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Director of the State Health Reform Assistance Network and Wilson School lecturer Heather Howard moderated a panel on healthcare reform on Friday. The panelists, six alumni involved in different sectors related to healthcare in the United States, each provided their individual and differing perspectives on the topic as they discussed issues facing the healthcare system, as well as various approaches for reform.

Matthew Klitus ’06, chief financial and strategy officer for MassHealth, Massachusetts’s combined program of Medicaid and the Children’s Health Insurance Program, explained the policy’s short-term, two-pronged approach to providing care; the program aims to control spending at the micro level as well as launch a statewide initiative for care organizations in Massachusetts. This initiative includes a shift away from pay-for-service and pay-for-volume healthcare into a more accountable payment system, he said.

Former Republican Rep. Nan Hayworth ’81 detailed her path in shifting from working as a private practice physician to running for office. She explained how her small practice was challenged by the administrative costs of dealing with insurers, which created a market disadvantage. This, she said, was what inspired her to join a large multi-specialty medical group hoping to alleviate these barriers. After a few years working in the healthcare communications industry, Hayworth noted that the 2008 presidential election inspired her to get involved in policy. She added that she was motivated to address the needs of what she perceived as a diverse and demanding consumer populace. Hayworth ran for Congress in 2010 and won, joining the Republican “freshmen” who changed the composition of the House.

“I did feel, and it has been played out, that the Affordable Care Act would cause at least as many problems as it would solve, and fundamentally the challenge that we have is that because of the federal government’s involvement in healthcare, starting in 1965 with the institution of Medicare… for numerous reasons, Medicare unfortunately led to a highly inflated cost structure in healthcare,” she explained. She noted that, in her opinion, the act has institutionalized this problem.

However, other panelists spoke in favor of the Affordable Care Act. T.R. Reid ’66, a reporter and documentarian, provided his perspective as an outsider to the industry, having only recently become involved in the conversation surrounding health policy. He lauded his home state of Colorado’s proposed plan for health care to be voted on in November. The ballot initiative, the Colorado Care Initiative, proposes a cooperative insurance plan that can cover anybody who elects to have it and that would be funded by an income tax.

“There is only one industrialized country that doesn’t cover everybody. That’s the world’s richest democracy, the United States of America,” he said. He pointed to the 33 million Americans who are without health insurance, as well as the 22,000 citizens he says die every year from treatable diseases for which they cannot afford care.

While Reid explained that he does not think that change can happen on a national basis, he argued for state-by-state reform, starting with Colorado, in order to enact progress.

Harvard Professor of Public Health Sara Singer ’86 addressed reform policy from the perspective of the delivery of affordable care, which she feels the country is better able to provide in its current state. Her focus is on a more holistic form of healthcare. Singer's research centers on comprehensive health through eating, sleeping and exercise habits. Her research also notes the roles of schools and community organizations in health-related habits. Her plan encourages clinicians to work collaboratively to best serve their patients. Through her work on healthcare management and healthcare delivery reform, Singer has sought to leave policy questions aside and instead address practical issues related to patient safety and reducing medical errors.

“I think we need to shift our mental model —the way we think about our healthcare system —to change our focus from specifically around the medical system, to open up our line of sight to thinking about taking on whole health,” she said.

Frederick Lepore ‘71, professor of neurology and ophthalmology at Rutgers University and the Robert Wood Johnson Medical School, focused on the “supply side” of the issue. Firstly, he explained, tuition for medical students is prohibitively high, and high debt load for students impels them to make salary-oriented decisions about what kind of doctors to be, creating an imbalance in the system. Furthermore, the constant turnover and changing landscape of faculty in medical schools hurts continuity and effective teaching.

Another key issue threatening healthcare supply is in the pharmaceutical sector, Samuel Young Jr. ’96 explained. He is a research group leader for the Research Group of the Molecular Mechanisms of Synaptic Function at the Max Planck Florida Institute for Neuroscience. Mental health disease is the most damaging stress on the health system as people live longer but their minds deteriorate, he explained. On a bipartisan level, he noted, scientific research and drug development is being defunded — and the promise of funding is so unreliable — such that he predicts that in 20 years, drugs needed to treat grave diseases will not exist.

The federal government is the biggest driver of basic research in the United States, he said, and consequently the nation is losing generations of scientists who are dissuaded from entering the business of developing medicine because of the constant stress of getting funding and consistent staff.

The panel, “Healthcare: Taking the National Temperature,” was sponsored by the Alumni Association of Princeton University and took place in Richardson Auditorium at 9 a.m. Friday.

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