Category Archives: Health Reform

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.

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.

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.