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27 Jun 2017


During June I had the opportunity to attend the annual meeting of the House of Delegates (HOD) of the American Medical Association (AmMA). It provided a fascinating insight into the challenging health policy issues in the US as well as the democratic decision-making processes of the AmMA.

The AmMA operates as the umbrella organisation for organised medicine in the US. It represents approximately 25 per cent of all registered physicians and is the primary voice for the profession in its advocacy to the Federal Government. The HOD meeting brings together delegates from across the profession as representatives of State and regional medical societies, and specialist medical societies. The medical students are also well-represented and are among the most articulate and passionate speakers.

Perhaps unsurprisingly many of the themes of the HOD meeting parallel key issues faced by the medical profession in Australia – the nature of health insurance coverage and lack of access to health care; the inadequacy of electronic health record systems; the burnout experienced by doctors including depression and suicide.

AmMA supported the introduction of the Affordable Care Act (ObamaCare) which caused significant division within the membership. However, it was clear from the debates that the delegates remain strongly in support of improved coverage and are concerned by the legislation put forward by the Trump administration (the American Health Care Act) to substantially amend ObamaCare. While the legislation is unlikely to make it through the US Senate, at least in its current form, the proposal would have the effect of removing cover for some 23 million Americans, an outcome that would be completely unacceptable in Australia.

The Australian health system was referred to approvingly in several debates during the meeting as an example of mandated public coverage but with the option of additional private cover.  One of the resolutions passed during the meeting was for the AmMA to call for public cover in circumstances where there was no other option. As the health insurers consolidate market share there is a concern that more patients will be left without cover.

The biggest recent advocacy win for the AmMA was when it combined with other lobbies to successfully challenge a series of planned mergers of health funds which would have had a direct impact on availability of cover. As outgoing AmMA President, Dr Andrew Gurman, stated, this was a major win for patients, physicians and the entire health care system as a result of a physician coalition led by the AmMA and several other representative medical societies.

The HOD meeting was an exercise in democracy with multiple reports and resolutions put before delegates for adoption, amendment, or rejection. This followed two days of committee meetings during which the resolutions were worked up by the delegates in eight separate committees and then reviewed by caucus meetings of each of the delegate groups before debate in the HOD. The business of the HOD was admirably managed by its Speaker, Dr Susan Bailey, with humour and discipline. All in all an informative and educational experience.


Published: 27 Jun 2017