Fix Health Care Problems

Brody prescribes fix for health care problems
By: Marie Cushing
Posted: 4/10/08When it comes to fixing the American health care system, politicians are failing. That was the message University President William Brody delivered during a lecture Monday on the major issues facing the health care system in America. The soon-to-retire president says the major problems with the health care system are not being discussed - and that college students will be the ones to suffer. "This is your future we're describing. I turn 65 next year. I'll go on Medicare, and you'll have to pay for it. And guess what? I can spend as much as I want and you will foot the bill," he said. With the cost of the health care system near two trillion dollars, polls show that health care is among the leading domestic issues for Americans today. But for Brody, politicians have not been taking a strong stand on the issues. He cited the lack of involvement by high-profile presidential candidates in the Hopkins-sponsored series of health care forums as an example. "Other than Mitt Romney, we struck out. They didn't want to talk about the issue ... people running for office are scared to have to commit themselves to a policy," Brody said. Assistant to the President Michael Field, who has helped organize the forums and helped Brody draft his remarks, said coordinators have not given up on attracting the top candidates. "We have been trying and we're continuing to try. It has something to do with this being such a topsy-turvy campaign cycle. Nothing went according to people's plans. And I think it has something to do with the fact that some politicians prefer not to talk," Field said. Although New York Senator and Democratic presidential hopeful Hillary Clinton agreed to film a forum earlier in the year, a date has not been set. Field attributed the delay to the hectic campaign schedule. "Sens. Obama and Clinton, who do want to talk, are so frenetically tied up that it's difficult to get on their schedules. We'll see if this changes after the party conventions," he said. No agreement has been made with Arizona Sen. John McCain, the likely Republican presidential nominee. "John McCain is essentially coasting. Since he has no battles he would seem to have the time, but he's not going out of his way to talk about it," Field said. Brody's retirement has not yet affected the forums, but Field expects it will at some point. A forum will soon be filmed with Senator Ted Kennedy in his U.S. Senate office. Former Speaker of the House Newt Gingrich has already taped a forum, and current Speaker Nancy Pelosi has agreed to film a counterpoint piece. In two weeks a forum will be taped with former congressman Billy Pauzin, president of pharmaceutical manufacturer PhRMA. Field also hoped to schedule a forum with George Halvorson, the head of Kaiser Permanente, who has agreed to participate in the series. Until then, health care issues will continue to fill the airwaves."You really can't pick up the paper or turn on the television without hearing about cost and coverage," Brody said. But it was three other "C's" - consistency, complexity and chronic illness - that he said are being neglected by politicians and the national media. According to Brody, the "dirty secret" of American health care is that accurate and complete care is given only 55 percent of the time, according to studies. "We're not talking about the kind of weird disease you have to come to Hopkins for," he said. Brody cited a study by the RAND Corporation, which found that doctors prescribe aspirin, beta-blockers or cholesterol-lowering medication for only half of heart attack outpatients. But other initiatives, such as teaching interns how to properly insert blood lines, have helped. Hopkins reduced the number of blood line infections from two times above the national average to eight months without a single infection in some ICUs. "That saves us between 11,000 and 22,000 dollars, as well as morbidity and mortality for the patient," Brody said. The United States is the leader in health care costs, and, according to Brody, the American medical system leads the world in another area: complexity. "If you ever tried to look at your hospital bill, you need to hire an accountant," Brody said. Throughout the years, Hopkins Hospital has seen the number of insurance plans rise to 770, each with their own rules and regulations. Dealing with the complex billing and collections system takes its toll - the Hospital spends 20 percent of costs on administration. While Brody saw a simple solution to this issue through the adoption of billing standards, such a proposal would take a political force that does not yet exist."Nobody is driven to enforce this because of the fear that it would be socialized medicine. Everybody's well-intentioned but it just gets worst and worse," he said. But with the government the major payer in health care, "whether you believe in socialized medicine or you hate it, it's here," Brody said. The final "C" in Brody's analysis of the health care system was chronic illness. "If you want to deal with health care costs you have to deal with the chronic patients because that's where the money is," Brody said. While in 2005 almost half of all Americans lived with a chronic illness, these diseases account for more than 75 percent of all medical care costs, according to the Centers for Disease Control. Brody cited a study by the National Institutes of Health, which found that older generic drugs were just as effective as the more expensive patented drugs. "If Medicare would implement the simple policy of generic substitution except when there are clinical disparities, we would have conservatively saved 5 billion dollars a year," he said. What seemed like a simple solution was complicated by politics. Pharmaceutical companies have restricted Medicare from negotiating medicine prices. Brody acknowledged two high-profile medical professionals in the audience: Nobel Laureate Peter Agre and Board of Trustees Vice Chair Mark Rubenstein. "I probably have to rewrite my speech because they'll be fact-checking it," he quipped.
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