Tag Archives: Health Care Reform

Health Reform ? hurray

This week will long be remembered as a momentous time in American health policy and politics.

President Obama signed the landmark health reform legislation and the Senate seems poised to complete the complicated process with passage of a reconciliation bill making a number of changes in the earlier law.

I have long worked for far-reaching overhaul of how we finance and deliver health care in America, and I celebrate this major accomplishment.

We are all hearing several narratives from different quarters ? that predictably conflict:

After decades of trying ? by Democrats and Republicans, far-reaching health reform has passed into law.

This is a major victory for a more compassionate and communitarian society.

President Obama and his party can be proud of their leadership on achieving this.
This legislation gives the federal government a significantly greater role in directing the American health care system.

Republicans will campaign against a government takeover of health care, and they could see major electoral gains this fall and in 2012.

Will it work?

Can we afford it?

Each of us will choose which of those and other narratives to emphasize.

I am very glad it passed, even with its flaws and other consequences that we don't yet know about.

On the whole ? we badly have needed to cover the uninsured ? and this legislation, when implemented, will do that in a big way. The fact that not everyone will be covered is surely true ? but this is a major step in the right direction.

As the head of a major public safety net institution, I am very concerned about the proposed cuts in Medicare. I have to believe, and I do, that these will not occur ? to anything like the extent promised ? because of the predictable push-back of seniors and health providers.

So what that means is this will add hugely to the federal budget deficit ? not a happy prospect, to be sure.

I continue to believe that our nation must press ahead with additional health system reform, that delivers quality care at much lower costs. We can do that ? but it will stretch us like nothing we have ever done before. Just like this process has challenged our political system.

Here at UNC we are dedicated to reform, and we are determined to be a leader ? creating a new model for organizing and delivering care.

So … Health reform has passed … With much more to come! I believe we will be arguing about all of this for months ? indeed for years to come.

Stay tuned!

Health Reform in 2010?

There are two weeks left in 2009, and there will be lots of holiday interruptions so the huge efforts to get agreement on a formula for national health reform, and push it through the Congress will surely go over into the New Year.

Each day seems to bring additional twists and turns to the tale one day our hopes are dashed, then the next day we learn of a new proposal which seems to have merit and support, then someone shoots it down.

With all of this I continue to believe that we will ultimately get large scale legislation passed and signed, and that it will overhaul our national health care system in substantial ways. And to be sure, we badly need to do this as a nation.

For months, one of the sticking points has been whether the legislation would establish a new public plan for health insurance that would give real competition to private health insurance. The theory has been that this would lower overall health care spending over time. The proponents of the public plan have criticized private health insurance loudly, and have heralded the public plan as the right idea for the future. Supporters of the public plan have tended to be from the left side of the political spectrum progressives as they are often called. But the notion of an effective alternative to private health insurance has been a popular notion with a broad array of citizens private insurers don't poll well these days.

But this fall the criticism of the public plan has centered on the idea it will simply add cost to an already very expensive health system, without really restraining spending much at all. And the Senate seems to lack the 60 votes needed to break a filibuster and pass the public plan.

Last week Senate Majority Leader Harry Reid came up with a new idea dropping the public plan altogether, and substituting for it a new idea (which has been around for decades). This new / old idea is to allow younger Americans to buy into the Medicare program so that people who are age 55 to 65 could join Medicare, with subsidies for those who cannot afford it on their own.

For a day or two it seemed that this might be a way around the impasse, but now some moderate Democrats have criticized this as being even more liberal than the public plan.

Who knows how this will turn out? We have many more twists and turns to navigate.

My prediction remains this will happen, meaning major health reform legislation will pass, in the early part of 2010.

The New Yorker magazine

The New Yorker magazine

For the first time, in addition, it seems that a growing number of legislators, policy wonks and pundits want actually to overhaul the health care system in some fundamental ways.

In this spirit, I recommend an article in last week's New Yorker magazine by Atul Gawande.

I believe he describes well the challenges we face in actually improving America's dysfunctional health care system.

Debate over mammograms reveals need for confidence in health care

This week we have had a disquieting reminder of one of the challenges we face in overhauling health care in America the public are deeply distrustful of experts.

The US Preventive Services Task Force an appointed body of leading clinicians and scientists issued a new recommendation of when women ought to have mammograms. Because it differed from what had previously been the advice, and especially because it differed from what millions of people thought they knew to be true the new guidelines were roundly criticized and scorned. By week's end, the USPSTF had tried to clarify what they were saying, and then the US Secretary of Health and Human Services asked the American people to disregard the recommendations altogether.

Not a pretty sight, especially for those who believe that we can improve care and make it more efficient and effective by carefully targeting what is done for individual patients.

I am one of those true believers in health services research and guidelines for the delivery of care comparative effectiveness research, as it is called these days.

I don't know what the right advice is for women regarding mammograms. But one thing I do know if this whole effort is going to work, we have to get to a place where the public has confidence in the experts else we might as well quit trying.

Maybe this is all due to our American individualism or maybe it is because so many of us learned to question authority. Whatever the explanation, it is not helpful to our efforts to construct a more rational health care system, guided by rigorous research and the consensus of the leading scientists and clinicians.

Until we solve this conundrum, we might want to slow down on our promises of health cost savings from comparative effectiveness research.

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: http://www.healthreformusa.com/petition/index.php

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 must include malpractice reform

I STRONGLY agree with this op-ed piece, which is in today’s Washington Post.

It is from my long-time friend, Phil Howard. He has, for years, been working on policy options for improving the way the medical malpractice system works, through his organization, Common Good.

Currently we have a system that is unfair and very arbitrary — a few patients and their lawyers get very large settlements, but most people who are injured in the course of their treatment get nothing.

And this unfair process contributes greatly to the extravagantly expensive American health care system, because it makes physicians and other providers order vastly more studies and other services — and it drives up the overall cost of care. Some thoughtful experts say it adds 30 percent to the cost of care.

So if we are to be serious about health care cost containment — this one must be taken on.

And the people who will benefit the most are not doctors and hospitals, but patients and families — and the American people.

Health care in North Carolina; a conversation with Bill Friday


I had the pleasure recently of sitting down for a conversation with Bill Friday, for his show on UNC-TV, North Carolina People, a venue for Bill to continue his important educational outreach to the people of his home state. You can watch the video here.

We talked about many important health-care topics and how they relate to North Carolina, from the current political climate for reform in Washington, to our state’s financial situation, to the future of medical education in our state.

I hope you will enjoy watching and listening as much as I enjoyed the experience.