Its origins in nineteenth-century attempts to professionalize the practice of American medicine and bring it under the control of a single corporate organization, the American Medical Association became the dominant force shaping medical practice in the United States following the Second World War. During the 1980s and 1990s, however, as lawyers have chipped away at doctors’ prestige, seeking redress for patients in cases of alleged malpractice, and as insurance companies increasingly pushed physicians to cut costs, the AMA has had to fight to maintain its dominant position.

Throughout its existence, the AMA has remained the main bastion of opposition to what it describes as “socialized medicine”—anything that might resemble a national health system. Frequently the AMA was able to stifle debate on this issue by drawing on widespread disdain for anything that might be associated with America’s Cold War adversary the Soviet Union. Post-Second World War prosperity has enabled many in the burgeoning middle class to afford private insurance. Many prefer a medically advanced, but unequal system to one that provides universal access, but which may involve more inferior medicine.

When the federal government endeavored to provide assistance for those who fell through the cracks in this system, generally the elderly and poor, the AMA did its best to oppose such efforts. The AMA campaigned against Medicare (healthcare for those over sixty-five years old), for example, because physicians believed it represented a step towards socialized medicine and would lead to the establishment of a “bureaucratic task force” that would invade “the privacy of the examination room.” Both Medicaid and Medicare ended up being adopted in Johnson’s “Great Society” legislative package, but only after they were framed as extensions of the existing Social Security system. Doctors had been assured that they would be able charge their usual fees for elderly and poor patients.

Attempts were made to push for a national system of healthcare during the first Clinton administration. Hillary Clinton’s healthcare plans were successfully undermined by a powerful alliance of the AMA and insurance companies, as well as by the First Lady’s inability to build a consensus on the issue, but this was also just one, albeit premature, initiative and not necessarily the end of the story.

Pressure to change may lead the AMA to alter its position in the future. The so-called “Patient Bill of Rights” (while offered in different guises by Democrats and Republicans) represents an attempt by Congress to respond to considerable dissatisfaction among Americans with the current healthcare system. With so much disaffection evident, the issue of healthcare reform is likely to remain an important issue in future presidential and congressional campaigns. Added to this, the AMA continues to feel threatened by the power of both attorneys and insurance companies.

Under a private system of healthcare the pressure to sue for malpractice is greater than under a nationalized system, partly because one physician is forced to advertise his or her services as superior to another’s and also because the provision of healthcare is given a price tag (inevitably leading to the question of whether the patient has received value for money). As malpractice suits increase in number, doctors’ own insurance fees escalate, and attorneys’ ongoing investigations of doctors bring to light a growing body of information that further reduces the public’s faith in the performance of medical practitioners. The AMA under such circumstances has tried to restrict such information and has even stated its opposition to reporting medical errors occurring at hospitals around the country. But if the Association pushes too hard in this direction it runs the risk of attracting further journalistic muckraking and of seeming to be akin to tobacco corporations (that withheld information about the dangers of smoking). The likely result would be ever-larger jury judgments in malpractice suits against physicians.

In addition, insurance companies, particularly the Health Maintenance Organizations (HMOs) have already begun to interfere with the sacred doctor—patient relationship once prized by physicians in the AMA, and which it was feared a socialized system might undermine. As the HMOs begin to give doctors and hospitals less reimbursement for the services they offer, and also endeavor to ration particular services (again as it was feared a socialized system would do), many hospitals have been going bankrupt. The result is that there is at present a problem rather similar to the high levels of competition that capitalists found inimical to their interests during the Progressive Era, and which led them in the direction of greater corporatism and increased government regulation. With the AMA currently feeling embattled, and with options open that were not there during years of rabid anti-communism, it is not out of the question that some form of national healthcare system will receive the support of America’s physicians during the next decade.