The American Medical Association (AMA) is discussed in three episodes of The Bob Zadek Show as an organization whose reach extends into licensing, federal reimbursement, and criminal law. The treatments differ in emphasis: one focuses on the AMA’s role in opposing nurse practitioners’ independence, one on its monopoly over Medicare’s coding system, and one on its unsuccessful opposition to marijuana criminalization. Across the three, the excerpts present a consistent portrait of an organization acting to protect the economic and institutional interests of physicians.
Occupational licensing and the nurse-practitioner fight
In a closing monologue, Bob Zadek took up the shortage of primary care physicians, which he said stood at about 9,000 and was expected to rise to about 66,000 over ten years. His proposed remedy was to let nurse practitioners—nurses with graduate degrees trained to perform nearly all the functions of a frontline family doctor—practice without physician supervision. Because occupational licensing is mostly a state matter, the rules vary: about 18 states then allowed nurse practitioners to practice without a doctor’s umbrella, and Zadek said California hoped to become the 19th. Hearings were under way but the issue had not been finalized Immigrants – The Ultimate Entrepreneurs (2013).
Zadek said he looked at the position papers filed against expanding nurse-practitioner practice and found roughly 25 organizations, all with an economic stake in keeping nurses from siphoning business from doctors, and not one consumer group arguing that consumers deserved to choose their provider. He characterized the arrangement as regulatory capture and as government acting “under the control of the American Medical Association or the California Medical Association in this case.” He framed the restriction as offensive to his own right to pick a healthcare provider, and noted a parallel with dental hygienists, most of whom are women and who in almost every state cannot open a storefront to clean teeth outside a dentist’s office. Most nurse practitioners are women and most doctors men, he said, so the supervision requirement means women cannot practice without being under the supervision of a male. He also pointed out that family doctors routinely refer patients to specialists and the state trusts that judgment, while not trusting the same referral from a nurse practitioner Immigrants – The Ultimate Entrepreneurs (2013).
The coding-system monopoly
Dr. Jeffrey Singer told Bob Zadek that the AMA lobbied Congress for and obtained a monopoly on the medical coding system beginning in the early 1980s. The AMA designs the codes each year—thousands of numbers covering every procedure, service, and diagnosis—and, Singer said, “The American Medical Association had a bonanza here. They had a monopoly.” With no competing coding systems, the AMA is paid by Medicare and by insurance companies to develop the codes, to the point that a significant, if not the majority, of AMA income comes from the codes rather than from membership Will Americans Accept Second Class Medicine? (2013).
Singer described how the codes reshaped medical practice: physicians had to describe services according to codes even when a code did not fit the patient’s problem, and they began acquiescing to the system for the sake of payment. Medicare then instituted price controls in the mid-1980s, with a commission setting what each procedure code is worth; Singer noted that Medicare sends him a book every October fixing the reimbursement for each code, so that the best surgeon in the world and a first-time operator receive the same amount. He contrasted this with law, telling Zadek that under Medicare rules he cannot reduce his fee for a patient with limited income because that would be discriminatory, while Zadek said he adjusts his own rates as a lawyer “every day.” Singer also said doctors’ offices now employ certified coding specialists, a field that emerged to maximize reimbursement, and that because payment requires a diagnosis, physicians must record a code such as breast pain for a normal exam—making epidemiological data suspect Will Americans Accept Second Class Medicine? (2013).
Marijuana prohibition
Dr. Rick Doblin told Bob Zadek that “the American Medical Association was the major organization that argued against the criminalization of marijuana” in Congress. The AMA said marijuana had many medical uses, that evidence of abuse was massively exaggerated, and that the risks were overstated—and its testimony “was completely ignored.” Doblin placed the criminalization in the context of Harry Anslinger, prohibition agents looking for something to criminalize after the end of alcohol prohibition, and a campaign aimed mostly at Mexicans and black jazz musicians Dr. Rick Doblin on MAPS and the War on Drugs (2016).
Earlier in the same conversation, Zadek read from an editorial he said was in the Journal of the American Medical Association, describing the early 20th-century climate in which mainstream institutions linked what he called—flagging the word as offensive today—“Negroes” with drug use. He quoted the journal’s claim that Black men in the South were reported addicted to cocaine sniffing and that newspapers claimed cocaine use caused them to rape white women more and enhanced their accuracy with a pistol, alongside a blue-ribbon panel’s statement about “the Chinaman” and a New York Times article on “Negro cocaine fiends.” Zadek’s point was that drug regulation had an ugly racial history unrelated to whether drugs are inherently dangerous. His quotations are his own reading from the historical sources, not statements by the AMA itself Dr. Rick Doblin on MAPS and the War on Drugs (2016).
Across episodes: the AMA as an obstacle and an institution
The three episodes span 2013 to 2016 and treat the AMA differently in each. In the earliest, Zadek names the AMA in passing as the force behind California’s resistance to nurse-practitioner independence, alongside the California Medical Association; the fullest account of its institutional role is the 2013 coding-system episode, where Singer, speaking as a physician, describes the AMA’s coding monopoly and its revenue from Medicare and insurers. The 2016 episode presents the AMA in a different posture altogether—as the major organization arguing against marijuana criminalization in Congress, whose testimony was ignored—and the excerpts do not connect that stance to the licensing or coding conduct. The later treatment does not revise the earlier; it simply places the AMA on the opposite side of a different question.
What the sources do not cover
The excerpts do not state the AMA’s founding date or principles, the size or structure of its membership, or its current official positions on nurse-practitioner scope of practice, coding, or marijuana. No source names the specific legislation granting the coding monopoly, the California bill on nurse practitioners, or the congressional action that criminalized marijuana. The AMA’s role in the Journal editorial Zadek quotes is not established by the excerpts; the journal is identified only as the publication. Nothing in the sources indicates whether the AMA took a position on the Medicare price controls or the commission that sets code values.