When the leadership of the American Medical Association decided to back the Democratic managed-care regulation bill earlier this year, it knew it was opening the association up to criticism from within the AMA and from traditional allies like congressional Republicans.
Since then, the AMA has gone full speed ahead in support of the measure. Its representatives have stood at the podium with leading Democrats, including Sen. Edward Kennedy (D-Mass), at dozens of press conferences. The AMA even has gone so far as to host President Clinton at its Washington offices for a roundtable discussion on healthcare quality.
And while the AMA has stuck to its decision, supporting the Democratic bill has not come without a price.
Last week the AMA flew about 100 doctors to Washington to lobby on behalf of the Democratic measure. Before the physicians' arrival, the House Republican Conference, which is the communication arm of the House GOP leadership, sent a "staff alert" to all Republican offices that suggested the AMA leadership had misinformed its members about both the GOP and Democratic bills.
"Do the local reps know the real facts about the (Democratic bill)?" the alert asked. It went on to criticize the AMA's position on nearly a dozen facets of the Democratic bill.
During the week, House Speaker Newt Gingrich (R-Ga.) met with AMA President Nancy Dickey, M.D., President-elect Thomas Reardon, M.D., and other AMA officials. Gingrich reportedly offered the AMA a last chance to repent, but he was rebuffed.
The most significant difference between the Democratic and Republican bills is how they handle the issue of health plan liability. The Democratic bill includes a provision making it easier for patients to sue a plan that has denied or delayed coverage for their care. The GOP bill does not include that provision but instead sets up a series of fines for plans that do not abide by the coverage decisions of an outside appeals panel. The GOP bill was passed by the House Friday, and action now moves to the Senate.
The AMA argues that the right to sue a health plan is necessary to keep plans from making medical decisions. Several other provider groups, including the American Hospital Association and the American Medical Group Association, oppose the liability provision in the Democratic bill.
Several Republicans said that although they disagree with the AMA's decision to support the Democratic bill, it's the association's tactics that have them most upset.
A GOP staffer who asked not to be identified said it seemed the AMA has gone out of its way to anger the Republican leadership.
Rep. Charlie Norwood (R-Ga.), said he believed the AMA leadership is out of touch with its membership.
"The (AMA members) I have talked to have not agreed with the positions of the AMA," Norwood said. "If the doctors understood what was at stake they would be on (the side of the GOP) bill."
Richard Diem, the AMA's director of congressional affairs, downplayed the importance of the AMA's disagreement with congressional Republicans.
"We've taken positions that have been in opposition to the (Clinton) administration, the Democrats and the Republicans, and it hasn't closed us to working with them," Diem said.