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An Action Plan to Address the Crisis in our Health Care System
Keynote Address
The National Episcopal Church Health Council
Washington, D.C.
April 8, 2003
Henry E. Simmons, M.D., M.P.H., F.A.C.P.
President, National Coalition on Health Care

Good morning and thank you for asking me to be with you today. I’m especially pleased to be here, because I believe that the actions of those of you in this room, in conjunction with similar efforts by many others of like mind could have a major impact on the crisis which faces us.

The health care problem that you will be addressing represents a major challenge to our nation, to our political leaders, and to individual Americans. For make no mistake about it: Our health care system is in deep trouble. We are spending much more than we should, even though we fall far short of insuring all our citizens. And we are not getting good value for our money. As I will explain in a few minutes, much of the health care that we do provide is either unnecessary, inefficiently or ineffectively delivered, or outright dangerous. The serious ethical and moral issues inherent in a system with such problems must be recognized and dealt with.

It is high time that America faces up to these problems, for they are going to grow worse. It is especially important to emphasize that the cost of action – of the reforms that will be necessary – is far less than the cost of inaction. And while progress can be made and has been made by concerned groups such as yours, ultimately no one group can solve these problems on its own. We are going to need comprehensive national legislation.

The National Coalition on Health Care has issued a report that graphically describes the huge storm facing our nation’s health care system. The main point I want to leave with you today is that the storm we face cannot be resolved by using the patchwork efforts of the past. Nor can the storm be dealt with by addressing only one or several of the problems we face. Resolution will require comprehensive health system reform. This briefing will explain why we have come to these conclusions.

Before beginning I’m going to take a few moments to describe who we are. The National Coalition on Health Care, your Coalition, is the nation’s largest and most broadly representative alliance working to help our nation to understand and address the serious problems we face. We are non-partisan and have always carried out our decade-long work in a “no-fault” manner. Former Presidents Bush, Carter, and Ford are our Honorary Co-chairs and our working Co-chairs are former Republican Governor Robert D. Ray of Iowa and former Democratic Congressman Paul G. Rogers of Florida. Our 100 members include major corporations, such as Alcoa, AT&T;, Georgia Pacific, S.B.C., and Verizon, our nation’s largest consumer, provider and labor groups, including AARP, AFL-CIO, and organizations representing all the nation’s major religious faiths. This extensive religious presence, including the Episcopal Church, enables us to speak out on the serious ethical issues, which arise from our troubled health care system. We are the only broadly representative group in our country today working for comprehensive health system reform. Our members relate to, represent or employ over 100 million Americans.

I have been asked to do three things in this briefing:

  • First, to summarize the nature and magnitude of the storm which faces us, the trends we expect from this point forward, and how these problems will adversely affect our society and the health care system.
  • Second, to describe in broad terms the reforms that we believe will be necessary to deal with this storm.
  • And third, to say a few words about what we feel must be done to move the health care debate toward solutions, the steps we are taking to help do so, and what I feel America’s churches can and must do to help achieve the reforms necessary.

Many of you are probably familiar with the best selling book “The Perfect Storm,” which chronicles the formation and unleashing of the most powerful storm in this century. It occurred because of the unprecedented confluence of nature’s most awesome forces. As with most storms there were warnings, and those who ignored those warnings lost their lives.

We recently described the problems besetting our health care system in similar terms in a report entitled “A Perfect Storm: The Confluence of Forces Affecting Health Care in America.” David Broder, the Pulitzer Prize-winning Washington Post journalist, wrote an extensive essay on our report which appeared in newspapers throughout the country. Our report shows that a “Perfect Storm” has now formed in our health care system; but unlike nature’s storm, this one will not abate in short order.

In fact, there is no end in sight, and there is reason to expect ever increasing intensity and damage. Never in our history have we faced this number of problems of this magnitude simultaneously.

What are the elements of the storm? There are three, they are interrelated, they are systemic, they are each rapidly growing worse; and, coming together, they have formed the equivalent of nature’s perfect storm.

The first element of the storm is costs. As this chart shows, health care spending in the United States, already the highest in the world on a per capita basis, will soon double to over 2.6 trillion dollars.

Health care premiums are rising at the fastest rate in our history at eight times the inflation rate. It is estimated that in only two more years the average family health insurance premium will exceed $10,000 a year.

Rising costs are going to be an increasingly contentious issue in collective bargaining and will also have a huge negative impact on our economy. The Congressional Budget Office and the Treasury Department have concluded that what they termed “runaway” health care costs are the largest single force that will drive our nation back into unsustainable deficits unless major changes are made at every level of our health care system. In other words, unless we achieve comprehensive system reform.

The second element of the storm is decreasing insurance coverage. Largely due to rapidly rising costs, coverage is decreasing and the employment-based health insurance system is eroding. Over time, an average of almost one million more Americans are added to the ranks of the uninsured each year. Most of these are from working middle-class families. We are already at a point where almost 80 million Americans are either uninsured or underinsured. That’s one out of every three non-elderly Americans. It has been estimated that the current economic downturn will add 11 million more to the ranks of the uninsured.

Because our nation lacks a system of universal coverage, as costs rise and as coverage falls, more costs will be shifted to those employers who provide coverage in order to pay for the growing number of uninsured. If the presently proposed and inadequate Medicare and Medicaid budgets are sustained, even more costs will be shifted to private sector payers and individuals. This inequitable and unethical cost-shift, which states and the federal government in their efforts to control Medicaid and Medicare costs will contribute to, will force more employers, especially small businesses, to drop or cut health insurance. This will directly impact the middle class, most of whom currently depend on the employment based health insurance system as their and their families safety net.

These first two problems are bad enough and in themselves create huge storm forces. But this is not all. There is a third major element of the storm — poor quality — which I want to focus on today, because until the quality problem is addressed, our coverage and cost problems cannot be fixed. The reason is that these three problems are inextricably linked.

Any good businessman knows that if you don’t pay attention to quality, you will end up wasting huge amounts of money. In Congressional testimony, Treasury Secretary Paul O’Neill, who has served as one of our individual supporters and who has extensively studied health care quality, estimated that because of our lack of attention to quality, we are wasting 30-50% of all that we currently spend for health care. A recent study by the Midwest Business Group on Health and the Juran Institute came to a similar conclusion. Lack of attention to quality then results in waste of more than 500 billion dollars each year. To business payers this translates into $1,700 – $2,000 of waste per covered employee.

Even though we have long known how difficult it is to contain costs in any sector if quality is poor, to this point in health care the focus – by government and private payers alike — has been almost exclusively on cost.

It is now clear that all the strategies used to date will not succeed in containing costs. The reasons are that the major drivers of rapidly rising cost are increased intensity of care and a sharp increase in our use of technology. This raises the critical question: Just how appropriate is the use of our technology, and just how good is the quality of our care?

A discussion of the quality problem is very timely, because Congress has been attempting to craft a “Patients’ Bill of Rights Act” to “fix” the quality problem which has allegedly been caused by managed care. This is a graphic illustration of how poorly understood the quality problem is.

We do have very serious quality problems, but the real problems are not due to managed care and will not be solved by more appeals, greater access to specialists, more second opinions, more choice, an increased right to sue, or unlimited amounts of health care.

The reason is that the major underlying cause of the quality problem is not bad health professionals, though there are some. Poor quality is mostly due to inadequate science, a lack of evidence-based medicine, inadequate technology assessment, and deficiencies in our data and major gaps in our quality control, standard setting, and information dissemination systems. In other words, we have a structurally flawed system.

As a result, too often no one, specialist or not, knows the right thing to do. The uncertainty which pervades much of medical practice today is manifested by the huge variation in care which exists from region to region, doctor to doctor, hospital to hospital. For example, breast cancer surgery rates for similar conditions vary 10 fold across the nation and there are many other examples of high variations in use (ICU care, prostate surgery, antibiotic use). In fact, the next time you hear someone claim that we have the best health care system in the world, you can reasonably ask, “Which one?”, because the type of health care delivered often varies dramatically depending not on need or solid evidence, but on where you receive your care. Too often we have huge differences in cost, with no differences in outcome. With so many different approaches being applied to similar patients, it is not possible that all physicians are doing the “right thing.”

Studies from Harvard and elsewhere show that medical accidents and medical errors are rampant in our health care system, and that the combination of medical negligence, errors, and accidents constitutes the nation’s “hidden epidemic.” The President’s Quality Commission concluded: “Exhaustive research documents the fact that today, in America, there is no guarantee that any individual (insured or not, rich or poor), will receive high-quality care for any particular health problem. The health care system is plagued with overuse, underuse, and misuse of health care services.” The Institute of Medicine of the National Academy of Sciences in its second quality report concluded that our health care system is “broken” and needs to be restructured from top to bottom.

It has been estimated that poor quality causes 250,000 preventable deaths each year and is now the third leading cause of death just behind cancer and heart disease.

There is no other business in this country that would be allowed to continue to operate even a day with quality problems of the magnitude I have described, nor would society pay more than 1.5 trillion dollars a year for its services. Yet this is now the case in our health care system.

The question I believe we all need to ask ourselves is: why do we continue to spend more than 1.5 trillion dollars each year to support a deeply flawed system and virtually zero to reform it or to improve its quality.

We know we can do far better. There is absolutely no doubt that we can, and fortunately tools are now available to help do just that. A number of these tools have been developed by our Coalition.

So these are the problems we face. We have concluded that systemic problems of the magnitude I have described cannot be solved by a “patch work” strategy. Forty years of national experience attests to the bankruptcy of such an approach.

The real tragedy here is that none of the tools we are currently using or contemplating — including a Patients’ Bill of Rights, cost sharing, managed care, tax rebates or MSA’s — have even a remote chance of successfully dealing with the storm we face.

We believe that through a public-private partnership, our nation will have to craft a set of policies that ultimately achieves the following goals:

  • Making sure every American has health insurance coverage; not just those over 64;
  • Improving the quality of all care;
  • Controlling total system costs and stopping cost shifting;
  • Creating a more viable and equitable mechanism of financing (i.e., creating; a level playing field); and
  • Simplifying administration.

Why must all these goals be achieved? Because our problems are inextricably intertwined; you cannot solve one without addressing them all.

It’s a vicious cycle. Without universal coverage, you cannot assure equity or quality, and in the absence of quality, you cannot afford universal coverage, nor can you contain costs. In addition, without universal coverage you can neither make the system less complex, control costs, stop cost-shifting, achieve a level playing field of equitable financing, or create a truly competitive market-based system. In fact, those who advanced the competition hypothesis warned us that it could not work in the absence of mandatory universal coverage and government oversight.

To those who claim that our nation cannot afford a system of universal coverage, we would say this: Every other advanced nation in the world has done so while spending one-half to two-thirds as much per capita as we do and attaining health outcomes at least as good as, and in a number of areas better than ours. We do not need more money, we need a better system.

So you can see that there is a lot of bad news. What is the good news?

The good news: The recognition of the increasing severity of these problems, and of the need for systemic reform, is also growing — among elected officials, opinion leaders, and members of the general public. The media have devoted more attention to the travails of the health care system, and their impacts, than we have seen in over a decade. More and more elected officials have been calling for a new national debate about the shape and future of the health care system – a debate that the National Coalition on Health Care has been instrumental in energizing and framing. And according to a new Harris Poll commissioned by the Coalition, nearly 90 percent of the public favors fundamental health care reforms – a remarkable level of receptivity and support. Because of the magnitude of this problem, health care is likely to be the transcendent domestic issue on which the next election will hinge – and it should be.

What all this means is that the National Coalition on Health Care – your Coalition – has an extraordinary opportunity now to impact that campaign and advance our common agenda: i.e., health care reform that secures affordable coverage for all Americans and improves the quality of care.

We have that opportunity in part because of our membership, which includes nearly a hundred leading organizations from many sectors of the American economy and society: major companies and the nation’s largest unions; associations of health care providers; religious and consumer groups; and health and pension funds. When the Coalition speaks out, it is perceived and received not as a special interest, but as a uniquely broad alliance that represents more than 100 million Americans.

And we have that opportunity in part because we have been, and continue to be, resolutely non-partisan. Members of Congress and members of the press alike know that they can trust our analysis of issues to be careful, straightforward, and reliable – and they know that we do not have a hidden agenda.

In the coming year, to advance the national debate and the prospects for reform, we will be developing new recommendations to the President and Congress about the objectives and options for reform. As always, we will move forward based on deliberations and consensus among our members.

Our team in Washington will continue to meet with Republican and Democratic members of Congress and their staffs to educate them about the problems of the health care system and the urgent need for reforms – and to provide technical counsel on policy options.

We will continue as well to brief reporters, editorial writers, and columnists – to inform and encourage further coverage.

We will work with our member organizations to develop and distribute materials about health care to their employees and associates.

We will issue and publicize new research, including forthcoming reports on the limited impact of the incremental policy changes that have been enacted in the past decade and on projected growth in health care costs. We will also work to dispel the many myths which currently impede rational discourse on this issue.

And we will continue to grow. In just the past year, we have added 35 new member organizations – another heartening sign of momentum. As our membership expands, so too will our reach, breadth, and political leverage.

In closing, I want to say a few words about why I feel you and others in our nation’s religious community will be crucial to the reform effort.

First of all, health care is a critical ethical issue in our society which as yet has not received the attention it deserves, and who can more legitimately highlight this than our religious community and the more than 100 million people of faith. Universal coverage for necessary and affordable care is the right and just thing to achieve. It is a necessary prerequisite to a productive and useful life.

Successfully mobilizing people of faith around this issue (especially if done in conjunction with other key elements of our society) creates an extremely powerful force, including a political force. Remember, your church alone counts among its members 10 Senators and 34 Representatives. Other religious communities count even more. These political leaders need broad support to move aggressively on this issue.

And remember also that our nation’s religious communities, collectively with their hospitals, nursing homes, educational and other institutions, are one of the nation’s largest employers – if not the largest. They then have a fiduciary responsibility through their health care and pension funds to reform our broken health care system.

So for these and many other reasons, you have a crucial role to play and your, potential impact is awesome. We look forward to working with you to bring that potential to bear in achieving our common goal of a more equitable, more affordable, and higher quality health care system for all.

You and we know that reform will not be easy. It will take hard work, political courage, resources, imagination, and it will take something else besides: the recognition among all of us that the stakes are so great, and the need for reform so compelling, that we will have to put aside partisan differences for the good of the country.

Our Coalition in conjunction with our nation’s religious communities has important work to do this year as we build on the momentum we have already helped generate. We believe we have an opportunity and a responsibility to help achieve necessary health system reforms and, in doing so, to advance the public welfare. I, think you will agree this is a job worth doing. We are honored and emboldened by your presence and commitment to this cause.

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