This weekend I heard Donna Shalala, president, University of Miami, and former secretary of the U.S. Dept. of Health & Human Services, as the keynote speaker at the opening of the Association of Health Care Journalists at the workshop in Miami on “Aging in the 21st Century: Getting There. As a liberal Democrat, she did spout not the party line. She threw out a number of notable one-liners:
1) “It’s not who pays the bills, it is the design of the delivery system that is more important.”
2) “We have very little evidence of how to manage chronic illnesses, but we are setting up some demonstration projects.”
3) “It is not the insurance company who defines the benefits that are provided; it is the employer who sets limits on what he is willing to pay for.”
She spoke at some lengths about some of the proposed changes in the Medicare Advantage Plans and the higher rates paid by CMS than under the standard Medicare plan. She noted the difficulty they had during her administration in getting people to get flu shots. They were not afraid of the shots; they didn’t want to make the co-pays or deductibles for something “unimportant” and were saving their claims for a major claim. She briefly mentioned a 6-month study she and Bob Dole had done of the VA and Army health care services with many of the same problems as the private systems in that they lacked continuity of care. What we need is an integrated, accountable program with a team approach rather than the current silo plan where everyone does his own thing. Our fee-for-service system doesn’t work, and neither did the HMO’s.
She speculated that even with the active opposition of the Republicans, we will see a health care reform plan this year. The center of the Democratic Party position that is neither extreme left or right probably represents the consensus of the American people, and they will support it. Health Care services are a major factor in the American economy, and the transparent and open approach that has been proposed by the Obama Administration is the right way to go even if it is messy and drawn-out. We have to bring together a broad range of divergent interests to coalesce around some basic issues and provide support to get them passed.
She closed by quoting one of her students who stated that the key to health care reform is campaign finance reform, i.e. get the money out of the system that gives the lobbyists all the clout and makes the legislators dependent upon continually raising money. That will be an even greater challenge.