MAY 1998 SURGEON GENERAL SAYS “HIDDEN EPIDEMIC” OF POOR QUALITY CARE MUST BE ADDRESSED

U.S. Surgeon General David Satcher, M.D., told Coalition members in May heíll follow in his predecessorsí footsteps and use his office as a bully pulpit to promote healthy lifestyles and regular physical exercise.

But Satcher says he also hopes to get the federal health bureaucracy in Washington to focus on problems it has too long ignored. Chief among them is the “hidden epidemic” related to health care quality. Satcher praised the Coalitionís efforts to bring this problem to the fore. “Despite a growing sophistication in technology and medical science, there continue to be real gaps in the quality of care available to many Americans,” he said.

In particular, Satcher wants to raise Americansí awareness of the disparities in the health status of blacks versus whites. He said black Americans are in overall poorer health than whites, have less access to care and poorer outcomes even when they do get care.

The fight to rectify that situation, Satcher said, involves expanding insurance coverage for low-income people overall but also strengthening the nationís public health infrastructure. He said it was no longer acceptable that the government spends only 1% of its health care budget on population-based prevention.

“Medicine and public health must become one,íí Satcher asserted. He said he was personally involved in an effort to create a more open dialogue between the American Medical Association and the American Public Health Association, two professional groups that have often been at ideological odds.

Satcher, who took office February 13, listed among his other priorities: assuring that kids get a healthy start in life and bringing mental health care into the nationís public health agenda. As an example of the latter, Satcher said the rising rate of teen suicide demands a public health response.

“We have environments of hopelessness in many parts of our country,” he said. “We must counter that with programs that offer hope. We have to make troubled teens part of the solution, not just point the finger at them.”

Pollster and Republican strategist Bill McInturff, a partner in Public Opinion Strategies, echoed Satcherís message. He said the erosion of public confidence in health care ñ and in managed care in particular ñ is deepening, with a third of the population now calling for “radical change” in the system.

He said Democratic candidates in this yearís elections will likely “cast Republicans as the pro-HMO party” if they (the Republicans) block patient protection legislation this summer or fall.

Former Colorado Governor Richard Lamm, now a professor at the University of Denver, told Coalition members that the nation should not move to cover all uninsured persons until it grapples with the controversial issue of setting necessary limits on the delivery and cost of medical care.

“We simply can not do it all,” Lamm said. “We must set priorities.” Lamm maintains that medicine has been too broadly defined to include such services as long term care and more recently alternative medicine. Paying for such services for the aging baby boomers, he said, would “break the bank” and not be an efficient use of health care dollars.

STUDY FINDS COMMON THEMES IN HEALTH SURVEYS

The American public has become increasingly concerned about our countryís health care system. People are worried about losing insurance coverage, paying for care if they lack coverage, and the quality of their care, even if they are insured. These concerns exist independent of the types of plans in which people are enrolled.

These are among the conclusions from a new analysis of 22 public opinion surveys on health care conducted between

December 1996 and December 1997. Taken together, the surveys represent the sentiments of almost 35,000 American consumers. The analysis, conducted by Joel Miller, policy director at the Coalition, is the first to probe for common themes among disparate, recent surveys.

In contrast to the past when concern was predominantly found among the poorer and uninsured populations, today those concerns also exist among middle-class, working Americans and especially those who have had recent contact with our health care system, the analysis found. In fact, the majority of Americans think the health care system is seriously flawed, and their confidence and trust in that system is eroding. The analysis reveals a disconnect

between the publicís concern and declining public confidence in the health care system and the solutions being proposed by lawmakers.

“At a time when most Americans are optimistic about the economy and their future, they are pessimistic about their ability to continue to obtain and afford high quality health care, especially if they become seriously ill,” said Henry E. Simmons, M.D., President of the Coalition. “This concern is grounded in their personal experiences or those of a relative or friend. In fact, four in ten Americans reported personally having had a ëbad experienceí with medical care,” he added.

COALITION BRIEFS BUSINESS LEADERS IN DENVER, DES MOINES

More than forty CEOís of major national corporations and local businesses attended Executive Briefings on Health Care conducted by the Coalition in Denver and Des Moines this spring.

The Coalition developed the Executive Briefing Series in response to feedback from previous conferences. The sessions were structured to focus beyond the immediate cost issues surrounding the provision of health care benefits to include a broader understanding of the meaningful role that business has in determining the nationís future health care environment.

Denver Meeting

The Coalitionís Denver meeting was co-sponsored by the Kauvar Foundation and the Daniels College of Business at the University of Denver. Attendees included CEOís, Chairmen, Presidents and Senior Vice Presidents who gathered at the University of Denverís Phipps Mansion for a four-hour session on March 31^st. The meeting began with welcoming remarks by James D. Griesemer, Ph.D., Dean of the Daniels College of Business, and Abe Kauvar, M.D., Founder and President of the Kauvar Foundation. The session was facilitated by Michael Maccoby, President, Maccoby Consulting.

The participants voiced concern about rising health care costs, a lack of public understanding of health care as a “system,” a need for universal insurance coverage and a common definition of health care quality.

Dr. Henry Simmons, the Coalitionís President, provided the group with an overview of the current state of the health care system. During the luncheon, Kenneth Thorpe, Ph.D., of Tulane University explained the rising costs of health care and the implications for business.

Des Moines Meeting

The meeting in Des Moines on April 2^nd was sponsored by the Iowa Business Council and was similar in content and structure to Denverís. Governor Robert D. Ray, former Governor of Iowa and Co-Chairman of the Coalition, opened the meeting and set the framework for the morning discussion. Participants in Des Moines voiced similar concerns about the cost, quality and access to health care as had the Denver participants.

The Coalition is planning additional meetings around the country to continue to challenge Americaís most innovative, resourceful business minds to apply their collective expertise in developing possible solutions to the problems facing this countryís health care system

The Executive Briefing Series is supported by a grant from the Robert Wood Johnson Foundation.

GRASSROOTS EFFORT SET FOR LAUNCH

The Coalition is poised to kick off a grassroots effort in 12 states to educate American opinion leaders, decision makers and voters on the necessity and importance of improving the American health care system. The campaign aims to make health care a top agenda item on the Congressional and Presidential elections in the year 2000.

This grassroots effort will begin in earnest July 1, 1998, when nine field organizers are brought on to work in the following states: New Hampshire, Georgia, South Carolina, Mississippi, Tennessee, Louisiana, Texas, Iowa, Michigan, Ohio, California and Arizona. The Coalition is seeking candidates to organize its efforts in Iowa, Michigan, Georgia/South Carolina and Ohio.

Once all the organizers are in place, they will meet in July in Northern Virginia for three days of intensive education on health care issues and also on the expectations and responsibilities of this effort. This will include a thorough briefing on the five key principles of the Coalition as well as specific contacts, strategies and tactics. The organizers will focus initially on evaluating their statesí public awareness of health care issues and meeting with key contacts affiliated with our member organizations. Additional state organizers will be added in the fall to begin work in January 1999.

The Coalition is developing outreach materials, including an informational video, a consumer handbook and an organizational brochure. Also being planned is an organizational newsletter which will be issued several times a year. Additionally, a questionnaire for all candidates for this yearís House and Senate Congressional races will be sent out in June along with an information packet about the National Coalition on Health Care and the key components of health care improvement. Information from this survey will be available in September.

The Coalition will have an active presence at two national gatherings of state legislatorsóthe National Council of State Legislators convention to be held in Las Vegas during July and the annual meeting of the American Legislative Exchange Council in Chicago in August. Although the Coalition does not currently envision grassroots efforts focused at the state legislative level, members of state legislatures are key opinion leaders who influence key decision-makers and the voting public at large.

FINDLAY, SCHWARTZ JOIN COALITION STAFF

Steven D. Findlay, former health care reporter for USA TODAY, has joined the Coalition staff as a Senior Policy Analyst and writer. He will be involved in the formulation and dissemination of policy studies and other Coalition initiatives.

Cynthia K. Schwartz, an experienced organizer for political and social issues groups, is the new Coordinator of the field staff who will oversee the grassroots efforts being undertaken by the Coalition.

Prior to USA TODAY, Steve was the Washington Editor of Business and Health Magazine from 1992 to 1996. Earlier, he was Associate Editor at U.S. News and World Report and covered medicine and health for the magazine. While at U.S. News, Steve helped launch the magazineís now-annual “best hospital” report. He had an earlier stint at USA TODAY shortly after the paper was started and before that was the Editor of the International Medical News Service. Steve received a Masterís Degree in Public Health from the Johns Hopkins University and a B.A. from the University of Colorado.

Cindy has had 11 years of experience in grassroots organization. She served as Field Director and then as Communications Director for the Coalition Against Bigger Trucks which successfully worked to keep large trucks off the nationís highways. From 1992 to 1993, Cindy was the Executive Director of the Middlesex County (N.J.) Democratic Organization. She has managed field operations for various groups at both the national and the state level. Cindy holds a B.F.A. from Virginia Commonwealth University.

UPCOMING RESEARCH STUDIES

A number of Coalition-commissioned research studies will be released over the next few months. They include:

• “The Role of Medical Savings Accounts in Health System Reform,” by Elliott K. Wicks, Ph.D., and Jack A. Meyer, Ph.D., of the Economic and Social Research Institute
• A series of studies on the implications of possible Medicare changes has been commissioned from The Lewin Group. The first two reports in that series are:
  • “Rethinking the Medicare Eligibility Age,” by John Sheils, David Stapleton, Ph.D., Jessica Graus and Andrea Fishman
  • “Demonstrating Quality Problems: The Case of Regional Variations”
• The Effect of Incremental Reform: A Look Back and A Look Ahead,”, by Uwe W. Reinhardt, Ph.D., James Madison Professor of Political Economy, Princeton University.
• “New Quality Management Agenda: Doing the Right Things Right,”, by Henry E. Simmons, M.D., M.P.H., F.A.C.P., and Joel Miller, National Coalition on Health Care
• “Best Practices in American Health Care: Approaches to Improving Quality Through Greater Efficiency in the Delivery of Health Care,” by Donald L. Berwick, M.D., President, Institute for Healthcare Improvement
• “Trends in the Number and Percent of Americans Without Health Insurance,” by Kenneth E. Thorpe, Ph.D., Tulane University Medical Center and Director of the Tulane Institute for Health Services Research.

COALITION HEARS BREAUX, KERREY, McCRERY ON HEALTH CARE PRIORITIES

Three members of Congress discussed their priorities in health care at the March meeting of the Coalition. Senator John B. Breaux (D-LA), who is the Chair of the Medicare Commission, briefed Coalition members on how the Commission would be structured. The 16-member bipartisan body will work through three Task Forces: Modeling, Reform, and Restructuring. The Task Forces will have 90 days to make their reports.

Public hearings will be used throughout the process in order to obtain the widest possible input. The Commission report is due March 1, 1999.

Universal eligibility for health insurance is the key to improving the health status of the American people, accordingly to Senator J. Robert Kerrey (D-NE). How we move from universal eligibility to universal coverage is another issue, Kerrey said. His concern is with the percentage of the federal budget that is tied up in entitlements. That percentage has been growing since the 1960ís, and very little discretionary money is available to fund needed programs, including health care research and delivery.

Congressman Jim McCrery (R-LA) is developing a health care proposal to deal with what he sees as the deterioration of the private health insurance system in this country. He believes that government is encroaching on the private market and that the trend should be halted through a combination of individual responsibility for health care and private sector initiatives to make health insurance more affordability for both individuals and small businesses.

NCHC GROWS

Several prominent Americans have joined the Coalition as Individual Supporters. They are: Robert Dole, former Majority Leader of the Senate, George Mitchell, former Majority Leader of the Senate, and Robert Michel, former Minority Leader of the House.

New organization members of the Coalition are:National Association for Home CareSheppard Pratt Health SystemThe University of Texas Medical Branch at GalvestonDaniels College of Business, University of DenverHenry Ford Health SystemThe Kauvar Foundation