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When President Barack Obama convened a meeting in May to discuss how the private sector could help reduce health care costs, Bryan resident Dr. James Rohack had a prominent seat at the table.
"I mentioned to the president that physicians will try to reduce the variation in care by coming up with best-practice guidelines so that when a patient comes to the ER with a headache, not everyone needs to get a CT scan," Rohack said.
But he said that the more than 200,000 physicians he represents as president of the American Medical Association needed something in return.
"I told the president that if you don't give us medical liability protection over being sued for not ordering the test, then we are going to keep ordering the test and we are not going to cut costs," he said.
Rohack said Obama listened and told him that the concept was worthy of discussion.
In September, the cardiologist was in the room applauding when Obama announced before a joint session of Congress that he was authorizing grant money to test ways to control medical liability.
It was one of the many times in the past few months that Rohack has played a role in the health care debate. He has traveled across the country giving speeches, speaking with politicians and being interviewed on national television and in major newspapers.
Rohack has been president of the AMA since June, and his term coincides with one of the most important moments in the organization's history. The position has given him a voice of authority on an issue that has dominated the national discussion this year.
A new approach
Rohack is the second Bryan resident to be AMA president in the past two decades. Texas A&M Health Science Center president Dr. Nancy Dickey served in the role in the '90s and was on the association's leadership board when the Clinton administration attempted comprehensive health care reform in the early part of the decade.
"The Clinton health care reform was done largely behind closed doors," Dickey said. "It was a hand-picked group of policy wonks and economists -- the AMA didn't have official seats at the table and didn't have formal ways of knowing what they were making."
Those attempts at reform failed, but Rohack said the AMA leadership became aware near the end of former President George W. Bush's term that the issue would emerge again.
He said the group recognized that the status quo wasn't working: Health insurance premiums were rising and forcing employers to drop their employee coverage, patient choice was limited and significant waste was evident in the health care system.
The association recognized that change couldn't happen late in Bush's term, so it began to reach out to the presidential candidates, Rohack said.
"At the time, AMA was interacting with both Senator Obama and Senator [John] McCain," he said. "We didn't care who won, we just wanted to make sure we talk about the richest country in the world with wonderful technology, but 40 million people have no health insurance."
The organization has taken stances on many issues, but it has most forcefully advocated for physician liability protection and stopping a scheduled 21 percent reduction in doctors' fees paid by Medicare.
The association's agenda was dealt a major blow on the latter issue Thursday when the Senate blocked a vote on a bill that would have averted cutting Medicare payments by $250 million over the next decade.
Senate leaders declared afterward that the issue wasn't dead, and Rohack will surely continue to advocate efforts to block the payment reductions.
As president, he doesn't determine the stances that the AMA takes on political issues. That is done by a large group of voting delegates representing various specialties and geographic locations.
"It is one of the most truly democratic organizations that I know," Dickey said.
But Rohack is the lead advocate, both publicly and behind doors.
"What we do when we are meeting with Congress and policymakers is we try to say, 'This is the policy the AMA has. How can we come to common ground?'"
Rohack has testified before Congress and met with elected leaders. He also gives scores of media interviews -- he is occasionally on cable news and, on the day he sat down for an interview for this story, he was scheduled to speak with a reporter from The Washington Post.
He also travels across the country to public speaking engagements to educate the public and update doctors.
In all, he said, Rohack spends about 200 days a year on the road.
"The reality is, giving credibility to what you say is what you want to do well," he said.
Credibility
Rohack stands at well over 6 feet, and he speaks with passion about medicine and caring for patients.
"When he takes that nice, deep voice of his and stands up to that microphone, he has been able to command attention," Dickey said.
Rohack draws upon his years of experience in all levels of medicine in his work in the AMA, he said.
Originally from upstate New York, he moved to Texas to attend school at the University of Texas at El Paso because he wanted to get away from the snow. He said he originally planned to become a priest, then became interested in psychology, but decided to go to medical school because his grades were good enough.
He graduated from the University of Texas Medical Branch at Galveston in 1980.
Rohack moved to Bryan in 1986 when Scott & White was opening a regional clinic. He also spent time volunteering for the local Health for All clinic.
"I enjoyed my clinical practice here, and then in '97, Scott & White asked me to come up to Temple to do more administrative stuff," he said.
He agreed, but he and his family didn't want to move from their home in Bryan. He lives on a ranch on Leonard Road, and his wife runs a wildlife rescue for birds of prey on the property.
"It is part of our contribution to the planet, and, when you talk about the uninsured, wildlife are the ultimate uninsured," he said.
At Scott & White, he now serves as medical director for system improvement and director of the Center for Healthcare Policy. He has stopped accepting new patients but continues to treat old ones, including some he has seen since he worked in Bryan and who drive more than an hour for appointments.
"I went into the medical profession to care for patients," he said. "I still find this rewarding for the patients as well as rewarding for myself."
His one-year term as president of AMA will expire in June. He said he recognizes that he is involved in discussions that will affect millions of people across the country.
"It is very humbling," he said. "I am kind of aware of where I am in history. Who knows what will happen in 50 years or 100 years from now, but hopefully next year, we will make some important changes."
