On The Record

Alexander Persaud
Aug 22
10 min read

Updated: 6 days ago

Preface

I’m writing this because of what I’ve seen working in primary care, especially in a community that doesn’t have nearly enough providers. Our clinic is PA-driven, and I’ve watched firsthand how much of the work physician assistants do to keep people cared for. They’re the ones patients often see first, the ones who follow up, the ones making sure nobody slips through the cracks. And yet I’ve also seen the constant pushback against them, the way the AMA works to limit their independence and box them in with the label “mid-levels,” as if the title alone should shrink the value of their care.

What really shocked me was realizing just how much of our system the AMA controls. I knew they had influence, but I didn’t understand the depth of it until I started digging into how the machine actually works. It’s not only policy, it’s money, too.

Once I saw this, I couldn’t unsee it. The AMA talks about protecting patients, but so much of their history has been about protecting their own dominance. They’ve fought against reforms that would expand care, they’ve lobbied to keep advanced practitioners under the thumb of physicians, and they’ve built a financial empire on the complexity of billing. The truth is, the system isn’t designed to serve communities like mine, it’s designed to serve the AMA. The AMA’s fear-mongering about “socialized medicine” and preventing advanced practitioners from encroaching on their scope has been played for decades, over and over like a broken record, without evolving, and yet it still holds the system hostage.

A Dark History

The American Medical Association, or AMA, is usually presented as a professional body that represents doctors, sets ethical standards, and advocates for patient safety. In reality, it is one of the most powerful political machines in American history, a force that has shaped not only how medicine is practiced, but also who gets to practice it, what care patients can access, and how much that care costs.

From its founding in 1847, the AMA worked to consolidate power for physicians and marginalize anyone else who might provide care. In the nineteenth century, that meant targeting midwives, homeopaths, and other healers. In the twentieth century, it meant blocking the rise of nurse practitioners, physician assistants, and other “mid-levels” who could expand access but threaten physician dominance. The AMA has consistently framed these fights as being about quality and safety, but the real battle has always been about control; who defines medicine, and who controls the money behind it.

That money is significant. Less than 20% of U.S. physicians are dues-paying AMA members, yet the organization is financially secure because it owns the billing coding system. Every doctor, hospital, or clinic must use these codes to bill insurance, and insurers, government agencies, and health systems all pay the AMA licensing fees for the right. This hidden monopoly functions like a toll booth for the entire healthcare system, generating far more revenue than membership dues ever could.

The monopoly also shapes how services are valued. Through its influence on the committee that sets Medicare reimbursement rates, the AMA helps decide what medical procedures are worth. Unsurprisingly, the system rewards procedures and high-tech interventions while undervaluing primary and preventive care. The ripple effect is profound: higher costs, skewed incentives, and fewer doctors choosing primary care.

The AMA’s campaigns have often been darker than they appear. In the early 20th century, it worked to exclude Black physicians and hospitals, opposing integration well into the civil rights era. It vilified midwives as dirty and untrained, driving childbirth into physician-controlled hospitals. During the Cold War, it branded nearly every attempt at national health insurance as “socialized medicine,” stoking fears of communism. For decades, it poured resources into fighting malpractice reforms that threatened its members’ financial interests, wrapping its efforts in the language of “freedom” while protecting physician control.

The fight against socialized medicine has been especially aggressive. In the 1930s and 40s the AMA blocked national insurance proposals. In the 1960s it campaigned against Medicare, even producing a record warning that government healthcare would end American freedom. More recently, it has opposed or watered down reforms that might cut costs but threaten physician incomes. While the rhetoric is about patient safety, the consistent goal has been preserving physician dominance and financial advantage.

For patients, the consequences are clear. The AMA has helped design a system that prizes complexity and billing over care, resists non-physician providers who could expand access, and leaves underserved communities without enough primary care. Preventive health is neglected while “sick-care” is reinforced. Patients face longer waits, higher costs, and fewer options, all while the AMA quietly collects licensing fees in the background.

The irony is stark: the AMA presents itself as medicine’s guardian and patients’ advocate, but in practice it has acted as a gatekeeper against innovation and accessibility. In many ways, it has built a system where the business of medicine outweighs the calling of care.

The Record

Operation Coffee Cup is one of the most fascinating, and disturbing, episodes in the AMA’s long history of political influence. In the late 1950s and early 1960s, the United States was grappling with the question of how to care for its growing elderly population. President John F. Kennedy and later Lyndon B. Johnson were pushing for what would eventually become Medicare: a government-backed health insurance program for seniors. The AMA saw this as an existential threat. To them, a publicly funded insurance system was a slippery slope to “socialized medicine,” a phrase they wielded like a weapon to conjure images of government control, rationing, and the destruction of American freedom.

But the AMA knew that doctors alone couldn’t win the battle. Physicians were a respected class, but their lobbying efforts risked being seen as self-serving. So they devised a campaign that would turn patients’ families, specifically, housewives—into grassroots soldiers against Medicare. They called it Operation Coffee Cup. The idea was simple but clever: organize small neighborhood gatherings where women would meet over coffee, listen to a pre-recorded message warning about the dangers of government-run healthcare, and then write letters to Congress urging them to oppose the legislation.

The most famous artifact of this campaign is a record the AMA distributed, featuring none other than then-Hollywood actor named Ronald Reagan. On the record, Reagan delivers a monologue warning that Medicare would lead to the destruction of American liberty. He claimed that once government entered healthcare, there would be no turning back, that Americans would wake up one day and find themselves explaining to their children what it used to mean to be free. Reagan’s calm, persuasive delivery made the message sound less like alarmist propaganda and more like common sense. The AMA harnessed his star power and packaged the recording for nationwide distribution. You can listen to the record below.

Operation Coffee Cup ~ 10 Minute Listen

Click to play or pause the record, double click to restart.

As you listen, remember who this message was meant for: suburban housewives in the early 1960s, gathered in living rooms over coffee while the country wrestled with the Cold War, civil rights, and the looming question of Medicare. Many were anxious about communism creeping into American life, wary of government intrusion, and protective of the freedoms their families enjoyed. To them, this record would not have sounded like propaganda, it would have sounded like common sense, a neighborly warning wrapped in reassurance. The fear it carried wasn’t abstract; it tapped into the very real anxieties of the time. And though the world has changed, the echo of that fear still lingers in the way power is guarded in medicine today.

Of course, their campaign ultimately failed in the immediate sense. Medicare passed in 1965, becoming one of the most popular and enduring social programs in American history. Millions of seniors gained access to healthcare they otherwise could not afford, and despite AMA’s warnings, freedom did not vanish overnight. Yet the legacy of Operation Coffee Cup lived on. It cemented the AMA’s reputation as a political powerhouse willing to use unconventional tactics to preserve its dominance. It also helped launch Ronald Reagan’s political career, as the themes he rehearsed on that record, government overreach, the threat of socialism, the sanctity of freedom, would define his later speeches and presidency.

Political Influence

Looking back, Operation Coffee Cup reveals the lengths the AMA has gone to in order to maintain control, even at the expense of patient welfare. Instead of embracing a program that would protect vulnerable seniors, they fought it tooth and nail, preferring to protect the market share of private physicians and insurance companies. They wrapped their arguments in the language of liberty, but at the core was the same driving force that has guided the AMA for decades: the preservation of physician monopoly and the financial structures that benefit it.

However, this alone did not deter the AMA. The AMA quickly shifted its strategy from opposition to influence. They inserted themselves into the regulatory framework of Medicare and Medicaid, ensuring that physician groups would have a decisive role in shaping reimbursement rules and medical billing standards. It wasn’t just about practicing medicine anymore, it was about controlling the economics of medicine. One of the clearest examples of this was their creation and control of the Current Procedural Terminology (CPT) code system. These codes, used for billing medical procedures, became the language of payment in American healthcare. By holding the reins of CPT, the AMA effectively turned itself into a toll booth operator for the entire healthcare system. Every insurer, every hospital, every provider had to use the system they managed. It was a brilliant play: even in a world with “socialized medicine for seniors,” the AMA could still make sure the flow of money passed through their hands.

Financially, this move solidified their influence. The AMA collects licensing fees from virtually every payer and system that uses CPT codes. That includes Medicare itself, private insurers, and even electronic health record vendors. It’s no exaggeration to say that the AMA monetized its defeat. They transformed from opponents of Medicare into profiteers from its very existence, showing how deeply their primary concern lies not in patient care but in financial dominance.

But influence over the billing system wasn’t enough. The AMA also doubled down on defending physicians’ exclusive role in providing care. This is where their campaigns against nurse practitioners, physician assistants, and other mid-levels come in. These healthcare professionals have consistently proven they can provide safe, effective, and often more affordable care, especially in underserved areas. Expanding their scope of practice could help solve America’s physician shortage and lower costs for patients. But for the AMA, this is seen as a direct threat to the physician monopoly.

Here is their most recent example of opposition. Through aggressive lobbying, fear-based public campaigns, and political donations, the AMA works to restrict what mid-levels can do. They push narratives that patient safety would be jeopardized if NPs or PAs practice independently, despite evidence showing the opposite in many contexts. They frame it as protecting standards of care, but the subtext is always the same: protecting the market share of physicians. By keeping mid-levels under tight supervision requirements, the AMA ensures that revenue streams remain tethered to doctors.

This isn’t just professional turf-war politics, it harms patients in real terms. Millions of Americans live in rural or underserved communities where physicians are scarce, but nurse practitioners and physician assistants are more readily available. By suppressing these providers’ ability to practice to the full extent of their training, the AMA perpetuates bottlenecks in care delivery. Patients wait longer for appointments, travel farther for basic services, and pay higher prices, all in the name of preserving physician dominance.

AMPAC

Fast-forward to today, and the American Medical Association isn’t just surviving, it’s thriving in the corridors of power, with deep pockets and deeper influence.

In 2022, the AMA spent over $21 million on federal lobbying, ranking it among the largest single advocacy spenders in the country. Nearly $5.3 million of that was poured into Capitol Hill just in Q2 alone. And the trend shows no signs of slowing: by early 2025, the AMA had already invested $8 million in just the first quarter, up more than 20% from the previous quarter.

That money isn’t lining politicians' pockets directly, it’s going through the AMA’s Political Action Committee (AMPAC). These funds allow the organization to back candidates, build relationships behind closed doors, and shape legislation before public debates even begin. It’s an entrenched ecosystem: AMPAC contributions lead to direct access to lawmakers, which in turn paves the way for policies favoring physician reimbursement, reimbursement models, and control over care delivery, even when those policies run counter to expanding patient access or lowering costs.

When it comes to universal care, the AMA has been equally strategic. Though younger physicians have pushed for neutrality, or even single-payer options, the AMA narrowly voted down such a resolution in 2019 (53% against 47%). Behind the scenes, this internal resistance preserved the status quo while avoiding outright opposition in public.

Still, the broader power play continues through alliances like Partnership for America’s Health Care Future, a coalition of hospitals, insurers, and pharma lobbying against Medicare-for-all. The AMA quietly stepped back from that group in 2020, but the narrative they helped build remains dominant: “government-run care is risky”

Not all of the AMA’s recent moves have been reactionary, though. In August 2025, the AMA notably abandoned its quiet advocacy posture by publicly denouncing administrative actions that threatened scientific consensus, like the disbanding of vaccine advisory boards. That shift signaled willingness to step into the media glare when public pressure demands it. Yet, this boldness remains reserved for issues where the optics outweigh profit mechanics.

Silence

Imagine a vast, unseen current flowing beneath the surface of American healthcare. On the surface, there are waves that catch the eye, politicians giving speeches, insurers haggling over premiums, hospitals clashing over budgets. But beneath it all runs a deep tide, steady and relentless, shaping the course of everything above. That current is the AMA.

Its influence doesn’t crash like thunder or roar like a storm. It moves quietly, with the persistence of undertow, pulling at lawmakers in late-night meetings, tugging on policy through big PAC donations, drawing every provider back toward its hidden center of gravity. Every committee it staffs, every billing code it controls, every narrative it feeds into the bloodstream of public debate serves to keep medicine orbiting within its reach.

Hospitals and pharmaceutical giants may shout the loudest, but the AMA’s voice is different: low, constant, and inescapable. Patients rarely hear it. Even physicians, who benefit and suffer under its weight, often mistake the current for the natural order of medicine.

The true legacy of the AMA is not noise, but silence, the silence of choices never offered, of reforms strangled before they take root, of providers barred from practicing fully, of patients paying more and waiting longer and blaming their providers. It is a tide that has been pulling for generations. And unless we name it, unless providers learn to resist it, we will continue to drift wherever they decide to take us.

Conclusions

I didn’t come to these conclusions on my own. A big influence was Blind Spots by Dr. Marty Makary, a surgeon and public health researcher who’s been outspoken about the hidden flaws in American medicine. His book lays bare how powerful institutions shape the system in ways patients rarely see, through billing practices, lobbying, and policies that quietly limit care while claiming to protect it.

What I hope you take away is that the struggles we face in healthcare today aren’t accidents, they’re the product of choices and power plays that stretch back decades. By seeing how deeply the AMA has shaped the system, you’ll question more of our medical associations and their decisions, demand better, and recognize that patient care should never be held hostage to politics or profit.