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American Medical Association

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The American Medical Association (AMA) is the largest association of medical doctors in the United States. Its purpose is to advance the interests of physicians, to promote better public health, to lobby for medical legislation, and to raise money for medical education. The AMA also publishes the Journal of the American Medical Association (JAMA), a prestigious medical journal. It also runs the SAVE program, which stands for Stop America's Violence Everywhere.

Contents

Political positions

For much of the twentieth century, the AMA opposed publicly funded medicine. In the 1930s, it attempted to prohibit its members from working for the primitive health maintenance organizations that had sprung up during the Great Depression; its subsequent conviction for violating the Sherman Antitrust Act was unanimously affirmed by the U.S. Supreme Court. American Medical Ass'n. v. United States, 317 U.S. 519 (1943). Its vehement campaign against Medicare in the 1950s and 1960s included the Operation Coffee Cup supported by Ronald Reagan. After the enactment of Medicare, however, the AMA has stated that it "continues to oppose attempts to cut Medicare funding or shift increased costs to beneficiaries at the expense of the quality or accessibility of care" and "strongly supports subsidization of prescription drugs for Medicare patients based on means testing". The AMA also campaigns to raise Medicare payments to physicians, arguing that increases will protect seniors' access to health care. In the 1990s it was part of the coalition that defeated the health care reform proposed by President Bill Clinton.

The AMA has given high priority to supporting changes in medical malpractice law to limit damage awards, which, it contends, contribute to rising health care costs. In many states, high risk specialists have moved to other states with such limits. For example, in 2004 not a single neurosurgeon remained in the entire southern half of Illinois. The main legislative emphasis in multiple states has been to effect caps on the amount that patients can receive for pain and suffering. These costs for pain and suffering are only those that exceed the actual costs of healthcare and lost income. Multiple states have found that limiting these costs have actually dramatically slowed increases in the costs of medical malpractice insurance.

Criticisms

Economist Milton Friedman (1979) argues the AMA limits the supply of physicians in order to raise physicians' wages. It does this through State government licensure of physicians and schools, as only physicians are generally regarded as qualified enough to judge potential physicians. Since less than 1% of physicians are denied states licenses, this has little effect on the supply of physicians. Since the number of medical students is highly controlled by the funding provided by the federal government for medical education, this is the most important limitation in the supply of physicians. State licensing boards are primarily composed entirely of physicians, who are generally members of the AMA. License revocation means not only loss of the doctor's livelihood, but a devastating blow both socially and professionally. The good news is that very few physicians ever lose their license, and those that do lose their licenses are generally guilty of extremely egregious offenses.

Critic Dale Steinreich, PhD, contends that the goal of the Council on Medical Education in 1904 was the shutting down more than half of all medical schools in the country (resulting in fewer doctors and thus higher fees). He also states that while there is nothing necessarily wrong with the seemingly high rejection rates found at most medical schools, that they are unreasonable given the relatively high quality pool of applicants. US medical schools graduate only 65% of the number of graduates needed to fill the existing medical residency slots. The remainder of these slots are filled by graduates of international medical schools. This means that the US medical school student population could increase by 50% without any effect on the numbers of physicians available to deliver care to the public. However, there would be significant cost to the US government to fund these additional slots in medical schools.

Henry E. Jones, MD notes that American's annual cost per capita for health care ($4,662.00) is nearly double that of health care in other countries and quality is not necessarily higher: American life expectancy is 42nd in the world, infant mortality is 37th, and about 100,000 patients die in U.S. hospitals each year from accidental injuries, medication errors, and adverse drug reactions (equivalent to two major airline crashes per day).

Jones contends that the high cost is primarily due to the AMA. If an MD feels competition from the local chiropractors, a naturopath, or a fellow MD of a different specialty infringing on his turf, he may complain to the AMA. A surgeon might complain of a general practitioner doing surgery or an obstetrician may complain about a family physician delivering babies. Jones argues that these complaints are reconfigured into safety concerns, such as "we are concerned that some in the chiropractic profession may be overstepping their areas of expertise and jeopardizing patient safety." If the targeted healthcare providers do not have a license to practice medicine from the AMA-controlled medical boards, the state attorney generals prosecute them for "practicing medicine without a license." If the group is licensed by the medical board, then its members are accused of practicing "below the standard of care." License revocation means not only loss of the doctor's livelihood, but a devastating blow both socially and professionally. Few physicians will go anywhere near that possibility.

References

  • Friedman, Milton & Rose (1979). Free to Choose. New York: Harcourt Brace Jovanovich. ISBN 0-15-133481-1.
  • Steinrich, Dale (2004). 100 Years of Medical Robbery. Ludwig von Mises Institute. [1] (http://www.mises.org/fullstory.aspx?control=1547&id=69)
  • Jones, Henry (2005). How Medical Boards Nationalized Health Care. Ludwig von Mises Institute. [2] (http://www.mises.org/fullstory.aspx?Id=1749)

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