Brainstorming About Health Care In First Of Summit 'Conversations'

February 25, 2009 - Oncology Times
By Peggy Eastman

John R. Seffrin, PhD, Chief Executive Officer of the American Cancer Society, and its advocacy affiliate, ACS CAN, participated in a health care summit at the University of Miami during which leaders from medicine, business, and government discussed ideas to reform the US health system in the new Presidential administration. The Summit Conversation on Health Care Reform, the first of 10 to be held across the United States, was a Webcast hosted by the University of Miami and sponsored by America's Agenda Health Care Education Fund, a Washington-based nonprofit group that has spearheaded the effort to achieve comprehensive health reform in the US.

Core Elements to Agree About

Participants and America's Agenda Managing Director Mark Blum said there is an emerging bipartisan consensus that to advance health care reform, groups with different constituencies need to agree on the core elements such reform should contain:

* Affordable coverage for all.

* Better management of chronic diseases.

* Stronger emphasis on disease prevention, with incentives to stay well.

* Accelerated use of health information technology (HIT), with an emphasis on interoperability.

Workers really need it [health reform], said America's Agenda President Doug Dority. No employer can sustain a double digit growth in health care costs year after year after year. Today, he added, A lot of people can't afford co-pays even if they have health insurance, and thus don't go to physicians.

The summit was held on the eve of the day the US House of Representatives approved the economic stimulus package President Obama says is essential to address the country's economic woes. That legislation includes important health care provisions, including money for HIT, more support for Medicaid, and extending health insurance benefits for those who lose their jobs.

Summit participants spent much of the Webcast time discussing strategies for disease prevention in an era when chronic disease is epidemic.

Technically, we don't have a health care system, Dr. Seffrin said. Instead, what the United States has is a disease care system that treats people when they get sick.

Summit participant and cancer survivor Billy Tauzin, President and CEO of the Pharmaceutical Research and Manufacturers of America (PhRMA) and a former member of Congress, agreed: Our system is designed around sick people, he said.

Noted former House of Representatives Majority Leader Dick Gephardt, whose son was diagnosed with cancer at age two, successfully treated and now 38: The goal should be to have healthier people, not just intervene when they get sick.

According to statistics from America's Agenda, 75% of US health care dollars are spent on chronic diseases such as cancer, diabetes, and heart disease, and two thirds of the increase in costs for health care are driven by the rising prevalence of chronic disease.

Centers for Disease Control and Prevention statistics show that in 2005 (the most recent data available), more than half of all Americans lived with at least one chronic disease. Partly to blame for this statistic is the rising rate of obesity, which is associated with many diseases including certain cancers and which accounted for about 27% of the rise in health spending from 1997 to 2005, some $223 billion.

We know obesity has doubled since 1985, and that doubling accounts for 15% to 30% of the growth in health spending, said Kenneth Thorpe, PhD, Director of Health Policy for America's Agenda and Professor and Chair of the Department of Health Policy and Management, Rollins School of Public Health at Emory University. Less than 1% of the US health care budget is spent on disease prevention.

Dr. Seffrin said that much of cancer is preventable and that solving the cancer problem is as much a social problem as a medical and scientific problem. We know what needs to be done, and the key is to get it done, he said.

Late in January the US Senate voted to expand SCHIP by raising the federal tobacco tax by 61 cents, to a total of $1 per pack - the largest single increase ever. Dr. Seffrin said the increase could potentially save more than 900,000 lives and pevent 1.9 million children from becoming lifelong smokers.

Expand SCHIP

ACS CAN spearheaded a recent advertising campaign with other groups urging Congress and President Obama to make health care reform a national priority. Dr. Seffrin cited tobacco control as an example of a social problem, since science has shown that smoking causes cancer.

As a step toward health reform, ACS CAN advocates expanding the State Children's Health Insurance Program (SCHIP) and paying for it with an increase in the federal cigarette tax. In line with the Bush administration's 2003 Interagency Committee on Smoking and Health, ACS CAN recommends raising the tax by $2 a pack (from the current 39 cents).

Dr. Seffrin noted that at a time when the economy is in the doldrums, such a tax would pay off because it is known that would-be smokers (especially young people) are sensitive to price and might never take up the habit. A 20% reduction in cancer mortality yields a $10 trillion value, he said.

The Scotts Miracle-Gro Example

Another speaker, James Hagedorn, CEO of Scotts Miracle-Gro Company, said that getting Americans to stop smoking, adopt healthy habits, and lose weight, all of which would move the country in the direction of disease prevention, is doable, because his company has done it.

Over two-thirds of our employees were high-risk; one-third of our people smoked, he said. Following a vigorous company-wide health improvement campaign, the employee smoking figure plummeted to 7%. Mr. Hagedorn said that four years ago, he instituted a healthy lifestyle program in which employees would not see an increase in their health insurance premium if they worked with a health coach on issues such as smoking cessation and weight loss.

The first year the program was free, but if employees refused to participate, the second year their premiums increased. Mr. Hagedorn said he takes the position that if he, as an employer, is paying for health care services, he has a right to try to ensure that he has healthier employees.

ANA President

Rebecca Patton, MSN, RN, CNOR, President of the American Nurses Association, agreed that much more emphasis needs to be put on disease prevention, rather than paying for health care once people become sick. Noting that advanced practice nurses are poised to tackle such problems as obesity and can do so cost-effectively, she said, Prevention is our natural fit as nurses.… I'd like to see the day when schools have nurses back in the schools.

Other participants focused on health information technology, noting that President Obama is on record as supporting much broader use of electronic medical information. HIT has been a great boon at the Cleveland Clinic, said C. Martin Harris, MD, MBA, Chairman of Information Technology there.

Paper records are being phased out at the Cleveland Clinic. It brings a real safety advantage to us-HIT can prevent drug-drug interactions, among other benefits, and save lives. What's really clear is that if we don't build the infrastructure properly, we will fail in transitioning from a disease-care system to a well-care system.

Ideally, Dr. Harris noted, a physician should be able to press a button and know if every women in his practice is up to date on her mammograms-something that HIT can make possible.

I think it's a critical part of health reform, Dr. Thorpe said. Today, when a patient has chronic comorbid conditions and is seeing multiple specialists, we need to have a complete clinical history of that patient across settings.

But former Secretary of Health and Human Services (in the Clinton administration) Donna E. Shalala, PhD, President of the University of Miami, home of the Miller School of Medicine, warned that HIT could be a disaster if it is not implemented correctly, with interoperability being a key factor. This is a nightmare for those of us who run academic health centers. This is the one part of health reform that scares me.

She said that while people tend to think of HIT as a simple solution to fixing the US health care system, which she called fragmented, fragmented, fragmented, in reality, it's not simple. And, she added, the government could spend a lot of money and it might be a mess. This one we've got to get right.

To those who say the Obama administration and Congress need to address economic recovery first and then tackle health care reform, Mr. Tauzin said he has an answer: Thisis the economy. This is the thing that will sink the economy if you don't fix it now. It will sink the nation.

US health spending currently accounts for 16% of the gross domestic product and is expected to rise to 25% by 2025, he added.

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