The United States’ health care system needs a "transformational change" toward a structure that provides a basic level of care for everyone and manages to break even in the process, one of the nation’s leading health-reform advocates told a Western University of Health Sciences audience Thursday.
John Kitzhaber, M.D., former governor of Oregon, spoke on "The Unfinished Business of the Baby Boom Generation: Health Care for the 21st Century," as the featured speaker for the inaugural Dr. Philip Pumerantz Distinguished Lectureship. The lectureship was established earlier this year as part of a generous donation to WesternU by Drs. Daljit and Elaine Sarkaria of Orange.
Nearly 300 invited guests, students, faculty and staff packed Lecture Halls East and West in the University’s Health Sciences Center to hear the talk by Kitzhaber, a former emergency room physician, state legislator, and lead author of the Oregon Health Plan, the framework of which is used to provide a basic level of medical coverage to every person in that state.
Kitzhaber served as Oregon’s governor from 1995 to 2003, and recently announced his candidacy for the office in the 2010 election.
Drawing on history to underscore the importance of health-care reform today, Kitzhaber said that the "greatest generation" – which included his parents – not only saved the world by defeating Nazi Germany in World War II, but also built the interstate highway system, the transmission grid, and the higher education system; created Social Security, Medicare and Medicaid; put men on the moon; and eradicated polio and smallpox.
"So I think it’s worthwhile asking … what kind of world are we leaving our kids?" Kitzhaber said. "What kind of world are we leaving to these students, and their children and grandchildren? It’s not a pretty picture, my friends."
Kizthaber noted that in January 2011, the first of 78 million baby boomers will become eligible for the Medicare program, which he described as an "unfunded entitlement program of $70 trillion." The cost of paying for the baby boom generation’s decades of care under that program will leave a "dark burden of debt over our children," he said.
Erasing the massive debt is only one part of the equation involved in solving the health-care crisis, Kitzhaber continued.
"The purpose of the U.S. health care system is not, in fact, to finance and deliver medical care," he said. "The purpose is to produce healthy people," even though the current debate is about how to pay for the system already in place.
"I think that is a fundamental misdiagnosis of the underlying problem," Kitzhaber said. "The problem isn’t how we pay for health care. The problem is what we’re buying, and how that care is organized and delivered."
After outlining categorical care and how health-care costs are shifted and subsidized, he asked this question: "Who has the responsibility to pay for the health care needs of those who cannot afford to do so themselves?"
Before answering, Kitzhaber took note of things he considers to be major problems in the current system:
- 10% of the population drives 70% of health care costs.
- An acute-care infectious disease model is still followed, rather than focusing on prevention and wellness.
- Health-care providers continue to be in solo or small group practices working independently.
- Patient data is not shared or easily accessible.
Arguably most important, he continued, is that "a strategy for sustained early childhood investment" must be a foundational component of any system that hopes to reduce costs of care and improve patient outcomes without sacrificing quality. Any serious health care reform needs three things, he said: a focus on wellness and childhood prevention, universal access to a basic level of care, and an integrated approach to health-care management.
Kitzhaber’s proposal for transformational change includes a publicly financed health-care service "floor" to which everyone would have access. But such a level of care cannot be an open-ended public responsibility, as it often is now, he said. It needs defined benefits, including a consensus that services that are highly effective and rank high in terms of population health should involve little or no cost-sharing, while elective and/or discretionary services should involve a high level of cost sharing, e.g., those who want them would pay most if not all of the cost for them.
The "defined populations" in Kitzhaber’s proposal would need single points of contact; population-wide health education; a mechanism for identifying at-risk children and families; regular, ongoing health screenings; and effective management of chronic conditions. Such a system also would require more flexibility in use of public resources like Medicare and Medicaid, he said.
Critically, U.S. citizens and their elected representatives need to figure out what they want health care to look like in the future, and map a course for getting there, Kitzhaber said. "The biggest problem, I think, with the national reform debate is that people didn’t agree on where they wanted to end up."
If Americans can embrace this transformative change and rethink health, the rewards will be immense, he concluded.
"Those obstacles in reforming the U.S. health care system, if we are successful in overcoming them, will have every bit as much an impact in the lives of our children and grandchildren and great-grandchildren as did the winning of the Second World War on my generation."
Prior to Dr. Kitzhaber’s address, Dr. Philip Pumerantz, founding president of WesternU, for whom the distinguished lectureship is named, expressed his gratitude to the Sarkarias for "their faith in me, and in my vision here at WesternU, and for endowing this lectureship in my name."
After observing that his wife, Harriet, typically would attend such events but could not make it that evening, Dr. Pumerantz added that she was watching the lecture’s Web cast via laptop computer. "So, hi honey," he said with a wave before yielding the podium to Dr. Thomas Fox, WesternU’s senior vice president for advancement, who introduced Dr. Kitzhaber.
Drs. Pumerantz, Fox and Kitzhaber also unveiled the commemorative plaque that will be used to observe the annual lectureship and list its featured speaker, and Dr. Fox read from a city of Pomona proclamation naming Oct. 1, 2009 as "Dr. Philip Pumerantz Distinguished Lectureship Day" in the city.
WesternU Senior Vice President for Advancement Thomas Fox, PhD, presents guest speaker John Kitzhaber, MD, with a gift on behalf of the university.
Dr. Kitzhaber mingles with WesternU administrators, faculty and students.
Drs. Elaine and Daljit Sarkaria and Dr. Kitzhaber.