When the real negotiations begin on President Clinton's health care plan, the American Medical Association will be at the table. The days of semi-exclusion when Hillary Rodham Clinton's massive task force was getting down to work are over. Now that the issue is moving to Capitol Hill, members of the House and Senate will be listening closely to what the AMA has to say. It is the nation's second largest dispenser of campaign funds: $2.94 million in 1992. With a membership of 297,000 doctors, it is triple the size of any competing physicians groups and its dues-payers have clout back home.
So the AMA matters even if it is not quite so dominant as it once was. In the 1930s, it blocked Franklin D. Roosevelt's health-insurance proposals. In the 1940s, it demolished Harry S Truman's national health program. In the 1970s, it blocked Jimmy Carter's hospital containment measures.
Just as the medical profession has changed profoundly over the years, so has the AMA. Today it accepts major tenets of the Clinton plan while raising strong objections to features it fears would interfere with the "freedom" of doctors and patients, hobble a physician's ability to earn what the AMA thinks he deserves and "lead to federal control of medical education and the physician work force." But the operative word is "compromise." It comes early in the game, and it augers well for reform of a system that all sides agree needs fixing.
On what do the AMA and the White House agree? On universal access to a system that guarantees medical care for all citizens. On a package of basic benefits for everyone. On a mandate for employers to provide health insurance for every employee. On setting insurance premiums at rates based on the medical experience of entire communities. On coverage for those who change jobs or have "pre-existing" medical problems. On elimination of massive red tape and paperwork.
These are crucial goals for successful health reform. They reflect the AMA's acceptance of a larger role for government in contrast to its earlier assaults on anything smacking of "socialized medicine." By backing an employer-based system, the medical group even finds itself closer to the administration plan than to rival Republican proposals.
Still, there are key aspects of the Clinton plan that render it presently unacceptable to the AMA. The group dislikes the notion of a super-powerful National Health Board. It opposes global budgets it fears would limit payments to health care providers while letting demand for medical services grow unchecked. It is concerned that proposed alliances of insurers and health care organizations would limit choice for patients and physicians.
How the competing ambitions of all those involved in the health care debate will be reconciled is a mystery. But the Clintons have the nation's attention. Because the AMA shares the general expectation that some major reforms will be enacted before next year's elections, the most recognized voice for American medicine is sure to be heard.