Ezekiel J. Emanuel on fizing health care
By Pam Hersh, Special Writer
The Monday afternoon lecture in Princeton University’s Dodds Auditorium, Robertson Hall, on a cold gray day could have been a nice location for a student to take a snooze after pulling an all-nighter or a community senior citizen to take his/her afternoon nap. But no one nodded off at the Feb. 24 lecture, even though the title of the talk, “Megatrends in Health Care,” sounded a bit sleep-inducing.
While his younger brother Rahm Emanuel, mayor of Chicago, was waking people up with talk about jumping into the icy waters of Lake Michigan with Jimmy Fallon, Dr. Ezekiel J. Emanuel, M.D., was giving audience members an intellectual jolt with his animated talk based on his book, “Reinventing American Health Care.”
As an administrator at a local hospital, I was riveted by the ideas spewing forth from Dr. Emanuel, an oncologist, bioethicist, vice provost for global initiatives and chair of the department of medical ethics and health policy at the University of Pennsylvania.
I would guess that all the audience members — as academics or health care professionals and/or consumers of health care services — have thought a lot about health-care delivery. And if I am fairly typical, most have complained about, whined about, judged and cursed our health-care system in its current form, done the same with the Affordable Care Act and have listened ad nausea to media commentators and politicians doing the same.
Dr. Emanuel, however, eschewed the unproductive behavior of empty ranting. Approaching the issue as though it was a sick patient, Dr. Emanuel tackled the situation with a laser focus. After diagnosing the illness, he devised a treatment protocol that is his prescription for going forward, for saving lives in a far more efficient and effective manner than currently occurring. One could argue with the specifics of his provocative comments, but no one could argue with the fact that it was exhilarating to be presented with a thoughtful, concrete, well-vetted and researched proposal about health-care reform in this country.
”It’s easy to give a speech about how bad things are in health care — we spend too much, get too little, etc. … but ultimately he was optimistic. Even though he was predicting significant disruption in health care over the next 10 years, he had specific suggestions for how to take advantage of the trends, and create a system that would lead to better health care and greater value,” said Heather Howard, former commissioner of Health and Senior Services for New Jersey and now a lecturer at the Woodrow Wilson School.
The elements of the disease were laid out in the subtitle of Dr. Emanuel’s book: “Reinventing American Health Care: How the Affordable Care Act Will Improve our Terribly Complex, Blatantly Unjust, Outrageously Expensive, Grossly Inefficient, Error Prone System.” Specifically, he noted that the health-care economy in the United States is $2.97 trillion, reflecting both steadily rising prices and overall inefficiency. The amount of money the United States spends on health care is equivalent to the entire GDP of France. He noted that even though prices are going up, demand in the health industry continues to be for very low prices.
Dr. Emanuel’s suggested treatments for the sick health-care industry include:
*- Ending insurance companies as we know them and replacing them with accountable care organizations, groups of doctors and hospitals that link reimbursements to the quality of care and are providing care in a more fiscally responsible manner.
*- Closing grossly inefficient hospitals, especially the large academic centers.
*- Ending employer sponsored insurance and evolving into a system that will look like a voucher system; and transforming medical education.
One cure he would not prescribe is a single payer system. “There is no chance of this happening in this country,” he said.
Galen Benshoof, a public affairs graduate student specializing in health policy, noted that “Emanuel’s message was that providers of care, including academic medical centers, will have to compete on quality to survive. That’s the key. Price matters deeply to consumers, and that will only intensify if cost sharing continues to rise. If you want them to pay high prices, you better make sure you have the quality to match. Quality indicators will become increasingly important to all payers, whether at the employer, government, or individual level. “
Although Galen thinks he has a career as a policy wonk working with the likes of Ezekiel Emanuel, I know of another talent he possesses: a talent for sleuthing. Galen solved the mystery of the man in the black shirt and white tie. Dr. Emanuel challenged the audience to identify a man with a black shirt and white tie in a picture with President Obama signing the Affordable Care Act.
No one in the audience knew who he was. But thanks to Galen’s research, I am able to email Dr. Emanuel and say that the mystery man in the black shirt is Ryan Smith of Turlock, Calif. But my computer kept crashing when I tried to open the links that explained why this man in the white tie was at the ceremony. Perhaps Dr. Emanuel could take on information technology as his next patient.