Category Archives: Health Policy

Senate Finance Committee Chair unveils his plan

Last week, President Obama spoke to a joint session of Congress about health reform, and polling afterwards has shown an upturn in support for him and for his recommendations for overhauling health care in America.

Today, Senator Max Baucus, the chair of the Senate Finance Committee, unveiled his long-awaited proposal. I continue to believe the SFC will be the main focus of congressional action on this very important issue. Click here to download a pdf version of the proposal.

The Baucus plan is still being analyzed by all the pundits and policy wonks I plan to write soon about its details. But based on the summary I've read, I like it. I believe it is a serious effort to deal with the big issues we face in an honest fashion.

Our concerns about the cost of care, the lack of access due to uninsurance and the quality and safety of health care in America are very real and they deserve to be faced and dealt with in a comprehensive fashion. The American people know that a lot is up for grabs, and they want this done right.

On September 17th, I will be part of a press conference at the National Press Club in Washington, DC. Several of us will be speaking on behalf of a much larger group of people who have worked on these issues for a long time researchers, clinicians and other leaders. This group from across the ideological spectrum is urging the Congress and the President to work together to make the most of this opportunity to put right some basic problems in our health care system.

Here is a link to the letter and a partial list of those of us who have signed it:

Also, the leaders of the four medical schools and academic medical centers in North Carolina have come together to put forward our recommendations on health reform. Drs. Victor Dzau from Duke, Paul Cunningham from ECU, John McConnell from Wake Forest and I wrote a letter, which we sent last week to Senator Kay Hagan and Senator Richard Burr.

We believe that the academic medical perspective on health reform is important to the national effort but it is especially important in North Carolina, given our major role in research, teaching the future health workforce, and caring for so many of our most vulnerable citizens. We will be working together to articulate these issues and concerns over the coming weeks.

This major national debate is now at full stage but it will go on for a while yet. In football terms, I'd say we are mid-way through the third quarter now.

Stay tuned much more to come.

Edward M. Kennedy a Personal Reflection

Today the news is filled with stories about the passing of Senator Edward Kennedy of Massachusetts from an incurable brain tumor. kennedy

During his almost fifty years in the Congress, Senator Kennedy has been a dominant leader in so many areas of our national life health and health care, education, civil rights, and on and on.

Twenty years ago, in the summer of 1989, as a mid-level member of President George H. W. Bush's White House staff, I was tapped to be the Administration's negotiator with the Congress for what came to be known as the Americans with Disabilities Act.

My chief counterpart in those negotiations was a person on Senator Kennedy's staff and across that summer I had many, many long meetings up on Capitol Hill. Some of those sessions included our bosses and there I was privileged to meet and get to know Senator Kennedy a bit.

I grew to admire him a great deal for his earnest commitment and tireless energy and focus. He was, and we were, ultimately successful, and the ADA is now the law of the land.

Of all the activities I have been involved with, across a number of government jobs, I am proudest of my work on the ADA.

Today I recall proudly and fondly my time twenty years ago and how I intersected briefly and in a small way with Senator Edward Kennedy.

He will be greatly missed.

Health Reform – an Update

Several people have asked me in the past few days for my perspective on what's happening to health reform in Washington.

For what it's worth, here goes

Congress is in recess until Labor Day, and they are back home having lots of meetings with their constituents. President Obama is also hosting events almost daily to discuss health reform with the American people.

We have a governmental system that is chaotic and messy at times and this is surely one of them. Remember the quote about making laws is like making sausage ¦

Several points I'd make

1. Although President Obama won handily (53 percent to McCain's 47 percent), there are a lot of Americans who did not vote for him. So it should be no surprise that many of them are showing up at events and town hall meetings and voicing their opposition to whatever the Democrats and the Obama Administration are working toward. The fact that politics has intruded is shocking to some people, I know, but that's the American way.

2. We still badly need to reform the American health care system and as hard as this public policy and political process is, we need to press ahead as a nation.

3. As we deal with the all too familiar problems of the cost of health care, the lack of access due to uninsurance, and the quality and safety of health care in America, a lot is up for grabs. A few weeks ago it seemed like the Congressional leadership were just going to steamroll the process and enact thoroughgoing reform of the entire system. Now the sheer magnitude of all this is scaring a lot of people, especially at a time of such great economic uncertainty.

4. Proposed reform that does not take seriously the need to constrain cost growth should not itself be taken seriously. And as much as I support prevention (and I do, I put Prevention in the name of the CDC), it likely will not reduce health care expenditures though it will make us all healthier. And as much as I support Health Information Technology (and I do, very much), it is likely to add to costs for the foreseeable future, not save.

5. We need to have a serious discussion as a nation about end of life care and we are beginning that conversation now. We waste (yes, that's the right word) a huge amount of resources there. But we as a nation don't want the government making these decisions like taking your mother off the respirator. My sister and brothers and I had some tough decisions to make as our mother and father were gravely ill, and we made them. But not the government.

6. But critics of the President are crassly scaring the American public with this issue and we need to counter their fears with an honest conversation about the limits of medical care, and help patients and families with those tough decisions.

7. There are some things the government does right and the Medicare program is one of them. We should be proud of it. And I am proud to say that for several years in the 1980s I was responsible for administering it. But it is not a model for the rest of the health care system it is outmoded and frozen in time, tied to a payment system of fee for service that does not make sense for doctors or patients.

8. That is one of the risks of the public plan option that is being debated right now can a government plan innovate and be creative over time?

9. Also, Medicare pays rates to doctors and hospitals that are below the actual costs of delivering that care. A new public plan, if linked to Medicare, would have tremendous clout in the market place institutions like ours would almost certainly have to take whatever rates they offered, even if greatly below our costs, which would surely worsen the crazy quilt of cross subsidization that we now have in health care finance in our country.

10. One of the ironies right now is that many in Congress are insisting on the public plan option because of their faith in the government's ability to run the program, yet many of the same Members are urging that a new independent body MedPAC enhanced be set up to make decisions and oversee the entire system, because they don't trust the regular governmental agencies (like HHS and CMS) and processes (like the Congress) to manage things well.

11. So ¦ where are we? I think the Senate Finance Committee proposal, which is yet to be completed, will be the plan that ultimately holds sway. Yes, there will be some who say it is too conservative, and others will say that it is too liberal (whatever those words mean in this complicated area). But I believe it is likely to pass this fall, surely amended many times. The political stakes are just too high for the President and the Congress they cannot allow failure.

12. So I'd suggest you keep your eye on Senator Baucus and his colleagues on the Senate Finance Committee, and try not to get too distracted by the sound and fury around the whole process.

13. Will such legislation be good for the country? I very much believe so. But this is woefully complicated and it needs to be done right. So taking a little more time is not a bad thing.

14. And what will such legislation mean for UNC Health Care? It's way too soon to answer that question with any finality, but given our huge problems with the uninsured, we would have to be better off, at least in the short and medium term, if those now uninsured are covered. The longer run is harder to predict because the risk is as costs rise, and they inevitably will, will our payments be cut so much that we end up worse off? Time will tell.

15. And in the meantime, we have recently launched an effort to redesign how we deliver care, so that we can be one of the places that people point to as an institution that delivers top quality care in an efficient manner, with lower overall costs. I very much believe that is do-able, but it won't be easy. It will stretch us as an institution, requiring our doctors and hospitals and others to work together in creative ways that we haven't even begun to try yet. But we must I want us to be a part of the solution, not a part of the problem.

More to come ¦ stay tuned.

Charlotte summit addresses health care

The Charlotte Chamber of Commerce holds a summit each year at which they focus on pressing matters affecting their area. This year's focus is health care in North Carolina.

The folks who have planned this year's meeting could not have chosen a more timely topic about which they can assist and educate the business community.

I will have the pleasure of speaking at tomorrow morning's meeting at the Hilton Charlotte University Place, and sharing with the audience UNC Health Care's unique perspective on what I believe to be a health care crisis in North Carolina.

I use the word “crisis” because persisting problems in our state and around the country, such as physician shortages and rising rates of chronic diseases have combined with current economic challenges to create just that.

Members of local and state Chambers of Commerce surely play a crucial role in how we we will respond. Small business owners and heads of multi-national corporations are all struggling to keep employees on the payrolls, and many have made difficult choices about increasing health care premiums.

UNC is both upstream of this crisis, because our researchers and clinicians are continually looking for ways to abate these issues, and downstream, because we feel the economic impact of unemployment and rising health care costs.

Last week, for a story in advance of tomorrow's meeting, I spoke with Charlotte Business Journal reporter, Jennifer Thomas, and shared with her the message I have delivered in other parts of the state, which is that we must act now to turn our crisis around. I made one slight adjustment to my earlier picture of health care in North Carolina: we now expect our uncompensated care for fiscal 2010 at UNC Health Care to reach $300 million, or more.

Jennifer asked about funds from the stimulus package, the American Recovery and Reinvestment Act that promises to provide funding to expand health care IT, extend COBRA benefits and add to our Medicaid coffers.

In a recent interview for HealthLeaders magazine about hospital IT, I pointed out that the stimulus money, because of its relatively short deadline, carries with a great risk. As I was quoted in the article,

“Unless we are careful, we may end up spending this money and not accomplishing nearly what ought to be accomplished. This notion seems to be driven by a too-simplistic idea that all we need to do is go out and buy a bunch of computers and wires and plug them all together and, bingo, great things will happen. We all know it’s more complicated than that.”

In the short term, these surely are welcome and necessary funds.

However, what we need most is substantive, national reform. Such changes, broad in scope, should have a very local impact to assist North Carolina businesses and all of our citizens.

Reform stays on track

Yesterday at the White House a group of representatives from various sectors of the health care industry met with President Obama to offer their long-term support for health care reform. Hospitals and physicians were there, as well as the health insurance, pharmaceutical industries and organized labor.

The meeting was noteworthy in that it keeps this very important discussion atop the national agenda and includes major stakeholders in health care. As the President himself said that some of the groups present yesterday had opposed previous attempts at reform. They now support it. That demonstrates that reform efforts this year are worth paying attention to organizations and special interests are now willing to put aside their differences to help find a solution.

While it is doubtful that a voluntary approach will result in dramatic cost reductions, the gathering of this group at the White House does signify the importance of inclusion and stake holder involvement. Our complicated, complex and costly health care system will, however, require much more. We still need a massive overhaul to keep costs in check, expand access and ensure quality and safety.

President Obama told the American public that reforming health care is crucial to stabilizing and growing our economy. I couldn't agree more. As I said most recently at the White House regional health reform forum in Greensboro, N.C., on March 31, we do not need to throw more money at the problem. The Obama Administration and the Office of Health Reform are on the right track. Our country needs to provide universal coverage, so that everyone has full access to the health care system. We need to invest in better IT systems that work more efficiently and effectively. We need to continue funding research to combat disease (and control costs). And, we can do all of this while improving quality.

We, as a nation, need to have the courage and fortitude to make reform a reality.

CDC manages swine flu

As a new strain of swine flu appears in the United States, the U.S. Centers for Disease Control and Prevention once again takes the lead.

The CDC, based in Atlanta, is uniquely qualified to deal with potential public health crises whether infectious diseases or other challenges. Its epidemiologists and laboratory scientists work in close partnership with colleagues around the world, as they are now, in Mexico, where this H1N1 flu strain first emerged.

Fortunately, we have not had any reported cases of swine flu in North Carolina. But at UNC we are taking the matter very seriously. We are taking extensive precautionary measures to ensure we are prepared to care for patients who might arrive at our doors, and to protect our staff who care for our patients.

The White House and the CDC reported today in a news briefing that each of the 20 people in the United States who contracted the flu has recovered without medical treatment. Basic hygiene practices, such as hand washing, covering your mouth when you sneeze and staying home when you are not feeling well go a long way to controlling the spread of even the most worrisome flu.

I applaud my former colleagues at the CDC, which I directed in the early 1990s, and I wish them the best of luck. They are consummate professionals who work tirelessly to keep the American public safe from threats to their health.

We discuss the state of health reform on “The State of Things”

I had an engaging conversation about health reform yesterday with Frank Stasio, host of the program “The State of Things” on our local NPR station WUNC. You can hear the interview, “Prescription for Health Care,” on the Web.

Mr. Stasio was well informed, and asked important questions ranging from how the wheels of reform move within the Washington Beltway to how unemployment is affecting the UNC Health Care System and the health care of the people in North Carolina.

I was grateful to share with Mr. Stasio and his listeners my belief that our country will come together soon to create a uniquely American form of health care. Providers, policy makers and representatives of the private sector, including those who once opposed universal health coverage, are willing to compromise. This is something we have to do if we truly value the health of the American public.

As N.C. Gov. Beverly Purdue said recently, we have a history in North Carolina of coming together to solve problems. We are doing so now with health care in a program called Community Care of North Carolina. Institutions across the state are working with community health care centers and private physicians to make sure our citizens get the most appropriate care. The UNC Health Care System has partnered with Piedmont Health Services Inc. We provide funds to Piedmont so patients can get care close to home without having to come to the emergency room in Chapel Hill. Dr. Warren Newton, who serves many roles for us at UNC, has led this program for us.

A community discussion on health reform

I have just returned from a large town hall meeting today in Greensboro, on the campus of NC A&T State University.

It was hosted by Governor Bev Perdue and my friend, Nancy-Ann DeParle, the head of the White House Office for Health Reform, and counselor to President Barack Obama. This regional health reform forum was attended by several hundred people, and was well covered by the news media.

I think it served a very useful purpose to tell in compelling fashion what the problems are with our too flawed health care system in America.

A number of real citizens told their stories of the challenges they have had to find and keep health insurance, and their difficulties in navigating our much too complex system.

Nancy-Ann called on me, and I was able to tell the other side of this story what it looks like to try to run a large safety net institution when unemployment is surging and uninsurance is causing a tidal wave of indigent patients to come our way. I cited the figures from a recent NC-IOM study that showed that with each one percent rise in NC's unemployment rate, we lose $14.4 million dollars. Since the rate has gone from the 4+ range to the 10+ range the impact on us is nearly $100 million!

I also said that it is my belief that we have plenty of money in America's health care system we just are not spending it very wisely. And I went on to say that we each will have to be willing to make changes and make sacrifices for the common good.

Finally, I said that I am more hopeful than I have been in many years that we are about to do major health reform and I urged us all to work together to make that happen.

Afterward several of us were able to have a small group meeting with Nancy-Ann DeParle and to talk in more detail with her. I urged her to be bold and to press ahead with this most important effort. I told her that unless each of us are a bit uncomfortable they are not pushing us hard enough.

All in all a very encouraging day. Read more about the event from WRAL-TV, Raleigh here and WUNC radio, Chapel Hill here.

View more of my comments here.

Health reform is integral to the economy

I have applauded President Obama's actions in making health care reform a prominent issue, and I was very glad to see that he mentioned health care, and science, repeatedly during his press conference Tuesday night.

The purpose for the press conference was to address the economy, and I think this is the context in which health reform belongs. Indeed, these tough economic times highlight the need for reform as unemployment, and costs, continue to rise. Unfortunately, our state of North Carolina recently received the dubious claim of having the highest rate of unemployment. We feel this as a very real pinch in the UNC Health Care System, but, more importantly, we feel for our patients and the people of the state.

I urge President Obama to seize this opportunity to make fundamental, meaningful, lasting changes that make health care more economical, and that provides high-quality coverage for everyone.

We do not need a more expensive health care system, we need to use the resources we now have more wisely.

Tomorrow I'll have the pleasure of speaking with the health care providers of the Mountain Area Health Education Center in Asheville, N.C., about our the state of North Carolina's health care system.

On March 31, 2009, in Greensboro, N.C., I hope to have the opportunity to raise some of these critical issues at President Obama's Regional Forum on Health Reform.

I go into a little detail in this video, recorded yesterday with one of our staff at UNC. I hope you will watch, and let me know your thoughts.