AMA Backs Away From Employer-Mandated Insurance : Medicine: Vote by rank-and-file doctors deals a blow to Clinton reform plan. The action reflects a sharp disagreement within the medical Establishment.
The American Medical Assn. dealt a blow to President Clinton’s health care reform proposal Tuesday, retreating from its earlier unequivocal support for a central element of the plan: the requirement that all employers provide health insurance for their employees.
The decision by the House of Delegates, the AMA’s 435-member policy-making body, reflected a sharp ideological disagreement within the medical Establishment over how best to provide health insurance coverage for all Americans. The AMA leadership clearly supports an employer mandate, but many rank-and-file doctors--particularly from Southern states--do not.
While the AMA did not completely reject the idea of an employer mandate, it significantly weakened a previous policy statement adopted in December, 1989, that expressed unqualified support for the concept. Under the new policy, the AMA would require health insurance coverage for all Americans, either through employer-provided or individually purchased plans.
Despite the potential importance of the AMA decision for the Administration, Clinton declined an invitation to address the meeting. A White House spokesman said that the decision does not reflect any dispute with the AMA, adding that the President wanted to honor a previous appointment with the prime minister of Spain.
The new policy effectively distances the nation’s dominant, 290,000-member physicians organization from the Clinton proposal. It also gives encouragement to Republicans and conservative Democrats in Congress who have vowed to oppose any legislation mandating that employers provide health insurance.
Lonnie R. Bristow, a San Pedro, Calif., internist and chairman of the AMA board, acknowledged that the AMA membership probably would have rescinded outright the organization’s support for an employer mandate if the leadership had not proposed a compromise endorsing both approaches.
Of all the major proposals for health care reform now before Congress, Clinton’s is the only one that would require all employers to help pay for their employees’ health care. Opponents of the employer mandate argue that it would bankrupt many small companies and put many people out of work.
The AMA’s action was a reflection of the conservative political views of many older physicians who dominate the AMA and of their friendships with small business owners in their hometowns who oppose an employer mandate. Bristow said that it also was recognition on the part of the AMA that many physicians “are small employers themselves.”
Also evident in the debate was a deep-seated fear among physicians, particularly older ones, that the President’s health care proposal would only exacerbate what they see as the intrusion of government and insurance companies into the doctor-patient relationship.
This feeling was strongly expressed by Edward Annis of Florida, who served as president of the organization three decades ago and spoke for opponents of the employer mandate.
Annis said that the AMA is having trouble recruiting members in Florida because many doctors think the organization “is going hand-in-hand with the Clinton Administration” on the notion of an employer mandate. He argued that the President proposed an employer mandate only to placate big business, which already provides insurance and “is not a friend of medicine.”
“It’s time to confront those who have destroyed American medicine,” said Annis, referring to efforts by big employers to cut health care costs.
Under the compromise, the AMA technically did not rescind the four-year-old policy pronouncement, which said: “The AMA endorses the concept of a phased-in requirement that employers (limited initially to large employers) provide health insurance coverage within the private sector for all full-time employees, with coverage expanded over several years with a program of diminishing tax credits or other incentives to avoid adverse effects on employees.”
However, the new policy states that the AMA will “accept individual health insurance as an alternative to employer-financed health insurance and that such individual insurance be given the same tax treatment as employer-sponsored insurance.” It also expresses support for creating a new category of individual retirement accounts to fund health care for Americans.
