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Snyderman advocates health reform

DUHS Chancellor Emeritus Dr. Ralph Snyderman recently wrote an op-ed for The Huffington Post titled “Making Sense of Health Care Reform.”
DUHS Chancellor Emeritus Dr. Ralph Snyderman recently wrote an op-ed for The Huffington Post titled “Making Sense of Health Care Reform.”

Last Tuesday, the Senate Finance Committee became the last of the five Congressional committees with jurisdiction over health care to pass a health care reform bill.

The bill passed by a 14-9 vote, with Sen. Olympia Snowe of Maine being the only Republican to vote in favor of the bill. The public option, a hotly debated component of health reform, is a major component of the bill passed by the Senate health committee, but it was not included in the Senate Finance Committee’s version. Senate Majority Leader Harry Reid, D-Nev. and Speaker of the House Nancy Pelosi, D-Calif. now have to work with the leaders of their respective chambers in order to merge the two Senate bills and three House bills into one bill for each chamber.

Dr. Ralph Snyderman, an outspoken advocate of health reform, is Chancellor Emeritus of Duke University, James B. Duke Professor of Medicine and past president and chief exective officer of the Duke University Health System. In light of his recent guest column in The Huffington Post titled “Making Sense of Health Care Reform,” The Chronicle’s Ethan Marks talked with Snyderman about his ideas for reforming the health care system and his opinions on some of the Congressional efforts so far.

The Chronicle: Now that the last of the five Congressional committees has passed a health reform bill, what do you think of the proposed changes so far?  Is there anything on the table that you don’t think is a good idea?

Ralph Snyderman: Well, one has to determine if one wants to be an optimist or a pessimist, and I will lean more toward being an optimist. The politics has made it very difficult to have a rational reform of how health care is delivered. What I am concerned about is that there will be, because of the increase in coverage, an increase in expense. The fact that there has been very little reform of how health care is actually delivered and how health care is paid for makes me think that the expenses might continue to rise. So I lean a little bit more toward the optimism. It’s better to have this than nothing, but I am hoping that we move from this to an approach that truly makes the delivery more cost-effective. We are capable of doing this.

TC: You have spent your lifetime working in many different areas of the health industry. How have these experiences shaped your ideas about the health care system and its need for reform?

RS: My prior experience in health care has led me to the inescapable conclusion that health care delivery is in need of major reform. While we have tremendous capabilities to improve episodes of disease, we have not focused as effectively as we can on prevention and early effective intervention. I think our capabilities of delivering better health care are far greater than what we actually do.

TC: You have long been a proponent of transitioning to a system of health care focused on prevention and personalized medicine, often termed “prospective care.” What exactly does a prospective health care system entail?

RS: What prospective care does is put more empowerment on the part of the individual, the patient, and it deals with disease before it does significant damage. In other words, rather than focusing on disease events once they occur, which is the way health care is generally practiced today, it tries to anticipate an individual’s risks and allows each one of them to work with the health system to minimize the risks.

TC: Does a prospective health care system actually reduce costs?

RS: Every evidence we have thus far is that prospective care reduces costs, and there are two very good examples that have been developed at Duke. One is the care of individuals with congestive heart failure, where we showed that a prospective health care approach greatly minimizes the clinical problems and reduces hospital admissions, and also reduces costs.... The Duke Prospective Health program for Duke employees and their families is also off to an outstanding start and has improved the health of the Duke community and decreased health care costs for the University and all its employees.

TC: How do you feel about the much-debated public option?

RS: I think the public option basically is a good idea in the sense that, for selected individuals that can’t get private insurance in other ways, there is an opportunity to be a bit more experimental in designing better, more cost-effective models of care. So on that side, I like it. The danger of a public option, if it’s not done right, is that the government pays for care at a much lower rate than private insurance. And most physicians and hospitals will tell you that they could not exist solely on the government rate. So by having a public option, there really is an unlevel playing field in the sense that the public option-type insurance has the benefit of lower expenses than private insurers. That’s a complicated answer, but unfortunately it is the reality, which makes the public option a difficult concept, although basically I think it is a good concept.

TC: There are many problems in our current system that are too pervasive to be fixed with one law or can even be adequately addressed by one push for reform.  How do you see our health care system changing and our efforts at reform evolving as we move into the future?

RS: I think that the most important initiative that could come from the health care legislation itself would be to change how medical costs are reimbursed to the providers—in other words, the reimbursement system which currently rewards disease rather than prevention. I think that would be the most important thing. I have to say there is a second thing, which is absolutely essential, and that is that individuals—you, me, and everyone else who reads this article—understands that health is one of their greatest resources, and they need to take ownership of it. What individuals can do for themselves, for most of their lives, is at least as great as what the health system can do for them. As a country, we need to understand the importance of our own health, and I am proud that Duke has developed a Prospective Health Care Club among its own students that truly values the importance of health.


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