The American Medical Association has long opposed government interference in physicians' clinical autonomy. But some critics are speculating that it sacrificed that principle to curry favor with Congress over economic issues.
The AMA and a prominent GOP senator deny any such deal.
On the same day last week that the AMA board of trustees reversed its position and endorsed a ban on partial-birth abortions, it also sent a letter to Congress detailing what changes it would like to see in the balanced-budget framework being debated on Capitol Hill.
The May 19 letter from P. John Seward, M.D., the AMA's executive vice president, to House Speaker Newt Gingrich (R-Ga.) outlines several suggested changes to the proposed formula for calculating and updating Medicare physician fees, including phase-ins or delays of policies that could reduce surgical and specialty fees.
Also included in the AMA's wish list were reforms to physician self-referral bans and malpractice laws.
The AMA's move takes on greater significance as the Republican-led Congress prepares to begin detailed budget work next month to eke out $115 billion in Medicare savings over five years.
Physician groups have said they are worried that because hospitals are so loudly protesting the threat of a one-year freeze on Medicare inpatient hospital payment rates, Congress will try to squeeze more out of physician payments (May 19, p. 27).
Because the GOP leadership was so strongly in support of the abortion ban, the AMA's support for the legislation could give the association more leverage in the upcoming battle over Medicare payments.
But both the AMA and the Republican leadership denied any relationship between the endorsement of the partial-birth abortion ban and pending changes to Medicare policy.
"Never in my conversations was this issue linked with any other policy," said Sen. William Frist (R-Tenn.), a surgeon who was credited with negotiating for the AMA's endorsement.
Said AMA spokesman James Stacey: "Our positions on public health issues are done one at a time. There's an absolutely compelling need to look at things in isolation."
But abortion-rights activists and AMA critics were quick to conclude that a deal was cut. They cited the timing of the letter and the AMA's traditional opposition to any government regulation of clinical decisions.
Furthermore, they said the AMA's broad legislative portfolio made the group vulnerable to GOP pressure to endorse the ban.
"Their action was unprecedented," said Vicki Saporta, executive director of the National Abortion Federation, which represents abortion providers. "It wouldn't be a surprise to me if it was something having to do with Medicare. They sacrificed women's health for a political agenda."
Said Rep. Fortney "Pete" Stark (D-Calif.), a longtime antagonist of the AMA: "It seems a little out of character for them to deal with a specific practice. Their issue is, `Let the doctor decide.'*"
The AMA's letter focused on two policies expected to hit surgeons especially hard.
It asked for a one-year delay, until 1999, for a change in the compensation formula for physician practice expenses. The change is expected to shift money from surgeons and procedure-oriented specialists to primary-care doctors.
The AMA also sought a two-year phase-in of a likely change to a single payment base for physician fees, a long-proposed adjustment that by itself would drop surgical fees by about 9.4% if it were to occur without a transition in 1998.
Ironically, it was a recent article in the association's weekly newspaper that gave opponents of partial-birth abortions another shot at a ban.
President Clinton vetoed such a ban last April, but this past March, the AMA published an interview with a lobbyist for the National Coalition of Abortion Providers who said pro-choice advocates had lied about how seldom the procedure is performed. The acknowledgment that the procedure was more common that previously thought reignited the push for a ban this year.