Reunions: Alumni address problems in national health care system

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Four alumni joined Wilson School professor Uwe Reinhardt to discuss the current state of America’s health care system and offer their views on the prospects of health care reform on Friday. The panel, titled “The Future of Health Care in America,” was among a handful of events kicking off the second day of Reunions and drew a sea of orange into the McCosh 50 lecture hall.

The speakers included Gil Omenn ’61, a professor of medicine, genetics, public health and bioinformatics at the University of Michigan, Thomas Reid ’66, and American reporter and the author of "The Healing of America," Derek van Amerongen ’76, the chief medical officer of Humana of Ohio, and Sara Singer ’86, an assistant professor of health care management and policy at the Harvard School of Public Health.

After an introduction by Reinhardt, each panelist proposed a brief evaluation of American health care based on his or her own professional perspective.

Omenn, who was actively involved with the science and technology and health care working groups on President Barack Obama’s 2008 campaign, said he fully supported the 2010 Affordable Care Act, though he noted that it was a difficult act to put into practice. “The aims are pretty straightforward but difficult to implement,” he explained.

He identified three critical health care issues that should dominate future discussions: promoting a better patient-centric approach using health information technology; continuing innovation in fields such as personalized medicine and the promotion of healthy living; and reducing costs.

“We need to reduce the cost of actual care, not just shift the cost from the government onto individuals or states,” he added.

Providing a political and international perspective, Reid pointed out that the United States is the only rich, equitable, free-market democracy that does not provide universal coverage, despite spending twice as much on health care on average as comparable states.

Although he endorsed “Obamacare” in 2010, Reid said, he now believes that the legislation is unlikely to succeed due to increasing state and potential Supreme Court challenges to the constitutionality of the focus of Obama's reform, the mandate that every individual must have coverage.

Given these circumstances, Reid proposed an alternative strategy. “The best thing that could happen for health care and Obama, politically, would be for the Supreme Court to throw out his law,” he said. Reid argued that this action would allow Democrats to tout universal coverage in 2012, a proven selling point in past elections.

The panel also examined the role of insurance providers, and van Amerongen shared his observations as a licensed doctor working on the payer side of health care. He said that insurance companies are very excited for health care reform because it is an opportunity to open a new market for millions of newly insured customers in 2014. According to him, the problem with physicians is that they do not check up on how their patients feel outside of the hospital room.

“After many years of taking what I thought was very good care of patients in my office, I would see them leave through the door and re-enter the dysfunctional world,” van Amerongen explained. "Quite frankly, the only institution in the United States which really cares about what was going on a population basis was the payer community.”

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Insurance providers have a unique influence on the promotion of healthy living in American society by giving incentives to curb bad habits such as prematurely stopping medications, smoking and consuming fast food, he said.

“We have entire programs with hundreds of pharmacists and nurses who spend their entire day reaching out to people and making sure they are [practicing healthy behavior],” van Amerongen explained. He elaborated by noting the provider community’s success in improving America’s “health status”, while physicians only play a role in its “medical status.”

Although the Affordable Care Act lacks systemic opportunities to promote healthier lifestyles, he added, insurance companies can still raise premiums of non-compliers, sponsor education and provide employers with incentives to hire individuals with good health habits.

In the final presentation, Singer said America’s health care reform troubles were the result of poor implementation rather than poor policy.

Effective integration of health care institutions is one of most important steps toward achieving meaningful reductions in excessive expenditures of money, time and resources, she said, as well as increased use of the health information technologies that could revolutionize care delivery.

“Achieving meaningful use of resources needs to go beyond taking the money and adopting a new system," Singer explaind. "It means putting them in your organization and working ... across organizations. This allows information exchange so that you can begin to eliminate duplicate texts and unnecessary service because they have already been done somewhere else."

When comparing a recent controversial Medicare voucher proposal with the Medicare reform included in the Affordable Care Act, Singer said that both approaches have the potential to succeed. However, she noted, the former “seeks to harness market power by placing the choice on patients ... while the [latter] harnesses the power of Medicare, the government, as a purchaser to directly affect how delivery is organized.”

The audience applauded at several points in the panel at points where the panelists noted America’s moral imperative to achieve universal health care coverage. George Barker ’61, who attended the event, said the panel was an effective overview of many important health care issues.

“I found this very impressive with balanced views and precise responses to questions,” he said. “It is such a comprehensive subject that, in an hour, they tried to cover what they could.”

Barker also said that the panel emphasized how an inadequate health care system and poor reform attempts have had real and immediate implications for an aging generation.

“I find it to be an incredible, complex subject, and every time I go to something like this, I learn more,” Barker added. “I don’t think that the whole area of Obamacare, as it is called, is really understood by a lot of people, and that’s a concern.”

“I thought that there were some very good questions from the audience like malpractice, getting older, long term care, that were good and which the panelists didn’t bring up,” added his wife Anne Barker, noting the audience’s active participation in the panel’s question-and-answer session.

Audience member Eugene Jones ’56 said that the many uncertainties surrounding the future of health care, which were exposed by the panel, are worrisome, “I am very much in favor of the plan now called Obamacare, but I think it was terribly weakened by the political process, and I’m worried about it,” he said. “I think there is a good chance of it being struck down by the Supreme Court.”