Yesterday, House Minority Leader John Boehner (R-OH) denied that doctors supported the health care bill now moving through the House and attacked the American Medical Association for endorsing the legislation:

REPORTER: What is your reaction to the AMA’s endorsement of Obama’s plan?

BOEHNER: I have yet to talk to a doctor who is supporting the plan that is moving through the House. And for the American Medical Association to come out in support of this plan, even though I would think a great majority of their doctors are opposed to it, strikes me as inconsistent at best.

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If Boehner hasn’t “talk[ed] to a doctor who is supporting the plan that is moving through the House,” then he isn’t getting out much. In fact, the grassroots doctors organization Doctors For America has 360 members in Boehner’s home-state of Ohio, and 13,642 doctors nationwide who support the major tenets of the House bill: expanding affordable coverage, ending the discriminatory practices of insurance companies, offering Americans the choice of a public option, re-orienting the incentives in the health care system to reward quality of care and allowing doctors to spend more time with patients, and giving doctors and patients more information about medical treatments and procedures.

“As physicians, we witness the terrible consequences of the health care crisis everyday. We see millions of hard working Americans struggling to pay their premiums and worrying that a single hospitalization may force them into foreclosure or bankruptcy. As a physician, this is why I want to see health reform for my patients and for our country,” DFA President Vivek Murthy said. In an interview with the Wonk Room, Murthy explained why doctors support the major tenets of the House plan. Watch it:

Similarly, in its endorsement of the House bill, the American Medical Association applauds the legislation for recognizing “that fundamental Medicare reforms, including repeal of the sustainable growth rate formula, are essential to the success of broader health system reforms,” investing in chronic disease management, and addressing the primary physician shortage.

Having obstructed health care reform in Congress, Boehner will now go back to Ohio, where some 390 people are losing their health care every day. If he wants to “talk” to “doctors” or even constituents who support the House bill, all he has to do is listen.

Last week, the American Medical Association issued a statement opposing “the introduction of a new public plan.” But today, in a speech to the organization, President Obama reiterated his support for a new public insurance plan:

If you don’t like your health coverage or don’t have any insurance, you will have a chance to take part in what we’re calling a Health Insurance Exchange…And one of these options needs to be a public option that will give people a broader range of choices and inject competition into the health care market so that force waste out of the system and keep the insurance companies honest.

Watch it:

In its initial statement, the AMA argued that “the introduction of a new public plan threatens to restrict patient choice by driving out private insurers, which currently provide coverage for nearly 70 percent of Americans” and later explained that it opposed “any public plan that forces physicians to participate, expands the fiscally-challenged Medicare program or pays Medicare rates” but “is willing to consider other variations of the public plan that are currently under discussion in Congress.”

Indeed, over the past week, lawmakers have began strongly considering alternatives to the public health option, with many embracing Sen. Kent Conrad’s (D-ND) “cooperative” compromise. But in his speech today, Obama reiterated his strong support for a truly national public health insurance plan. Obama told doctors, “I understand that you are concerned that today’s Medicare rates will be applied broadly in a way that means our cost savings are coming off your backs….With reform, we will ensure that you are being reimbursed in a thoughtful way tied to patient outcomes instead of relying on yearly negotiations about the Sustainable Growth Rate formula that’s based on politics and the state of the federal budget in any given year…The public option is not your enemy, it is your friend, I believe.”

Pushing back against critics who argue that a new public option would lead to a government takeover of health care, Obama reiterated his support for allowing Americans to keep their current coverage. “It is important for us to build on our traditions here in the United States. So, when you hear the naysayers claim that I’m trying to bring about government-run health care, know this – they are not telling the truth,” Obama said.

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Responding to the American Medical Association’s recent rejection of a robust public health care plan that uses Medicare prices and Medicare’s leverage to lower health care costs, Matt Yglesias argues that “medical doctors don’t really have a big interest in making health care more efficient“:

After all, what looks like inefficiency to health care wonks looks like “income” to doctors. Defense contractors don’t like procurement reform, and when school systems try to reform their labor practices to better reward quality teaching, teacher’s unions tend to oppose it. Such is life. Incumbent stakeholders don’t like change, but when you have an inefficient system—like health care in the United States—it’s often very helpful to push change that incumbent stakeholders don’t like.

But some doctors have distanced themselves from the AMA’s statements. Doctors For America (DFA) — grassroots organization of doctors in all fifty states — issued a statement and hosted a conference call in support of a robust public option. Unlike the AMA, which has been steadily loosing power and currently represents “maybe 20% of physicians in this country,” DFA is “a grassroots organization” putting forth the views of “thousands of physicians” rather than “a small group of organizers.”

For these doctors, payment reform that prioritizes care quality and patient access to affordable coverage supersedes the issue of provider reimbursement. “What concerns physicians more than are they being paid enough is really what they’re being paid for,” DFA President Vivek Murthy explained:

You know, right now we have a system that rewards volume and procedures and doesn’t necessarily reward quality of care or the time that physicians take to spend with their patients. I think what’s a priority for all physicians—whether they’re a generalist, whether a specialist, whether academic physicians or private physicians—is that we restructure payment in a way that does reward quality and does reward time spent with patients, and that’s the kind of system that we’d be willing to support

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Indeed, unlike a co-op or some kind of state based arrangement, a robust public option would not only drive down costs but also begin implementing payment system reforms that could help doctors deliver better care to their patients.

The New York Times is reporting that the American Medical Association will be lobbying Congress to oppose a public health insurance program, an integral part of health reform. In an attempt at damage control, the AMA has responded with a statement declaring it would support a public option if it operates like a for-profit insurance agency. In effect, the AMA still opposes reform. While Igor Volsky details the various reasons why the member physicians of the AMA should support a public health insurance program, it is important to consider that the AMA as an institution is not a neutral player simply representing doctors. Started in the mid 19th century as an accrediting organization, the AMA has morphed into a behemoth lobbying and member services entity that is deeply entwined with the for-profit health industry.

In the past century, the growth of AMA has been not only funded by health industry lobbies such as drug makers, but this relationship has tailored AMA’s anti-reform policy agenda. In reading the Huffington Post and the New America Foundation articles revealing AMA’s opposition to health reform during the New Deal, its efforts to block the passage of Medicare, and the AMA’s critical role in defeating health reform in 1993, questions arise over why the AMA has historically opposed any initiative to take health care out of the hands of the for-profit health industry.

In the first 50 years after its inception, the AMA struggled to fill its coffers. Because member dues were deemed insufficient to fund its various activities, the AMA eventually decided to sell advertising space for its medical journal JAMA to drug companies. Expanding on this business model, AMA President George Simmons decided to create the “AMA seal-of-approval” for favored drugs in 1899, resulting in a five-fold increase in advertising revenue by 1909. Simmons, it turned out, had no credible medical credentials and the AMA did no drug testing for the products given the seal-of-approval.

Simmons was later driven out of the AMA, but his model for extracting fees for branding medical practices and products persisted. Simmons’ focus on molding public opinion also became one of the greatest weapons of the AMA – his “Propaganda Department” would soon expand to communicate the AMA’s views through a column syndicated published in over 200 newspapers, a weekly radio program, and various books about how homeopathic practices and non-AMA approved drugs were “quackery.”

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The American Medical Association is walking back from its strong opposition to the public option. This morning, the New York Times’ Robert Pear reported that in comments submitted to the Senate Finance Committee, the AMA stated that “the introduction of a new public plan threatens to restrict patient choice by driving out private insurers, which currently provide coverage for nearly 70 percent of Americans.”

But now, the AMA has issued a statement saying that it is willing to accept a public plan that looks like the private option:

Today’s New York Times story creates a false impression about the AMA’s position on a public plan option in health care reform legislation. The AMA opposes any public plan that forces physicians to participate, expands the fiscally-challenged Medicare program or pays Medicare rates, but the AMA is willing to consider other variations of the public plan that are currently under discussion in Congress. This includes a federally chartered co-op health plan or a level playing field option for all plans. The AMA is working to achieve meaningful health reform this year and is ready to stand behind legislation that includes coverage options that work for patients and physicians.”

A public plan that lacks the ability to negotiate cheaper rates with providers and push private insurers to do the same is a public plan in name only. While it may provide a repository for individuals who don’t trust private insurers, it will be unable to significantly lower health care costs. A trigger proposal would postpone the enactment of a public option and the co-op public health alternatives would be unable to exert the purchasing power of a Medicare-like public option.