Just days before President Barack Obama is set to address the American Medical Association to pitch its members on his vision for health care reform, the 250,000-member physician group announced it would oppose a major component of that effort.
On Wednesday night, the New York Times reported that AMA was "letting Congress know" that it would resist a public plan for health insurance coverage.
Politically, the revelation could be a potentially significant blow to progressive health care reform advocates, who contend that a public option is the best way to reduce costs and increase insurance coverage. AMA has the institutional resources and the prestige to impact debates in the halls of Congress.
Historically and philosophically, however, AMA's opposition is hardly newsworthy. Despite a lofty reputation and purported commitment to universal coverage, AMA has fought almost every major effort at health care reform of the past 70 years. The group's reputation on this matter is so notorious that historians pinpoint it with creating the ominous sounding phrase "socialized medicine" in the early decades of the 1900s.
"The AMA used it to mean any kind of proposal that involved an increased role for the government in the health care system," Jonathan Oberlander, a professor of health policy at the University of North Carolina, told NPR in a 2007 interview. "They also used it to mean things in the private system that they didn't like. So, at one point, HMOs were a form of socialized medicine."
Indeed, the role played by AMA throughout health care reform battles past has often been primarily as the defender of the status quo. In 1935, fears of an AMA backlash helped persuade Franklin Roosevelt's advisers to drop a health care article from the Social Security package -- fearful that the opposition would sink the legislation altogether.
Concerned about government restriction on and oversight over surgical activities -- not to mention the loss of physician income -- the group deployed the "socialized medicine" argument to undermine Harry Truman's effort at a national health care system years later.
In 1961, AMA organized a campaign to block Medicare. Titled "Operation Coffeecup," the effort insisted that the government-sponsored system would lead to a varying form of totalitarianism. For a spokesman, the group turned to Ronald Reagan, who lent his famous actor's voice to a 10-minute plus recording.
"One of the traditional methods of imposing state-ism or socialism on a people has been by way of medicine," said the then-future president. "It is very easy to disguise a medical program as a humanitarian project. Most people are a little reluctant to oppose anything that suggests medical care for people who possibly can't afford it."
During the most recent effort at reform -- the Clinton administration's go at it in the early '90s -- AMA found itself, once again, the spoiler. The group, worried about cost-control measures, poured $3 million into defeating Hillary Clinton's proposal. Perhaps as significantly, it lent its name (and the prestige of its members) to the political opposition. In 1995, AMA endorsed then-House Speaker Newt Gingrich's Medicare Preservation Act. It was interpreted, at the time, as a patently political ploy - an effort to align with the party that held the keys to legislative power.
The same cannot be said of the American Medical Association's decision to oppose a public plan in the current health care reform quarrel, in which the Obama White House holds the vast majority of political power. Indeed, up until Wednesday, AMA, like most other private players, had kept its powder dry.
So why speak up now? The group cited impossible-to-avoid policy disagreements.
"The A.M.A. does not believe that creating a public health insurance option for non-disabled individuals under age 65 is the best way to expand health insurance coverage and lower costs," read an organizational statement to the Senate Finance Committee. "The introduction of a new public plan threatens to restrict patient choice by driving out private insurers, which currently provide coverage for nearly 70 percent of Americans."
Without private insurers in the market, the statement added, "the corresponding surge in public plan participation would likely lead to an explosion of costs that would need to be absorbed by taxpayers."
On this front as well, AMA's critics have room to scoff. Indeed, in mid-February, the Commonwealth Fund put out a report on the most cost-effective ways to revamp the health care industry. The public plan, it concluded, "plays a central role in harnessing markets for positive change" by lowering premiums for many Americans by, potentially, $1,000 a year. In addition, the Commonwealth Fund added, a public plan would help decrease the number of uninsured in the country from "an estimated 48 million in 2009 (16 percent of the U.S. population) to 4 million by 2012."