Category Archives: Health Policy

Health Reform 2009

It is clear that the new Obama Administration and the Congress are going to have a serious go at health reform this year.

As someone who has been trying to help accomplish a substantial overhaul of our flawed health care financing and delivery system for decades, this is a really interesting and even exciting time. A lot is at stake, but we have a major opportunity to make major improvements in health and health care in America.

Last week, President Obama hosted a health policy summit at the White House that focused primarily on covering the uninsured and cutting costs. He also asserted that now, more than ever, is the time to discuss how we will implement health care in the future. This time is a time for opportunity and evaluation.

In regard to the summit, I spoke with several people about my thoughts. I think we ought to target covering the uninsured, in an efficient manner that controls (and does not add to) costs. There are real opportunities for making progress on implementing electronic health records, doing comparative effectiveness research to guide practice and payment, etc.

The White House Office for Health Reform, headed by my friend Nancy-Ann DeParle, is going to be hosting several regional forums on health reform around the country. One of them will be in Greensboro, North Carolina, on March 31. The others will be in California, Iowa, Michigan and Vermont in March and early April, with the intent of gathering ideas from local communities about how to fix the system.

The problems of the country's and the state's health system are mirrored at UNC Health Care. We're the state's safety net hospital. At UNC, we've seen a dramatic increase in uncompensated care, to unprecedented levels. In some of our clinics, 40 percent of our patients are uninsured now. As North Carolina's unemployment rate worsens (yesterday it was announced as 9.7 percent), this tidal wave of uncompensated care will get much worse, I fear.

I'm pleased that our country and our state are making headway in the discussion of health care policy. I look forward to sharing what we are doing with others at the White House forum in Greensboro.

President Obama said in his speech to the summit attendees on March 5, what better time than now and what better cause for us to take up?”

White House Health Summit

Yesterday I spoke with Sarah Avery from the Raleigh News & Observer in regard to the White House health summit. I advised that we should implement a health care system that covers everyone, avoids duplications and inefficiencies that run rampant in our health system today, and supports development and implementation of electronic health records. I also shared some of the challenges the UNC Health Care System is facing right now, such as the growing number of uninsured and the increase in the amount of uncompensated care we provide. Read the full article here.

What are your thoughts on the health care issues facing our current president and our health system?

Obama appoints Sebelius and DeParle

Yesterday President Obama announced his nomination of Kansas Governor Kathleen Sebelius as Secretary of Health and Human Services, and his appointment of Nancy-Ann DeParle as Counselor to the President and Director of the White House Office for Health Reform.

Governor Sebelius is an experienced state leader, with a proven track record in health matters. Before her election as governor, she served eight years as Kansas' insurance commissioner. In both roles she has had extensive involvement in health insurance issues.

HHS is the largest cabinet department, and it is a huge management and leadership challenge. In the 80s and 90s, I headed two of the agencies within HHS first, the Health Care Financing Administration (now called the Centers for Medicare and Medicaid Services), and later the Centers for Disease Control and Prevention. HHS also includes the National Institutes for Health and the Food and Drug Administration, and others.

Nancy-Ann DeParle is a proven leader in health and health care. I am pleased to say she is a close personal friend of mine.

She served with distinction as a Tennessee state government cabinet head, a senior official in the federal Office of Management and Budget, and then she also headed the Health Care Financing Administration.

Over the past eight years, she has been a very successful leader in the health business community. I have served with her on two corporate boards, and we are also on the board of trustees of the Robert Wood Johnson Foundation.

I believe President Obama has made very wise choices with these two appointments. The country very much needs for them to be successful in their important tasks.

Council for Entrepreneurial Development’s Biotech 2009 Conference

A few days ago, I participated in a panel discussion at Biotech 2009, a conference in Raleigh, put on by the Council for Entrepreneurial Development.

My fellow panelists included Dennis Gillings of Quintiles, Victor Dzau, of Duke, Maureen Kelley O'Connor, of Blue Cross, and Michael Baldock, of Quattro Partners. We were asked to talk about what the new Obama Administration and the Congress mean for the biotech industry and for health care in general.

I said that the Obama Administration is still likely to make a major push for health care reform, despite not having Senator Tom Daschle to lead the effort. I remain rather hopeful but the challenges got much more difficult when he dropped out.

I also said that the new FDA is likely to be much more skeptical toward the pharma and biotech industries than has been the case in recent years.

And I also talked about the push toward investment in comparative effectiveness, including more than a billion dollars in the just enacted stimulus package. I am a great believer in the importance of producing more information on what works in medical practice, and how to compare therapies. I said that this will be a major challenge to the drug industry, as it will require much more rigorous demonstration of the worthiness of new therapies.

The new landscape presents many opportunities and challenges. I very much hope we do take advantage of the new leadership in Washington to make major improvements in health care financing and delivery. It will be VERY difficult, but our current system has tremendous problems.

Council for Entrepreneurial Development’s 18th Annual Biotech Conference

On Feb. 16, I will be participating in a panel on the possible direction the new administration's policies may take toward the biotechnology and pharmaceutical industries as part of the Council for Entrepreneurial Development's 18th annual biotech conference. I will be joined by Robert Ingram, Dennis Gillings, Victor Dzau and Maureen Kelley O'Connor, some of the great minds in health care and health policy in our state. I look forward to being a part of this discussion and hope you will join us. Read more about the panel here.

How do you think the new administration's policies will affect the biotechnology and pharmaceutical industries?

Hope for Change

This week Barack Obama becomes our 44th President.

In a host of ways it is evident that Americans yearn for new leadership
and new politics for our nation.

Like millions of others, I am hopeful that President Obama will do great
things for America. The transition for the new administration has gone
quite smoothly, and he has selected a team of highly qualified,
impressive people.

The inaugural celebrations now unfolding will be exciting and filled
with promise.

It is my hope that he will call on all of us to pull together, to put
partisanship behind us, and to sacrifice together to heal our land.

We have some huge problems — the frightening economic chaos and our
deeply flawed health care system are the most obvious to me.

Charting the path to improvement and even solutions will be very
difficult. But we have to give our very best effort.

I am convinced that President Obama wants to lead us to do just that.

May he, and we, be successful.

Interview with UAB School of Medicine’s quarterly publication

I recently discussed my thoughts on health policy issues the new president should address with my alma mater, the University of Alabama Birmingham School of Medicine, for its alumni newsletter. I talked about health insurance, budget needs for federal health programs and the possible reorganization of the Department of Health and Human Services. To read the Fall 2008 issue, click here.

White House Fellows

The news this week, both in North Carolina and nationally, features distinguished people who are alumni of the White House Fellows program.

This great program was founded by President Lyndon Johnson in the 1960s. UNC President Bill Friday played a major role in the early years of the White House Fellows.

Governor-elect Bev Perdue has named Asheboro businessman Keith Crisco as North Carolina’s new Secretary of Commerce. Keith was a White House Fellow in 1970-71, and he served as an assistant to the U.S. Secretary of Commerce.

And the very strong rumor is that President-elect Barack Obama is about to name Dr. Sanjay Gupta as U.S. Surgeon General. Sanjay was a White House Fellow in 1997-98, and he served as a member of the White House staff.

I am proud of these two leading citizens — and the opportunities they will shortly have to serve. And I am especially proud of the White House Fellows Program. I was a White House Fellow myself, in 1982-83, and served as a member of the White House domestic policy staff. It was a wonderful experience, and it gave me insights and opportunities that have been of great benefit across the rest of my career.

Keith Crisco has been a leader for workplace health in our state, and I believe he will carry that same passion to this new role.

Sanjay Gupta has been an eloquent communicator of health messages to the lay audience, as CNN’s medical correspondent. He is also a practicing neurosurgeon. I think he will make a great Surgeon General, since that job is communicating to the American people about important issues of health and wellness.

I very much hope he will choose to focus on what I think is the predominant health issue facing our country — the epidemic of obesity. We desperately need to reverse the trends to create a healthier America, with effective diet and exercise leading to fitness and wellness.

All the best to these two great Americans!!

Help for CMS

With much talk these days of dramatic health reform for the Nation, it is important to pay some attention to the infrastructure that carries it out.

Ten years ago, several colleagues and I wrote a short paper urging more support for the Health Care Financing Administration, which is responsible for Medicare and Medicaid. The agency was renamed the Centers for Medicare and Medicaid Services, but it still needs much more than a name change.

Much of what we said ten years ago still is relevant. Many of us are renewing these recommendations for the incoming Obama Administration.

Advice to the Obama Administration

A few months ago, I was asked to highlight key issues that the next
president should address. This was well before the election.
Here is what I said:

I would advise the next president to move quickly to formulate a plan
to cover all Americans with health insurance. It needs to be a
bipartisan consensus plan because nothing else has a chance of passing
Congress. Lots of good ideas have been proposed and debated for many
years; put them together and move on with the heavy lifting of
negotiating with Congress.

Increase the budgets for the federal health agencies — in particular
the Food and Drug Administration, the Centers for Disease Control and
Prevention, and the National Institutes of Health. A huge increase in
their budgets would be a rounding error for the rest of the budget, and
it would make a big impact on the public’s health. Avoid playing
politics with the Medicare and Medicaid programs. These gigantic
programs need a respite from tinkering, and the staffs running the
programs need to be rebuilt and strengthened.

Finally, ignore anyone who says that the U.S. Department of Health and
Human Services should be reorganized. Recent reorganizations have
caused more harm than good. Instead, pick people to run the department
and its agencies who are skilled in leading large government units; it
is not like a private business or a university.

Now at the beginning of 2009, I’d add that the plan for health reform
should include a strong emphasis on quality. An investment in
measurement and improvement of health care quality and patient safety is
clearly an essential element of overall reform. This should include
funding for expanding the work of the Agency for Healthcare Research and
Quality, and for other key activities.

It is an exciting time for our nation. The incoming Obama
Administration is bring us all a sense of hope and opportunity.

I am more hopeful than I have been in many, many years that we might be
on the verge of making a dramatic improvement in health care and in the
health of the American people.