Campaigning to build the widest possible consensus for reform of the nation’s health care system, Barack Obama told the delegates of the American Medical Association that he wants their support, too. Persuasive and always polite, the president did not mention the embarrassing truth about his hosts—namely, that the A.M.A. has undermined universal care with mindless zeal for more than 70 years.
The real question is not what the A.M.A. will support or whether the attitudes of the A.M.A. have changed, but why anyone would still heed its policy prescriptions. Very few national organizations have been so wrong for so long about the matters most salient to its own members.
The A.M.A.’s sad history dates back to the Depression of the 1930s, when progressive doctors sought to organize themselves into the first health cooperatives, or health maintenance organizations, so that they could provide care to working families under a group plan. Seeing a threat to its own power, the A.M.A., in a blatant antitrust violation, prohibited members from working for those early health maintenance organizations.
During the decades that followed, the A.M.A. dedicated millions of dollars to stopping universal health care in the United States, even as other developed nations were establishing a variety of successful systems that covered every citizen while holding down costs. This was an obsession that the organization shared with political forces on the far right. When President Harry Truman proposed a national health plan in 1948, the A.M.A. unleashed a red-baiting fury.
In The Culture of the Cold War, Stephen J. Whitfield recalls how the A.M.A. vowed to “resist the enslavement of the medical profession,” warning that Truman was attempting to impose “a monstrosity of Bolshevik bureaucracy” on America. In pamphlets issued to fight the Truman plan, A.M.A. publicists included a phony quote from Lenin proclaiming “socialized medicine is the keystone to the arch of the Socialist State.” The same pamphlets smeared supporters of Truman’s “compulsory health insurance” plan by connecting them to the Communist Party.
Having killed Truman’s bill, the A.M.A. continued to amass enormous amounts of money for what historians say was the most massive special-interest campaign in American history from the beginning of the republic to that time. Among the darkest episodes was its opposition to free government-sponsored distribution of the Salk polio vaccine, which the A.M.A. and its extremist allies regarded as yet another step toward socialism. That plan, too, was killed, depriving millions of children and adults of critical care during a national epidemic, in an act that amounted to a lobbying violation of the Hippocratic oath.
When John F. Kennedy began to work toward a national health system in 1962, the A.M.A. again mounted a costly and clever opposition campaign, whose estimated cost reached $50 million—a lot of money in those days.
It was a stealth effort, known as Operation Coffee Cup, that relied on doctors’ wives to spread a propaganda message, taped by Ronald Reagan, among their friends and neighbors. As always, the rhetoric was hot. National health insurance would destroy “the sacred relationship between doctor and patient,” and even “the sanctity of human personality.” Doctors would be “regimented and made subordinate to the bureaucrat, and the people forced by law to accept such medical care as could be provided by a politically appointed bureaucrat.”
The A.M.A. finally met defeat in 1965, when President Lyndon Johnson and a bipartisan coalition in Congress succeeded in passing Medicare. By then, public support for national health insurance had swelled, leading to a massive repudiation of right-wing ideology and the Republican Party in the 1964 election. Indeed, many Republicans realized that their party’s adherence to the A.M.A.’s rigid opposition had led to their catastrophic electoral failure.
That lesson was lost on the A.M.A., whose delegates soon elected a daffy far-right doctor employed by oil billionaire H. L. Hunt as their president, with a mandate to wage total war against Medicare. The organization has continued to fight reform even until now, helping to kill plans proposed by every Democratic president.
The A.M.A. is like a company union that pretends to represent employees while always protecting the interest of the boss. The result is that American doctors find themselves at the mercy of corporate insurance bureaucrats—and that most of them no longer belong to the once-venerable organization that purports to speak for them. If the A.M.A. truly supports reform this time, as its leaders have announced, then it must abandon its historic subservience to corporate medicine. These physicians are long overdue to heal themselves.