This unsavory complex has gotten so unwieldy and glutinous that it needs to be broken up from a disinterested party. There are now four components of the Healthcare Industry Complex. Why cannot the Medical Association, the Hospital Association, the Health Insurance Industry, or the Government Medicare/Medicaid Center reform Health Care in the United States?

We will give the background on these four components of the American Health Care Industry over the next four months in our attempt to analyze why these four healthcare organizations are unable to objectively reform the American Health Care Industry.

The American Medical Association (A brief overview: 1847 to 1900)

In 1847, the American Medical Association (AMA) was founded in Philadelphia by Nathan Smith Davis as a national professional medical organization. The organization was established not only to advance scientific research and improve medical education standards but to improve public health. The AMA established the world’s first national code for ethical medical practice, the AMA Code of Medical Ethics. The organization educated people about the dangers of patent medicines and called for legislation regulating their production and sale.

In May 1848, the AMA held its first meeting in Baltimore. The resulting Committee on Surgery produced the report Transactions of the American Medical Association. In 1846, the organization created a committee dedicated to analyzing the methodology of vital records registration.^[15] It urged state governments to adopt measures to register births, marriages and deaths within their populations.^[16]

At the organization’s second meeting in 1849, Thomas Wood suggested a committee on medical science to establish a board to analyze quack remedies and nostrums to be published in order to inform the public about the dangers of such remedies.^[17] The AMA’s attempts to expose quack remedies aided the passage of the first Pure Food and Drug Act in 1906.^[18]

The AMA Committee on Ethics advocated for recognition of qualified female physicians in 1869, and the AMA inducted its first female member, Sarah Hackett Stevenson, as an Illinois State Medical Society delegate in 1876.^[19]

The Journal of the American Medical Association was launched in 1883. The organization’s founder, Nathan Smith Davis, served as the first editor of the publication.^[20]

AMA pushed for laws requiring compulsory smallpox vaccinations in 1899.^[25]

The American Medical Association 1900-2000

The American Medical Association established a policy of opposition to compulsory health insurance by state or federal government in 1920.^[

In May 1922, the Woman’s Auxiliary to the American Medical Association was organized.^[32] The following year, the AMA established standards for medical specialty training residency programs.^[33] The Association later published its first list of hospitals approved for residency training in 1927.^[34]

The Normal Diet, a comprehensive listing of what Americans should be eating, was published by the AMA in 1938.^[36

The AMA first published the Current Procedural Terminology coding system in 1966. The system was created for uniform reporting of outpatient physician services. The first manual was 163 pages and contained only four-digit codes with descriptions of each.^[10] A second edition of the book was published in 1970 with a fifth digit added.^[45]

The AMA spoke out against gender discrimination in medical institutions in the 1970s. In the 1970s, the AMA spoke out against gender discrimination in medical institutions.^[47] In 1975, the American Medical Association adopted a policy stating that “unequivocal-discrimination based on sexual orientation is improper and unacceptable by any part of the federation of medicine.”^[50] It adopted a resolution to repeal all state sodomy laws.^[51]

In 1972, the AMA launched a “war on smoking” and supported legislation that would prohibit tobacco sample disbursement.^[48]

In 1976, the AMA began encouraging all public facilities to have handicap access.^[52

AMA 2000 to the present (And opposition to government medicine changed!)

In 2009, the American Medical Association released a public letter to the United States Congress and President Barack Obama endorsing his proposed overhaul to the public health care system, including universal health coverage.^[70] The following year, it offered “qualified support” for the Patient Protection and Affordable Care Act.^[71]

In 2015, the AMA declared there is no medically valid reason to exclude transgender individuals from serving in the U.S. military. The Human Rights Campaign lauded the decision.^[75]

The Association announced its opposition to replacing the federal health care law in March 2017, claiming millions of Americans would lose health care coverage.^[76]

Policy positions

The AMA has one of the largest political lobbying budgets of any organization in the United States. Its political positions throughout its history have often been controversial. In the 1930s, the AMA attempted to prohibit its members from working for the health maintenance organizations established during the Great Depression, which violated the Sherman Antitrust Act and resulted in a conviction ultimately affirmed by the US Supreme Court.^[1]

The AMA sponsors the Specialty Society Relative Value Scale Update Committee which is an influential group of 29 physicians, mostly specialists, who help determine the value of different physicians’ labor in Medicare prices.

CPT is a registered trademark of the American Medical Association, and its largest single source of income.^[13]

The AMA holds the copyright for the CPT coding system.^[14] However, in Practice Management v. American Medical Association^[15] the U.S. Court of Appeals for the Ninth Circuit held that while the AMA owned the copyright, it could not enjoin a competitor on the basis that the AMA had misused its copyright.^[16] Practice Management had argued that the publication of the CPT into federal regulation invalidated the copyright; the general debate around copyright and regulation access was revived in 2012^[17] by a petition motivated by an Administrative Conference of the United States recommendation.^[18]

Despite the copyrighted nature of the CPT code sets, the use of the code is mandated by almost all health insurance payment and information systems, including the Centers for Medicare and Medicaid Services (CMS) and HIPAA, and the data for the code sets appears in the Federal Register.

As a result, it is necessary for most users of the CPT code (principally providers of services) to pay license fees for access to the code.^[19]

Charitable activities

The AMA Foundation provides approximately $1,000,000 annually in tuition assistance to financially needy students. This has to be seen on the background that in 2007, graduating medical students carried a mean debt load of $140,000 which rose to $220,000 after four years of negative amortization during residency^[1] medical student debt has increased by 7% each successive year.^[2] By the time debt is paid off, it is sometimes almost half a million dollars.^[3]

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Editor: With the AMA changing political stance on Health Care, can they now be objective in formulating a National Health Care Plan that will be fair in representing physicians and their patients? The AMA now receives more income from the government with their publication of the Current Procedural Terminology (CPT codes) which are a requirement for insurance billing than they obtain from their own membership dues. Do they now represent government healthcare and the health insurance industry more than their own membership? Does this not interfere in formulating objective reform in the health care industry?

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