During the vice presidential debate after Paul Ryan accurately outlined the damaging economic effects of Obamacare (ironically named the Patient Protection and Affordable Care Act) Joe Biden retorted, “But the AMA has endorsed Obamacare!”  And it is true.  The American Medical Association, the most widely known group purportedly representing doctors in America has been firmly behind this egregious bit of expensive and health killing legislation. Why?

The answer, as in most cases, involves following the money. There was a time, up until the 1980’s, that the AMA made most of its revenue from physician dues. In those days, presumably, they cared about the issues that negatively affected physicians, and by extension, the practice of medicine and patient care. In 1963, when the AMA was not given equal time to rebut President Kennedy’s Madison Square Garden speech arguing for Medicare, the AMA rented the empty Garden, and then President Dr. Edward Annis made an impassioned televised plea, exhorting Americans to avoid the trap of socialized health care.

Today’s AMA is a different animal. This year, only 15 percent of practicing physicians are members, down from 75 percent in the 1950s. Between 2008 and 2010, membership declined by 5 percent. But, in spite of hemorrhaging members, the organization has done financially better than ever. Between 1987 and 1999, the organization was variably “in the red”, and never reported over $7.6 million in yearly profit, but, beginning in 2000, for twelve consecutive years the organization has consistently operated “in the black.” Reporting record net incomes of $39.8 million in 2005, and most recently $24.7 million profit in 2011.

Now, if this were a restaurant with diminishing customers and record returns, the Feds would investigate the owner– suspecting money laundering or drugs. So what is the AMA’s secret?  In the mid 1980’s, the AMA, in a brilliant business move, created a coding system that all doctors and hospitals required to bill the government or private insurance: the CPT codebook. And, as the codification of medicine required more and more paperwork, the AMA was more than happy to step in and supply electronic systems to help both the government and the doctors all at a price, of course.

Every time you visit your doctor, whether for a consultation, or to have a surgical procedure, the physician and hospital must consult the CPT and ICD-9 books to assign code numbers to that visit. Of course these codes change yearly (which guarantees ongoing purchasing), and become more complex (thereby guaranteeing increased pricing).  The new mandated electronic medical records systems which are bankrupting doctors, slowing patient care, and creating a whole new breed of serious medical error, are brought to you courtesy of this AMA/government partnership.

Worse yet, the AMA has become an arm—sometimes a strong-arm –of the government. Under the balanced budget act, there is a fixed pot of money for physician reimbursement. In this fixed pot scenario, if internists, for example, are to be paid more for their patient care, someone else—general surgeons say—must be paid less. Needless to say, everyone wants a seat at the table when the government money is doled out, and who is more knowledgeable to be in charge than…you guessed it– the AMA. Theoretically, all specialty areas of medicine have representation in this process, however, that is not always the case. According to the AMA rules, if a specialty society doesn’t maintain a certain level of AMA membership among its members it loses its seat on the bargaining committee. In other words, the AMA says, “Belong to us or you won’t get paid.”

The Gambino family bosses should take note of all this—the pressure tactics will look familiar, but even their consigliore haven’t figured out how to coopt the government into forcing people to buy their products.

Although a huge number of physicians have spoken out against Obamacare, have written the AMA, and have ultimately voted with their feet, when such a small percentage of AMA revenue comes from physicians’ dues, why should it care what physicians in practice think about Obamacare, or anything, for that matter?

Admittedly, there are physicians who are in favor of Obamacare, and ultimately a single party system.  By way of background, medical doctors were the largest group, by profession, to vote for Hitler in the 1932 election, so we don’t always make good decisions.

Some doctors who favor Obamacare are simply looking for simplification of their lives, not recognizing the serious ethical as well as financial consequences of being employees of the state machine. Some doctors are in specialties which particularly benefit from government largesse. Not all Pediatricians believe in government run health care, but many do. Thanks to government mandates they are paid for vaccinations, and through various aid programs, they are paid for “well child visits” –medical care that parents in a free market might not pay for.

And then there are a small committed group of true medical socialists such as Ezekiel Emanuel (brother of Rahm) who believe people, left to themselves, are incapable of arranging for their own health care. He favors Obamacare as the first step to universal British style government health care. These doctors want the government to take control and provide medical care in a “rational way.” According to Dr. Immanuel (Lancet 2009, “The Disability Adjusted Life Year”) the fairest way to distribute health care is through his formula which can assign value to people’s lives. He can mathematically calculate whose life is “objectively less valuable” and thereby assign health care dollars away from that individual. If you are under two years old (I guess you are not a real person until age two in socialists’ eyes) or over sixty, have a terminal illness or disability, you are allotted no significant health care dollars. If you are in one of those groups, as many of us baby boomers now are, just kiss your ass goodbye, because in the brave new world of Emanuel you will not be able to opt out and buy your own health care—that would be unfair to those in the system.

There are, in fact, many medical organizations standing up against the government takeover of medicine.  The Association of American Physicians, a free market medical group fighting against socialized medicine since the 1943, is the only group to challenge Obamacare in the courts, and is pending appeal. Doctors for Patient Care is a newly formed organization whose raison d’etre is the overturning of Obamacare and ultimately all government interference in medicine. The American College of Surgeons, The American Academy of Dermatologists Association, the American Urologic Association, the Congress of Neurologic Surgeons, and 37 other professional state and local organizations have gone on record opposing Obamacare. Sadly, The AMA, like the German and Ontario Medical Associations before it, has become an agency of the federal government, not an advocate for patients or private practice physicians who are committed to the best care of their individual patients. So, yes, Joe—the AMA supported Obamacare, but  for your sake, I hope your doctor does not.