Commentary: Patients first? Putting the OSMA Ohio governor endorsement in perspective

In mid-September, the Ohio State Medical Association’s Political Action Committee (OSMAPAC) endorsed Vivek Ramaswamy for governor over Dr. Amy Acton, a physician and Ohio’s former health director whom many credit with saving lives during the pandemic. Ramaswamy is a billionaire biotech investor.

Physicians took notice. More than 1,000 signed an open letter backing Acton, warning that Ramaswamy’s positions, including calling Medicare and Medicaid “a mistake,” threaten patients’ access to care. Many signers belong to OSMA.

Anyone who has studied the history of American health reform will recognize the pattern. The most powerful physicians’ organization, the American Medical Association, has repeatedly stood in the way of patient-centered reform. That is not a fluke.

Organized medicine exists to advance the professional and economic interests of physicians. Benefits to patients are sometimes real, but they are more often incidental.

The record is long. In 1920, after initial openness, the AMA’s House of Delegates came out against compulsory health insurance. In the 1920s it fought the Sheppard-Towner Act, which funded state maternal and child health programs, as a threat to fee-for-service medicine.

In 1943, the Supreme Court upheld the AMA’s conviction for conspiring to cripple a Washington, D.C., prepaid group practice that threatened fee-for-service medicine. After World War II, the AMA assessed members $25 each to fund a campaign against Truman’s national health insurance plan, branding it “socialized medicine.”

In 1961, it enlisted Ronald Reagan for “Operation Coffee Cup,” recorded messages warning that Medicare would end American freedom.

As we know, Medicare passed and became a dependable and integral source of physician income.

By 2009, the AMA was backing the health reform push that became the Affordable Care Act, which put millions of newly insured patients in physicians’ waiting rooms. The through-line is not political partisanship, but members’ interests: resist what threatens them, welcome what helps them.

We saw this dynamic at work during the COVID-19 pandemic, when, as the Ohio Capital Journal reported in 2021, the Ohio Hospital Association and Ohio Osteopathic Association publicly – and rightly – opposed dangerous anti-public health bills being pushed through the General Assembly.

The problem is they did this at the same time as their PACs contributed to the sponsors of that very bill.

The formal explanation for such hypocrisy is that these organizations’ political action committees operate independently of the main organizations. But voters can fairly ask why they should trust these organizations’ public statements when their campaign contributions point the other way.

I say this not to criticize organized medicine. Representing members is a legitimate function for trade associations.

The error is ours, the voters, when we mistake a political endorsement for a verdict on patients’ welfare. Professional interests, not Hippocratic fidelity, drives these decisions.

In announcing its endorsement, OSMAPAC cited Ramaswamy’s backing of physician-led care, efforts to grow the physician workforce, and plans to reduce administrative obstacles for physicians.

OSMA President Dr. Gary Katz explained that Ramaswamy believes physicians, not insurers, should make medical decisions, and noted that OSMA’s members span the political spectrum.

Fewer prior authorizations and less insurer interference are reasonable positions for health professionals to take — and anybody who listens to Dr. Acton talk about health care access and public health knows that she supports reducing the administrative burden and other barriers that undermine patient care.

But instead of support for patients, OSMA offered a litany of physician-centric practice conditions.

Missing was any mention of improving our approach to chronic disease, Ohio’s unacceptable disparities in infant mortality, private-equity raids on rural hospitals, or the coverage losses Ohioans face as major Medicaid and ACA changes arrive in 2027.

The comparison with other health-sector groups is instructive. In April, the Ohio Nurses Association, a union representing more than 10,000 nurses and other health professionals, endorsed Acton, citing health care costs and union values.

The Columbus Medical Association did not make an endorsement. Three health-sector organizations made three different choices, each reflecting its constituency. The nurses’ union is also an interest group, and it said so by naming its values.

Even within physician ranks, there is no single “physician” position. The more than 1,000 doctors backing Acton are as much physicians as the small panel of board members that made the OSMAPAC endorsement.

We should read the endorsement for what it is: one governing board’s judgment about what serves its profession. It tells you something about physicians’ interests, about which thoughtful physicians can and do disagree. 

But it cannot tell you what is best for Ohioans, more generally, and it certainly is not a marker of which candidate will put patients first.

For that, look at the candidates’ records on coverage, public health, and the hospitals and clinics Ohioans depend on. And remember history, which counsels some skepticism whenever organized medicine claims to speak for the public.