This article first appeared in the St. Louis Beacon, April 17, 2009 - Federal lawmakers who sponsored a "Health Care Reform Listening Post" session in north St. Louis County on Friday got an earful of advice from participants who blamed runaway health-care costs on factors ranging from brand-name prescription drugs to Tater Tots.
The conference sponsors were U.S. Rep. William Lacy Clay, D-St. Louis, Russ Carnahan, D-St. Louis, and Jo Ann Emerson, R-Cape Girardeau. They asked a range of local health-care providers and consumers what Congress needed to do when and if it remakes the nation's health-care system.
The Tater Tot discussion rose when moderator Don Marsh of KWMU asked the panelists about the highest health priority.
Dr. Denise Hooks-Anderson, president of the Mound City Medical Forum, was talking about the high cost of high-tech medicine when she began talking about school lunches.
"A lot of you would be appalled by what they feed children in St. Louis public schools and in some of the poorest districts across the country," she told the audience of about 100. "When you're 8 and have a choice between broccoli and Tater Tots, which would you choose? That should never be an option."
She then argued that what's being served in school lunchrooms is one reason health costs escalate. "We're producing children who become obese adults with hypertension, diabetes, the cycle goes on and on. Then you need all the drug busters, the hypertensive medicine, the anti-diabetic medication -- that's where the costs are rising."
She appealed to the lawmakers and health-care professionals to "focus on prevention that would reduce costs."
Information Technology
Other panelists undoubtedly surprised the congressional group by suggesting that some ideas being discussed might be more hype than help.
Steve Lipstein, chief executive of BJC Healthcare, suggested that savings from health information technology, which includes streamlining records and moving from paper to digital systems, might not produce the promised benefits.
"The savings that have been mentioned are hyped and inflated by those who stand to benefit," he argued. "So we ought to be cautious."
While praising the value of health-information technology, he added that the rush to focus on this issue amounts to "attempts to do behavior modification on 830,000 physicians. You know that's a tall order."
A better immediate approach, he says, would be to simplify the ways records are sent and exchanged instead of letting the government get its foot in the door in a major way.
"We transmit millions and millions of bits of clinical data pursuant to financial transactions," he says of BJC. "That could be standardized, simplified (which could) eliminate variations among hospitals, among doctors, among payers without going to a single payer solution."
He cited the banking industry as a model of how to shift to standardized methods of transmitting data.
"You can go anywhere in the world and interface with a computer that takes money out of your account and puts it in the currency of a foreign country. So where I would start is with the very practical area of that interface between those who provide health care services and those who pay for them."
Doing that, he argues, would remove billions of dollars of needless cost "out of the system without all this behavior modification we think will be so easy."
Marsh of KWMU quipped that it was refreshing to "hear there's something in the banking industry these days that is worthy. We don't hear much of that."
Generic Drugs
Meanwhile, Dr. Steve Miller, of Express Scripts Pharmaceutical, raised some eyebrows when he argued that $42 billion in prescription drug costs could be squeezed out of the system through better management and giving patients more access to generic drugs. He added that the health outcomes might turn out to be better with generics because their cheaper cost would give patients an incentive to buy and take them.
On another matter, Lipstein said lawmakers were making nation-to-nation comparisons on health-care costs that don't explain factors that are driving up costs in this country.
"If you look at this room of people and look at their health-care status, about 20 percent of their health care is linked to how much we spend in the system, about 5 percent is linked to their genetic profiles and 20 percent is linked to lifestyle and behavior. But 55 percent is correlated with their income, education and poverty level."
He says these three variables, the social determinants of health, are among issues that lawmakers should address.
Emerson came up with the idea of conducting listening posts in Missouri because she was getting so many conflicting comments from constituents and professionals about what's wrong and right with the American health care system.
"Here you have all the stakeholders in the same room. Not only do they listen to us, they hear from others. We need to persuade people to change their minds about things. The best way to do it is in front of peers and force them to hear what the other side has to say."
Clay, in whose congressional district the session was held, says many disturbing points surfaced, including the $42 million in unnecessarily costly medications and administrative costs.
"We know there is some fat in the budget for health care," he said. "We also heard from the other side that reimbursement rates for Medicaid need to go up and that there aren't enough primary-care physicians available in some locations. I think we as members of Congress are working to listen to those stakeholders and come up with solutions."
Carnahan says reforms are urgent nationally and especially in Missouri, where he says 1.5 million residents were uninsured at some point in 2007 and 2008.
"That's astonishing. Some have told President (Barack) Obama that health care is too big an issue. But he has said that the economic recovery is absolutely linked with health-care reform. Over the last eight years, premiums have doubled, wages were stagnant and 46 million people lack coverage. We can all agree this is a good time to take this on."
