Oct. 23--Saying she still had "marks on my back from healthcare reform," University of Miami President Donna Shalala told 100 South Florida healthcare leaders Wednesday that the key to making major changes was getting a consensus.
She noted the country had never "taken a giant leap" in any large social change without first getting agreement that there was a problem and then getting agreement on what the solution should be.
The former leader of Health and Human Services in the Clinton administration when a major attempt at reform failed, Shalala said the country had to pursue simultaneously both covering the 45 million uninsured and reducing ever-increasing costs. If the solution is not close to universal coverage, she said, there would be major cost shifting onto those who did have coverage.
She said that small steps might be helpful. "I like IT," she said of moves to increase the use of electronic records and other information technology, "but we're not going to solve the problems of healthcare with IT."
The seven panelists who followed her during a discussion at UM's Wellness Center agreed that the system needed huge reforms, but there was no consensus about what should be done.
Richard Umbdenstock, chief executive of the American Hospital Association, said conversations with 100 major groups had agreed on five major but vague building blocks, including "health coverage for all, paid by all," without saying how that should be done.
Umbdenstock said he was "very optimistic" a new administration and a new Congress would act quickly on healthcare reform because it was part of the country's basic infrastructure that needs fixing.
But Mark Wilson, president of the Florida Chamber of Commerce, said he was "not optimistic." He said the state's leaders should not wait for the government to change the healthcare system, but should rely on free enterprise to make the changes. "It's the patients and small businesses paying the bills," Wilson said.
NO CONSENSUS
He saw no consensus on what should be done, and therefore no direction to move forward.
David Lawrence Jr., chair of The Chidren's Trust, said it was "beyond painful" that "any child and any family doesn't have healthcare" when "$400 million a day is spent to bring democracy to Iraq."
Marvin O'Quinn, chief executive of the Jackson Health System, talked about "fragmentation of costs" and how much money was wasted on end-of-life care.
Julieta Romano said that without insurance, she had lost teeth and hadn't been able to replace them. She found the system very frustrating and was concerned with putting "a child in the hands of someone who cares more about his two mortgages" than he does her child.
TORT REFORM
Several noted that tort reform could do a lot to reduce healthcare costs. Umbdenstock said the best estimates he had seen were about 5 to 7 percent of costs were due to doctors ordering extra tests or procedures merely because they are afraid of being sued if they do less.
That works out to about $130 billion of the nation's annual $2.2 trillion healthcare spending, but Umbdenstock said that with an increasingly Democratic Senate he didn't anticipate any move to toward reforming the malpractice legal system.
Pedro Jose "Joe" Greer Jr., a gastroenterologist and a leader at Florida International University's fledgling medical school, said that doctors had a "basic morality" imperative to take care of the poor and suggested each doctor treat two uninsured patients each day.
Frank Maderal, president-elect of the Dade County Medical Association, said that would be hard for most doctors to do because they had many expenses, including the "girls in the office" wanting annual raises.
Lawrence noted they were "women, not girls. . . . Frank, we're going to get you into this century," he said, drawing a laugh from a crowd.
AREAS OF CONCERN
Several speakers in the audience told the panel they were concerned their own personal areas were being ignored.
The mother of an autistic child said she was concerned not enough attention was being given to early treatments. A nurse worried that none of the panel members had mentioned the important contributions of nurses. A psychiatrist complained mental health was a low priority. A dietitian wanted payers to be more supportive of wellness and diet treatment.
After the panel discussion, Wilson of the Florida Chamber said in an interview that Toyota had shown it could build a great car by eliciting comments from everyone.
"But there has to be a common goal. Are we trying to make a better car? Or a truck? Or a submarine? We need to agree on a goal first."
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