As Democrats tout the American Medical Association’s endorsement of their health care overhaul, critics are saying it’s no surprise the Democrats were able to gain the AMA’s support — thanks to a little-known monopoly that sends millions of dollars to the trade group each year.

The AMA holds the exclusive rights to the medical billing codes that doctors are required to use when they submit bills to insurance plans. This arrangement may be getting in the way of making health care less expensive and potentially more effective.

The AMA’s monopoly is the product of a once-secret deal, struck in the early 1980’s, that allowed the government to streamline billing procedures for its insurance programs by setting a single code set as the standard. Under that deal, the AMA maintains and updates the codes at no cost to the government, but generates millions each year selling the code books and software licenses to doctors and insurers.

Many questioned why the traditionally conservative group was willing to lend its support to a Democratic agenda that failed address key AMA concerns, such as a permanent fix to the looming annual cuts in Medicare payment rates to physicians, a matter which was put off until next year.

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