Wait & See

The American Medical Association has one pain that two aspirins and a good night's sleep won't ease, and that is President Johnson's medicare proposals. Last week 24,000 members of the A.M.A. swarmed into Manhattan for their annual convention. The question of what to do about medicare--or, more precisely, how to oppose it--was the main issue facing the A.M.A.'s governing body. There was very little it could do that would be effective, since the House of Representatives has already passed a medicare bill, and the Senate Finance Committee has just approved a similar draft.

Most of the visiting physicians spent their time cruising through four floors of Manhattan's vast Coliseum, examining commercial and scientific exhibits and attending scores of meetings at which no fewer than 631 learned papers were presented (see following stories). The Coliseum had an extra attraction: a picket line of 150 doctors who marched about, protesting that the A.M.A. was not doing enough in some states to end discrimination against Negro physicians and patients.

Nine in the Hopper. The week's real action took place a few blocks away in a ballroom of the Americana Hotel, where the ruling 234-member House of Delegates met to thrash out the medicare dispute. The mood there, in the words of Former A.M.A. President Edward R. Annis, was one of "contained frustration."

There was no doubt that the delegates, almost to a man, were against medicare. The official position was that Government financing of health care for the aged will bring Government control, and with this will come deterioration in the quality of care. Therefore A.M.A. must oppose it. But how? No fewer than nine resolutions were in the hopper when the delegates convened, all urging that doctors boycott medicare if the Administration's bill is enacted.

Smothered. To President James Z. Appel, a homespun general practitioner and surgeon from Lancaster, Pa., talk of a doctors' boycott, even euphemized under the name of "non-participation," was wrong and dangerous. Though he himself opposed the bill, Dr. Appel said that the medical profession "must participate in the actual implementation of the legislation if and when it becomes law."

Some delegates were having none of that. A few reported receiving telegrams urging "Impeach Appel!" and in the wrangling that went on for four days behind closed doors, old labels took on a new twist. The "radicals" wanted a boycott that would mean that doctors would refuse to cooperate at all with medicare. The "conservatives" were the more cautious, who insisted that they didn't like medicare either, and would do everything in their power to oppose its enactment, but would, as President Appel had urged, go along if it becomes law.

The conservatives won. The boycott resolutions were smothered in committee. The House of Delegates adopted an omnibus resolution proclaiming the A.M.A.'s devotion to the freedom and high quality of medical care, to the profession's code of ethics, and to the Kerr-Mills Act, which provides federal-state help to people who declare themselves "medically indigent." The delegates then sidestepped and agreed to review the effects of medicare after it becomes law, then "take whatever action is deemed necessary."

Sublimated. The upshot is likely to be that all but a few "radicals" will cooperate with medicare. Meanwhile, A.M.A.'s top officers want a chance to sit down with Administration forces, perhaps with the President himself, in the hope that they can influence the rules and regulations under which medicare will be administered.

Some of that responsibility will fall to the man who was named to succeed Dr. Appel as president a year from now. He is Dr. Charles L. Hudson, 61, formerly in private practice as an internist in Cleveland and, since 1962, on salary at the Cleveland Clinic. Hudson discreetly refused to take a personal stand on medicare. Said he last week: "I've determined to sublimate my views to those of the A.M.A. and the House of Delegates."

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