislation to reverse the cut, the AMA, which had endorsed him in his re-election campaign, quickly yanked its support. Then when the Texas Republican ultimately voted for a final version of the bill, the association offered its backing again. Cornyn, according to senior aides, angrily responded that he'd rather do without it.
When AMA president Dr. J. James Rohack approached Cornyn last week outside the Senate chamber asking for his vote, the senator tartly refused, then turned on his heel and went to cast his "no" vote.
The association is hardly the only health care lobby that opted to try to strike a deal with Obama and Democrats on the health overhaul instead of fighting it outright; insurers, hospitals, drugmakers and others have done the same, with varying degrees of success. The AMA has spent more than $32 million lobbying Congress in the last two years.