The American Medical Association met here this week at a time when medicine could become the country's next regulated public utility.
The Carter administration has proposed to control every hospitaql's revenues. Health. Education and Welfare Secretary Joseph A. Calfano Jr. told the AMA here that this is "merely a stopgap" to precede more profound health system reform. AMA officials have a copy of June 4 memo to Califano form his health financing director, listing control of doctors' fees as one possible cost-saving initiative.
Yet in the face of such challenges, AMA leaders were forced to spend much of their time in th last several days beating back an attempt by medicine's right wing to withdraw AMA support form any new form of national health insurance.
The attempt was beaten back. The AMA today is far from the anteleduvian, anti-everything group its foes often depict.
The AMA strongly backed federal aid to increase the doctor supply. It sought increases in HEW appropriations this year for sveral medical programs.
Doctors in many states have been policing their dishonest or incompetent members more vigoriously, and seeking new laws to strengthen the state medical boards that can revoke or suspend doctors' licenses. Medical society members are enthusiastically mandated program to monintor hospitals stays to cuts hospital costs.
Still, a young turk here - Dr. Gaylord NOrdine, 32, outgoing, chairman of the AMA's growing Resident Physicians Section, representating 12,000 of the nation's 63,000 doctors still in hospital training - said in an interview: "The AMA reacts to changes, rather than making them."
The mann thrust in almost every AMA discussion this week was not so much how to break new ground as how to curb government interference.
The doctor, said new AMA president Dr.John Budd of Cleveland, if he is to protect his patient. The AMA, said Budd, is therefore "a citadel for survival of boluntary action, as opposed to the expanding power of centralized government."
But what the AMA delegates did not hear was much discussion of what the Carter administration and most health leaders consider to be medicine's No. 1 problem: its high cost.
The AMA has its own national commission on the cost of medical care. The 28 members, only 11 of them doctors, will make recommendations to the AMA in December.
But there isn't much time - maybe only until January, until the administration develops some hard new health policies, one commission member warned here.
He was Dr. Paul Ellwood, who heads InterStudy, a Minneapolis-based health study group. In 1970 he persuaded the Nixon administration to push prepaid care by "Health Maintenance Organizations," or "HMOS," to help cut health costs. HEW Undersecretary Hale Champion last week announced a similar new push.
HMOS, like the West Coast Kaiser plans must compete in the medical marketplace for their patients, and since they sell care for a set sum per month, must keep down costs. Hence they make less use fo hospital beds, the most costly sites for care.
"This is the kind of change," Ellwood said, "that uses incentives to control costs far better than regulation - which usually doesn't work. I think we have to let the administration know we doctors prefer and are ready to help develop incentive-based programs."
The goal, he added, needs to be getting cost-cutting incentives into every hospital and medical pravtice, not just stresses cost-cutting too much.
A physician rose before the House of Delegates complain about the bureaucrats who are trying to increase medical competition.
"The Federal Trade Commission has 1,800 lawyers on their staff, which is frightening," said Dr. H. William Porterfield of Columbus, Ohio. "Most are young fellows just out of law school trying to prove themselves in areas they don't know a lot about. If we have to take them on, let's take them on."
A doctor-listener with experience in both medical practice and government said: "He's right about some of those kid lawyers.
The trouble is that they (the doctors) don't come with good alternatives, or they keep coming up with them too late."