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A Mississippi Business Journal Q&A

Physician J. Edward Hill readies for role as president of AMA

Tupelo — Physician J. Edward Hill is poised to preside over the American Medical Association (AMA) next June, a 157-year old national association with 250,000 members.

Born in Omaha, Neb., Hill moved to Vicksburg with his parents at the age of four and proudly calls himself a native Mississippian. After earning an undergraduate degree from the University of Mississippi, Hill earned a medical degree from the University of Mississippi School of Medicine (UMC) in 1964. He has been actively involved in AMA leadership roles since 1984, and is the first UMC graduate to be named president-elect of AMA, the only national organization uniting physicians from all 50 states and more than 100 specialties.

After completing an internship while serving four years as a commissioned officer in the U.S. Navy, where he was a general medical officer in a naval destroyer group, Hill returned to Mississippi, practicing medicine in the Delta — Hollandale, Greenville and Leland — for 27 years before starting a new residency teaching program for family doctors at North Mississippi Medical Center in Tupelo.

The Mississippi Business Journal asked Hill about his career as a rural practitioner, his campaign platform for the AMA presidency and his stance on controversial issues affecting the AMA and the general population.

Mississippi Business Journal: After serving in the military, why did you return to what was then known as the poorest region of the country?

Edward Hill: Two reasons. My father had preached to us from the time we were old enough to listen until we went off to college that if well-educated people didn’t return to Mississippi and build their lives, the state would remain 50th. All that preaching over the years had an impact, so I came home to see if I could contribute to a Mississippi community.

We had planned to stay in the Delta for a short time to establish ourselves. At that time, the Delta was what I’d describe as third world, and we wanted to see if we could make a difference. We planned to stay three years and ended up staying 27. It was a very rewarding place to practice and live, and I think we accomplished some good things there.

MBJ: Tell us about your move to Tupelo.

EH: North Mississippi Medical Center made me an opportunity — starting a new teaching program — that I couldn’t pass up. It’s something I’d always wanted to do, and has been one of the best things I’ve ever done. It was also one of the hardest jobs I’ve ever had, but they gave me tremendous support. It’s a remarkable institution. It’s one of, if not the largest, rural primary care delivery systems in the country. It covers 22 counties in Mississippi and three counties in Alabama. It’s a well-organized system of healthcare that I think should be considered a model for the rest of the country.

MBJ: Why was it so important for you to get involved on a national basis?

EH: I learned early on that if you can build coalitions with your colleagues and other groups, you can change things. As painful as the democratic process is, it works. That’s the way I saw changing the medical landscape and healthcare. As I got more involved with the AMA, one thing led to another, and here I am.

MBJ: Nationwide, the AMA had a listing of 20 states in crisis because of the need for tort reform. Mississippi was just crossed off the list. How many states remain in crisis, and what is the AMA doing about it?
EH: We just added Massachusetts as our 20th state. We’re trying to get a medical liability reform bill through the Senate. Nine times, the House of Representatives has passed by a large majority a medical liability reform bill. The Senate has repeatedly failed to act on what the public wants — a cap on non-economic damages. We have good evidence to prove that is what a majority of the public wants. The President supports it. Health and Human Services supports it. We still consider that our number one legislative priority and will redouble our efforts to get that legislation through.

Even though there’s encouragement from legislative changes in Mississippi and Texas and some other states, going state-by-state is not going to solve the problem. Many states have a constitutional amendment against capping non-economic damages. That’s the number one thing in any bill that’s going to make a difference in the skyrocketing liability premium levels. We won’t stop until we get the job done.

MBJ: Some physicians have addressed the medical malpractice liability crisis by going “bare everywhere.” Is that trend becoming more prevalent?

EH: It did for a while, but it slowed down. The risk is too enormous to recommend as an option, but I understand the fear and frustration that has driven some physicians and specialists to drop liability insurance altogether. Again, it’s a sign of a broken system that needs significant reforming.

MBJ: Even though medical liability reform is a high priority issue for the AMA, what other issues are important to association members?

EH: I ran my campaign on AMA balancing its advocacy agenda with public health issues that are so terribly important to us all. I think the American public wants the AMA to fight for public health problems, such as the 44 million people with no health insurance coverage. A lack of insurance coverage in the richest country in the world is a national disgrace. It’s an economic problem, but it’s also a public health problem, and I think we need to become champions for those people without coverage.

We have social problems that drive hundreds of millions of dollars of medical care costs that we don’t have any definitive approach to. The AMA should also be championing those issues such as obesity, teenage pregnancy, sexually transmitted diseases, suicides and violence. We could go a long way toward solving some of those “professional responsibility” social issues that would also help us with our leverage to get what we want in the advocacy agenda like medical liability reform or Medicare reform. Medicare is not a sustainable system. If it’s not reformed, it’s not going to be available at all for our grandchildren.

MBJ: Tell us about AMA’s plan to provide healthcare coverage for everyone.

EH: It’s essentially a tax credit proposal where tax credits are refundable, advanceable and are inversely proportional to income. The poorest people who cannot afford healthcare insurance would get the biggest tax credits. It’s refundable so that people who don’t even pay income tax would still get the tax credits to buy health insurance. It’s advanceable so that people who don’t have enough money to pay their premiums can get a voucher in advance to pay their premiums. We think we can provide 95% of the public with this plan, in combination with a “defined contribution” from employers that wish to participate. By doing this, employers would have an easier time budgeting their healthcare expenses from year to year. To allow that market to be available, we want to expand it and have “health insurance marks” that have multiple choices for patients because one size in America does not fit all.

A brief sketch of this plan is about choice, defined contributions, and refundable, advanceable tax credits inversely proportional to income. We have taken this plan to big industry and let everyone make suggestions. We’re refining this plan continuously, and we think it will work.

MBJ: Regulations regarding electronic transactions and privacy of personal health information, mandated by the Health Insurance Portability and Accountability Act (HIPAA) of 1996, brought a scramble for compliance in 2003. How’s that going?

EH: It’s going well. The problem with HIPAA was that the medical community was already living up to the standards anyway. Confidentiality of healthcare records is something that’s pounded into us from the time we’re in medical school. So I don’t think it was as big a problem in our industry as it was in other industries.

MBJ: Also, what’s the latest on the push for electronic medical records?

EH: Electronic medical records are a must. The sooner, the better. But they have to be affordable and practically used. Right now, we have too many systems and vendors talking to each other. The President just came out with a new initiative for medical information technology because he knows the medical community has got to catch up with other industries in electronic information. When you’re talking about a two-, three- or four-doctor office, that’s a tremendous expense. A lot of people are working hard on that issue, particularly the American Academy of Family Physicians, to make it affordable for family doctors and other private care doctors to use. It will reduce error and improve the overall quality of care.
I’ll bet you could put on a white coat with “doctor” on it and walk into a medical records department of a hospital, ask for a record and more than likely get it. Well, you can’t do that with electronic medical records because you have firewalls and the system is more secure.

MBJ: Health and Human Services Secretary Tommy Thompson recently announced the formation of a task force to study whether drug reimportation can be done safely. How big of a problem has this become?

EH: The safety of drug supply is a bigger problem than people realize, but has been overshadowed by the strong desire and need for people to be able to get drugs affordably. I understand that problem. What frightens us all is being able to guaranty the safety of those drugs being reimported. We don’t know what happens to them when they leave the country and come back. In order to do that, there’s been a proposal for the Food and Drug Administration (FDA) to guarantee the safety of those drugs before reimportation could occur. That’s fine except that a system to make sure those drugs are safe is enormously expensive. And also, a system like that is very complex and would take a long time to set up. Could we even afford to guaranty the safety of a reimported drug? That’s the problem. I know the public is so frustrated because they feel the cost is so great that they are leaning toward reimportation and possibly neglecting safety.

It’s a very simple issue for people who have a $500- or $1,000-a-month drug bill and don’t know how they’ll pay for it. In their minds, drug reimportation would be cheaper. But when you consider other facets, it’s a very complex issue. In Canada, for instance, Canadians use a minimal amount of drugs compared to what Americans use. If we start reimporting all their drugs, they’ll have a shortage in Canada. I think they’re already complaining about that.

The pharmaceutical industry has some responsibility for that problem relative to their pricing. That’s a discussion I’m sure they’ve had with Congress and will continue. They have a legitimate argument about the amount of money they spend on research and development, but if you compare that to the amount of money they spend on direct consumer advertising, it doesn’t compute.

Contact MBJ contributing writer Lynne W. Jeter at mbj@thewritingdesk.com.


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