By Andelman, David A.
Management Review , Vol. 86, No. 2
The American Medical Association seemingly works for common good of the entire public, but behind that image is a group that lobbies hard for its members' particular interests.
There is a force in Washington more quiet, more effective than any political party, than any multinational corporation, than even the most visible and most potent interest groups. It spends more money than the National Rifle Association, as much as the Tobacco Institute. Its lobbysts and their checkbooks play some role in more congression office and campaigns than General Motors. Its representatives are leaders and political forces in every congressional district, every community in America. Its priorities, it contends, are the health and well-being of all the American people. But its interests are those of a single group of 300,000 individuals and their families. It is the American Medical Association.
For a half-century, the American Medical Association has shaped the legislation and regulations that form the basis of America's healthcare system. Its methods have been studied and emulated by corporate lobbyists and interest groups. Even its own officials are not bashful about their extraordinary success.
"I would say we are probably among the most effective lobbying operations in Washington" says James Stacey, one of the American Medical Association's top Washington officials. "We are effective because we are fortunate to have physicians in every congressional district in the country, many with an active interest in legislation and an active interest in politics. That's an incredible plus. The other plus is that we have the public on our side on a high percentage of our issues. And we are bipartisan, always have been, always will be. We contribute to candidates for both parties."
Each assertion is true. And each is as carefully crafted as the American Medical Association's multiple messages. The nation's medical practitioners, it seems, are also the ultimate manipulators of the American political system. Often, but not always, it is for the common good. But there's lots more to its Washington mission than simply the common good--a lesson that is not lost on those who have studied the methods of their success.
"They invented this stuff" says John Canham-Klyne of Public Citizen Congress Watch, who has often gone up against the Goliath of the American Medical Association. "They became the model of how to get your way in Congress in a big national fight and how to mobilize."
Seeds of Power
The modern lobbying techniques of the American Medical Association date to 1949 and Truman's sweeping proposal for a national hospital insurance system--the precursor of Medicare. It was one of the pillars of the Fair Deal--Harry S. Truman's attempt to extend Franklin Delano Roosevelt's New Deal into the postwar era. There was more to it than simply national health insurance--indeed, there was something in it, in theory, for everyone. There was an expansion of medical, dental and nursing schools, subsidies for new hospitals. And it all went down to a resounding defeat, largely at the hands of the American Medical Association.
"Socialized medicine" was the rallying cry of the grass-roots campaign. But, in fact, there was much more--it was a question of monopoly and power. National health insurance could dictate the levels of fees and the nature of services being provided. More medical schools could have meant more physicians, possibly diluting the lucrative franchises of existing practitioners. So the American Medical Association mobilized.
The association's leaders recognized a half-century ago the enormous power of two central elements it had the potential to mobilize. First was the "grass roots," millions of voters across the country who, every two years, decided whether congressmen would have their jobs for another term. Second was money, from contributors who could be mobilized to finance the campaigns of those who would vote on legislation critical to the association's members. …