University at Buffalo - The State University of New York

Published: February 16, 2006

By SUE WUETCHER
Reporter Editor

Sen. Hillary Rodham Clinton brought her crusade for health-care reform to UB on Monday, moderating a roundtable discussion designed to discuss what is wrong with the current health-care system and ask what can be done to make it right.

Sen. Hillary Clinton speaks at the roundtable discussion on health care. At right is David Dunn, vice president for health sciences.
PHOTO: DOUGLAS LEVERE

"Right now, we've got the incentives wrong in health care," Clinton told a standing-room-only crowd in Harriman Hall. "Our medical system is numb to the relationship between cost and result, it's blind to the need to pay for prevention and it's deaf to the need to reward individuals and good corporate citizens who both take care of themselves and provide decent coverage for their workers."

David Dunn, UB vice president for health sciences, joined Clinton in hosting the event. Others on the panel were Bruce Holm, UB senior vice provost and executive director of the New York State Center of Excellence in Bioinformatics and Life Sciences; Timothy Freer, vice president for global human resources, New Era Cap Co.; James R. Kaskie, chief executive officer, Kaleida Health; Rhonda Frederick, chief operating officer, People Inc.; and Norman Bitterman, plant manager, Hard Manufacturing.

In opening remarks, Dunn noted that the Founding Fathers included certain inalienable rights—life, liberty and the pursuit of happiness—in the Declaration of Independence.

"They didn't mention health care, though," Dunn said. "I think had they known what things would look like in the current health-care climate, they probably would've included that as a fourth point."

Clinton, who spearheaded the failed attempt during her husband's administration to reform the health-care system, began her remarks by offering a number of statistics that underscore what she says is wrong with the system:

• More than 45 million Americans have no health insurance, including 13 million children.

• The U.S. spends more than any nation in the world on health care, yet life expectancy ranks 34th.

• Last year, the U.S. spent more than $1.7 trillion on health care—16 percent of the country's national income. At that rate, one-third of the nation's gross domestic product will go toward health-care costs within 35 years.

• Health-care crises are a major factor in half of all personal bankruptcies. Seventy-five percent of Americans who went bankrupt due to health-related reasons had health insurance.

Incentives inside the health-care system are "backwards and payments are upside down," she said, with insurance "too often paying for costly and debilitating treatment but not for low-cost prevention."

For example, she noted, insurance will pay to amputate a person's foot, but not for treatment to prevent that amputation.

Moreover, the market rewards businesses that "unload health-care costs onto their employees and local governments, while punishing companies that try to do the right thing."

Companies are cutting benefits, shifting costs to workers and dropping coverage entirely, she said.

"The deck is stacked against those corporate citizens who try to provide decent coverage," she said.

She pointed out that in Western New York, more than 90 percent of small businesses with 10 or fewer employees do not offer health insurance. "They cannot afford it," she said.

U.S. businesses are competing with countries like Canada and Japan, where health-care costs are shared by everyone, and countries like China, where workers have little or no health-care coverage, Clinton said.

"We know we're losing jobs because we haven't figured out how to help companies pay for health care," she said.

Clinton did offer some suggestions for improving the system. She cited the benefits of evidence-based medicine—in which treatment is supported by scientific research—and the importance of investing in medical information technology. She lauded the Veterans Administration health-care system, which she said, has expanded the use of information technology to increase efficiency and provide quality health care. The VA uses electronic medical records, wireless interfaces between health-care professionals and bar codes to track medications and dosages.

"The VA is leading in reducing medical errors, improving patient safety and delivering high-quality care," Clinton said. "We can do this in our private and public health system for everybody, but it requires leadership, she said, stressing the importance of creating a health information technology infrastructure to reduce mistakes and waste, and avoid redundancies.

She also emphasized that consumers need better-informed choices for health care. The pharmaceutical industry is spending billions of dollars advertising directly to patients, she said, with many drug companies spending more money advertising their drugs than researching and creating new drugs. "There's a real mismatch in priorities here," she said, noting that consumers and physicians need more information with which to compare treatments and determine which are the most appropriate and the most cost-effective.

Clinton noted that although efficacy studies are performed on drugs before they go on the market, no comparative studies of their effectiveness are done once they're on the market. She said she was able to have inserted into the Medicaid law a provision that the government must fund comparative effectiveness studies of drugs. In fact, one of the first studies will be on Vioxx and other drugs in its class, she added.

Comparative effectiveness will help physicians and patients make better decisions and will improve patient safety and contain health-care costs by putting research to work, she said.

"With this research using appropriate risk adjustment, we can move toward a health-care financing system that awards providers for high-quality care based on evidence and clinical best practices," she said.

While the current conversation focuses on health care and the economy, "it's also about our moral values as a nation," Clinton maintained.

"We have a moral responsibility to figure out how to make our health-care system work," she said. "We can save money and do the right thing if we get smart about coming up with a uniquely American health-care system that reflects way Americans live today we're in 21st century."

In his remarks, Holm noted that the Center of Excellence is working to pull together health-related groups in Western New York, among them UB, Roswell Park Cancer Institute, the Kaleida and Catholic health systems, third-party payors, the Erie County Department of Health and Buffalo Academy of Medicine, to facilitate communication and coordination of efforts. This "allows us to be able to take a look at what's going on, what's going right, what needs to be changed," he said.

However, "We can't mandate what each of the different systems will do," he said, noting that a research paradigm, particularly in the bioinformatics area, must be worked out to facilitate the integration of data. Ontology is the tool for doing this, he says, are , and the center of excellence has some of the world's leading experts in the field.

A goal of the center of excellence, Holm said, is to "use biomedical informatics and its research to be able to create those systems that allow us to improve safety, quality and efficiency of treatment, the ability to reduce medical errors, the ability to avoid the repetition of lab tests, and variation in types of care, which is, in effect, use of evidence-based medicine."