OBESE SURGEON GENERAL: SELF-INFLICTED HEALTH CONDITIONS CAUSED BY LIFESTYLE ARE HALF OF THE NATIONAL HEALTH CARE COSTS

The U.S. House of Representatives poised to vote on health-care reform in days, the battle over how to fix the nation's health-care system has reached the boiling point.

Meanwhile, most Americans, AND ALL OF CONGRESS, haven't the slightest clue what the 2,400-page H.R. 3590 bill will mean for them if it indeed passes with the help of Congress' controversial budget reconciliation rules. While politicians claim the ultimate goal of health-care reform is to contain the rising cost of health care for families and small businesses while not increasing the national deficit, how to accomplish that goal is anybody's guess.

With some Americans paying health insurance premiums bigger than their mortgages, senior citizens concerned about the bill's impact on Medicare coverage, and some 40 million Americans who have no health insurance (and sometimes no access to care either), it's obvious the system is broken.

How do we fix THE HEALTH CARE, ASKING THE leaders of some of the nation's top hospitals to give us their take on health-care reform. Here's what they had to say:

David Feinberg, M.D., M.BA.
CEO, UCLA Hospital System
"The debate they're having now in Washington is the wrong discussion," says Feinberg. "They're not talking about health-care reform. They're talking about health insurance reform. The bill in Congress has nothing to do with health care." He explains that health care could be fixed overnight if people would stop using alcohol and drugs, eat right and exercise.

"I have 800 patients in this hospital today, and I bet 50 percent of them have illnesses that could have been completely prevented," Feinberg says. "That situation is not going to get better with a 'public option.'"

He points out that even people without health insurance can receive care when they need it in the emergency room, and, while it's not ideal, they're not being denied care because they don't have health insurance. "It's impossible to give high quality, low cost care to everyone. What we need is to decrease demand for health care."

According to Feinberg, some 75 percent of illnesses are treated at home, whether that's a bad cold or a sprained ankle, and he says that health-care reform should be focused on home care. "When you compare us to other countries with similar Gross Domestic Products, they spend half what we do on health care because they have a different lifestyle," he says. "We either need to change our lifestyle, or it's going to be very expensive."

"With all due respect," he adds, "the surgeon general is obese. I don't think the President of the United States should be solving this." Rather, he says, each individual needs to come to terms with the fact that eating right, exercising, and avoiding smoking and alcohol will transform not only their own lives but the ever increasing cost of health care in this country.

Edward D. Miller, M.D.
CEO, Johns Hopkins Medicine
Miller sees the crux of the problem as health care delivery and says the federal government shouldn't be quick to implement models that have not been tested and may or may not work. "The science of health care delivery is still nascent," Miller points out.

"Many models exist, including ... medical homes, and value-based purchasing, but few have been tested on a large scale." He feels more attention needs to be given to research and testing these models before attempting to overhaul the nation's health care system.

"I believe we need to move from fee-for-service to a value-based type of payment system that rewards quality and outcomes," he adds. "Insuring more people is imperative, but achieving that alone is not enough."

Miller says he knows the status quo isn't working or sustainable. "But to really bring down costs," he says, "we have to change the way care is delivered and paid for." Miller would like to see the nation's policy makers commit to accelerating research into health-care delivery and payment innovations first.

Jeffrey Korsmo
Executive Director, Mayo Clinic Health Policy Center
Korsmo says the Mayo Clinic Health Policy Center has four main areas of concern when it comes to health-care reform. The first of those is providing patients a higher quality of care, and that includes better service as well as better safety at a lower cost. Korsmo says another problem with the current health care system overall is coordinating patient care. He points out that about two-thirds of national health care costs go to treat patients with multiple chronic conditions, yet doctors and hospitals aren't doing a very good job of communicating with each other about individual patients' care, meaning that patients seeing more than one doctor may not be benefiting from those doctors pooling resources, coordinating treatments and, ultimately, cutting costs.

Korsmo says he also feels patients need to being paying for value. "Today what we're paying for is volume, not quality," he points out, noting that the standard of care tends to be more tests and more hospitalizations rather than working to meet a patient's very individual needs.

While Korsmo also believes we need a system where everyone is insured, he understands that insurance alone isn't going to reform health care. "We need a more equitable health care system," he says. He wants to see more patients having access to quality care as a result of improving technology that will allow patients to monitor conditions at home instead of having to make regular doctor visits.

He says technology is going to become increasingly important in health care, as the shortage of primary care providers worsens. Korsmo says a big part of the solution to improving health care that isn't talked about enough is education reform. "Not as many people are choosing to go into primary care," he says "because it doesn't pay as well and the cost of insurance is so high." If we can make it easier and cheaper for primary care physicians to practice medicine, quality of care on the front lines will improve as well.

C. Martin Harris, M.D., M.B.A.
CIO, Cleveland Clinic
Echoing the concerns of his counterparts at other major hospitals, Harris believes improved technology is the key to better health care in this country. "If the distribution of disease remains the same 20 years from now as it is now, we're going to have a major challenge providing services to all those patients," he says.

The solution, he points out, is in overhauling the delivery of health care. The Cleveland Clinic, for example, has been building a tool that allows patients with chronic common conditions like high blood pressure, diabetes and heart failure to monitor their conditions at home, have that data captured digitally, and then sent to the electronic medical record at their hospital or doctor's office where their physicians can receive continual feedback on the patient's status.

"Our hope with this model is that patients won't have to come in as frequently," Harris explains, eliminating the "episodic care" that most patients receive today where they may visit their doctor once every 120 days or so. Reduced doctor visits will also mean reduced costs for everyone -- health-care providers, employers and patients.

Like UCLA's Feinberg though, Harris says prevention is another key that isn't getting enough attention. "If we can engage people to alter their lifestyles, we can lower the health care cost burden over the next 20 years," he says. "What can we do to prevent disease? That needs to be part of the care cycle."

One of the least qualified people to become the surgeon general, an obese woman at least 50 pounds overweight, is now preaching the virtues of health!