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Local brew with national impact: How could I avoid a story where officials mention Arnie and health care in the same sentence?



Governor Ahh-nold. Saviour of Medicaid?

A conference was held on our failing health care system, and what is clear is that neither Bush nor Kerry have any real fixes for this mess. (Durham Herald-Sun):

The U.S. health system did not win top grades during a forum Wednesday that brought together educators from three of the nation’s premier medical schools — even though two of the panelists were former federal health officials.

Although representing different points on the political spectrum, the panelists seemed to agree that America’s medical infrastructure is mired in decades of bureaucracy, waste and political pressures.

UNC’s top doctor, Bill Roper, and Bruce Vladeck, a professor of health policy and geriatrics at the Mount Sinai School of Medicine and a member of the New York City Board of Health, are both former administrators of the federal Health Care Financing Administration (HCFA) — now the Centers for Medicare & Medicaid Services.

They spoke during the forum, hosted by the joint UNC-Duke Health Policy Forum, on the topic, “What the 2004 Election Means for Health Policy in 2005 and Beyond”. Joining them were panel moderator Tom Ricketts, a UNC health policy specialist, and Duke’s Kevin Schulman, a health care economics expert.

Roper, who was HCFA’s administrator during the Reagan years, proclaimed himself a longtime Bush supporter at the outset of Wednesday’s discussion.

That would indicate he prefers less government, Roper said, but as dean of UNC’s School of Medicine, chief executive officer of UNC Health Care and vice chancellor for medical affairs at UNC, he probably should champion the expansion of the national health system. That would be in UNC’s best interest, he said, because it could bring more hospital payments from Medicaid and Medicare and more grants for medical research from the National Institutes of Health.

“It’s a classic case of where you stand depends on where you sit,” he said. Neither George Bush nor John Kerry proposed any form of universal health care during the recent campaign, he said. That is because health policy is driven by the national budget, and there’s “enormous pressure to restrict spending in the years ahead.”

For UNC, medical liability costs are a major issue, he said. And tort reform isn’t likely under the current congressional structure, he said, although he favors a proposal from a group called Common Good that advocates special medical courts, where the verdicts would be rendered by judges trained to evaluate scientific evidence.

Schulman also noted that neither presidential candidate offered a viable plan for controlling health care costs. The Duke professor of medicine and professor of business administration at the Fuqua School of Business and director of the Center for Clinical and Genetic Economics of the Duke Clinical Research Institute also predicted chaos in 2006 when the Medicare Modernization Act takes full hold.

Schulman said he foresees a Medicare decision to pay only for generic drugs for senior citizens. Big pharmaceutical companies won’t accept that, he predicted, although the economy has to absorb the rising costs somehow.

“But what worries me most, and what neither party mentioned, is Medicaid,” Vladeck said, noting that the state-run health program for the poor and disabled is even bigger and more expensive than Medicare. The program has inherent limits, he said, because states run it and send a bill to the federal government for its share of the program, leading to excess spending.

God help me, those of us in the Medicaid programs are looking to Arnold Schwarzenegger, believe it or not, as our savior,” he chuckled, referring to the California governor’s efforts to stem his state’s Medicaid spending.

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Pam Spaulding

Pam Spaulding