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Home / Washington Business - May/June 2007 / Q&A with Don Brennan, Vice chair, Board of Directors, Swedish Medical Center, Seattle - Health Care Reform: Evolution — not revolution |
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Q&A with Don Brennan, Vice chair, Board of Directors, Swedish Medical Center, Seattle - Health Care Reform: Evolution — not revolution |
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Written On: May/June 2007 |
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Donald A. Brennan has made hospital and health care administration his life’s work. He has been president and CEO of St. Louis-based Ascension Health, president and CEO of Daughters of Charity National Health System, president and CEO of Sisters of Providence Health System, and CEO of Group Health Cooperative. He has also taught classes on health administration and policy at the University of Colorado, the University of Washington and St. Louis University. Brennan currently serves on the Washington Health Care Forum. Until recently, he was on the board of trustees at the Washington Health Foundation, and from 1993 to 1995 he was a member of the Washington Health Services Commission.
Q: How do you see the status of health care in Washington today?
A: It really is a tale of two worlds. Most of us have access to a first-class system of health care, except for the 10 percent or so of us who are uninsured. It’s a complicated problem. Health care reform is more complex and comprehensive than just insurance. There is no magic bullet to cure the problems facing the health care industry.
If we are to achieve full coverage for all, there are, I believe, three possible ways to do it. The first would be for employers to provide for their employees, with the government picking up the cost for the unemployed or uninsurable. The second would be individual mandates, again with subsidies from the government for those who are unable to pay. The last option is a taxpayer-funded system of universal health care.
Q: Do you see one or the other of these as the way we are headed?
A: I think the culture in our country would not support a taxpayer-funded system of universal health care as an option at this time. I believe the solution requires a private sector/public sector partnership. And it is not something we can expect to happen all at once. This will be a very thoughtful, step-by-step process as we work our way through improving the quality and efficiency of delivering health care to people in all walks of life.
Q: It seems we don’t have many companies offering health care policies in Washington, and one of the reasons often given is the large number of mandates imposed by our state government. Do we have a problem with mandates in our health care system?
A: I don’t honestly believe that mandates are the driving issue. That said, however, I think we must be very, very cautious both with existing mandates and with future attempts to make mandates. While removing or reducing the number of mandates would certainly impact the cost and delivery of health care in Washington, it will not solve the overall problem in terms of costs escalating at well above the rate of inflation and the 10 percent or so of the population lacking health insurance.
Q: Why are costs rising at rates much higher than the rate of inflation?
A: There are enormous complexities in the cost of health care delivery. I don’t believe we will ever get the cost down to the rate of inflation because, as our technology improves, we can do so much more. Also, people are living longer.
Q: What about the Massachusetts model? With their former governor, Mitt Romney, running for president, I’m sure we’re going to be hearing a lot more about it in the months ahead.
A: I don’t fully understand it. However, it is significant that states are trying different approaches—Massachusetts and California come to mind, for example. I think there is value in this. It’s not yet clear that these are going to work, but it is certainly worth the effort to try. The more things we debate and try at the state level, the more solutions we’re going to find.
Although states can be inventive and can experiment, in the long term we’re going to need some sort of national solution. Health plans must be able to serve the needs of a work force that is increasingly mobile, and health care must be available as workers move from state to state.
Q: Do we really need to turn the health care system on its ear and reinvent it?
A: I would rather we proceed in a much more deliberate manner. The reality is that if we’re not careful, we could make it worse. Our end goal has to be full coverage for all that is delivered in a cost-effective manner.
Q: What suggestions do you have for starting us toward this goal?
A: I would start by setting incentives through our payment and regulatory system to reward quality care delivered in an efficient manner. There are a lot of inefficiencies in the system right now and we are, to some extent, rewarding those behaviors. We need to establish a proven health care system that pays for necessary and proven procedures and one that is much more transparent so all can understand it.
I believe, too, that there must be some financial involvement by patients, perhaps in the form of an insurance co-pay, to help make certain the system is not misused.
Q: What about health care systems in other countries—Canada and Sweden come to mind? Can we adapt one of these models for use in the United States?
A: I think the system we ultimately develop will be reflective of our own culture. As I said, in the long run we need some sort of national system, but I don’t believe the answer is to adopt an existing system from another country and apply it to the United States.
Sweden, for example, has a fairly homogeneous population and is perhaps better able to implement a state-run system serving its citizens. In the United States, though, our population is made up of many diverse elements which would, I think, make a system like Sweden’s hard for us to accept culturally. We have to build our own.
Q: We’re already seeing considerable debate on health care as the nation moves toward its next presidential election. Is this a good thing?
A: I think good, healthy debate will help us in the long run. Hopefully, we can do it in a way that will be constructive.
Q: In 1993 when the Clinton administration was pushing a national health care plan, Washington tried to adopt legislation that mirrored many of the provisions of this plan. Nothing ever came of this and it fell by the wayside. What happened?
A: There are several elements to this. First of all, I don’t think the public will was there for these to succeed. Secondly, we tried to change the whole system at once. I believe this is going to be a much more of an evolutionary process—one that works towards its goals one step at a time.
Another problem was that it was going to be forced on us, and I don’t think we were quite ready for that. Finally, business at all levels felt left out of the planning process and was not at all comfortable with the plan either at the national level or with those reforms Washington was trying to legislate.
If I learned anything from this it is that reforming health care is going to be a marathon. When you start changing the health care system you are touching everybody in one way or another. We must design processes that engage people, and we must be committed to the long-term goal of full coverage.
Q: Do federal programs such as Medicaid and Medicare contribute to the problem?
A: The short answer is yes. More so Medicaid than Medicare. Medicare serves our senior citizens and comes closer to covering costs. Medicaid, on the other hand, serves the poor who do not have access to health care, and often the amount it will pay for specific treatments is well short of the cost. This underfunding shifts the cost from the public sector back to the private sector.
Q: You currently serve on the Washington Health Care Forum. Could you describe this group for us?
A: It was created six years ago to bring CEOs of health plans, major provider groups, and medical, hospital and business associations together to look at ways we can make the current health system work better. That’s what we’re trying to do.
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