The American Medical Association's House of Delegates has reinforced its call for employer mandates for large companies and individually mandated insurance for small employers.
Meeting in Chicago last week, delegates did so by narrowly defeating resolutions that many delegates said could have painted the AMA's reform lobbying effort into a corner.
"Don't tie the board's hands," pleaded one Ohio physician to the delegates as they debated a resolution to oppose President Clinton's national healthcare reform plan.
A New Jersey physician said any negative action by the delegates would paint the AMA as obstructionists to reform, a characterization he said the AMA has avoided so far in the healthcare reform debate.
By a voice vote, the 430 delegates rejected the anti-Clinton resolution as well as another that called on the AMA to actively oppose employer-mandated insurance to extend healthcare benefits to more Americans.
The actions maintain the AMA's support of employer-mandated insurance for companies with 100 or more employees and individually mandated insurance for employees in companies with fewer than 100 employees.
By defeating the resolutions, the AMA leadership withstood calls from conservative physicians who oppose a large-scale overhaul of the nation's healthcare delivery system.
The AMA House of Delegates, which meets annually in Chicago, is the association's top policymaking body.
The actions demonstrate that the AMA isn't saying no to reform but rather is working on how best to accomplish it, said James Todd, M.D., the AMA's executive vice president.
Even though the high-profile resolutions on reform were rejected, conservative physicians were successful in pushing the AMA into taking a stronger-albeit subtle-position against the creation of a single-payer healthcare system.
For example, the delegates reviewed a report on single-payer systems prepared by the AMA's board of trustees and later amended by a subcommittee of the AMA House. The report recommended that the association reaffirm its opposition to "current" single-payer systems and study variations of single-payer systems that are developed as state or national healthcare reform plans.
After several passionate speeches from physician delegates opposed to single-payer systems, the House eliminated the word "current" from the report because it felt it left the door open for future AMA support of such a system.
The delegates struck the second recommendation from the report, arguing that any evaluation of single-payer systems might signal a softening of the AMA's position.
The delegates also rejected a third recommendation, introduced on the floor of the House by a California physician, that called on the AMA to conduct a study of the pros and cons of single-payer systems.