CHICAGO -- Leaders of the American Medical Association pleaded with impatient doctors Sunday to remain politically neutral in the national health-care reform debate, or risk losing clout in Washington.
Trying to control the annual meeting, AMA leaders downplayed divisions in the 290,000-member organization and emphasized the need to speak with one voice on Capitol Hill.
"The worst thing we could do now would be to make a radical change in policy, to send a message to the public and to Congress that we are uncertain," said AMA executive vice president James Todd.
The theme was repeated by top AMA officials, who want to stand by support for a plan to insure all Americans through a combination of requirements on employers and individuals.
But it failed to quell the vehement opposition many physicians have to President Clinton's plan. They threatened to force up-or-down votes on the Clinton plan, its key requirement that employers pay 80% of workers' health insurance premiums, and a conservative alternative to allow consumers to pay health costs with tax-free medical savings accounts.
"We don't like to see government mandate for physicians. Why should we ask them to mandate for employers?" asked Texas anaesthesiologist Joseph Annis.
In the lexicon of someone familiar with earthquakes, California internist Lonnie Bristow, chairman of the AMA Board of Trustees and its new president-elect, dismissed conservatives' efforts as "reverberations."
"I don't interpret this as being some sort of groundswell," he said. "I doubt that there will be a major change in policy."
Some conservatives suspect AMA leaders have promised not to oppose key elements of the Clinton plan in exchange for concessions - like limiting medical-malpractice fees and awards, and allowing doctors to negotiate collectively with managed-care companies.
But Todd flatly denied any such collusion: "No deals have been made. . . . Because we have practiced so well this non-partisan neutrality, no door is closed to us in Washington."
But an AMA health-reform committee heard more than three hours of fractious debate. That panel must decide by Tuesday whether to stay the course or take a more adamant stand against Clinton's plan.
Backing the current AMA-preferred mix - employer mandates on firms with more than 100 workers, and individual insurance in smaller firms - Michigan pediatric surgeon Susan Adelman urged the group to "keep both bullets in our gun" for tactical reasons.
But Texas surgeon Milton Davis urged a firm stand against the employer mandate. "There's nothing in the world wrong with going into a tactical situation and sticking to your principles," he said.
Most doctors in managed care
The number of physicians participating in managed care organizations increased 16% in the past four years. Who participates:
