Implementing Health Care Reform — An Interview with HHS Secretary Kathleen Sebelius
Politician interview overview
Sebelius is the current Secretary of the Department of Health and Human Services has taken over when Congress was debating the sweeping healthcare reform bill that was put forward by the Obama administration. The Following is a summary of the interview that she gave to me and later appeared in The New England Journal of Medicine. Her opinion is especially important given that she is directly in charge of implementing the provisions contained in the healthcare reform bill.
The opinions expressed in this summary correspond to the time when it took place i.e. January 2011. Therefore, it’s important to note that there are bound to be some changes that may have taken place since January.
It’s important to note that every paragraph of the following summary represents answers to the questions I posed to Secretary Sebelius. I posed questions that touched on the implementation of ACA and how the Obama administration plans to reform the industry. The questions revolved around Medicare and Medicaid cost drivers, reinforcement of preventive measures, the role of the individual states in the implementation of the reform law, concerns about primary care, and the remuneration of practitioners involved in it. Also, I asked the secretary about the provisions of the reform bill that deal with fraud and irregularities in medicare and Medicaid and how they will be addressed.
Interview Summary. Implementing health care reform
The secretary revealed that the Obama administration plans to take a closer look at the cost drivers of Medicaid and Medicare (Iglehart, 2011, par: 1). The authorities will especially use the provisions contained in the Affordable Care Act (ACA) that allow Medicaid and Medicare to join private medical organizations to deliver affordable and high-quality healthcare. A major undoing of the system right now according to the secretary is that Medicare pays the same rate regardless of the quality of care delivered.
Regarding whether defensive medicine is a cost driver, Sebelius referred to President Obama’s approach of leaving all options on the table except for those that put caps on damages. According to the secretary, there are about 12 model initiatives involving participating in hospital systems and medical groups. She also revealed that several states are testing various ways of improving patient safety that will culminate in lower insurance liability costs and timely payment to harmed patients.
In terms of prevention measures, Sebelius reinforced his view and that of the administration that considers reduced tobacco use as a preventive measure (Iglehart, 2011, Par: 2). This is despite the refusal of the bipartisan Congressional Budget Office to concur with the view. The secretary says that that reduced tobacco use is considered a cost saver by its direct and indirect consequences on the prevalence of cancer, heart disease, lung disease, and asthma, which according to her are cost drivers.
In terms of implementation on the state level, the secretary revealed how she has been on an outreach offensive to the nation’s governors (Iglehart, 2011, Par: 4). She also restated her belief that the states are the main drivers to the implementation of the ACA. She played down the current lawsuits against the ACA and reiterated the initiatives taken by many of the same states to create a new insurance marketplace. Once again the secretary addressed the reigning misconception that the ACA amounts to a federal takeover of healthcare.
According to her, the federal government provides the backstop in any healthcare initiatives states want to undertake. The secretary firmly believes that implementation will not be jeopardized in the new political divide in Washington where Republicans control the House. Additionally, efforts to repeal the ACA will never succeed especially given that President Obama is still in office (Iglehart, 2011, Par: 5).
The secretary conceded that there has been a shortage of primary care providers and that the problem has been ignored for more than a decade (Iglehart, 2011, Par: 6). She added that doctors practicing in primary care are also underpaid compared to specialists. She was quick to point out that the stimulus money and the ACA have significantly shifted focus on primary care practitioners, gerontologists, and general surgeons.
She revealed that so far more than 16000 additional primary care providers will be hired thanks to the stimulus law in the next five years. In an effort perhaps to underscore the importance of primary healthcare, the secretary emphasized her belief that increased focus on health interventions at an early stage will help in the delivery of primary care. This she said will be done through an emphasis on health and wellness strategies that will help in promoting population health while reducing demand for healthcare services. She added that the federal government is willing to discuss with states on various incentives that will help in the training and practicing of nurses which in the long run will help better deliver improved primary care.
About the remuneration of medical practitioners, the secretary asserted that ACA will create new incentives for recent medical graduates in a bid to encourage graduates to pursue a career in primary care (Iglehart, 2011, Par: 8). The law according to Sebelius, has begun to change the overall medicare payment formulae that in the long run will ensure primary care income is at par with that of specialists.
She especially emphasized the use of medicare funds that support graduate medical education to emphasize among students the enhancement of primary care positions. On the same note, the secretary acknowledged that the physicians and medicare have had an uneasy relationship due to Congress’s failure to fix the formula which Medicare uses to set physicians’ payments. Furthermore, she also admitted that she expects physicians to be a little more skeptical of the abilities and willingness of the government to fix the issue through ACA. Sebelius believes the issue can only be fixed through more engagement of Congress in the year 2011 to reform all areas not connected to ACA so that the contention on the SGR formula can be fixed.
According to the secretary, the ACA fronted by the Obama administration is the toughest anti-fraud piece of legislation yet in the history of healthcare (Iglehart, 2011, Par: 10). The provisions contained in the law specifically address rampant fraud, wastage, and abuse in Medicare and Medicaid. This according to Sebelius will be ensured through a more rigorous application of medicare billing number that includes extra verification, bonding, and fingerprinting in some instances. She referred to the fact that impeding a fraud investigation was not considered a crime up until the time ACA was passed. There will also be efforts to upgrade federal billing and data systems that have lagged behind those that are used in the private sector.
Referring to the Arizona decision to discontinue payments for some organ transplantations which she said had helped many people and with a high success rate, the secretary reiterated her desires and willingness to be flexible throughout in discharging her duties especially in the implementation of ACA (Iglehart, 2011, Par: 11). She acknowledged that every state in the nation is unique in its way and faced with unique challenges. She stated her commitment to work together with state governors especially on federal waivers that are always sought out by governors when they pursuing various healthcare goals. Though some requirements cannot be waived, the secretary said that she is ready to work with governors to address the problems that plague their states as far as healthcare is concerned.
Reference
Iglehart, J.K. (2011). Implementing Health Care Reform — An Interview with HHS Secretary Kathleen Sebelius. The New England Journal of Medicine 2011; 364:297-299.