Ignore the AMA and listen to your doctor, President Obama

As a society, we trust doctors to be more concerned with the pulse of their patients than the pulse of commerce. Yet the American Medical Association is using that trust to try to block a robust public-insurance option as part of health reform.

In fact the AMA now represents only 19 percent of practicing physicians (that's my calculation, which the AMA neither confirms nor contests). Its membership has declined in part because of its embarrassing historical record: The AMA supported segregation, opposed President Harry Truman's plans for national health insurance, backed tobacco, denounced Medicare and opposed President Bill Clinton's health-reform plan.

So I hope President Barack Obama tunes out the AMA and reaches out instead to somebody to whom he's turned often for medical advice. That's Dr. David Scheiner, a Chicago internist who was Obama's doctor for more than two decades, until he moved into the White House this year.

"They've always been on the wrong side of things," Scheiner told me, speaking of the AMA. "They may be protecting their interests, but they're not protecting the interests of the American public.

"In the past, physicians have risked their lives to take care of patients. The patient's health was the bottom line, not the checkbook. Today, it's just immoral what's going on. It's abominable, all these people without health care."

Scheiner, 70, favors the public-insurance option and would love to go further and see Medicare for all. He greatly admires Obama but worries that his health reforms won't go far enough.

Dr. J. James Rohack, the president of the AMA, insisted to me that his group is committed to making health insurance accessible for all Americans, and that its paramount concern is patient health.

"When you don't have health insurance, you live sicker and you die younger," he said. "And that's not something we're proud of as Americans."

He added that the AMA is not necessarily opposed to a public option, and I have the impression that it might accept a pallid one built on co-ops. Rohack wouldn't repudiate his association's letter to the Senate Finance Committee warning against a new public plan. That letter declared: "The introduction of a new public plan threatens to restrict patient choice by driving out private insurers."

I don't mind the AMA lobbying on behalf of doctors in the many areas where physicians and patients have common interests. The association is dead right, for example, in calling for curbs on lawsuits, which raise medical costs for everyone.

An excellent study published in 2006 in The New England Journal of Medicine found that for every dollar paid in compensation as a result of lawsuits against doctors, 54 cents goes to legal and administrative costs.

That's an absurd waste of money. Moreover, aggressive law leads to defensive medicine, in the form of extra medical tests that waste everybody's money. Tort reform should be a part of health reform.

Yet when the AMA uses its lobbying muscle to oppose major health reform — yet again! — that feels like a betrayal. Doctors work hard to keep us healthy when we're in their offices, and that's why they win our trust and admiration — yet the AMA's lobbying has sometimes undermined the health of the very patients whom the doctors have sworn to uphold.

I might expect the American Association of Used Car Dealers to focus exclusively on wallet-fattening, but we expect better of physicians.

In fairness, most physicians expect better as well, which is why the AMA is on the decline.

"It's what has led to the decline of the AMA over the last half century," said Dr. David Himmelstein, a Massachusetts physician who also teaches at Harvard Medical School. "At this point only one in five practicing doctors are in the AMA, and even among its members about half disagree with its policies." To back that last point, Himmelstein pointed to surveys showing a surprising number of AMA members who support a single-payer system.

For his part, Himmelstein co-founded Physicians for a National Health Program, which now has more than 16,000 members. The far larger American College of Physicians, which is composed of internists and is the second-largest organization of doctors, is also open to a single-payer system and a public-insurance option. It also quite rightly calls for emphasizing primary care.

The American Medical Student Association has issued a sharp statement disagreeing with the AMA.

The student association declared that it "not only supports but insists upon a public-health-insurance option."

Look, a public option is no panacea, and it won't automatically set right the many shortcomings in our health system. But if that option is killed in gestation, then we're back to Square 1 and there's little hope of progress in solving the vast challenges confronting us.

So, President Obama, don't listen to the AMA on this issue. Instead, for starters, call your doctor!

Nicholas D. Kristof is a regular columnist for The New York Times.