BREAKING: AMA Meeting Report From LSMS Delegate
{Forwarded from Mike Ellis, MD}

APPRECIATION TO OUR LSMS ALTERNATE DELEGATE, JEFF WHITE, MD, FOR THIS WELL DONE SUMMARY OF THIS PART OF OUR AMA MEETING (later reports from AMA will also include bylaws changes, ethical issues, science and education, etc.)

The AMA is promoting that the outcome of the meeting was to reaffirm the prior commitment of the AMA to health system reform. Although that is true in the most general sense, in fact many substantive specific policy changes and clarifications occurred.
The press is reporting that the "dissident doctors" failed to overturn the AMA Board's endorsement of HR 3962, since the direct effort to do so mounted by the Georgia-led coalition (which included Louisiana)  failed on the House floor. In fact we were able to take several actions which, in summation, accomplished the same thing though in a much less public way.
Although President Rohack refused to publicly state that the AMA did not endorse HR 3962 from the AMA podium today, on Sunday I publicly read into the proceedings of Reference Committee B Dr. Rohack's statement as published in the Houston Chronicle:
"It's not a perfect bill. We supported it, but didn't endorse it, which would mean we agree with 100 percent of it."
Ackerman, T. Health care, with a Texas perspective. Houston Chronicle. November 8, 2009: B1, B5.
This, taken with the resounding adoption of three Louisiana proposals designed to establish the primacy of AMA House of Delegates Policy in the debate, leaves no real question as to the lack of an endorsement of HR 3962 by either Dr. Rohack or the House of Delegates.
On a Louisiana motion, the House of Delegates clarified that the "AMA principles" for support of health system reform alternatives endorsed at the Annual Meeting this summer (pluralism, freedom of choice, freedom of practice, and universal access for patients) are to be interpreted in accordance with "AMA policies," and thus are not broad, ill-defined concepts which could possibly be interpreted more liberally.
On a second Louisiana motion, the House of Delegates completely changed the characterization of the AMA "critical elements"  to be included in the enactment of health system reforms by the Congress, renaming them as "critical components of AMA policy." This in effect ensures that AMA negotiations on the Senate Bill and the final Bill must be consistent with AMA policy on these points.
And on a third Louisiana motion, the House of Delegates changed a proposed AMA statement of support for the AMA leadership efforts---from a statement of support for their efforts to "promote health system reform in the United States" to a statement of support for their efforts to "promote AMA policies for health system reform in the United States." (My emphasis.)
This critical distinction was challenged on the floor by the American Academy of Family Physicians in a request for  reconsideration after initial passage. The reconsideration request resoundingly failed, and the House of Delegates was emphatic in this clarification. It is clear that the House of Delegates supports the leadership in advancement of AMA policies, but has not given them carte blanche.
You can see the initial manifestation of this on the AMA website this evening, where for the first time in the debate the AMA lists publicly those things in HR 3962 that the AMA supports, those that it opposes, and those that are of concern. See:
This document was put forward as a result of direct and public insistence by Dr. Donald Palmisano on the floor of the House of Delegates, including a one-on-one floor-to-podium exchange with AMA President Jim Rohack earlier today.
In another critical victory, we gained a  new direct requirement that the AMA "actively and publicly" support the inclusion in health system reform legislation the right of physicians and patients  to privately contract without penalty to patient and physician.
In other vitally important areas, we established new AMA policy to actively and publicly oppose an Independent Medicare Commission that could remove Congressional authority over Medicare payment policy.
We established  a clear directive that national health system reform must include a permanent SGR fix which is indexed for cost inflation. In a critical distinction, this was not directed as a negotiation item--it is a results item which must be included in the final reform package.
We took a similar action regarding single payer issues, establishing as a results item that a new single payer government-run health care system is not to be included in the final reform package.
Although a direct effort to prohibit AMA endorsement of the public option failed, we established as new AMA policy that any insurance coverage option offered in an exchange, which would include a public option, must conform to a uniform solvency requirement and must not receive special advantages from government subsidies. Also, very importantly, Dr. Stormy Johnson requested and received on the floor of the House the clear, direct and public ruling of the Speaker of the House that the failure of the House to reject the public option was not to be considered an endorsement of the public option. The neutrality of the AMA on the public option was thereby maintained.  
You can see an overview of all of this at:
Likewise, the details are available in the annotated report of Reference Committee B at:
I do not want the members to be discouraged. Much good was accomplished.
I will forward an even more detailed analysis soon.
There is much work yet to be done, and we live to fight another day.....

SUMMARY by Jeff White, MD, LSMS Alt Delegate

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