WASHINGTON — Washington. -- For decades, the American Medical Association's role in public policy paralleled that of the National Rifle Association. As the NRA represents the special interest of the firearms industry, the AMA represents the special interest of doctors. As the NRA called any step toward gun control a violation of the Bill of Rights, the AMA said any step toward national health insurance was ''socialized medicine.''
But now that the Berlin wall has fallen and the 1990s are well under way, the AMA has decided to catch up with the century -- to advocate that the United States join the rest of the civilized, industrialized world and make sure that all its citizens have access to decent medical care. This remarkable turnabout comes because even while U.S. medical technology leads the world, public health sinks to the level of scandal.
To be sure, not all members of the AMA are out campaigning for national health insurance; it's not that big a miracle. But the Journal of the AMA, its official voice, devotes its entire current issue to the need for complete reform of the health-care system.
''It is no longer acceptable morally, ethically or economically for so many of our people to be uninsured or seriously underinsured,'' says the Journal's editor, George D. Lundberg. This country has the knowledge and resources to solve the problem, he insists. What it lacks is the leadership.
By speaking up as it has, the AMA would seem to remove the single greatest obstacle to political progress on the issue. Since before World War II, organized doctors have been the most adamant and effective opponents of national health insurance. They fought it when it was proposed by Harry Truman, and they fought it when it was proposed by Lyndon Johnson. They were still fighting it when the first limited version, Medicaid and Medicare, was put through in 1965.
Twenty-six years ago this July, I traveled with Johnson to Independence, Missouri, where he shared honors with Truman as he signed that landmark legislation. Wilbur Cohen, the former Health, Education and Welfare secretary who had shaped it, said then, ''The long ideological dispute in this country over national health insurance no longer is whether every American should be protected by comprehensive coverage, but how or when.''
Mr. Cohen was partly right. Medicare and Medicaid have now existed for more than a quarter-century, and the nation has not collapsed into socialism. Public opinion had changed so far by 1974 that a Republican president, none other than Richard Nixon, offered a substantial health-insurance program.
Mr. Nixon said his health proposal was his ''top domestic priority.'' It would have required employers to furnish employees insurance plans covering standard benefits and provided federally subsidized coverage for the poor. Even Ted Kennedy, then as now pushing government-financed coverage for all, said the Nixon effort was ''a major step'' toward national health insurance.
Needless to say, it did not pass. Nor has Mr. Kennedy's plan, though the subject has been thoroughly and repeatedly debated in committee. On their surface, the continuing objections have not been over whether there should be full coverage, but over when and how. Those objections have determined whether, and the answer has been no.
The AMA's belated declaration of conscience should be a catalyst to congressional action, as it already has been to public debate. The Journal said in strong words that the 31 to 36 million uninsured Americans are disproportionately poor minorities, and
noted that the U.S. and South Africa are the only industrialized nations without a national health policy. It said that in our country, ''a long-crying need has developed into a national moral imperative and now into a pragmatic necessity as well.''
But it did not come out flatly for national health insurance. It presented a span of opinions on exactly what should be done. It urged action, but what kind of action, if any, will be decided by politicians. There is a clear opportunity here for one party or the other to cut through decades of debate and make national health insurance what Dick Nixon called it for one day 17 years ago -- our top domestic priority.
The Bush administration, so far, is studying several approaches. None promises to be drastic. The Democrats are wailing that they have no broad-based issue for 1992. Let them open their eyes.