America Ball Land: American Medical Association supports Barack Obama's healthcare reform plan

Endorsement by the AMA speeds the way for the president to accomplish one of his signature campaign promises

America's largest and most powerful doctors group has endorsed Barack Obama's massive overhaul of the US healthcare system, removing a substantial hurdle to legislation that Democrats hope will extend health coverage to most of the estimated 46 million Americans who currently lack it.

The American Medical Association, which vigorously opposed Bill and Hillary Clinton's 1990s reform effort, today pledged to work with congressional leaders to ensure legislation is soon passed. The group endorsed the strongest legislation currently on the table, proposed this week by top Democrats in the House of Representatives. The group long opposed government intervention in the healthcare system for fear that its physician members would see their lucrative pay decline.

With no universal public programme akin to the National Health Service, Americans rely on a patchwork of employee-provided healthcare, government programmes for the poor, elderly and veterans, and costly private health insurance coverage. Americans spend one out of every six dollars on healthcare - roughly twice as much per capita as other industrialised nations - but lag behind in life expectancy, infant mortality and other health indicators.

The medical association's surprise turnaround may be an indication they see reform as inevitable and hope to influence the legislation at the margins. In its letter to Charles Rangel, a powerful New York Democrat, the group said it hoped for "constructive dialogue" during revision of the legislation.

"We pledge to work with the House committees and leadership to build support for passage of health reform legislation to expand access to high quality, affordable health care for all Americans," the group wrote in a letter signed by executive vice president Michael Maves. The letter was obtained by advocacy group Healthcare for Americans Now. The medical association was expected to issue a statement later today.

The endorsement from a heretofore chief opponent of healthcare reform speeds the way for Obama to accomplish one of his signature campaign promises. Wal-Mart, America's largest private employer, has also backed Obama's effort. The president has made reform a top priority in his nascent administration, and in recent weeks has pushed hard for legislation, dispatching lieutenants to rally support on Capitol Hill and making speeches.

Key to the bill is a health plan provided by the government that would be available to all Americans on a sliding fee scale. The insurance industry and many in Washington fear that would drive Americans out of the lucrative private insurance market.

It also includes a clearinghouse for private insurance plans, to make it easier for American to shop for coverage. Among other provisions, it bars insurers from denying coverage based on pre-existing medical conditions, beefs up a public healthcare programme for the poor, and subsidises coverage for those who need help with costly insurance premiums.

The entire programme is expected to cost more than $1tn over ten years. Obama said he hopes to have legislation finalised by August. The bill endorsed by the association would be paid for in large part by a tax on the 2 million richest Americans.

Doctors and hospital groups and the insurance industry have long rallied against Obama's proposals, warning of rationed care, long waits for treatment, bureaucratic meddling in the doctor-patient relationship, and massive government borrowing to pay for the programmes.