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ROBERT SIEGEL, host:

Now, Dr. James Rohack President of the American Medical Association. The AMA, a perennial foe of Democratic presidents who've tried to overhaul health care, has endorsed the House Democrats' bill. Some state medical associations like the one in Texas, disagree. Among other things, they don't like the public health care option. But Dr. Rohack, a Texas cardiologist, says the AMA has endorsed the bill not for what it is now but for what it may yet become.

Dr. JAMES ROHACK (President, American Medical Association): Clearly the American Medical Association is committed to having fundamental health system reform this year. And the reason is: status quo's unacceptable. And when our house of delegates - which compose all states, all specialty societies - came together in June, they voted on principles that we should evaluate all health system proposals and we did, and for that reason, felt that the political process needs to continue on. And so that's the reason for our endorsement to move that process forward.

SIEGEL: The House Democrats' bill does not address a perennial concern of the doctors, which is a liability - medical liability. In fact, the Texas Medical Association was concerned that it doesn't address the issues of malpractice awards and malpractice insurance risk. Why not?

Dr. ROHACK: Well, clearly, if we are going to be providing something that's affordable for everyone, we're going to have to reduce unnecessary costs, and defensive medicine is contributing to some of those unnecessary costs. And so when President Obama spoke to the AMA house of delegates in June, he recognized that defensive medicine was one of the contributors to unnecessary costs. And so we're willing to work with the White House, the Congress to try and come up with some solutions if we're going to provide what we believe is long overdue fundamental health system reform.

SIEGEL: One solution is a cap on liability - I believe in Texas it's quarter of a million dollars. Is that the sort of solution you're thinking of or could you imagine a different way of adjudicating complaints against doctors?

Dr. ROHACK: Well, clearly we know that there are some proven reforms that have reduced unnecessary costs, and that is caps. However, we are also committed to look at alternatives. We want to make sure patients are cared for, but we also want to say what can we do to make our system safer and improve the quality to reduce those unnecessary costs.

SIEGEL: What do you make of the fact that isn't in the House bill?

Dr. ROHACK: Well, again as we mentioned we endorsed the bill to keep the process moving.

SIEGEL: It's a more tentative - a work in progress, as you see it.

Dr. ROHACK: This is America's legislative process. We did not believe that the bill that was introduced was going to be the final bill. But we also believe that this was too early to call the bill and say, that's it we're not going to play anymore. We believe, like a baseball game, we're in the second inning.

SIEGEL: I want to ask you about a recent article in The New Yorker magazine by Atul Gawande, which described how McAllen, Texas, has the most expensive health care in the country, essentially because the doctors there are collecting as much money as they possibly can, largely from public health plans, by ordering more tests and more procedures than doctors are anywhere else - even in the next county in Texas, where there's a very similar patient population. Why hasn't the AMA stood up for best practices, best outcomes, most efficient outcomes, and given doctors standards that they have to adhere to?

Dr. ROHACK: Well, actually, the AMA has tried - over the last six years, that we have actually brought the profession together through specialty societies, through our physician consortium on performance improvement - to come up with those best practices for patients. What McAllen, Texas, is, is not only a unique area but it's also one of the poorest counties in the United States. And so there's cost-shifting that's going on there because of the uninsured burden. So we're committed as the AMA to try and create a solution so that we can reduce unnecessary variation in care, but also have that liability protection so that if we don't order that extra test, or do that extra procedure, we don't have to worry about being sued because we didn't do that test that wasn't necessary.

SIEGEL: But as doctors in McAllen told Atul Gawande, in Texas, liabilities capped at $250,000 and in other counties in Texas people aren't ordering the same test. They say it's not malpractice. It's a commercial culture, in that particular place, in doctors trying to make as much as the system permits them.

Dr. ROHACK: The reality is, is that there is variation in care. And part of the reason we have variation in care is we don't have, many times, the science to help guide patients and physicians - is a device or a drug better for that patient? The FDA approves new drugs. The FDA approves new devices, but there's no matching. And that's why we were very supportive of legislation to create comparative effectiveness research, so we can have information to be able to provide the doctor and the patient, at the time care is delivered, what's really best for them.

SIEGEL: Dr. James Rohack, president of the American Medical Association, thank you very much.

Dr. ROHACK: Thank you.

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