As the oldest, largest and most influential national physician organization, the American Medical Association (AMA) is an easy target and sometimes receives a disproportionate share of blame for the ills of the American health care system. It comes with the territory. And while some may criticize the AMA’s historical efforts, our intention is always to promote the best interest of patients and physicians.
However, the author of a recent op-ed in The New York Times really missed the mark when she placed much blame for the failings of today’s health system, regardless of national political dynamics, squarely on the AMA’s shoulders. In her column, Christy Ford Chapin highlights many outdated storylines and incomplete snapshots of not just of the AMA, but the trajectory of health care in America.
Ms. Chapin writes, “the problem with American health care is not the care, it’s the insurance,” and then outlines a selective sketch of the evolution of American health care.
Her piece makes no mention, for example, of employer-sponsored coverage or the amazing advances in medicine, and she certainly overlooks that health care and the systems of care delivery in 1917 are not interchangeable with health care in 2017.
While views on health and health care have certainly changed in society and within the physician community during the AMA’s 170-year history, our mission has been unwavering: to promote the art and science of medicine and the betterment of public health. However, the best way to achieve this mission continues to evolve and change as health care changes.
Health care today includes a robust mix of employer-sponsored insurance coverage, a safety net for the poor through Medicaid, for kids through CHIP, for the elderly through Medicare, and now for the previously uninsured, through the insurance exchanges created by the Affordable Care Act (ACA). Our support for these various programs, including support for the ACA in 2010, is driven by our understanding that people without health insurance coverage live sicker and die younger. This access to care ensures that all Americans receive not just care in case of an emergency, but care to live a better, healthier life.
While we support a choice of options for patients to have public or private insurance coverage, the AMA continues to advocate for improvements that will help patients. For veterans who receive care from the VA, the AMA has pushed for improved access and an end to systemic barriers to care, particularly for men and women who do not live near a VA hospital. For Medicare patients, we succeeded in urging the Centers for Medicare and Medicaid Services (CMS) to cover Diabetes Prevention Programs for Medicare beneficiaries—an outcome that will reduce costs and improve health outcomes.
In terms of maintaining choice and competition in the private insurance market, the AMA recently completed a successful 21-month advocacy effort to oppose insurance mega mergers that would have been a bad deal for patients and harmful for the nation’s health system. In this fight, the AMA won a significant victory to protect patient choice.
The AMA is also shaping the future of health care. We strongly reaffirmed our vision for America’s health system and have opposed legislation that would reduce coverage, threaten Medicaid and undermine important patient protections. We advocate our belief that the patient remains at the center of all reform efforts through the Patients Before Politics initiative.
Because of our collaborative work in improving health outcomes, a quarter million Americans have self-screened for prediabetes in our fight against one of the nation’s most prevalent chronic diseases. Through our work to reinvent medical education, we spearheaded and published a textbook on health system science, which will better prepare our next generation of physicians to meet the challenges of 21st century health care delivery. We support innovation in health information technology that will make digital health work better for patients and physicians.
It is our unwavering commitment to our patients and our profession that called us to lead a national conversation about responsible opioid prescribing. This year, we saw notable progress in this urgent fight, from fewer prescriptions written to better access to the overdose antidote naloxone. The AMA stimulated grassroots pressure to address growing concerns about escalating prescription drug prices through our TruthinRx.org campaign.
The AMA continues to proactively meet the changing needs of patients and physicians, as acknowledged by a longtime reporter and a veteran observer of the AMA, who recently wrote a piece in MedPage Today headlined “AMA, I Hardly Knew Ye,” outlining the numerous ways the AMA has evolved to meet the changing demands of patients and the health care system:
For decades the AMA House of Delegates was a really large old boys club—not ole boys' club because the ‘boys‘ were really old as in they were old enough to vote when Kennedy and Nixon debated in 1960, and that's when the voting age was 21. And those old guys were also white, whiter, and whitest.
I was covering the AMA when it elected its first black president, Lonnie Bristow, and its first woman president, Nancy Dickey.
How much has it changed? ...
… The AMA actually came out foursquare against cutting Medicaid through caps on coverage, including the use of block grants, while at the same time it authorized a feasibility study of a public option for private market insurance. Wowza.
Chapin’s mischaracterization of the AMA and the dynamics that have shaped health care in The New York Times isn’t the first of its kind, and it certainly won’t be the last. But at the AMA today, we are dedicated to thoughtful review of policy proposals, including those on health system reform. We will evaluate these proposals based on policy that is developed by the AMA House of Delegates and guided by our unwavering goal of protecting patients and improving the health of the nation.
