Despite four straight years in the red, the American Medical Association continues to open its wallet wide in Washington, lobbying federal lawmakers at a free-spending pace matched by few other organizations.
In fact, the Chicago-based AMA, which has posted after-tax operating losses amounting to nearly $28 million in the past four years, spent $7.8 million in the first six months of 2000 to lobby federal lawmakers on pet issues such as antitrust relief for physicians and managed-care reform.
The AMA's spending was the second-highest of any company or association, eclipsed only by the U.S. Chamber of Commerce, which spent $9.7 million on lobbying in the same period, according to FECInfo, a nonpartisan research group that follows political spending in the nation's capital.
The AMA, which has a 60-person staff in a Washington office about three blocks north of the White House, has always been a major political operative on Capitol Hill. About two years ago, Fortune magazine ranked it No. 13 in a listing of the 25 most powerful Washington-based lobbying groups.
Some say the AMA's influence has waned along with its membership, which dipped slightly last year to about 290,000. A failure to pass a patients' bill of rights underscores that trend, one consumer advocate said.
"Years ago, if the AMA came in and gave its blessing to a bill that said you can sue your health plan, Congress would have passed it," said Charles Inlander, president of the People's Medical Society, a health-advocacy group based in Allentown, Pa. "Now, the health plans have more influence than the AMA. I'm not sure all the money they're spending is anything more than the last gasp of dying men."
But Thomas Reardon, M.D., immediate past president of the AMA, believes the organization is more influential than it was a decade ago. "That money is well-spent, or we wouldn't do it," said the general-practice physician from Boring, Ore. "The membership wants us to do this and be even more effective. We're trying hard. I think we probably have more clout and influence now than we had 10 years ago."
In 1999, the AMA spent $18 million on lobbying efforts, an association official confirmed. The organization itemizes every cost related to its legislative efforts, including travel expenses for top officials who testify before Congress, research, and lobbying support from staff workers in the Chicago headquarters and a national grass-roots "House Call" campaign to build support for key initiatives.
Still, the generous spending has not yet translated into clear legislative triumphs on the key issues of a patients' bill of rights, antitrust relief for physicians, comprehensive Medicare reforms and increased insurance coverage through tax credits.
"We believe the AMA is a dying organization," said Sidney Wolfe, M.D., director of Public Citizen's Health Research Group in Washington. "The evidence is that their membership has gone from a peak of about 70% of all physicians to about 32% or 33%. And I'm sure one of the reasons is that doctors don't feel they're getting their money's worth. Many doctors don't believe the AMA is representing them."
AMA officials counter that the lobbying effort has, in fact, led to some legislative action, including votes in the past two years on both a patients' bill of rights and antitrust relief for physicians. Neither of those measures has become law, but the AMA said it will not let them die without a fight.
"Look what we've worked on in the last couple of years," the AMA's Reardon said. "We got the patients' bill of rights through the House. We got the Campbell bill (on antitrust relief) through the House. And our idea of tax credits to help finance the uninsured has gained strength and interest in Washington. It's now part of the president's package. We cover a lot."
Other observers said the AMA is waging an effective political fight in Washington.
"The AMA operates in an environment in which they're up against huge amounts of money that dwarfs what they spend," said Peter Warren, spokesman for the California Medical Association, which represents about 343,000 physicians. "They do a good job in that context. Is there room for improvement? Yes. They're trying to amalgamate the interests of all the doctors in the country. When they do that, they're not able to take into account the interests of very different environments (like California's)."