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In a break from its traditional forbearance on government insurance mandates, the AMA's House of Delegates has decided to swing the powerful physician group's lobbying efforts in back of federal and state provisions that would slap a tax penalty on anyone who can afford health insurance but doesn't buy it.

For individuals, the penalty would fall on anyone who makes more than $49,000 a year who fails to buy a catastrophic care policy. For families of four, the financial line would be drawn at $100,000. But the AMA was conspicuously silent on how big penalties should be.

AMA trustee Dr. Ardis Hoven referred to the measure as a "carrot." Details on the stick were ignored but were likely to be aimed at 5 million people in what the doctors' group called mostly young, relatively affluent families who go uninsured.

For the AMA, the tax penalty was just one of the most prominent in a series of new initiatives adopted at the annual policy-making gathering in Chicago. Every summer, hundreds of delegates from around the country head to the Midwestern city to debate and vote over where and how the physician group will throw its considerable political weight, while renewing its annual effort to keep Medicare reimbursement cuts at bay.

One of the chief targets of delegates this year was the Food and Drug Administration. The AMA passed an initiative calling on the agency to block direct-to-consumer ads for newly approved drugs in the hope that physicians can be given enough time to learn more about a new therapy before they start to prescribe it — or field requests from patients.

The AMA also delivered a public slap in the face to the agency for the way that it believes political concerns have trumped science in the drug approval process. The agency "should not permit political considerations to overrule scientific evidence in making policy decisions," says the policy statement, in what appeared to be a direct broadside at the FDA's inaction concerning a request to make the controversial morning-after contraceptive, Plan B, available over-the-counter.

While admonishing drug companies who hire actors to play doctors in commercials, the AMA had even tougher language for doctors who agree to take on the role of pitching pharmaceutical products. Doctors should be discouraged from playing salesmen, but if they do, the ads should include a "prominent warning" that they have been paid for it.

Other subjects backed by the delegates:

· An initiative calling for a more efficient method for delivering flu vaccine around the country so that physicians can be sure to immunize the most threatened groups.

· A policy that demands health plans publicly explain the way that policies are priced and what they pay for health services. "Patients are being provided with incomplete and selective information," said AMA board member Dr. Cyril Hetsko.

· A call for an end to alcohol ads during college sports shows. "Promoting alcohol use to young adults is irresponsible," said AMA board member Dr. J. James Rohack.

· A set of principles that will help ensure that store-based health clinics offer quality care, including protocols for working with a patient's local doctor.

The AMA still wields considerable influence in Congress and in various state legislatures, but over the past 10 years that political star power has dimmed considerably as the membership in the group has steadily and slowly slid south. In recent gatherings AMA leaders have raised concerns that their membership is too old, too white and too male to truly represent the nation's 850,000 doctors. But some of the association's loudest critics suggest its biggest concern is that the AMA is too small, currently numbering 244,005 members.

Significantly, that figure represented the first small gain in membership seen in years, with an additional 3,300 members signing up as dues-paying members in 2005 compared to 2004. Even at its historically slimmed down size, though, the AMA still wields an annual budget of more than $28 million and is seen as a key player in Congress when it comes to negotiating new rates for Medicare patients.

The AMA's stance on public health policy is as bullish as ever. And with the public's concern about healthcare growing right along with their premiums, AMA president Dr. William G. Plested III insisted that the association was ideally situated to lead the charge for change.

"We are, I would contend, witnessing a combination of circumstances favorable for change," he told delegates to a standing ovation. "And we are the ones — we, America's physicians — to lead that change."

Whatever new social legislation is backed, though, few issues are likely to divert the AMA from its annual assault on its chief legislative agenda: warding off fresh rounds of cuts to Medicare reimbursement rates. Delegates took time out from meetings to direct a fresh wave of e-mails and phone calls to Washington, D.C. to illuminate a position that has become an annual and unending crusade for physicians.

Soon after the delegates went home, the AMA issued a new report showing that doctors enter the profession with an average of more than $120,000 in debt.

"We're already seeing the makings of a physician shortage," says AMA chair Cecil Wilson, who swiftly put the latest figures on student debt to use in reinvigorating the association's war against fresh rounds of projected Medicare reimbursement cuts.

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