SOM Alumni Dissect Health Care Reform

The two bills now being considered for reforming the U.S. health care system are long, intricate, and to many citizens, confusing. On Nov. 19, the SOM Healthcare club and student government brought together a panel of experts — all SOM alumni from either the full-time MBA program or SOM’s executive MBA program — to discuss the reform effort and offer their particular points of view on what it will and will not do. With experience in three areas of healthcare (hospitals, pharmaceuticals, and insurance) the group broke down the impact they foresee to their respective sectors and suggested ways they would improve the bills.

Howard Forman, MD, professor of diagnostic radiology and management and co-director of the SOM executive MBA "Leadership in Healthcare" program, hosted the panel, providing a summary of the bills. Forman, speaking in particular about the bill now before the U.S. Senate, said the proposals would improve access to healthcare for most of those currently uninsured, would be sustainably funded, but would not do enough to reduce costs. He then opened the conversation to the panelists: Michael Apkon, MD, ’02, vice president and executive director of Yale New Haven Children’s Hospital; Dan Jorgensen, MD, eMBA ’07, senior director of global research and development at Pfizer; and Ramon Soto eMBA ’08, vice president of marketing strategy and communications at Aetna.

Apkon, who considers expanding access to care a crucial point of reform, said he’d like to see a greater emphasis on reorganizing the delivery of medical services, arguing that quality could be improved and costs cut if there was greater coordination between medical specialties and an emphasis on creating incentives both for doctors and patients that reward healthy living and smart medicine. Concerning the role both insurers and the government have in encouraging the right kind of treatment, he said, "What’s paid for is what will get done."

Jorgensen explained how the pharmaceutical industry is currently undergoing a major transition, one that would be accelerated by reform. He said some companies have already begun to raise drug prices, which he said would establish a "price basis" for any new programs. As a former practicing physician, he said he’d like to see serious tort reform added to any reform package, adding that fear of lawsuits have driven a number of doctors he knows out of medicine. "They end up practicing defensive medicine," he said.

To Soto, the current bills don’t represent health care reform, but health insurance reform. His industry, he said, will likely face the biggest upheaval that may be brought about by any changes to the system. He said a major mistake of the bills is that they put access before cost and quality and that a public option would have an impact opposite to what’s intended. He said the government plan would be below actual costs, which would shift costs to private plans and ultimately lead to higher premiums for individuals. "I don’t believe it creates a level playing field," he said.

By the end of the hour, all four speakers agreed that they would make significant changes to the bills if they could, focusing on controlling costs, tort reform, and creating incentives to make medical services more efficient and ultimately more effective. No one tried to argue this was at all easy. "It’s not like the federal government can tell Aetna how to realign its services," Forman said. Added Soto, "We’ve got to find a way to separate policy from politics."