The Opposite of Socialized Medicine

A small, litigious group has spent decades trying to stop the government from telling doctors what to do. What happens if it succeeds?

Bettmann / Getty / Katie Martin / The Atlantic

When the vaccine crackdown came, it was the doctors, of all people, who felt censored. It all started last year, when Adam Schiff, a Democratic representative from California, sent letters to Amazon and other tech giants expressing concern that the companies feature anti-vaccine videos and information on their platforms. Schiff cited a report by CNN that found that many searches on Amazon related to vaccines led to anti-vax content. The first listing, for instance, was a sponsored post for the book Vaccines on Trial, which is dedicated to “children who had to suffer due to adverse vaccine reactions.”

Amazon removed anti-vaccine movies like Vaxxed: From Cover-Up to Catastrophe from its Prime streaming service, incensing advocates opposed to mandatory vaccines and leading to a lawsuit that was filed against Schiff a few weeks ago. The lawsuit came from a New York woman who wants more information about vaccines, alongside an organization that, on the surface, seems counterintuitive: a group of doctors called the Association of American Physicians and Surgeons.

The lawsuit alleges that Schiff’s actions are tantamount to censorship. As a result of his letters, the suit says, Amazon kicked AAPS out of an affiliate network through which the organization had earned commissions. According to the group, searches on Facebook for AAPS vaccine articles instead yielded links to the World Health Organization, the National Institutes of Health, and the Centers for Disease Control and Prevention. One of the AAPS articles that was allegedly suppressed states, “Measles is a vexing problem, and more complete, forced vaccination will likely not solve it.” (Schiff’s office did not respond to a request for comment.)

The Association of American Physicians and Surgeons might sound like another boring doctors’ group politely debating telehealth legislation. But AAPS is a small yet vociferous interest group. Like Zelig with a stethoscope, it has popped up in nearly every major health-care debate for decades, including the Affordable Care Act and opioids, and it wields a surprising amount of influence. Senator Rand Paul of Kentucky was outed as a member in 2010. (A Paul spokesperson told me that while the senator is no longer a member, he is supportive of AAPS’s fight against Obamacare.) When Representative Tom Price of Georgia was nominated to lead President Donald Trump’s Department of Health and Human Services, several newspapers pointed out that he, too, was a member. (At the time, an HHS spokesperson said that not all doctors in a group believe the same thing.)

Though AAPS often takes positions that are associated with conservative groups, it sometimes goes even further, pushing fringe views that most mainstream conservatives do not endorse, such as the belief that mandatory vaccination is “equivalent to human experimentation” and that Medicare is “evil.” Over the years, the group seems to have coalesced around an ethos of radical self-determination and a belief that mainstream science isn’t always trustworthy. It’s the most curious of medical organizations: a doctors’ interest group that seems more invested in the interests of doctors, rather than public health.

At a time when doctors are facing scorching levels of burnout, health-care costs are soaring, and seemingly everyone is frustrated with the status quo, AAPS seems to have come up with an unusual answer: to turn back the clock. AAPS sees its vision as forward-looking and modern, but the group’s rhetoric recalls an era when a doctor would treat you for just a few bucks. No insurance deductible would need to be met first, and no intimidating vaccine schedule had been mandated from above.

AAPS has been called the Tea Party’s favorite doctors, but it’s actually a more fitting health-care group for the Trump era. As Trump has contributed to sowing doubt about the scientific consensus, AAPS is seizing the moment. The group just wants to make health care great again—even if that means tearing it apart.

AAPS was founded in 1943 in opposition to an early effort to provide universal health care to Americans. It first shot to fame half a century later, when it sued then–first lady Hillary Clinton to gain access to the records of her Task Force on National Health Care Reform. (Though the Clinton administration was initially ordered to pay AAPS’s lawyer fees and other costs, eventually a federal appeals court ruled in its favor.)

Today, the group has moved beyond simply opposing health-care reform, with the apparent intent to throw sand in any and all government gears. It seems most invested in protecting doctors from regulations. “We believe in private medicine,” Jane Orient, AAPS’s longtime executive director and primary spokesperson, told me in a phone interview. “We have opposed attempts to intrude government and other third parties between the patients and the physicians.”

Orient said that AAPS’s membership consists of “under 5,000” of the country’s million or so doctors. She is a physician herself, based in Tucson and licensed by the Arizona Medical Board. According to AAPS’s tax forms, Orient makes $181,000 a year from the group, though she said in an email that much of this goes toward running the office, such as IT support and office supplies, and that her salary is $48,000. On Facebook, someone named Jane Orient from Tucson posts AAPS press releases on her feed, along with ads for radiation detectors, conspiracy theories about vaccines, and inspirational posts from Orient would not confirm whether this was her Facebook page.

During our call, Orient was down on insurance companies, as well as electronic health records and anyone or anything that might tell a doctor what to do, ever. In 2005, Orient backed doctors who prescribe lots of opioids, telling a newspaper that doctors were being “imprisoned for prescribing in good faith with the intention of relieving pain.” (The opioid epidemic has claimed 700,000 American lives.) In 2007, AAPS sued the Texas Medical Board to stop it from relying on anonymous complaints to retaliate against doctors suspected of wrongdoing. (AAPS lost.) Later, AAPS became the first medical society to sue to overturn the Affordable Care Act, saying that it “spells the end of freedom in medicine as we know it.”

During the 2018 election cycle, AAPS donated $16,000 to federal political candidates, all of them Republicans, according to the Center for Responsive Politics. Orient herself has consistently donated small amounts of money to candidates, almost exclusively Republicans, since 1998. But the group drifts from the Republican establishment in many ways. Orient said she opposes some traditionally conservative health-care policies, such as the Massachusetts predecessor to the Affordable Care Act devised by the conservative Heritage Foundation. Regarding Trump, Orient said he has been “a disappointment in some ways,” but that AAPS is “very glad for some of the things that he has done,” such as continuing to oppose Obamacare.

Several mainstream conservatives I reached out to declined to speak with me about AAPS. When I finally got one right-leaning health wonk, Joe Antos, on the phone, he said he had been thinking of the wrong AAPS and did not know much about the group.

Meanwhile, a media-relations representative at the American Medical Association, the main doctors’ group in America, mentioned that he'd expect the AAPS to accuse the AMA of having a ‘fascist’ relationship with the government. Orient told me that AAPS does not consider the AMA fascist, “although we certainly criticize many of their policies. We think it is important to define terms precisely and not to indulge in name-calling.”

Perhaps the only thing Americans agree on when it comes to health care today is that something’s gotta give. Electronic records are a nightmare for many doctors, and patients hate fighting with insurers as much as doctors do. It’s natural to want to just nuke it all. AAPS presents an extreme vision of that: What would happen if the government didn’t make doctors do, well, anything? I’ve met with some doctors who see anti-vaccine patients and who also don’t accept insurance, and I was taken by how free, self-actualized, and otherwise perky they were. Many doctors might readily swap an overcrowded primary-care practice for a concierge gig like that.

AAPS seems to have pushed this vision of the unfettered doctor too far, though. Over time, it has taken a puzzling turn toward unconventional medical views, as exemplified by its legal tangle with Schiff. To Orient, the government should not even dictate essential medications that protect public health. Asked whether vaccines increase the risk of autism, she said, “I think that the definitive research has not been done.” (The overwhelming scientific consensus is that vaccines do not cause autism.)

In 2015, after measles broke out at Disneyland, AAPS put out a press release questioning the safety of vaccines. The group has suggested that women who have abortions are at a higher risk of breast cancer, though mainstream scientists say this is false. In 2008, an article on AAPS’s website suggested that President Barack Obama was covertly hypnotizing people with his speeches, and that this might explain why Jews voted for him. AAPS’s journal, the Journal of American Physicians and Surgeons, has published articles raising doubts that HIV causes AIDS and questioning the wisdom of urging people to quit smoking, according to the Louisville Courier Journal.

Orient told me that the articles in the group’s journal don’t necessarily represent the official policy of AAPS. She called the story from the Louisville Courier Journal a “hit piece,” saying that the smoking article was arguing simply that “constantly telling [people] that nicotine is addictive might give them an excuse not to try” to quit. Regarding the abortion–breast cancer link, she said in an email that “there is a large and growing number of articles supporting this, although ‘mainstream’ American researchers deny it and focus on a small number of articles with negative findings.” She denied the suggestion about Jews and said that the entire AAPS article was referencing an article from another source.

Orient disagrees with the premise of this article, too. She said that AAPS cares most about patients, not doctors. Rather than being backwards-looking, she said, the group is “looking forward to a future in which there’s more innovation and more freedom, instead of one in which there’s tighter government control.” With such freedom, Orient told me, “we could have a thriving, innovative, friendly medical practice where when you call the doctor’s office on the phone, instead of saying, ‘What insurance do you have?’ the doctor’s office will say, ‘How can we help you?’”

AAPS’s apparent yearning for patients to pay with cash and for doctors to do as they please has historical precedent. Medicare only arrived in 1966. Before that, the options for seniors were to, as PolitiFact notes, “spend their savings, rely on funding from their children … hope for charity from the hospitals or avoid care altogether.” In the early 1970s, only certain states had school vaccination laws—and their measles rates were 40 to 51 percent lower than in schools without such laws.

There were indeed fewer rules and less paperwork back then. But the AAPS doesn’t seem to offer a solution for the fact that these days, a single “How can we help you?” from a doctor can result in a five-figure bill. In recent years, the group has focused on opposing calls for single-payer health care, and it even came out against surprise-billing legislation, which would protect patients from out-of-network hospital bills and has garnered bipartisan support in several states. (Orient dismissed these measures as “price controls imposed on physicians.”)

In our conversation, Orient did say that physicians should strive to help people who can’t pay, that hospitals should charge more reasonable and transparent prices, and that patients are often able to reduce their hospital bills through negotiation. But in 2016, Orient wrote in an op-ed that some people might simply sell their belongings to pay their medical bills. “Consider this,” she wrote. “Would you rather buy a nice car and risk having to sell it to pay a bill, or pay the insurance company the same amount and never get to drive the car?” (Orient stands by this, writing in an email, “If you lived beyond your means and bought a car that you couldn’t afford, and did not provide for future medical costs, how much sympathy should you receive?”)

Most health groups today have a specific idea for how to reform medical care, whether through single-payer health care or Netflix for doctors. The trouble with AAPS’s vision for America is that it exhibits a nostalgia for a past that never existed. Measles killed hundreds of Americans a year before the vaccine became available. Americans are drowning in medical debt that kindly doctors haven’t successfully eliminated, and selling our cars to pay for medical care would strike few people as the right answer. The idea that doctors always do right by patients, and that patients always have the money to pay, and that no one ever gets measles at Disneyland, is a tempting dream. The problem is, it’s just that.