The AMA (American Medical Association) is an interesting example of where our institutions are headed.

This is a trade organization. It lobbies Congress on behalf of medical doctors and puts out policy positions. It has no role in government and no enforcement power to actually do anything, but is still quite influential.

The AMA used to have a large majority of all physicians in the US as members, but it has dwindled over the years so instead of having >80% of doctors it now has <20%. So now, although it purports to represent the whole of the medical profession, it really represents a pretty small slice, since of course only a minority of the remaining dues-paying members are even really involved. The people who are active with the AMA now slant heavily towards silver spoon types. Those are the sorts of people who have enough money in the bank to handle the demands of the medical profession and pay for medical school while still having enough free time to get involved in politics. They’re also the sort of people who have powerful friends. So the institution is a pretty extreme example of luxury beliefs. The people who are active there literally do not know anyone who isn’t rich, and most of them probably do not see Medicaid patients, if they bother to practice medicine at all. Even from the perspective of other physicians, they’re cloistered and out of touch.

I’ve been active with my state medical association and I’ve thought about trying to gain some sway in the national AMA, but from what I’ve seen I’m not convinced that anyone who isn’t an old money type or a DEI hire can really make much of a difference.

Because it is not a governmental institution, the AMA is not very transparent and is hard to change. But a lot of actual legislators and regulators will take their marching orders from the AMA even as its influence declines.