Fifty years ago this month, at the 1968 meeting of the American Medical Association, a fourth-year medical student named Peter Schnall seized the microphone and scolded several hundred of the most prestigious, highly educated white men in America.
“Organized medicine has never felt responsible and accountable to the American people for its actions and continues to deny them any significant voice in determining the nature of services offered to them,” Schnall chastised the group.
“Shut up!” yelled the doctors, who were accustomed to being treated with respect and deference, not with outrage and indignation.
Schnall’s outburst, coordinated by members of Martin Luther King Jr.’s Poor People’s Campaign and the Medical Committee for Human Rights, aimed to be a wake-up call to an institution that was highly successful at protecting physicians’ “interests against encroachment” but failed to meet the public health and human needs of patients by opposing both civil rights and the expansion of safety-net health programs.
At a time when Jim Crow racism harmed the health of millions of African-Americans in the South, the AMA repeatedly rebuffed requests from the National Medical Association, an organization that represents African-American physicians, to work together to end racial health disparities.
Even after the passage of the Civil Rights Act in 1964, the AMA allowed local medical societies to discriminate against physicians and patients of color. The AMA also mobilized attacks against major social programs intended to benefit all Americans, from Social Security to Medicare and Medicaid. In 1948, the AMA leadership spent millions on a campaign to characterize President Truman’s popular universal health care plan as “socialized medicine.”
Today, in the midst of a revived Poor People’s Campaign, physicians and medical students are again pressuring the AMA to be more responsive to the needs of the nation’s uninsured and underinsured. At the AMA’s House of Delegates annual meeting in Chicago this weekend, its Medical Student Section will ask the AMA to end its decades-long opposition to a single-payer health insurance program, a system better known as Medicare for All that would be publicly financed but privately delivered. Why bother? For better or for worse, the AMA sets the agenda for American health policy.
It is clear to medical students that no matter how well they are trained, far too many Americans will remain sick and poor under market-based medicine.
Our wildly inefficient system is currently dominated by private insurance companies, a health care model spearheaded by the AMA. It produces some of the worst health outcomes in the industrialized world — the U.S. has the highest infant mortality rate and the highest number of avoidable deaths — and devours an ever-increasing share of our economy, with health spending accounting for a whopping 17.9 percent of our gross domestic product. Despite the improvements of the Affordable Care Act, 28 million Americans remain uninsured, without access to primary care that could prevent costly and life-threatening diseases. Those fortunate enough to have insurance face prohibitively expensive co-pays, premiums, and deductibles that limit access to care, and medical expenses are a leading cause of bankruptcy.
Contrary to the AMA’s assertions, a single-payer system would give health care providers more autonomy because their clinical decisions wouldn’t be second-guessed by insurance companies. Patients would have free choice of any doctor, allowing providers to compete based on quality of care. Physicians would spend less time on administrative responsibilities like paperwork and billing, and more time seeing patients, which boosts both their work satisfaction and income. In fact, when Canada implemented its single-payer program, physicians enjoyed long-term salary increases.
The AMA’s opposition to Medicare for All puts the organization at odds with the public and with America’s doctors. Sixty percent of Americans believe the federal government has a responsibility to provide health coverage for all; 51 percent specifically support the creation of a single-payer health system, as does the majority (56 percent) of practicing physicians. The single-payer bill in the House of Representatives, H.R. 676, now has a record 122 co-sponsors; in the Senate, Bernie Sanders introduced his updated Medicare for All Act in 2017 with a record 16 Senate co-sponsors, including most of the leading Democratic contenders for president in 2020.
In the AMA’s evaluation of these and other health system reform proposals, it asserts that a national health program could lead to a concentration of market power in the hands of the government, limiting patient choice and physician autonomy: “Reform proposals should balance fairly the market power between payers and physicians or be opposed.”
Although the AMA’s membership has steadily declined since the 1950s, it remains the most powerful doctors group in the country. The growing Medicare for All campaign is unlikely to be won without its support.
Will the AMA choose to move toward guaranteeing health care as a human right or continue down the wrong side of history by linking patients’ health to the vagaries of the private insurance market?
The activists who staged the protest at the AMA meeting in 1968 hoped that the organization would finally recognize health as a human right. It didn’t. A lot has changed in the ensuing 50 years. It’s time the AMA does, too.
Jonathan Michels is a premedical student at the University of North Carolina at Greensboro. Robertha Barnes is an MS/MD student at SUNY Upstate Medical University. Sydney Russell Leed is an MD/MPH student at SUNY Upstate Medical University. All are board members of Physicians for a National Health Program, an organization that advocates for an improved and expanded Medicare for All health system.
Wow! The world of fantasy medicine knows no bounds. Good luck becoming a doctor in the real world.
I will give you a few facts:
Medicare pays the LOWEST rates than any provider in my specialty by far.
Every year you can hear MDs cringe when the new Medicare fee schedule is published, sometimes the fees for a procedure go down 30- 50 percent with no increases in any other areas. You cannot negotiate with Medicare. It is take it or leave it. Can’t imagine how it would be when they control 100 percent, which will make you effectively their employee. With those fees, I would have to CLOSE my practice. My 15 employees would be unemployed.
That is without mentioning all kinds of additional paperwork and/or credentials required by Medicare but not by anyone else.
I do not even believe your numbers. I do not know one of my colleagues who support this and are in fact dreading the day when this happens.
They are in fact preparing to quit practice as soon as this becomes law.
Nice article. Interestingly, it didn’t say anything about emphasis on health (emphasizing prevention and health promotion). Obesity is rampant. Wouldn’t it make sense to use our energies more on education and ad campaigns depicting health than on fast food or beer?
Jonathan, I am glad you are “pre-med”. If you do become an MD, maybe by then we will have government run single payer. Then you will realize how it feels to work under a ruthless monopoly whose only solution to skyrocketing costs is to pay you less and less until you can barely afford to pay your bills, and realize your plumber is better off than you. Market forces create value, quality, innovation, competition, pursuit of excellence. Single payer is a race to mediocrity and indifference. Do not drink the Koolaid friend. Educate yourself young Jedi.
I have had CFS for 2 years. Went to at least 20 doctors who said I either had sleep problems or depression.
My neighbor sent me articles written by Dr. Theodore Henderson of Centennial Colorado, who is an MD, Psychiatrist and expert at SPECT brain scans. I had $2,000 of blood work done at LabCorp . I had very high levels of antibodies to 4 herpes viruses, even though I don’t have physical symptoms. Have started taking 2,000 mg of Valaycyclovir anti fungal medicine. Seems to be working some.
Health economists agree that single-payer saves money, while covering everyone . Single-payer systems , including the US VA, have been able to negotiate 50% discounts on pharmaceuticals . Notably, Canada’s transition to a single-payer system, “did not lead to a loss in physician income” . A single-payer system would also help address high rates of burnout in the US through administrative simplification.
The AMA has an incredible opportunity to move onto the right side of history this weekend. It’s not only the right thing to do, it’s also in the best interest of physicians.
 Pollin’s analysis of SB 562 in California https://www.peri.umass.edu/media/k2/attachments/PollinZetZalZECONOMICZANALYSISZOFZCAZSINGLE-PAYERZPROPOSAL—5-31-17.pdf
See Resolution 108 on page 247 of the AMA Annual 2018 handbook PDF: https://www.ama-assn.org/sites/default/files/media-browser/public/hod/a18-handbook.pdf
Reference Committee A will discuss the resolution between 1:30-5p.m. Sunday, June 10, in Regency Ballroom A, West Tower Ballroom Level, Hyatt Regency Chicago.
The House of Delegates will debate the resolution and vote on it during one of its business sessions on Monday, Tuesday, or Wednesday.
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