2008 Symposium

Building a Mandate for Change Change: The Time is Now

Tom Brokaw, former anchor at NBC News, told participants gathered at the Mayo Clinic National Symposium on Health Care Reform that "the time has come to make dramatic changes in the manner in which we deliver and pay for a fundamental obligation of a society – to have available the means and the resources to care for the health needs of its poorest as well as its wealthiest members.

"If the civic health of society is secure, but the physical health of the citizens is fraught with uncertainty, unfairness, anxiety, contradictions and onerous costs, then the infrastructure of any society is weakened in an unacceptable fashion."

Brokaw said the health care debate is full of unanswered questions: Government run or private? How to motivate individuals to be responsible for their own health? How to accelerate use of technology in health care? As baby boomers get older, will their health needs overwhelm us?

"Our challenges may seem monumental, but they pale besides those of the generations that came before," he said. "We have the will, the resources, the technology – and most of all we have the recognition that fixing health care in America is central to the obligations that we have to each other."

Panel discussion

Helen Darling, National Business Group on Health, and Dennis Rivera, Service Employees International Union, shared common concerns about the lack of affordable and accessible health care.

"We have to institute change as soon as possible," said Darling. "We can no longer afford a health care system that is ineffective and inefficient – whether we are one of the lucky ones with good coverage or are one of the 47 million who are uninsured."

Darling said that some items employers consider "non negotiable" in a reformed system include:

• Ensure everyone receives medically necessary and appropriate care.
• Make sure every hospital and ambulatory care center is safe.
• Redesign payment systems to reward outcomes and support primary care and prevention.
• Increase funding for comparative effectiveness research.

She advocated that every adult should be required to have health coverage for themselves and dependents.

"It is in our national interest to ensure that every resident of the United States receive necessary, evidence-based health care," she said. "Our system has plenty of money in it to meet those commitments. We should not delay any more. We have to keep the momentum going."

Rivera said the health care issue poses a huge challenge for the workforce and employers of America. He called systemic health care reform "an issue of morality and human decency.

"We need to make something happen and we need to make it happen now," he said. "Maybe it will not be the best solution, but doing nothing will be even worse."

Non-negotiable items for labor include:

• Employers, government and individuals must share responsibility for financing the system. People need to be able to move seamlessly from one system to another without loss of benefits or coverage.
• All Americans must be guaranteed their choice of doctors and hospitals.
• Long-term care must be fully integrated into the system.

A panel of Ian Morrison, Ph.D., an author, consultant and futurist; and Gary Kaplan, M.D., of the Virginia Mason Medical Center; Michael Porter, Ph.D., of the Harvard Medical School; and James Guest of the Consumer's Union looked at some of the ways health care needed to change.

Patients want universal access to health care, said Dr. Morrison. But when the system is broken, access is not good enough. We need to fix the delivery system. He said health care is so far behind in technology – not just behind other industries, but behind other countries. He said we can't just automate the current system, though, we need to redesign the work so we are not "automating garbage."

Guest said consumers are scared. Even those who have insurance, 40 percent said they fear a medical emergency. He said that consumers haven't been seen as a force in the past but that we are going to see a mobilization from the consumer sector.

The system is not organized or structured in such a way to give people what they want and need, Dr. Porter noted. It was pointed out that Medicare pays doctors in Miami $50,000 more per patient per year on average than in Seattle, with no difference in length of life among the two patient groups.

The government is going to have to play a role in determining outcomes, and as a convener, collector of data, disseminator of information, Dr. Kaplan stated. He pointed to the examples of organ transplants and in vitro fertilization where the government requires providers to collect and publish specific outcome measures which are then published on the Web. Dr. Kaplan said this kind of outcomes information can have a "transformative effect" on the system.