When the American Medical Association threw its support behind the House health care overhaul, Democrats gleefully seized on the backing by the doctors lobby as akin to nabbing the Good Housekeeping Seal of Approval.
But the endorsement masked deep divisions within the medical community, where parochial concerns and broader ideological differences remain over how health care reform should be accomplished.
The inability of medical professionals to speak with one voice is not surprising given the independent nature of doctors, say physicians who serve in Congress.
It is pretty typical for doctors to be all over the place, said Rep. Michael Burgess (R-Texas), an obstetrician. We dont function well as a group.
Already, a number of state medical affiliates have bucked the AMA an umbrella group that represents regional, national and specialty interests by opposing the House product for fear it will increase their Medicaid patient burden and prevent them from operating physician-owned hospitals.
Surgeons and other specialists have their own beefs with the legislation, which they view as tilted toward primary care physicians. Plastic surgeons are livid at a proposal in the Senate plan that would slap a 5 percent tax on elective cosmetic surgery. And some conservative doctors vehemently oppose what they regard as increased government interference as epitomized by the public insurance option.
But others, including family physicians and nurses, have applauded legislation that calls for bolstering primary care and health care accessibility.
Although Burgess is a member of the AMA, he opposed the House health care bill, which he said did not deal with Medicare payment reform and barely addressed the medical liability issue.
A House Divided
Burgess complained the Democrats had succeeded in pitting the specialists against the primary care physicians.
Part of the Democratic strategy was to make us a house divided, he said.
Rep. Jim McDermott (D-Wash.), a psychiatrist, agreed that consensus is difficult to come by in the medical community.
It is hard to find anybody who you can say is the voice of medicine, said McDermott, who does not belong to the AMA but is a member of the American Psychiatric Association.
The liberal Congressman said that over the years the AMAs dominance has been chipped away by the proliferation of specialists groups.
Nevertheless, McDermott, who voted for the House health care bill, said the AMA is better positioned to take the long-term view than specialty groups, which he noted are focused on how legislation would immediately affect their practices.
The disputes over the direction of health care boiled over at a meeting earlier this month of the AMAs House of Delegates in Houston when a dissident faction unsuccessfully sought to persuade the association to back away from its support of the House plan.
What we see in these bills is the government taking over more and more control, said Donald Palmisano, a New Orleans physician and past president of the AMA, who was one of the leaders of the dissenting doctors.
AMA President J. James Rohack, a Texas cardiologist, said the debate within the medical community shows the emotional aspect of health care. He said doctors views are shaped by their geography and differing practices and that medical professionals can look at data and interpret it differently.
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