Kudos to The Wall Street Journal for finding some clues to the AMA’s PR strategy; and those who think the AMA has caved should read its story. Reporter Janet Adamy interviewed CBO director Douglas Elmendorf about the agency’s scoring of the bill’s cost-cutting provisions. “This legislation says we’re going to raise doctors’ payments, and we score that with the cost it’s going to have,” Elmendorf told the paper. Then came this e-mail message to the Journal from Cecil Wilson, the AMA’s president elect:

Reforming the flawed Medicare physician-payment system is very important to the final health-reform package, as are covering the uninsured, medical liability reform and many other elements of the bill. AMA’s support for a final package will depend on all its components.

Translation: If doctor payments are cut to arrive at much needed savings, then the AMA may not support the bill.

Another clue comes from the Web site of the Center for Medicine in the Public Interest, which itself is involved in lobbying against a public plan. Is the AMA using its sister organizations, the state medical societies, to do the dirty work while putting on a smiley face for the rest of the world? Some state societies are grouping together to fight the public plan, and are “adamant” in their opposition to other bill provisions as well.

Dispatching doctors in the states to contact their legislators is powerful stuff. On its Web site, the Medical Association of Georgia urges members to contact their Congressional reps and says that a public plan “will ultimately lead to a government-run, single-payer health care system” and “a catalyst for the expansion of ‘clinical’ comparative effectiveness to ‘cost’ comparative effectiveness which will result in the rationing of care—driving a wedge between patients and physicians.” Kind of sounds like the old AMA, doesn’t it?

If you’re having trouble following all this, a quote from Niccolo Machiavelli might help: “For the great majority of mankind are satisfied with appearance as through they were realities, and are often more influenced by the things that seem than by those that are.” In this fight, nothing is at it seems.

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Trudy Lieberman is a fellow at the Center for Advancing Health and a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for The Second Opinion, CJR’s healthcare desk, which is part of our United States Project on the coverage of politics and policy. Follow her on Twitter @Trudy_Lieberman.