Health Care

Medical associations wade into politics

September 9, 2021

Ray Carter

The AMA has embraced Critical Race Theory—vowing to use “lenses of racial, gender, LGBTQ+, disability, class, and social justices”—and has called for removing sex designation from birth certificates. The OSMA opposed legislation to ban abortion after a baby’s heartbeat becomes detectable, opposed legislation protecting consumers from surprise medical bills, and is working to strip parents of the right to choose if their children wear masks in school.

On its website, the Oklahoma State Medical Association (OSMA) says its vision is to be “the leading voice in health care for Oklahoma’s patients, families and physicians” and that its goals include being “the leading resource for health care policy.”

The American Medical Association (AMA) similarly states on its website that it “promotes the art and science of medicine and the betterment of public health.”

At the state and national level, the two groups have waded into numerous political issues, ranging from the AMA’s embrace of Critical Race Theory to the OSMA’s efforts to strip Oklahoma parents of the right to choose if their children wear masks in school.

Each group portrays its agenda as one embraced by the broad medical profession. But most doctors in Oklahoma do not belong to either organization.

“There are just over 1 million doctors in the U.S. today, and less than 15 percent of them now belong to the AMA,” said Sally C. Pipes, president of and fellow in health care policy at the Pacific Research Institute. “Back in the 1950s, 75 percent of docs belonged to the AMA. The polling shows that the AMA is not meeting the needs or the interests of the members.”

“I remember a time when the AMA could boast representing all of 30 percent,” said Michael F. Cannon, director of health policy studies for the libertarian Cato Institute. “Its share of doctors was twice the size of its current share, and they were still outnumbered two-to-one by doctors who did not belong. I don’t think anyone much disputes that the AMA represents a small-and-declining share of physicians.”

Similarly, the number of doctors who belong to the OSMA is apparently less than half of the physician workforce in Oklahoma—and truly active members may be far less.

A recent affidavit filed in court by Mary Clarke, president of the OSMA, claimed the organization represented “4,000 physicians and medical students across the state.” According to the “Oklahoma Physician Workforce Profile” produced by the Association of American Medical Colleges (AAMC), there were 8,151 active physicians in Oklahoma, 1,143 medical students, and 1,148 residents in 2018, the most recent year for which reporting is available.

On the OSMA’s “Find a Physician” page, an online directory that the groups says is “based on data provided by members,” a search for all available physicians produces a list of roughly 500 individuals. That represents just 6 percent of active doctors in the state of Oklahoma.

The OSMA did not respond to requests for comment regarding the number of practicing physicians who belong to the organization.

The Politics of Masks

When the OSMA filed a lawsuit to overturn a new state law that prevented schools from imposing mask mandates unless a state health emergency has been declared, leaving the mask decision in the hands of parents, the petition included Clarke’s affidavit, in which she declared that masks were a “scientifically proven way of helping to mitigate the spread of COVID.”

“Data both national and here in Oklahoma have shown that communities with mask mandates exhibited significantly lower infection rates and levels of community spread than those without,” Clark wrote.

Clark’s assertions are undermined by publicly available state data.

Weekly state epidemiology and surveillance reports produced by the Oklahoma government kept track of the per-capita rate of COVID-19 infections in areas with and without mask mandates until early 2021. Those reports showed that infections in areas that instituted mask mandates nonetheless surged dramatically from Sept. 1, 2020 to the end of the year. By December 2020, COVID-19 spread in Oklahoma was greater in areas of Oklahoma with mask mandates than in areas without mask mandates, measured on a per-capita basis.

From Sept. 1 to Dec. 1, 2020, the increase in COVID-19 infections was almost identical in both mandate and non-mandate areas of Oklahoma. According to state reports, areas with mask mandates experienced a 306-percent increase in infections during that time. By the end of January 2021, officials at the Oklahoma State Department of Health said they were no longer able to provide accurate data on what, if any, impact mask mandates had on COVID-19 transmission and stopped providing that information to the public.

Some studies have suggested potential reduction of COVID spread is associated with mask-wearing, such as a recent randomized-trial of community-level mask promotion in rural Bangladesh.

But those findings have been countered by other, often robust, studies.

A 2020 study, published in the journal Annals of Internal Medicine, reviewed data taken in April and May 2020 in Denmark from 3030 participants who were randomly assigned to wear face masks and another 2994 who did not wear face masks. The difference in infection rates between the two groups was deemed statistically insignificant.

Another recent study calculated total COVID-19 case growth and mask use for the continental United States from March 2020 to March 2021 using data from the Centers for Disease Control and Prevention and the Institute for Health Metrics and Evaluation. The project estimated post-mask-mandate case growth in non-mandate states and compared it to rates in states with mandates.

“In summary, mask mandates and use were poor predictors of COVID-19 spread in US states,” the study concluded. “Case growth was independent of mandates at low and high rates of community spread, and mask use did not predict case growth during the Summer or Fall-Winter waves.”

While the OSMA’s political activity regarding mask mandates may offend many Oklahomans, Cannon said that incident is far less offensive than other stances typically taken by medical associations, noting they typically lobby against legislation that would expand the number of providers or even things as simple as modernization efforts.

During the 2021 legislative session, the OSMA opposed legislation that would have required providers to give a good-faith estimate of cost to patients prior to service, a proposed law designed to protect consumers from “surprise” medical bills that lead to bankruptcy. The OSMA also opposed legislation to ban abortion after a baby’s heartbeat becomes detectable.

Racial, Gender, and LGBTQ+ Justice

At the national level, the AMA has called for removing sex from birth certificates, saying there is “no clear standard for defining sex designation” and that designating sex on birth certificates “as male or female suggests that sex is simple and binary.”

The AMA has also adopted an “Organizational Strategic Plan to Embed Racial Justice and Advance Health Equity” that vows to embed “racial justice and equity at the core of our AMA strategy” by “consistently using lenses of racial, gender, LGBTQ+, disability, class and social justices.” That plan also decries “the myth of meritocracy, and other malignant narratives.”

In 2019, the AMA’s House of Delegates narrowly rejected a measure to drop the organization’s longstanding opposition to a single-payer (government-run) health-care system by a vote of 53 percent to 47 percent.

The fact that 47 percent of AMA delegates supported that proposal shows that as the AMA’s membership has declined those who remain are increasingly radical, Pipes said.

“We’ve seen a real change in who belongs to the AMA,” Pipes said. “They’ve got a division, Physicians for National Health Insurance—i.e., single payer. They’ve got Students for National Health Insurance. But they’re really not representing most of the docs. Fewer than 15 percent is a really small number.”

Lee S. Gross, president of the Docs 4 Patient Care Foundation, said that state medical associations are increasingly driven not by the needs of doctors, but by the wants of larger hospitals that have absorbed physician practices.

“With the majority of physicians now being employed, they no longer have direct incentives to pay out thousands to these societies, rather leaving it up to their employers to sort out the policy battles,” Gross said. “Of course, employers/hospitals tend to promote policies that increase complexity, driving more physicians into employment. (Akin to Walmart advocating for policies that put small business competition under.)”

Cannon said groups like the AMA and OSMA provide no benefit to consumers and routinely impede progress.

“They should all just fold, every last one of them,” Cannon said. “Because every one of these groups is anti-consumer. The AMA’s effect on health care in the United States has been not just negative, but horrifically so. For 100 years, it’s agenda has been to protect the incomes and the autonomy of physicians, and it has done so at the expense of patients, many of whom have paid with their lives.”