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Ama To Obama: Feh.

From my vantage point about ten feet away from the television set, here's a thumbnail sketch of President Obama's speech to the American Medical Association today.

Reform will deliver beter quality medicine. (Tepid applause.)

Reform will reduce the cost burden on employers and the government. (Tepid applause.)

Reform will save people from having to choose between seeing the doctor and paying rent. (Tepid applause.)

Reform will change the malpractice system. (Roaring, sustained applause.)

And so it went for the rest of the speech. Speaking for well over an hour, Obama gave a detailed account of what he wanted to accomplish with health reform--and why. It was not a dramatic speech or even a particularly engaging one. Yes, Obama was actually boring. But the address was thorough, comprehensive, and designed to appeal to his audience's better instincts. "You entered this profession to be healers," Obama said, "and that’s what our health care system should let you be."

They were stirring words. And yet the audience remain decidedly unstirred. They reacted not as high-minded champions of health and the public interest, but like any other interest group, focused entirely on their narrow economic interests. Fixing malpractice. Ending the annually scheduled reduction in Medicare payments. And even then, the approval was qualified. Once Obama made clear he didn't want to cap malpractice awards, as the AMA has long desired and Republicans usually promise, the clapping stopped. A few people actually booed. 

I suppose this isn't surprising. Among other things, the AMA represents an ever-shrinking portion of the physician population. And, by all appearances, it represents the profession at both its most craven and conservative. Remember, this is the organization that funded pro-tobacco candidates even as its top public health priority was to reduce smoking. And, remember, this is the orgnaization that in 1995 endorsed Newt Gingrich's plan to savage Medicare by, among other things, forcing beneficiaries to pay more for their care. What convinced the AMA to make this deal? Chiefly, it was Gingrich's agreement to strike a provision that would have cut physician fees. 

Of course, not all physicians agreed with the AMA back then. The American College of Physicians, a more liberal group, protested the cuts because of what it would mean for the eldery. And the same is true today. Smaller, more liberal physician groups are lining up behind reform. They want malpractice relief and a Medicare fix, too. But they also want what's best for their patients--and their country. They want to help construct a deal, one that works for everybody.

So the question going forward is how the medical profession as a whole chooses to act. Whatever their lobbying presence in Washington, physicians have enormous influence over the public as individuals. Health reform is a complex issue; patients will be asking their doctors, whom they trust, what to think.

Physicians say they have a higher obligation than other professions, that they are healers and not just tradesmen looking to make a buck. And many really believe that, I know. Now is the time to show it.

Noteworthy historical comparison: Over at the Health Care Blog, Michael Millenson reminds us that Hillary Clinton got a rousing reception when she spoke to the AMA in 1993. But she did it by playing more to the organization's predispositions. And, of course, she ended up failing in her reform effort. So perhaps a speech with less sugarcoating bodes well for reform, even if it wasn't quite what this year's audience wanted to hear.

Jonathan Cohn