ATLANTA -- The meetings of the American Medical Association's House of Delegates are events only doctors and a few federal bureaucrats fully appreciate.
Yet decisions made at the AMA House can have profound effects on nearly every American. Though the AMA membership claims fewer than half of all doctors, it actually represents them all. It is the Chicago-based organization to which the federal government and others turn to hear the voice of doctors everywhere. It has a well-organized bureaucracy that keeps track of all 600,000 physicians. It influences both medical school and hospital accreditation bodies.
The AMA also has grass-roots political power that makes it a major force in Washington lobbying, and it has one of the nation's largest political-action committees. No other doctor group is nearly so all-encompassing. And the AMA is the bastion of free-enterprise, fee-for-service independent medical practitice.
Dr. James Sammons, the AMA's executive vice-president, is politically astute -- highly respected by friends and foes in Congress, the regulatory agencies, and the AMA membership. Unlike his predecessors, who viewed the government as a dark force, Sammons has forged working relationships with it. In Washington, says Sammons, "we have access to the decision-makers, they listen to our views, and sometimes they even agree with us."
He adds that "our emphasis is dealing with issues before they make problems." Make no mistake about it, though, doctors have problems.
Most Americans feel doctors live the good life. But doctors don't see it that way. And anyone who sat through the four-day meeting here -- anyone with a translator -- might almost feel American medicine was teetering on collapse.
The translator would be needed because debates are veiled by both jargon and rules of procedure. Without careful preparation, the alphabet soup of RVS, PRO, MAAC, and DRG is as incomprehensible as a physician's handwritten prescription.
In recent sessions, the press focused on AMA's policies on AIDS and smoking. But important as those stances were, they were not what drew physicians together for those meetings.
What did? Try money issues and what the delegates call the "intrusion of government in the practice of medicine." Put another way, the doctors meet to plan ways to protect their incomes and to avoid limits on payments from government or insurance companies.
So as usual, when the doctors met here this month, they hurled epithets at federal regulators and felt sorry for themselves and their patients, ostensibly threatened by a decline in the quality of care. As usual, they saw disaster just over the horizon. But this time, perhaps, the wolf in RVS clothing was closer to the door than usual.