Why the AMA Is Selling Us Out

We shouldn’t be surprised that the American Medical Association has come out against government-sponsored insurance plan. The AMA these days has many concerns other than medicine. It is a main proponent of “tort reform,” a vast right-wing conspiracy to enhance corporate profits by denying citizens’ 7th Amendment rights to sue for damages in court.

Although it still pretends to be the voice of American physicians, in fact it has been losing membership steadily for the past several years. The most recent information I could find says that about a third of American physicians are members. It has struggled financially with dwindling membership dues.

The AMA and the American Council of Engineering Companies are co-founders of the American Tort Reform Association (ATRA), which has turned into an umbrella group of special interests and astroturf organizations pushing for tort reform legislation. The ties of “tort reform” to the Right, via Karl Rove, are legendary.

Take, for example, the organization Citizens Against Lawsuit Abuse (CALA), which has chapters in several states actively pushing “tort reform” to state legislatures. According to SourceWatch, CALA is an astroturf organization commissioned by the Philip Morris tobacco company in 1995, and Philip Morris continues to fund and direct CALA through ATRA. SourceWatch says,

A “privileged and confidential” Philip Morris (PM) tort reform budget from 1995shows that PM spent over $16 million to instigate tort reform during that year alone, and that PM paid an international public relations firm called APCO & Associates (now known as APCO Worldwide) almost $1 million in 1995 to implement tort reform efforts behind the scenes.

ATRA promotes CALA on its website (scroll to bottom) as

… citizen activists fed up with the high cost and injustice in our legal system. They work actively within their communities to urge individual responsibility, safety, and to chronicle abuses of the legal system and to fight for civil justice reform.

Yeah, right.

It is ironic that the AMA, which 20 years ago stood up to the tobacco industry by calling for a ban on tobacco ads, is now in bed with it. They’re shacked up in a shabby off-the interstate motel hoping no one finds them, but they’re in bed just the same.

23 thoughts on “Why the AMA Is Selling Us Out

  1. Read Dr Chris McCoy’s “I Quit” letter to the AMA on CommonDreams, just posted today. Excerpt:

    …when health care reform has been necessary, the AMA has always stood on the wrong side of history. The AMA opposed the creation of Medicare in the 1930s, when it was first proposed as part of Social Security. The AMA opposed Medicare again in the 1960s, going as far as to hire an actor named Ronald Reagan to read a script to the AMA Auxiliary declaring Medicare as the first step toward socialism, and concluding with the statement that if Medicare were to become law, “One day, we will awake to find that we have socialism…. One of these days, you and I will to spend our sunset years telling our children, and our children’s children, what it was once like in America when men were free.”

  2. I have a friend who feels good about the plan if the AMA is against it. He thinks its a good sign.

  3. I’m actually something of a fan of a little bit of tort reform. I mean, should a guy be able to sue both Lawn Boy and Lowes because his lawn tractor didn’t have a warning label that said “do not use to cut hair”? I guess maybe it’s too difficult to write “must pass the laugh test” into legislation, but there are in fact a lot of frivolous lawsuits, and they do in fact raise costs for the rest of us.

    The AMA’s agenda is simple: they’re trying to reduce their malpractice premiums. It’s not a bad goal, actually, but they might want to consider doing it by reducing actual malpractice rather than tampering with my right to sue for damages when actually harmed.

    As to public health care, they’re worried that the government is going to drive down their fees. Maybe if they’d keep their lobbying $’s in their pocket, they wouldn’t have to worry so much…

  4. Couple of edits needed: Citizens for Against Lawsuit Abuse (4th paragraph).

    ban on tobocco tobacco ads (final paragraph)

    I wonder how much the increase in tobacco taxes has inflamed right wing rage. Nicotine withdrawal can be pretty stressful, and the price of a pack went up $0.60 on April 1. Hmm, teabaggers might have had more traction if they’d been protesting tobacco restrictions.

  5. Dave S.

    “I guess maybe it’s too difficult to write “must pass the laugh test” into legislation, but there are in fact a lot of frivolous lawsuits, and they do in fact raise costs for the rest of us.”

    That is what judges and juries are for, to decide whether a lawsuit is frivolous (do you believe in our justice system?). If the AMA ,the business roundtable, and the Chamber of commerce have their way you wouldn’t be able to sue a doctor for cutting off the wrong leg, you couldn’t sue McDonalds for poisoning you (although they do on a lower level everyday), you wouldn’t be able to sue for anything. Tort reform is code for screw the working man, screw the middle class. It is code that the right uses to avoid saying what they know would be objectionable to most, like reverse racism is code for: “minorities are lazy and want a handout”. What raises the cost of healthcare is the for profit mostly unregulated system that we have today. A system that forces 40+ million to use emergency rooms as a doctors office. 40 + million people that don’t have any preventative care, that’s what raises healthcare costs.

  6. Dave S –

    I have an idea on tort reform. When 2 parties have a disagreement about an injury, we will get a group of disinterested regular people, maybe from a pool of registered voters, and we will take this panel and have them hear both sides of the argument, in like a closed room – with witnesses.. and just let them decide. We could call it a jury trial – what an IDEA!.

  7. There are all kinds of independent studies (i.e., not funded by corporations or insurance companies) that show the number of genuinely frivolous suits is very small. The Right has pushed a lot of propaganda about frivolous suits, often by editing the facts of legitimate suits and making them sound ridiculous, then sending the goons out to talk about them in media.

    This isn’t to say that the system isn’t often abused, but most juries don’t hand out big damage awards unless the facts of the case merit the awards.

  8. I think the AMA talks about malpractice because they feel it drives some unnecessary procedures through an ass covering dynamic.

    If I go in for a broken arm I probably should just get an Xray and a cast. I’ve heard anecdotes of broken arm patients getting blood work, etc… Maybe it is just BS, a jury should know better than to demand an ER physician detect liver cancer when the patient has presented a fracture.

    There is some evidence that CYA does add costs to medical care. This article at the New Yorker bears on it at the margins.

  9. wmd — that’s the excuse, but in reality when reforms are put in place that reduce lawsuits nearly to zero, nothing changes. Health care costs do not go down. The same procedures and tests are still ordered. Malpractice insurance usually does go down after tort reform, but the cost savings are not passed on to the health care consumer. If anything, the New Yorker article you cite pretty much confirms that a lot of other stuff than CYA is behind the extra costs.

  10. I read about a study on malpractice suits quite some time ago in The Washington Post before it became such a rightwing rag. The conclusion was that most malpractice suits came from the upper middle class and the very rich; thus, malpractice suits by lower middle class and the poor seldom are brought against doctors. I thought that was an interesting finding and have wondered if any more studies have been done.

    On a more pleasant note, I thought the story today about Obama giving a young girl in Green Bay an absent-from-class-note to be really cute. The young girl’s name is Kennedy. Even the Bushies couldn’t have choreographed something that funny. The story is at the following website: http://blogs.wsj.com/washwire/2009/06/11/obama-pens-a-notable-excuse-for-10-year-old-student/

  11. Canada is a much less litigious country than the States. Usually, that’s a good thing although I can think of an extremely incompetent ob-gyn who wreaked a lot of havoc in southern Ontario for much too long before being stopped. He no longer practices, but I can’t remember if he was sued, much less to within an inch of his life.

    I think what happened to me in 2003-2004 is an interesting example of how NOT suing can be the right thing.

    I had a hip replacement in 2003. My surgeon had an international reputation and was always surounded by a coterie of foreign students who came to learn at the master’s feet. During the surgery, the surgeon broke my femur. It’s something that happens, though it is fairly rare. Normally, outcomes are just fine, though it takes a bit longer to heal.

    Very long story short: When it became clear that I was not healing properly, Dr. God immediately told me that I was not imagining anything and that something was indeed wrong; he apologized to me profusely IN FRONT OF ALL HIS STUDENTS, and said he would re-operate and correct the problem–which he did.

    It was not an experience I would wish on anyone, but believe me, I was much happier having a healthy life back, than being a few million dollars richer.

    It’s hard to sue in Canada, but at least in my experience, it makes the docs more honest and willing to correct their mistakes.

  12. In my day job, I work a lot with personal-injury lawyers, manufacturing-defect situations, and theories of liability. First, I’ll state the obvious: lawyers really, really, really want to make money. Second, unless there’s a likely chance that they’ll be defending against a countersuit, most personal-injury lawyers accept clients on a contingency basis. They have to obtain a settlement for their client in order to make any money for themselves. If a potential client comes in the door with a complaint that doesn’t pass the “laugh test,” very, very few lawyers would agree to represent the client.

    Corporations like Lawn Boy and Lowes have vast economic resources, compared to your average workaday idiot who misuses a product and is injured by his or her own stupidity. Nine-point-nine times out of ten, if a corporation is on the receiving end of a “frivolous” lawsuit, they’ll let it go to trial, and they won’t be sorry. The corporation wins, and they’ve established case law that essentially closes the door on future “frivolity” for the same cause.

    Remember the faux-example of “Little Old Lady v. McDonald’s Coffee”? That case is an urban legend of “frivolous lawsuits.” Before that case was decided, McDonald’s had been warned many times not to be serve its coffee at a scalding temperature. Many customers had been scalded before “Little Old Lady” was, in fact, seriously injured. (Have you ever noticed, too, how those cheap, crappy beverage lids at drive-thrus never stay on? Ounce of prevention, or pound of cure? It costs so little to make those lids safe.) A jury awarded “Little Old Lady” a ridiculously high sum, which the judge immediately and drastically reduced. Of course, McDonald’s appealed anyway. In the end “Little Old Lady” got very little, and McDonald’s learned a valuable lesson: it can lose in court and still win in public opinion, because people are lazy and don’t bother to check the facts.

  13. Canadian Reader: wow, your Dr. God was a benevolent Dr. God. I can’t imagine any of the U.S. surgeons I’ve ever met doing what yours did.

  14. I predict that malpractice insurance is going up very shortly, if they haven’t already begun raising rates for the year. Insurance companies take a portion of every premium and invest it in things like real estate. (Supposedly this helps to keep rates lower.) With all the real estate problems of late, I’d say their profits are down and they must make them up. (Insurance companies never accept losses, you know.

  15. That New Yorker article points out that Mayo Clinic has a care paradigm that provides better care at lower cost, while for profit medicine has some CYA drivers. That’s what I mean by the article being relevant at the margins.

    If we could get more clinics using the Mayo/Grand Junction processes… a lot of cost could be driven out of the system. Of course wingnuts will talk about government interference in the practice of medicine.

    I duplicated the link – I think the article is well worth commending to a wide audience. (h/t baseline scenario)

  16. wmd — take a look at the New Yorker article again and read the part in which the author has dinner with a group of doctors in McAllen. When the author asks why health care is so expensive, one of them blames the tort system. But Texas has passed several sweeping tort reform laws, the last in 2003, that have made filing malpractice suits extremely burdensome, to the point that only the most blatantly obvious circumstances of malpractice are being taken to court.

    The author points this out, and the doctors admit that malpractice litigation has dropped to just about zero. Then the doctors grudgingly admit that the reason they order all the extra tests and procedures is NOT CYA, but that they make more money doing so.

    And from there the author goes on to make the case that not-for-profit hospitals and medical groups tend to have both lower costs and better outcomes, and this is in part because physicians either get no extra income from ordering extra stuff, or else the local medical community actively discourages ordering extra stuff.

    It’s also worth noting that in the past 20 years or so more than half of the states have enacted some kind of tort reform to curtail malpractice and other personal injury lawsuits and cap the amount of damages juries can award. The cost of health care is not affected at all by these measures. The cost of health care continues to increase at the same rates as in non-tort reform states. In the case of Texas, it has increased faster

    We need to get over the idea that malpractice litigation is a factor in rising cost of health care.

  17. uncledad — you’re not in the twit filter. The anti-spam system sometimes filters comments for reasons I do not understand.

  18. The doctors grudgingly admit that it isn’t CYA. Grudgingly being a key word – they have internalized that they have to CYA because of fear of lawsuits. When they have it dragged out of them that this doesn’t hold water they’ll cop to it… soon after they will be back to knowing they have to order the tests or be sued.

    Changing the (profit) incentives for added tests is needed. I’m not very sanguine about change happening fast, I think that absent incentives to order extra tests there still will be cultural inertia to order them, as well as the aforementioned internalized CYA message.

    BTW, thanks for engaging on this. That article helped me go from half baked ideas about where the problem lies into a somewhat deeper understanding. Obviously. The message that the Mayo clinic delivers higher quality care at a lower cost, why can’t we restructure health care more towards their model is a winner (and Obama picked up on it). It is worth repeating – the Mayo clinic has a deservedly good reputation and the surprise that they are low cost can help overcome the sense that health care is politically intractable.

  19. soon after they will be back to knowing they have to order the tests or be sued

    But that’s not something they “know,” it’s an excuse for their own bad behavior. Eliminating the threat of litigation doesn’t cause them to stop ordering extra tests. There is some old data taken with very limited sampling that argues physicians in “unreformed” states order more procedures than those that don’t, but there is other, more recent data that refutes that, and shows there is no reliable correlation between state tort law and physician practices.

    When physicians are surveyed they often claim that X percent of their tests are ordered for CYA purposes, but their actual behavior doesn’t bear that out. And this is an important point, because the “defensive medicine” myth is a major part of the Right’s argument that (1) health care can be “reformed” and remain private and for-profit; and (2) personal injury litigation in general is bad for business and needs to be stopped, 7th Amendment be damned. It’s very important not to give these arguments legitimacy.

    There’s a website maintained by Americans for Insurance Reform that has some good information and is worth checking out —


  20. … grudgingly admit that the reason they order all the extra tests and procedures is NOT CYA, but that they make more money doing so.

    I’m imputing physician’s mental constructs when I say physicians will “know” they have to order tests for CYA purposes. I believe that doctors want to feel they act altruistically, knowing that profit is driving their decisions is a hard lesson to internalize. I think that for profit doctors will fall back on disproved rationales for their behavior so they can feel good about that behavior.

    I’m not saying it (the rationale) is legitimate, just that I see it as something to overcome.

    The Mayo model uses team case review to arrive at healthy outcomes at lower costs. If a test isn’t needed other physicians speak up and reduce the waste. Peer esteem is a good motivator, the crux is getting peers that are concerned with healthy outcomes at low cost. In McAllen it seems that peer physicians value profit most.

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