Tom Daschle Will Be Next Secretary of HHS: What Does This Mean For Healthcare?
Tom Daschle - Photo Credit: CBS News
I’ve had my eye on Tom Daschle for many months – and attended a healthcare conference in June ’08 in which he was the keynote. I blogged about his ideas previously, but thought it would be valuable to repost them here (h/t to The Healthcare Blog):
Tom Daschle, former Senate Majority Leader from South Dakota, was the keynote speaker at the Fighting Chronic Disease: The Missing Link in Health Reform conference here in Washington, DC. His analysis of the healthcare crisis is this:
US Healthcare has three major problems: 1) Cost containment. We spend $8000/capita – 40% more than the next most expensive country in the world (Switzerland). Last year businesses spent more on healthcare than they made in profits. General motors spends more on healthcare than they do on steel.
2) Quality control. The US system cannot integrate and create the kind of efficiencies necessary. The WHO has listed us as 35 in overall health outcomes. Some people ask, “If we have a quality problem, why do kings and queens come to the US for their healthcare?” They come to the best places like the Mayo Clinic, the Cleveland Clinic, or Johns Hopkins. They don’t go to rural South Dakota. We have islands of excellence in a sea of mediocrity.
3) Access. People are unable to get insurance if they have a pre-existing condition. 47 million people don’t have health insurance. We have a primary care shortage, and hospitals turning away patients because they’re full.
His solutions are these:
- Universal coverage. If we don’t have universal coverage we can’t possibly deal with the universal problems that we have in our country.
- Cost shifting is not cost savings. By excluding people from the system we’re driving costs up for taxpayers – about $1500/person/year.
- We must recognize the importance of continuity of care and the need for a medical home. Chronic care management can only occur if we coordinate the care from the beginning, and not delegating the responsibility of care to the Medicare system when the patient reaches the age of 65.
- We must focus on wellness and prevention. Every dollar spent on water fluoridation saves 38 dollars in dental costs. Providing mammograms every two years to all women ages 50-69 costs only $9000 for every life year saved.
- Lack of transparency is a devastating aspect of our healthcare system. We can’t fix a system that we don’t understand.
- Best practices – we need to adopt them.
- We need electronic medical records. We’re in 21st century operating rooms with 19th century administrative rooms. We use too much paper – we should be digital.
- We have to pool resources to bring down costs.
- We need to enforce the Stark laws and make sure that proprietary medicine is kept in check.
- We rely too much on doctors and not enough on nurse practitioners, pharmacists, and physician assistants. They could be used to address the primary care shortage that we have today.
- We have to change our infrastructure. Congress isn’t capable of dealing with the complexity of the decision-making in healthcare. We need a decision-making authority, a federal health board, that has the political autonomy and expertise and statutory ability to make the tough decisions on healthcare on a regular basis. Having this infrastructure in place would allow us the opportunity to integrate public and private mechanisms within our healthcare system in a far more efficient way.
What do I think of this? First of all, I agree with much of what Tom said (especially points 2-7) and I respect his opinions. However, I was also very interested in Nancy Johnson’s retort (she is a recently retired republican congresswoman from Connecticut).
Nancy essentially said that any attempt at universal coverage will fail if we don’t address the infrastructure problem first. So while she agrees in principle with Tom Daschle’s aspirations and ideals, she believes that if we don’t have a streamlined IT infrastructure for our healthcare system in place FIRST, there’s not much benefit in having universal coverage.
As I’ve always said, “equal access to nothing is nothing.”
I also think of it this way: imagine you own a theme park like Disney World and you have thousands of people clamoring at the gates to enter the park. One option is to remove the gates (e.g. universal coverage) to solve consumer demand. Another option is to design the park for maximal crowd flow, to figure out how to stagger entry to various rides, and to provide multiple options for people while they’re waiting – and then invite people to enter in an orderly fashion.
Obviously, this is not a perfect analogy – but my opinion is that until we streamline healthcare (primarily through IT solutions), we’ll continue to be victims of painful inefficiencies that waste everyone’s time. It’s as if our theme park has no gates, no maps, no redirection of crowd flow, no velvet-roped queues, and the people who get on the rides first are not the ones who’ve been waiting the longest, but the “VIPs” with good insurance or cash in the bank. It’s chaotic and unfair.
Quite frankly, I think we could learn a lot from Disney World – and I hope and pray that next year’s healthcare solution is not simply ”remove the gates.”
What do you think?
Thanks for the post, I had to get myself away from the congressional hearings on bailing out the auto industry or I was going to go crazy.
Right, access to what? I like your analogy. Part of the American Nurses Association’s HSR agenda deals with workforce – a concept that not many plans identify. If the workforce isn’t present to care for all these people who suddenly have coverage, we’ll have the dreaded immense wait times to be seen by a provider and get treatment or care. If that happens, those decrying universal access as socialism will have a field day, and the system will definitely fail. The primary care shortage is also evident with what happened in Massachusettes, no? Suddenly all these people have access but there’s nowhere to get care.
Timing will be everything, and we can’t change the entire system at once. What we need to do is advocate for what you say – fixing the infrastructure and the workforce issues before we let everyone into the park.
Dr. Val –
Excellent post and coverage, and insightful metaphors.
Fascinating timing with the analogy as well, being that Disney is building a hospital:
http://www.healthleadersmedia.com/content/223751/topic/WS_HLM2_MAR/Are-You-Ready-for-Some-Marketing-Magic.html
“We rely too much on doctors and not enough on nurse practitioners, pharmacists, and physician assistants. They could be used to address the primary care shortage that we have today.”
What Daschle is essentially saying is that some care is better than no care. In the hands of improperly trained practitioners (midlevels) who are trying to be replacements for physicians, patients will be worse off. He is ignoring why there is a shortage of PCPs. Daschle has no recommendation for increasing pay for PCPs.
I don’t like where he is headed.
“We need to enforce the Stark laws and make sure that proprietary medicine is kept in check.”
No, we need LESS government regulation, not more.
“We rely too much on doctors and not enough on nurse practitioners, pharmacists, and physician assistants. They could be used to address the primary care shortage that we have today.”
Non-physician practitioners have an important role to play, but they aren’t going to replace primary care physicians. If IM and FP docs are on the endangered species list, why is an NP going to do the same job for less money? Answer: they won’t. No one is going to. At the moment, literally no one is. That’s why we have overcrowded emergency departments and are spending over $2 trillion on health care. These chickens aren’t COMING home to roost. They’re here and have been for some time. Until you start paying primary care docs enough to attract people to the profession, any health care reform proposal is destined to fail.