The American Mendacity Association

After years of witnessing the demise of the American health care system, I’ve come to think of the American Medical Association as primarily a self-serving, duplicitous organization. I grew up thinking that it was almost a priestly sect that cared about health and healing. Ten years of working in the health insurance industry opened my eyes. Happily, the AMA’s membership is going down, not simply because doctors are leaving in droves. Now, younger doctors are choosing other organizations like the Physicians For a National Health Program and unions.

“The US healthcare system relies on a heavily subsidized and lightly regulated private sector,” Marcella Alsan, Professor of Public Policy at Harvard Kennedy School, wrote in a July 2024 article entitled “Why the US Doesn’t Have National Health Insurance : The Political Role of the AMA.”

How many federal regulations are there? As of 2017, the United States federal government had 88,899 rules and regulations (counting from 1995). The Code of Federal Regulations (CFR) contains over 200,000 pages of regulations. No wonder the AMA has been free to shun regulations – who can keep track?

Professor Alsan (and other contributors to the historical study) write that the common explanations as to why the US is one of a few countries left without a national health system are:

• A history of individualistic culture (the self-reliant American)
• Union bargaining
• Inflationary pressure and favorable tax benefits for employer-sponsored health insurance.

But there is another long-lived factor that resides at the feet of the AMA. This well-funded interest group launched a full-on marketing campaign after World War II when European countries were designing their national programs. Here’s a sample of what was used on the public to support the AMA’s scare tactics.

Described by the AMA as an “Armageddon moment,” the organization was afraid the new National Health Service in the UK would cross the pond and arrive in the US, believing that state-sponsored healthcare was out of the question for Americans.

The second alarm came with the 1948 election of Harry Truman, according to Alsan. Truman was a “strong backer of national health insurance,” plus he had a “commanding Democrat majority in Congress.” This could put a national insurance program in the public eye as an agenda item. And the third reason was Americans “were highly in favor of national insurance, especially a purported concern for the less fortunate.”

The Campaign Components

The AMA hired the most aggressive publicity company at the time – Webster and Baxter – and developed two components in the AMA-WB campaign.

1. Using mass advertising, AMA-WB linked a national health program with socialism. This campaign was supported by tie-in advertising from other industries promoting the fear of war-time price controls.
2. The AMA also called on doctors to discuss private health insurance with their patients and to distribute pamphlets that echoed the theme of independence.

According to the study, “through local and state medical organizations, physicians looking to defray medical costs had organized their own insurance product, which came to be known as Blue Shield, and they were eager for enrollees. All told, approximately $250 million (in current terms) was spent to sway voters, an unprecedented amount for the time.

Doctors were also instructed to use their prestige to urge local civic organizations to pass resolutions against national health insurance.”

Game Over

When Blue Shield was combined with Blue Cross, it was essentially game over for a national health plan. From the BC/BS history site: “Blue Cross began in 1929, as a partnership between a local hospital and its financially struggling patients. Baylor University hospital administrators were seeking a way to make healthcare more affordable for their patients, many of whom were Dallas public school teachers. The hospital administration started off with a plan for them to prepay 50 cents a month for up to 21 days of hospitalization annually. The Baylor Plan was an immediate success.”

The 20% rapid increase in private health insurance dampened the desire for legislation that could have brought about a national, affordable program. The study also found the campaign successful in altering how legislators described a national program. The use of worrying words like “compulsory” gave the AMA just what it was looking for – consumer fear. And just like today, how the Gallop polling asked their questions back then gave the AMA even more clout by rigging the choice of answers in a survey.

Soon the idea of national health insurance died from a form of national “iatrogenics” –death induced by a physician’s words or therapy.

The Question Remains

Why didn’t the US change course in later years? The study offered several reasons why.

• “First, as middle-class Americans gained private coverage for themselves and eventually their dependents, the public option became less personally useful to many voters.
• “Second, for-profit insurance firms increasingly entered the healthcare landscape: alongside pharmaceutical companies, hospitals, and specialist physicians, these groups continue to financially gain from and are a barrier to deviating from the status quo.
• “Third, the ideological argument that state involvement in healthcare invariably leads to socialism is still commonplace in the US – whenever reforms are proposed, the opposition’s response often explicitly refers to fears of socialism.”

My question after years of reading and research is: What happened to doctors? Was it pushing out all of the other forms of healing and care? Was it just about money and power? Is it the incursion of big pharma into the practice of medicine and near total silence on nutrition? Is it choosing a specialty so early that puts doctors into a silo of knowledge and higher income, ignoring the fact that there is a whole person before them, not a single disease or issue? Once I get past my antipathy at what they have become (not all, but far too many), I carry a sadness and disappointment these many years later.

The AMA Updated

• At its peak in the early 1950s, 75% of American physicians were AMA members. By 1997, the AMA’s 300,000 members only represented 40% of doctors.
• In 2022, the American Medical Association generated about $493 million in revenue. Of that sum, less than $34 million came from membership dues. By far the largest revenue source was “royalties and credentialing products,” at over $293 million. Other significant revenue sources included insurance commissions ($33.2 million), journal revenues ($30.8 million), and advertising ($13.3 million).
• The AMA has been described as “a relentless opponent of universal healthcare.” Recently, however, support for a single-payer health care system has come from a substantial minority of AMA members, particularly younger members. In 2019, the AMA House of Delegates voted on a proposal to end opposition to a single-payer health care system. It failed but earned support from 47% of the delegates.

“Whenever a doctor cannot do good, he must be kept from doing harm.” Hippocrates

Photo credits: Old operating room – National library of medicine.