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Susan Dentzer, editor-in-chief, Health Affairs Magazine, addresses guests at a luncheon sponsored by the Nashville Health Care Council.

At the July 11 Nashville Health Care Council luncheon, Tom Aaron of Deloitte & Touche, whose Center for Health Solutions sponsored the event, introduced Susan Dentzer, editor-in-chief of Health Affairs magazine and admitted to “Googling her,” finding a rich lode of accomplishments and honors.

Dentzer became editor of Health Affairs, the nation’s leading journal of health policy thought and research, in May of this year, after a decade as on-air health correspondent for “The NewsHour with Jim Lehrer” on PBS. She was previously chief economics correspondent and economics columnist for U.S. News and World Report. She currently serves on a number of national boards and committees, including the Council on Foreign Relations, and the Board of Directors of the International Rescue Committee and the Global Health Council. Dentzer is a member of the Kaiser Commission on Medicaid and the Uninsured, as well as the National Advisory Committee for the Robert Wood Johnson Foundation’s Investigator Awards in Health Policy Research.

Dentzer acknowledged that the audience of Nashville healthcare executives was “truly an impressive group that serves as the real world version of health affairs professionals that academics write about.”

Dentzer chose to talk about “Things that I Find Dispiriting in the Current Political Situation” and “Things That Give Me Hope - The Healthcare Reform Debate that I Wish We were Having.”

On the list of “dispiriting” events, she listed the recent Congressional roller coaster ride tied to the scheduled physician Medicare payment cut, as well as the Congressional budgeting technique, begun in 2003, that attempts to balance expenditures with “offsets,” Congressspeak for “cuts in other parts of the budget unrelated to the expenditure.”

She pointed out that after the House passed a bill to take away cuts in Medicare reimbursements by an overwhelming margin, Democrats in the Senate enticed Senator Kennedy out of brain cancer recuperation to cast the deciding vote for cutting off debate, all under the shadow of a White House threat to veto any change. “This,” she said, “all fits in the Yogi Berra school of health policy reform — it ain’t over … until it’s over!”

What she wishes the Congress were debating: the fact that the Medicare Program has liabilities five or six times more than Social Security; a “dysfunctional” system of paying doctors; the fact that we spend a fortune on people in the last stages of life; and a political system that is mired in deep denial of current and future reality. As a matter of fact, Dentzer said that “neither McCain nor Obama have a whole lot greater embrace of reality than Congress does.”

Although Obama has not revealed any details of his healthcare plan, it is presumed that it will essentially be a “big version of the federal employees’ plan” and would have to be subsidized, perhaps up to $65 billion. On the other hand, she feels McCain’s plan is “equally disheartening, but in different ways.” McCain proposes “to eliminate the tax exclusion of health insurance. In other words, he proposes to make contributions from employers to employees’ health insurance plans taxable to workers for the first time.” The revenue from these taxes would be reallocated to provide “allowances” for healthcare for every family. His plan also calls for the creation of “high risk pools” for the uninsurable, although Dentzer finds it hard to imagine how McCain plans to fund these high risk pools, traditionally a huge drain on any budget.

Dentzer admitted that campaign healthcare proposals are, by design, always “half baked,” to prevent their being picked apart before the candidate is even elected.

“Actually,” she said, “expecting a candidate to put out a full plan is like buying a pet snake and trying to teach it to be able fetch a ball. It’s not going to happen.”

Dentzer imagined the healthcare debate we could be having — discussing issues such as:

• What are we willing to spend?

• Is the country willing to do what is necessary to bend the cost curve?

• How can we prioritize the expenditures of a nation knowing that a dollar of someone’s expenditure is a dollar of someone else’s income?

• Why do we put up with so much inefficiency?

• Are we as a nation getting the best care?

• If we knew the true costs, would we be willing to delay introducing some technologies or to wait longer for access?

When the floor was opened to questions from the audience, she was asked about Health Savings Accounts (HSAs), which she said might become “the next sub-prime mortgage crisis,” as people choose to walk away from large medical bills they cannot pay, and about medical tourism which is “taking our best and brightest leaders at fabulous salaries.” Dentzer predicted worldwide growth for this trend, forecasting that Bangladesh will become “the” go-to medical destination, even for patients from the United States.

The audience also asked about the mental health parity bill, which Dentzer predicted will pass in accommodation to the Congressional calendar. As to the financial prospects for “doc in a box” retail clinics, she feels they have yet to prove the validity of their business model. “Inertia” could be the winner in several Congressional debates, she said, with no real resolution in either direction as members will choose to “kick the can down the road” rather than address controversial issues.

In healthcare, as in other parts of national life, she ventured that perhaps Winston Churchill’s famous analysis is the most hopeful forecast: “Americans always do the right thing — after having exhausted all the other possibilities.”



August 2008

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