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Bringing light to the health care imbroglio
Medical school administrator Nancy Nielsen joined Michael Cropp of Independent Health and Ann Monroe of the Community Health Foundation of Western and Central New York in a discussion of health care reform as part of the annual Gerald S. Lippes Speaker Series. Photo: UB LAW FORUM
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“As a country, we have to decide what part of health care is a right, a privilege and a responsibility.”
Amid a national debate over health care reform that has generated more heat than light, a UB panel brought civility, reason—and hope—to the topic.
The panelists were the centerpiece of a recent discussion, “U.S. Health Care: In Search of a Cure,” that was the fifth installment of the annual Gerald S. Lippes Speaker Series, sponsored by UB Law School and the School of Management.
The speaker series, funded through a gift by Gerald S. Lippes ’64, is devoted to current issues in business and finance, with the goal of encouraging dialogue between business and legal professionals. This year’s event was moderated by Annemarie Franczyk, a longtime Western New York journalist who now teaches in the Communications Department at Buffalo State College.
The panelists were Michael W. Cropp, president and CEO of health insurer Independent Health; Ann F. Monroe, president of the Community Health Foundation of Western and Central New York; and Nancy H. Nielsen, immediate past president of the American Medical Association and senior associate dean for medical education at UB.
Although much of the focus in Congress has been on macro-level changes, one major theme that emerged from the UB discussion was Americans’ responsibility to take charge of their health.
“Americans are fiercely independent. We can’t stand it when government tells us what we can and cannot do,” Nielsen said. “But at some point we have to take ownership as individuals for that part of our health that is controllable by us. That’s a tough conversation, and we are not going to have that conversation at a time when people are yelling about death panels and killing Granny. We are not ever going to have a thoughtful conversation if we can’t get beyond those things.”
Added Cropp: “Seventy to 75 percent of the costs in health care today are driven by the care of people with chronic diseases. Many of those diseases are tied to risk factors that are individual factors or choices that we make—obesity, lack of physical activity, smoking—all risk factors for heart disease and other chronic conditions. We can bring everybody into the system with insurance, we can improve the system through payment reform, insurance reform, care redesign, but if we continue to bring the same illness burden into the system, we’re still going to have a devil of a time paying for it.”
Monroe sought to frame health care reform as one of national priorities. “At the core of the issue are really a couple of fundamental societal value questions,” she said. “Health and health care are not the same thing. We have bought the idea that if we can only improve the health care system, we will have better health, and I think that is only a part of what this is about. Unlike some of our European friends, we’ve never really made the decision here about whether health is a right or a privilege based on where you live, how much money you make, what color you are, etc. We’ve crafted a system where disparities are rampant.”
Nielsen agreed. “As a country, we have to decide what part of health care is a right, a privilege and a responsibility,” she said. “The libertarians would say, ‘it’s all a responsibility and you should save your money, care for your family and pay your medical bills when they come.’ And that’s great—until your 8-year-old daughter gets leukemia. Nobody has that amount of money. It just doesn’t work.
“We have to figure out how we are going to have affordable health insurance made available to all Americans,” she said. “It doesn’t do any good to mandate something that people can’t afford. We have to figure out how to make it affordable, how to help those who need the help, and to make sure that people who don’t need the help step up to their responsibilities. You can’t have a health insurance system unless everyone’s in it.”
That question of health coverage for every American, the panelists noted, has dominated the political debate.
“Universal coverage is the goal, and we all agree that we want to get there,” Cropp said. “But Congress has taken half-steps that are going to be counterproductive and move us away from that goal. The politically difficult discussions about mandates and bringing more people in were beyond the appetite for change that Congress has had so far.”
In Nielsen’s estimation, “I think they will do something this year, because politicians don’t like to do hard things ever, and they won’t do them in an election year, and next year is an election year. I’m not sure that it will be anything other than half-steps, though.”
And even if reform laws are passed, Monroe worries about implementing them. “One of my concerns is the length of time it will take to get from legislation being signed by the president to the impact and change actually occurring for people,” she said. “There are estimates of four or five years for many of the pieces to be implemented. A lot of people are thinking, ‘well, if it gets passed this year, maybe I’ll have health insurance in the spring.’ It just doesn’t work like that.”
Other concerns raised in the wide-ranging discussion were dealing with the costs of long-term care, especially in the rapidly aging population of Western New York; the dearth of primary care providers in many areas of the country as more medical students choose to go into specialized practice; and the need to listen to patients and create a system that will treat them as individuals. A spirited question-and-answer period followed the panel discussion.
Nielsen summed up the hope that the national discussion of health care reform could itself be reformed into a civil and productive engagement. “We’ve got to get beyond who is the enemy of the day,” she said. “We have to get beyond saying ‘the insurers are the most evil people who walk the face of the earth,’ or ‘I can’t stand my congressman’ or ‘Congress is full of bozos.’
“The reality is that we are all in this together—patients, doctors, health plans, the government,” she said. “We have to solve it. We need not rhetoric, we need not yelling, we need not labels or calling people names. We need to have the most thoughtful people come together and say, ‘what are we going to do in a way that we can afford it and sustain it?’”
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