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Just what the doctor ordered?

The AMA's shrewd endorsement of health care reform

In TGIF spirit, let's keep it short:

I was startled to learn yesterday that the American Medical Association - the establishment group that heretofore opposed every attempt at health care reform, most notably Medicare circa 1965 - has now tendered its endorsement of the House Democrats' sweeping health reform bill.

This is the same AMA that worked in cahoots with the Republicans to oppose government health insurance for seniors four decades ago. At the time, back when Lyndon Johnson was pushing the Medicare concept as part of his Great Society, the AMA put out statements condemning the idea as "a dangerous adventure in government medicine," and they were seconded by conservative allies such as the fledgling politician Ronald Reagan, who warned that Medicare would compel seniors to spend their "sunset years telling our children and our children's children what it was like in America when men were free." (Today, I wonder how many seniors partaking of Medicare consider themselves to be enslaved as a result.)

But I digress. Top Democrats, as well as President Obama, were thrilled yesterday - perhaps prematurely, as we shall soon see - that the AMA had decided to endorse the House Democratic bill; after all, it contains all kinds of liberal provisions, such as a government-backed health insurance option, and a surtax on the richest Americans in order to help pay for it all. The AMA said, in its letter, that it wished to voice its "appreciation and support" for this Democratic measure, which is designed to extend private and public coverage to virtually all Americans.

Shortly after the AMA spoke, Obama crowed that "these doctors are now joining the chorus of Americans who know that the time to reform what is broken about the health care system is now." John Dingell, the prime House Democratic sponsor, marveled how "quite honestly, it's has been difficult to win the support of this organization going all the way back to the 1930s." Indeed, Republicans can hardly be pleased that its traditional ally has decided to step on the GOP message of No.

But Democrats might be wise to view the AMA move with just a smidgen of cynicism.

For starters, the AMA has a direct stake in the House Democratic bill, which would fix a Medicare proviso that annually calls for cuts in doctor fees. And even assuming the House Democratic bill emerges intact (it hasn't yet passed a committee, much less gone to the floor), that doctor fee proviso might vanish altogether once the House and Senate get together to hash out common ground.

And who knows what's next anyway. The nonpartisan Congressional Budget Office zapped the Democrats yesterday by warning that the health care reforms now under consideration will be darn costly. Said the CBO chief, "In the legislation that has been reported, we do not see the sort of fundamental changes that would be necessary to reduce the trajectory of federal health spending by a significant amount."

Granted, the CBO didn't look at any of the current congressional efforts to save money via proposed trims in Medicare and Medicaid; indeed, the CBO chief wrote several days ago that his warning "does not take into account other parts of the proposal that would raise taxes or reduce other spending (particularly in Medicare) in an effort to offset the federal costs of the coverage provisions." Nevertheless, the CBO's core warning is grist for the Republican opposition, and threatens to complicate the Obama/Democratic efforts to produce a sweeping but cost-effective reform bill before their desired August deadline.

All of which means that the AMA is being politically shrewd. By endorsing a liberal reform bill, the group can promote itself as enlightened and broad-minded - while knowing full well that nearly 20 state medical societies have already vowed to fight creation of the public insurance option. And if the health reform effort ultimately falls apart or suffers significant diminishment, the AMA can always say, "Hey, we took the high road, we were with you guys all the way, so you can't blame us for this thing going down. Better luck next time. Take two aspirins and call us in the morning."


From the last day of the Sonia Sotomayor confirmation hearings...

Sen. Arlen Specter, addressing white firefighter Frank Ricci: "Do you have any reason to think that Judge Sotomayor acted in anything other than good faith in trying to reach a fair decision in the case?"

(Translation: "Ms. Sotomayor, as an appeals judge, ruled against you, Mr. Ricci. The Republicans who invited you here consider you to be their poster boy in the fight to keep her off the Supreme Court. Do you think she acted in bad faith and therefore should not be elevated to the U.S. Supreme Court?") 

Ricci: "That's beyond my legal expertise. I simply welcome an invitation by the United States Senate to come here today."

(Translation: "No.")

Game over.