There is nothing more powerful than an idea whose time has come. There is nothing less powerful than an idea whose time has come and gone.

In 1846, and for more than 100 years after that, the American Medical Association as a nationwide organization for all physicians was a powerful idea whose time had come. It worked well for many things and OK for many more.

Then, in the 1970s, 80s, 90s, it came apart and now has the least representation of actual members of a widely diverse base than ever and shows few signs of recuperation. Recently, I advocated that all American physicians should become members of the AMA for their entire time in medicine.

Responses, both published and unpublished, were vigorous.

The divide between physicians who think that the AMA should fight for them and those who think that the AMA should fight for the health of the people seems too large to bridge in 2012.

When you add to that the often expressed belief that the AMA fails on both fronts, it really becomes unsalvageable.

Perhaps it is as simple as a reflection of the gridlock in the American government, red states vs blue states and within states, red counties vs blue counties. Too-far-right Republicans and too-far-left Democrats, and few in the middle, with few willing to compromise.

Perhaps it is as simple as generational gaps between the key motivations of medical students entering medical school during different decades as the landscape, environment, and ecology of American medicine has changed so abruptly, in fact in midstream of many medical careers.

I see only three ways to rescue the AMA. Membership in the AMA, state, and county medical association could be made a legal condition for state medical licensure, or a national medical license.

Or, the AMA could change its key objective. It could either become a lobbying organization representing all physicians with group bargaining, to the fullest extent of the law, or a new law that allows collective bargaining.

Or, it could follow its current key objective and truly “promote the art and science of medicine and the betterment of public health” and stop also trying to represent the financial interests of its members.

Depending upon how these played out, this “new” AMA could spin off the eternally successful journal publishing effort as a separate publishing business. It could close the Washington office. Physicians could go mostly to salaries from not-for-profit multispecialty managed care organizations like Kaiser Permanente or Geisinger, or various ACOs.

Without a strong AMA speaking for all American physicians, Medicare for All is just around the corner. And this Medicare will not be fee-for–service, since that failed to control costs. It will be physicians on salary from ACOs, HMOs, government run clinics, and the like. No private insurance companies, thus no need for billing, so no need for coding.

Goodbye AMA lucrative CPT, no more hated RUC. Physicians who refuse to take Medicare patients (my estimate less than 5%) will still be allowed to care for private, pay-as-you-go, out-of-pocket patients, concierge level or less.

And, if you think physicians are angry now, wait 5, 10, 15 years, and there will be another effort to rebirth an AMA, probably like the old one. Oh my.

George Lundberg is a MedPage Today Editor-at-Large and former editor of the Journal of the American Medical Association.