Crusading Editor Led AMA to Urge Insurance for All : Health: Doctor remembered inequities in black charity hospital 40 years ago. He’s called a ‘moral force.’

When the American Medical Assn. issued its historic call for universal health insurance this week, few realized that the roots of the stodgy AMA’s surprisingly passionate plea go back almost four decades--to a dilapidated charity hospital in Mobile, Ala.

There, a part-time orderly named George D. Lundberg seethed at the unjust treatment of blacks. It went against everything his devoutly religious parents from Scandinavia had instilled in him, and the young medical student vowed to do his part to redress the wrongs and indignities that America’s dispossessed endured at the hands of the medical Establishment.

Lundberg was endowed with a keenly analytical mind and, above all, a sense of timing. Those qualities clearly served him well as he coaxed the conservative physicians’ group to call on President Bush and Congress Monday to enact sweeping health care reforms.

The AMA, with Lundberg leading the way, said that it is “no longer acceptable morally, ethically or economically” for 33 million citizens, a third of them children, to live with inadequate or nonexistent health insurance. Lundberg blamed “long-standing, systematic, institutionalized” racism for the fact that a vastly disproportionate number of the uninsured and under-insured are minority members.

As the independent-minded editor of the AMA’s weekly medical journal, Lundberg has repeatedly taken controversial positions, such as crusades against smoking and boxing, that were later adopted by the AMA’s policy-making House of Delegates.

“He’s a moral force at the AMA,” said Emily Friedman, a Chicago health policy analyst. “He’s wanted to do this for a long time,” she added, referring to the call for health care reforms. “He dragged the AMA into this.”

Dr. James S. Todd, the AMA’s executive vice president, confirmed this view.

“He’s taken the AMA beyond where it naturally would have wound up. I admire Lundberg and give him and the AMA credit--as someone who often criticizes them,” said Kevin Grumbach, a San Francisco physician who advocates far more sweeping reforms.

“I’ve tried to be realistic as to the speed and direction with which one can move an organization like this,” Lundberg, 58, said. “It becomes a matter of judging the timing as to when one can take positions on controversial issues and how far one can go.”

The AMA’s challenge to the federal government follows similar calls by many other interest groups, ranging from big labor to conservative think tanks. Still, it is noteworthy that the AMA issued such a call at all.

“It’s extraordinary,” said Robert J. Blendon, a Harvard professor of health policy and management. “It’s the first time in 50 years that the AMA has put itself squarely behind a proposal for a universal plan that addresses a broad range of health concerns.”

However, analysts are quick to note--and AMA officers concede--that it was the growing health care crisis that propelled the AMA toward taking a bold stance.

“Organized medicine was really pushed to make a stand,” Friedman said.

Most Americans have basic health insurance. But the cost of medical care has been soaring--now accounting for 12.2% of the gross national product. And, with no end in sight, more and more people are being squeezed financially or abandoned altogether by insurers.

In addition, employers are experiencing alarming increases in health care costs. According to a bipartisan congressional commission, corporate America’s health spending in 1987 equaled 94% of its after-tax profits, up from about 14% in 1965 and 74% in 1984.

“No specific event” led to the AMA’s call for reform, said C. John Tupper, a Davis, Calif., internist and AMA president. “It was just a general realization that the status quo cannot continue, that the old, customary method of payment had become archaic.”

Lundberg consulted with no interest group or AMA executives before deciding a year ago to devote this week’s entire issue of the Journal of the American Medical Assn. to the health care crisis, featuring about 70 competing proposals for reform. And he persuaded editors of the nine AMA specialty journals to do the same. They highlighted the rare publishing event at a press conference in Washington, calling on the federal government to take action.

“Clearly, they made, as an organization, a very definite decision to devote their influence, clout and resources to becoming a more active player in the process. That’s a very welcome bit of news,” said Tamera Stanton, legislative director for Sen. John D. (Jay) Rockefeller IV (D-W.Va.), chairman of the bipartisan congressional commission, commonly called the Pepper Commission in honor of the late Rep. Claude Pepper (D-Fla.).

The man widely credited with pushing the AMA to call for universal health coverage was born in a Catholic hospital in Pensacola, Fla.--because there was no hospital in the family’s home town of Spring Hill, Ala. His parents, both teachers, were members of the Swedish Evangelical Mission Covenant Church and had fled Sweden to escape religious persecution.

As an undergraduate at the University of Alabama, Lundberg spent Sundays preaching sermons in the local jail. To earn tuition for the Medical College of Alabama, he sold Bibles and worked as an orderly at an all-black hospital.

“That was still a completely segregated South then. Caring for the poor was an all-day, everyday, event,” Lundberg recalled. “So my background has been one of intense immersion in all this.”

Lundberg spent two decades in California, first as an Army pathologist at the Presidio in San Francisco and then at USC from 1967 to 1977 as a professor. Later, he was chairman of the department of pathology at UC Davis, whose dean was John Tupper--the man who stood with Lundberg under the hot television lights at the Washington press conference Monday.

Lundberg is in his 10th year as editor of the AMA Journal, which has become a provocative magazine that is often the talk of the medical world--and beyond. “He wants (the Journal) to be a force for change,” Friedman said.

In 1987, Lundberg started a “Caring for the Poor” column as well as other socially aware features, often running and rerunning certain pieces every year between Thanksgiving and Christmas.

Lundberg has undisputed editorial control of the Journal. But he is well aware that all but one of his 13 predecessors were dismissed or left the job under fire. “And I assume I’ll meet that fate also,” he said with a laugh.

In the meantime, Lundberg intends to speak his mind and pull no punches.

Profile: George D. Lundberg Born: March 21, 1933

Hometown: Spring Hill, Ala.

Education: B.S., University of Alabama, 1952; M.D., Medical College of Alabama, 1957

Career highlights: 1967-77 professor at USC Medical School and director of labs, L.A. County-USC Medical Center; 1977-82, professor and chair of pathology, UC Davis; since 1982: editor-in-chief, Journal of the American Medical Assn.