At the annual meeting of the American Medical Association in Chicago this week I learned a valuable lesson. In politics, ideas are important, but ideas alone do not necessarily carry the day, no matter how right they are. Instead, the vote of the majority rules, as well it should.

The main issue before the House of Delegates at this meeting was whether the AMA should continue to support “required” individual responsibility to purchase health insurance, widely thought to be the lynchpin of the Patient Protection and Affordable Care Act of 2010 (Obamacare). While everyone in the House agrees that individuals should exercise personal responsibility and obtain health insurance, there is considerable disagreement over the word REQUIRED.

Responsibility is defined by Webster as “the quality of a person who can be trusted to do what is expected.” But if one adds the word require, defined as “make it necessary for someone to do something,” the resulting phrase is an oxymoron. “Required responsibility,” is a frequently used euphemism for government mandate, which is the antithesis of freedom of choice. This is the fundamental issue behind the challenge being made by 28 states in Federal court as to whether the healthcare law is constitutional. Obviously, AMA policy on this issue will have no influence on the ultimate decision of the Supreme Court, but physicians in the House of Delegates continue to feel strongly that they should weigh in on this issue, largely as a means of expressing to one another either their support or rejection of Obamacare.

The problem is that more than 80% of America’s practicing physicians have either left the AMA or never joined because of various stances the organization has taken on political issues over the last few decades. Decline in membership accelerated following the AMA leadership’s public support of the highly contentious healthcare reform legislation introduced in 2009 and passed in 2010. Many of those who remain in the AMA favor a more regulated healthcare environment and therefore have achieved a disproportionate voice. Obviously, when issues like the individual mandate are voted on in the House of Delegates the opinions of the majority of America’s physicians are not truly represented with the result being a consistent and “progressive” transition in AMA policy favoring more government regulation and control of the practice of medicine.

I must admit that I was somewhat encouraged to note that during this meeting the House of Delegates passed a resolution calling for repeal of one of the least popular provisions in Obamacare, the Independent Payment Advisory Board. But, on the issue of the individual mandate the progressives were unwilling to compromise at all, despite our best efforts. What actually happened is summarized below.

Reference Committee A combined three new resolutions dealing with the mandate along with a report from the AMA’s Council on Medical Services (CMS) and then brought the issue to the floor of the House. Their recommendation was to accept the CMS report that reaffirmed existing policy in support of the mandate. It is important to note that this particular report was actually the result of the house having referred this exact same issue to CMS last November following a contentious debate at the interim meeting. At that meeting in San Diego, those of us who oppose the mandate were well organized and argued successfully to rescind the existing policy. While the margin was close, the majority did indeed vote to rescind the AMA policy that supports the mandate. However, because this item was only one part of a larger measure, the opposition used a parliamentary maneuver to have the entire measure referred, effectively undoing the vote. Not surprisingly, when the CMS report was released shortly before this meeting they made no reference to the previous vote.

At this week’s meeting the proponents of the mandate were not only better organized, but they were totally inflexible. Recognizing that the debate was contentious, the Medical Student section testified at the reference committee that a bill is currently in the Congress that would allow the states to determine how to achieve coverage for all their citizens, whether by tax incentives, insurance exchanges, mandated purchase or by whatever other means that would achieve the stated goal of universal coverage. The Coalition of State Medical and National Specialty Societies believed this was an appropriate and reasonable compromise and offered the following additional resolved as an amendment to the recommendations of the Reference Committee when this item came up.

That our AMA advocate that the choice to implement a requirement for individuals to purchase health insurance be left exclusively to the states.

Testimony was heard on both sides for about 30 minutes. My personal testimony was as follows:

“The issue of our AMA’s perceived support for a Federal mandate that all individuals purchase health insurance is one that has divided this house and to a large degree the entire community of American physicians, and we all know that a House divided cannot stand. As a cosponsor of Resolution 109 my organization stands behind the idea that our AMA should not support a Federal insurance mandate, however, we respect the opinions of those who hold an opposing position. We believe that the amendment to CMS report 9 offered by Alabama is a reasonable compromise that we can all agree to.

This House is comprised of delegations from every state and specialty society, and while we have many things in common we all live and work in different environments, both physically and politically. The wisdom of the Founders of this country recognized that a one-size-fits-all approach to issues that are personal and individual have the potential to be very divisive and are best handled at state and local levels. We would urge all sides to agree that our AMA policy should reflect a collective position that allows our nation to achieve our AMA’s stated goal of universal coverage by whatever method they believe works best for their own citizenry.”

Despite our best arguments, the vote this time was nearly two to one against our amendment. With this action the AMA reaffirmed a position that most of America’s physicians and most Americans disagree.

I’ve heard many of my colleagues say that the AMA is already a lost cause. Perhaps they’re right, but currently it remains the recognized voice of America’s physicians in Congress and by the public at large. Obviously dejected following the mandate vote I was talking with Greg Emmert, Jr., M.D. a delegate from Ohio. Greg said something that resonated with me and made me stop and reflect. He said, “We will quit when freedom is no longer worth defending.” While this may not be as profound as “Give me liberty or give me death,” it embodies a philosophy that should be embraced by every American. I told him that he can rest assured that at least some of us in the AMA House have not given up the fight. We will continue to put forward ideas and seek the support of our colleagues. If we are unable to turn our once proud AMA away from the obvious iceberg of total government control, it will be come a Titanic memory.