The AMA Says No To A Public Plan. Maybe.

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As Jay notes below, we have had what might be a major development in the health care debate. In this morning’s NYT, Robert Pear reports:

As the health care debate heats up, the American Medical Association is letting Congress know that it will oppose creation of a government-sponsored insurance plan, which President Obama and many other Democrats see as an essential element of legislation to remake the health care system.

The opposition, which comes as Mr. Obama prepares to address the powerful doctors’ group on Monday in Chicago, could be a major hurdle for advocates of a public insurance plan. The A.M.A., with about 250,000 members, is America’s largest physician organization.

While committed to the goal of affordable health insurance for all, the association had said in a general statement of principles that health services should be “provided through private markets, as they are currently.” It is now reacting, for the first time, to specific legislative proposals being drafted by Congress.

In the presidential campaign last year and in a letter to Congress last week, Mr. Obama called for a new “public health insurance option,” which he said would compete with private insurers and keep them honest.

Speaker Nancy Pelosi of California said Wednesday that she supported that goal. “A bill will not come out of the House without a public option,” she said Wednesday on MSNBC.

But in comments submitted to the Senate Finance Committee, the American Medical Association said: “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. 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.”

A major blow? Not necessarily, says TNR’s Jonathan Cohn:

The AMA is not as powerful as it was in the mid 20th Century, when it was arguably the organization most responsible for blocking efforts at national health insurance. Nor does the medical community speak with the same unified, conservative voice it once did. Different types of physicians hold different views and speak through different organizations. Primary care physicians in partiuclar–organized through groups like American Academy of Family Phyisicians and the American Pediatrics Association–are generally more liberal and may well speak out in favor of the public plan, if they haven’t already.

Meanwhile, public plan advocates in Congress aren’t giving up. Over the past few weeks, according to sources, House committee staff have been involved in serious negotiations with representatives of various physician groups, attempting to win their overt support not just for reform but for a public plan option specifically. As an enticement, they’ve been promising to fix permanently the SGR problem–that is, the annually scheduled adjustment to the “sustainable growth rate” in Medicare, which threaten increasingly large cuts in physician payments before Congress inevitably postpones changes for a year. Reformers, including President Obama, have already talked about doing this; apparently, the offer the House Dems are making is to follow through on this and to make it a good, solid fix. (I say “apparently” because, while I’ve been told these discussions are taking place, I don’t know the details.)
The AMA, according to the same sources, was part of these discussions. The fact that it has come out against the public option suggests, obviously, the talks aren’t going that well. Still, a senior Democratic House aide points out the AMA’s specific choice of language: A public option would not be “the best” way to deliver coverage. That’s not quite the slamming the door, this aide says: “I see flexibility there.”

And I will say, once again, all of this will likely hinge on what kind of public plan we are talking about.