The AMA May Reconsider Single-Payer Health Care

Is the American Medical Association going soft on single-payer health care? We’re about to find out.

For more than a century, the most influential U.S. physician group has stridently opposed what could generally be described as “national health insurance.” It famously helped defeat health reform efforts in the 1930s and 1940s, delayed the establishment of Medicare for years, and helped sink President Bill Clinton’s health overhaul in the 1990s.

So it was a big deal when the AMA endorsed the Affordable Care Act in 2009. 

(An aside: A main reason the organization offered its support was the promise, in its early forms, that Obamacare would end a pernicious Medicare payment cut. That didn’t happen until 2015. But that’s a whole ‘nother story.)

The last time the AMA’s House of Delegates, its policymaking body, debated single-payer health care was in 2019. That effort was spearheaded by the more left-leaning medical student section. The students’ resolution would not have specifically endorsed a single-payer program, such as Medicare-for-all. Instead, they just aimed for the AMA to be neutral on single-payer, dropping its longtime official opposition.

The students’ resolution failed, but much more narrowly than anticipated: 53 percent to 47 percent.

This time, it’s not the student section of the organization pushing for a single-payer resolution to be offered at the House of Delegates meeting later this month, at National Harbor outside Washington. It’s the delegation of practicing doctors from New England.

That alone should help the resolution get taken more seriously than in 2019, said Rohan Khazanchi, who was involved in the student effort in 2019 and is now a second-year resident in internal medicine and pediatrics at Harvard.

• “For better or worse, the student section is the conscience of the organization,” Khazanchi said. “They’re always bringing issues of health and social justice to the floor. But sometimes it’s a little harder for other stakeholders in the House to get behind that.”

He’s also more optimistic because the makeup and leadership of the AMA has shifted in recent years, embracing challenges like health inequities and racism in medicine. “Really big, meaty health justice issues are now being taken on as an express priority of the organization,” he said.

That leftward shift in political outlook is showing up not just in the AMA, but in medicine as a whole. As the physician population has become younger, more female and less White, doctors (and other college graduates in medicine) have moved from being a reliable Republican constituency to a more reliable Democratic one.

But even if the AMA votes to stop fighting single-payer, as a practical matter, the resolution won’t have much impact. The organization maintains other policies that would still preclude support for any proposal that would increase the power of payers — including the government — over patients and physicians, an AMA spokesperson said in an email. 

Another stab at a broad overhaul of the U.S. health-care system is pretty unlikely in the near future anyway, said Zeke Emanuel, a physician who helped former president Barack Obama win passage of the Affordable Care Act and is now vice-provost for global issues and co-director of the Healthcare Transformation Institute at the University of Pennsylvania.

• “The system sucks worse than ever. I do think there’s more dissatisfaction” among patients and care providers, he said, despite the ACA extending insurance coverage to millions of Americans.
• “I don’t think it’s at a critical level, and more importantly, we don’t know how to do the strategic reform,” he added.

So the AMA adopting a single-payer resolution won’t “fundamentally change the equation,” Emanuel said. But he feels it would send an important signal. “Docs feel pulled in a million different ways,” he said, “undermining their ability to do the job and their satisfaction. They’re not doing what they came into medicine for, to care for patients.”

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