AMA Stance on Health Plan Draws Fire

The American Medical Association's (AMA) criticism earlier this week of President Clinton's health plan has drawn a strong, but mixed, response from the Harvard and Boston-area health care community.

Members of public, private and educational medical institutions, while agreeing with some of the AMA's concerns, decried its statements as too hasty and too strong. Some even questioned whether the statements accurately represented the opinion of a majority of doctors.

Rashi Fein, professor of economics of medicine at the Medical School, when asked whether the AMA spoke for a majority of doctors, replied, "It doesn't."

Among those aspects of the plan that the AMA deemed unacceptable were regulation of insurance premiums, cuts in Medicare and Medicaid, and the cost control on treatment of specific cases.

Fein said that he was surprised by the harshness of the AMA's statements, but he did not think it meant certain defeat for Clinton's plan--despite the organization's urging that its members begin recruiting patients to help fight against the plan.

Mark Peterson, associate professor of public policy and political science at the University of Pittsburgh, said that only about a half of American doctors now belong to the AMA and that other organizations have gained power over the last five years.

Peterson, who addressed a panel on health care at the Kennedy School on Thursday, said, "If the AMA came out with a warm endorsement of the plan, I would be very worried about the plan."

Despite the fact that the AMA may no longer be the dominant institution it once was, it still holds tremendous lobbying power on Capitol Hill and may be able to affect crucial votes as the Clinton plan is submitted for Congressional approval.

Susan L. Fruman, vice president of planning and marketing for the Boston-based group Paradigm Medical Teams, did not specifically oppose the AMA's objections. But she did say that her company "supports the fact thatsomething needs to change."

In contrast, second-year Medical School studentJoshua M. Sharfstein '91 said he sympathized withsome of the AMA's concerns.

He also said he recognized legitimate fearsthat the Clinton plan could "wipe out privatepractice medicine" and that doctors could become"employees of insurance companies."

Sharfstein's concerns were echoed by Cambridgephysician and Medical School Instructor inMedicine Dr. Stanley E. Sagov.

Budget Cap

Sagov said he is also concerned about patientchoice, and urged that a "budget cap for totalhealth care expenditures" as viable concerns withthe Clinton plan should be discussed.

But Sagov lamented that "It seems like [theAMA] went a lot further than that."

Sharfstein and Sagov also questioned whetherthe AMA could act as a true indicator of the willof most doctors, echoing Peterson.

Sagov assessed the current conflict between theAMA and the Clinton administration as"unfortunate."

"We need to change our health care system tomake it available to everyone," he said.

Sharon Sudarshan contributed to thereporting of this story.

In contrast, second-year Medical School studentJoshua M. Sharfstein '91 said he sympathized withsome of the AMA's concerns.

He also said he recognized legitimate fearsthat the Clinton plan could "wipe out privatepractice medicine" and that doctors could become"employees of insurance companies."

Sharfstein's concerns were echoed by Cambridgephysician and Medical School Instructor inMedicine Dr. Stanley E. Sagov.

Budget Cap

Sagov said he is also concerned about patientchoice, and urged that a "budget cap for totalhealth care expenditures" as viable concerns withthe Clinton plan should be discussed.

But Sagov lamented that "It seems like [theAMA] went a lot further than that."

Sharfstein and Sagov also questioned whetherthe AMA could act as a true indicator of the willof most doctors, echoing Peterson.

Sagov assessed the current conflict between theAMA and the Clinton administration as"unfortunate."

"We need to change our health care system tomake it available to everyone," he said.

Sharon Sudarshan contributed to thereporting of this story.