AMA: Healthcare Reform Bill a 'Starting Point'

As Congress and President Obama square off over healthcare reform, one of the most prominent and widely courted voices in the debate is the American Medical Association, the country's largest physician organization. The AMA gave Obama a mostly warm reception when he spoke at its annual conference in June and made big news last week by backing the House's healthcare bill. The amicable tone is a departure from the 1990s, when the AMA helped defeat President Clinton's healthcare reform plan. U.S. News spoke last week with AMA President James Rohack about the prospects and challenges of healthcare reform. Excerpts:

The AMA surprised some people when it came out in support of the House bill last week. What was behind the endorsement?

The AMA is clearly committed to health reform this year. We believe the status quo is unacceptable. We want to make sure patients have access to a healthcare system that has affordable health insurance coverage for everybody. As we took a look at those principles and the bill that was being proposed, we knew that our endorsement would be helpful to keep the legislative process moving forward.

You also called the bill a "starting point," which suggests you're not totally satisfied.

We are committed to reducing unnecessary costs in healthcare, and clearly that bill did not address the unnecessary costs of defensive medicine [when doctors order extra tests to protect themselves from lawsuits]. So we are trying to work to get the bill amended so there can be ways to address the unnecessary costs of additional tests or therapies that are being done because of defensive medicine.

Politically, one of the big concerns right now is that the Democrats' plans don't do enough to make healthcare cheaper. Do you agree?

If Congress has the will to achieve a vision of affordable healthcare coverage for everyone—and we agree that's where we need to go to—they are going to have to address reducing unnecessary costs. Defensive medicine is an unnecessary cost. Antitrust barriers that prevent physicians from interacting with each other—that's another real barrier to reducing unnecessary costs. If Congress is committed, we're committed to work with them to come up with something that is going to be right for patients and right for the physician who cares for them.

You're a cardiologist. How has that shaped your view of what's needed for real healthcare reform?

Many of the patients I care for have medical conditions that they are going to have all their lives. Many times we have to use medications. One of the things I've recognized is that sometimes medications come out and you're not really sure which one is right for your patient. I think with health reform, there's an opportunity to say comparative-effectiveness research can be very helpful for a patient and a physician to know what's best for them—as long as it's not mandated that you have to go one way versus another, because patients are different. It's important information that right now we just don't have.

You've emphasized the problem of defensive medicine. Just how costly is it?

Some have estimated in the $200 billion range. Others have said it may not be as much. The bottom line is it is a significant contributor to tests being done to prevent problems in a courtroom down the road. People who show up to an emergency room now with abdominal pain wind up getting a CT scan. In the past, it was "Well, your belly isn't tender. Your white count is not elevated. The chance you have anything going on that's of concern is about 1 in a million." But say you didn't order the CT scan, and later on it comes back, and oops, you were one of the 1 in a million and you get a suit. So then everybody said, "OK, we're just going to order CTs on everybody." The problem is there is no protection. There is no safe harbor. If you follow the guidelines and don't order tests, you can still be sued.

What about chronic diseases? There are studies that say two thirds of the recent rise in healthcare spending is due to obesity, diabetes, and other chronic conditions.

When you take a look at mortality rates for heart attacks 30 years ago, if you had a heart attack and you made it to the hospital, you had a 30 percent chance of dying in the hospital. Now your rates are 2 percent or less. We have done wonderful, great things in the U.S. We just haven't kept up with the evolution of how we need to align incentives to have patients stay healthy and avoid the unnecessary costs.