The American Medical Association (AMA) is the largest national association of physicians in the United States. In 2022, the AMA claimed 271,660 members, including non-dues-paying retired physicians. ¹

Though the AMA’s influence has waned since the middle of the 20th century, it remains one of the most powerful nonprofits in the American medical industry. Due to its influence and structure, critics allege that it functions as a self-interested government-backed cartel. ²

Through extensive lobbying, advertising, and advisory efforts, the AMA has played a key role in the crafting of American health care policy since its founding in 1847The AMA was a strong supporter of the Affordable Care Act (also known as Obamacare) but continues its long-standing opposition to a single-payer health care system organized by the federal government. While the AMA’s political policy recommendations tend to be left-of-center, its views on race and gender have drifted further left since 2016. The AMA has officially declared racism to be a public health issue, blamed racial health outcome disparities on racism in the medical industry, and has encouraged the prohibition on using race as a biological proxy in medical settings. In 2021, the AMA published a guide recommending physicians align their language with social justice ideology; for instance, by rejecting the connection between personal health and individual decision-making.

History

In the mid-19th century, the American medical industry was lightly regulated; doctors often did not require medical school degrees to practice as long as they had state licenses. Faced with a glut of physicians, both doctor salaries and quality were considered low. In 1847, the American Medical Association was formed as the first national physician association through the merger of numerous state associations. The goal of the AMA was to both raise physician quality and pay by pushing for government regulations to restrict the supply of American doctors. ³

The AMA soon “gained control over education and licensure. By the turn of the twentieth century, reformers had codified new requirements for medical schools, and the number of schools plummeted, along with the number of new doctors.” In the early 20th century, AMA membership exploded both due to the organization’s political influence and the protection from malpractice it offered through insurance packages. The organization gained more political power and briefly supported a federal single-payer insurance system, but quickly reversed course and became an opponent. ³

The rise of the AMA was also fueled by widely recognized and generally successful national campaigns. In 1859, the AMA launched a campaign against abortion that encouraged its members to refuse to perform the practice. By 1900, the AMA had successfully pushed for anti-abortion laws in nearly every state. In 1917, the AMA declared support for prohibition of alcohol; under national Prohibition, only medical doctors could prescribe alcohol. ⁴

The AMA’s political power peaked in the 1940s through 1970s. Its influence reshaped the medical profession, shifting doctors from generalism to specialization, and away from being independent small-business owners to more commonly being employees in corporations within highly regulated environments. ³

At its peak in the early 1950s, 75 percent of American physicians were AMA members. By 1997, the AMA’s 300,000 members only represented 40 percent of doctors. The decline has been attributed to perceived conflicts of interest with major health care companies and political disagreements. Per capita physician membership declined until only 15 percent of doctors were AMA members in 2011. A steep decline in membership from 2008 to 2010 was partially attributed to members dissenting from the organization’s support for the Affordable Care Act and federally mandated health insurance. ^{5 4} Some doctors have expressed discontent that the AMA is still considered a leading representative of American physicians despite its relatively low membership. ⁶

Funding

In 2022, the American Medical Association generated about $493 million in revenue. Of that sum, less than $34 million came from membership dues. By far the largest revenue source was “royalties and credentialing products,” at over $293 million. Other significant revenue sources included insurance commissions ($33.2 million), journal revenues ($30.8 million), and advertising ($13.3 million). ⁷ The AMA’s reliance on commercial sources for revenue rather than membership dues has drawn criticism that the organization is beholden to business interests and does not adequately represent American physicians. ⁶ Critics have alleged that the AMA has sold data harvested from its members to private companies. ⁸

A key source of funding for the AMA is the licensing of Current Procedural Technology (CPT) codes, a system for medical expenditure reimbursement to which the AMA has exclusive intellectual property rights. In 1983, the federal government declared that CPT would be the sole reimbursement system used for Medicare and Medicaid expenditures. Critics argue that this arrangement constitutes a government-backed private monopoly. ⁸

Health Care Policy Positions

Role of non-Physicians

The American Medical Association supports measures to fight what it calls “scope creep,” or the expanded roles of non-physician medical workers such as nurses. According to the AMA, only physicians have the necessary training to perform high-level medical tasks and diagnostics effectively. Allowing nurses or physician assistants to, for instance, order tests or prescribe medicine, allegedly leads to lower quality care and increased costs as hospitals provide a greater quantity of lower value care. In addition to operating an advertising campaign against scope creep, the AMA fights state and federal legislation that expands the role of non-physicians, such as bills that permit physician assistants to operate without direct physician oversight. ⁹

Medicare and Medicaid

The AMA operates the Specialty Society Relative Value Scale Update Committee (RUC), a committee that serves in a key advisory capacity to the Centers for Medicare and Medicaid Services (CMS): “The RUC’s recommendations […] significantly influence the relative values assigned to physician services and, as a result, how much physicians are paid” by Medicare and Medicaid reimbursement. At least as of 2008, the CMS had accepted 90 percent of the RUC’s recommendations. ¹⁰

Presently, the AMA is pushing for steep increases in physician pay from Medicare. Physician payments were frozen in 2001, resulting in a 26 percent pay cut in real terms by 2021 due to inflation. ¹¹

Single-Payer Health Care

The AMA has been described as “a relentless opponent of universal healthcare.” As early as 1949, the AMA opposed a single-payer health care system (as an extension of Social Security) proposed by President Harry Truman, calling it “socialized medicine.” In 1961, the AMA hired film actor and future President Ronald Reagan to work on an advertisement against Medicare. In 2019, the AMA joined “Partnership for America’s Health Care Future,” a group supportive of the Affordable Care Act but opposed to a single-payer system such as Medicare-for-All. ¹²

However, a 2022 New Yorker report revealed that a single-payer health care system has support from a substantial minority of AMA members, particularly younger members. In 2019, the AMA House of Delegates voted on a proposal to end opposition to a single-payer health care system, which failed but earned support from 47 percent of delegates. ³

Affordable Care Act

The AMA supports reforming the Affordable Care Act (also known as Obamacare) to expand its coverage over the currently uninsured population by tweaking various subsidies and tax credits that primarily apply to low-income individuals. ¹³

Other Policies

The AMA opposes prior authorization, a cost-control policy that requires physicians to attain authorization from health plans for specific treatments. The AMA argues that the policy is needlessly burdensome for physicians and administrators, thereby resulting in increased costs and abandoned care. ¹⁴

The AMA supports federal and state policies that promote access to telehealth services, including covering telehealth under Medicare. ¹⁵

The AMA supports combatting the ongoing opioid epidemic by funding treatment options, increasing access to naloxone, and supporting telehealth, among other policies. ¹⁶

Cultural Positions

Racism

Since at least 2018, when the American Medical Association House of Delegates meeting presented the “Plan for Continued Progress Toward Health Equity,” the AMA has asserted that the American health care system is fundamentally racist and needs ardent reform. The AMA has asserted that differentials in health outcomes between white and non-white patients, like cancer survival rates and infant mortality rates, indicate racism by medical professionals against non-white patients. In 2020, AMA Board Member Willarda Edwards stated, “The AMA recognizes that racism negatively impacts and exacerbates health inequities among historically marginalized communities. Without systemic and structural-level change, health inequities will continue to exist, and the overall health of the nation will suffer.” ¹⁷

In 2023, after the U.S. Supreme Court declared affirmative action in university admissions to be unconstitutional, the AMA declared support for affirmative action policies, particularly in medical school admissions. ¹⁸

In 2021, the AMA announced that it was adopting a new set of guidelines “to dismantle racist policies and practices across all of health care.” ¹⁹

A few months earlier, AMA chief health equity officer Aletha Maybank wrote an 83-page report arguing that the AMA is “rooted in white patriarchy and affluent supremacy” and must counteract its history with anti-racist policies. As evidence, Maybank pointed to instances of AMA-affiliated doctors practicing surgical procedures on black female slaves before the Civil War. She identified “colonization” and “capitalism” as other “root causes of oppression” in the United States. ²⁰

The AMA adopted guidelines that established definitions for “systemic racism, explicit and implicit bias and microaggressions” in health care settings and required health care providers to “actively […] prevent and address” these issues. Necessary measures include providing special antiracist training for personnel and establishing protocols for reporting and punishing infractions. Institutions are required to “[take] every complaint seriously.” ¹⁹

In December 2020, the AMA declared racism to be a “public health threat.” ²¹ According to a June 2020 survey run by the AMA, “early in the [COVID-19] epidemic it became clear that Black, American Indian and Indigenous, Latino/Latina/Latinx and Hispanic and Pacific Islander communities, as well as historically marginalized and medically vulnerable populations, were disproportionately affected by COVID-19.” The disproportionate impact allegedly included an increase in racist sentiment toward racial minority physicians. ²²

Earlier in 2020, the AMA updated its “Civil and Human Rights” policies regarding the concept of “race.” The AMA declared that “race is a social construct” as opposed to being rooted in biological or genetic variables. Furthermore, the AMA encouraged doctors to ignore race as a risk factor for disease, and instead emphasize “the experience of racism, and social determinants of health.” ²³

Most controversially, the AMA endorsed a policy of prohibiting health care providers from “using race as a proxy for biology or genetics in medical education, research, and clinical practice,” and encouraged medical students to expunge race from their studies except to acknowledge how race as a concept can harm medical outcomes. This meant, for instance, that health care providers should no longer acknowledge African ancestry as a risk factor for sickle cell anemia, even though the disease almost entirely exists within African-descended populations. ²³

Gender and Sexuality

The American Medical Association supports “gender-affirming care” for transgender individuals. ²⁴ In June 2023, the AMA officially announced its opposition to mandatory reporting of gender dysphoria or sexual orientation in children to their parents. ¹⁸

In October 2022, the AMA sent a letter to the U.S. Department of Justice requesting a federal crackdown on “high-profile users on social media” who allegedly spread disinformation regarding transgender children. ²⁴

Current AMA president Jesse Ehrenfeld is the first openly gay leader of the organization. ²

Language

In 2021, the American Medical Association released “Advancing Health Equity: A Guide to Language, Narrative and Concepts,” which included recommendations to reform common medical language. For instance, the guide recommended replacing “vulnerable” with “oppressed” because the latter better highlights “the power relations that create vulnerability and poverty.” The guide states: “People are not vulnerable; they are made vulnerable.” ²⁵

Other suggestions include rejecting individualism, diminishing the importance of personal decision-making, replacing “equality” with “equity,” and highlighting “the political roots underlying apparently ‘natural’ economic arrangements, such as property rights.” ²⁵

Journalist Connor Friesdorf criticized the guidelines as “rife with specious reasoning, questionable assumptions, and dubious judgments, all presented in an effort to get doctors talking like ideologues of the social-justice left.” For instance, he pointed out that “vulnerable” is not synonymous with “oppressed;” while women are generally considered oppressed within left-wing circles, men were more susceptible to severe cases of COVID-19. ²⁵

Obesity

In June 2023, the AMA criticized the use of the body mass index (BMI) to assess obesity and general health. The organization claimed that BMI is associated with “racist exclusion” and “historical harm” because the measurement was formulated primarily with data from white populations that do not properly apply to non-white populations. In its decision, the AMA cited data showing that non-white populations were at higher risk of some diseases at lower BMI levels than white populations. ²⁶

Lobbying

The American Medical Association is one of the largest sources of lobbying expenditure in the United States. Since 1998, the AMA has spent between just under $15 million and almost $23 million annually on federal lobbying. ²⁷ In 2022, the AMA spent over $21 million on federal lobbying, the seventh most of any organization in the U.S. ²⁸

American Medical Association PAC

In the 2022 election cycle, the American Medical Association PAC (AMA PAC) spent $1.8 million, a standard amount for the past decade. During the 2010s, expenditures typically ranged around $5 million. ²⁹

During the 2022 cycle, the AMA PAC slightly favored Democratic candidates as it has since the 2018 cycle. Prior to 2018, the AMA PAC had contributed more to Republicans in all but two election cycles dating to 1990. ²⁹

COVID-19

Throughout the COVID-19 pandemic, the American Medical Association supported the implementation of stricter rules by the federal government. For instance, in January 2022, the AMA criticized a new policy recommendation from the U.S. Centers for Disease Control and Prevention (CDC) for having insufficiently strict COVID-19 quarantine guidelines. ³⁰

Criticism

The American Medical Association has been criticized by left-of-center and right-leaning sources for operating as a cartel. ¹²

In 2019, the Guardian published a piece by four medical students from the left-of-center Physicians for a National Health Program that stated: “The AMA claims to represent the interests and values of our nation’s doctors. But it has long been the public relations face of America’s private health insurance system, which treats healthcare as a commodity” and has created an unfair system with inferior patient outcomes, including high costs and high infant mortality rates. The authors claim that the AMA’s influence has prevented the United States from establishing a government-based single-payer health care system, and thus has left almost 30 million Americans uninsured. ¹²

Right-wing and libertarian critics accuse the AMA of using government power to manipulate free markets for the benefit of its members and at the expense of the general population. Libertarian economist Milton Friedman’s views of the AMA have been summarized as “a government-sanctioned guild or trade cartel that would raise health care costs and diminish quality.” Libertarian magazine Reason furthered the summary: “That’s because the costs of AMA’s aggressive tactics to keep physician wages up by, among other things, imposing onerous licensure rules, capping the number of new doctors, and harassing nurses, midwives etc. who can treat certain routine conditions more cheaply than doctors have become painfully obvious.” ³¹

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