Same Diagnosis, Different Prescription

In the political posturing over federal health care reform, the physician fraternity stands divided.

The Texas Medical Association staunchly opposes the measure Congress is considering. The American Medical Association cautiously supports it.

Walking the fine line between them is AMA President J. James Rohack, a Texas A&M Health Science Center cardiologist and former TMA president who’s still a member of the state organization.

To many medical observers, the split over reform is emblematic of a fissure that’s widened between the two organizations.

While roughly 44,000 Texas doctors are members of the TMA, health care consultants say just a third of them are also members of the AMA. Rohack’s close ties to both organizations have caused some heartburn at the TMA, these consultants say — but served to soften the contradictory rhetoric. 

To Rohack, it’s a lot less dramatic. The two organizations agree and disagree with the same elements of the health care reform bill, he said. But they’ve got different constituencies, different seats at the table, and different strategies on when or whether to endorse legislation.

“There have been people that have felt there has been a split between the TMA and the AMA, but the goals are really the same,” Rohack said. “The TMA’s luxury is, their accountability is just to the Texas physicians, whereas the AMA’s accountability is to the whole nation.”

Fundamentally, the two organizations stand in agreement on most reform issues, said current TMA President William Fleming, a Houston neurologist.

They want to expand health insurance, force providers to cover preexisting conditions, and fix the Medicare payment formula. Both organizations support caps on non-economic damages in malpractice suits, and allowing physicians to have an ownership stake in hospitals — neither of which is a likely end result of the reform.

“If you cut to the chase, we’re saying the same thing,” Fleming said. “The difference is, they’re in Washington, we’re in Texas. They’re more of a lobbying organization, we’re more grassroots.”

Their policy strategies, however, are opposite. The TMA won’t endorse a bill without key provisions its members want, Rohack said; the AMA will in order to keep the debate moving.   

Political consultants say the AMA’s strategy is a calculated risk. While the organization’s cautious support will likely cost it members — including medical specialists who fear what reform will mean for their pocketbooks — consultants say the AMA gains bargaining power and a seat at the negotiating table.

“The AMA is playing a smart political game,” said Tom Banning, CEO of the Texas Academy of Family Physicians. “They’re looking at the long term, at what their opportunities are given the national debate.”

Meanwhile, the TMA and many other state organizations are playing it safe for their constituents, said health policy consultant Kim Ross, formerly the TMA's chief lobbyist.

The reality is that the TMA doesn’t have a big seat at the negotiating table because Texas lawmakers — the bulk of them Republican — don’t either. The TMA’s safe strategy, Ross said, is to take a policy stance that plays to its members, many of whom have serious concerns with the legislation. 

“There’s not anyone among the medical lobby who doesn’t understand the politics of it,” said Ross, who now consults for medical organizations across the country. “It’s the strategy of being in the room for the end game, as opposed to posturing before your members.”