Is the American health care system broken?

Question: Is the American health care system broken?

Bill Novelli: Yes. The American health care system is broken. It’s headed for a meltdown. We’ve got declining quality of care. We’ve got these rising costs that people can’t afford. Companies can’t afford them, and individuals can’t afford them. Families can’t afford them. And then we’ve got rising numbers of uninsured. And if you put all those things together, what we have is a system that’s essentially melting down. 

Question: How do we fix it?

Bill Novelli: There are a number of things that we have to do. First of all, we’ve got to contain costs. We just can’t keep paying the cost that we’re paying. Right now we pay about twice as much as the next highest industrialized country, and our health outcomes are worse. So we’ve got to . . . We’ve got to squeeze costs out of the system, and there are some obvious ways. Information technology, for example. Bringing down the price of prescription drugs. Doing more to manage chronic disease, which is the most common kind of disease today. These are all things that we need to do. Getting the uninsured covered so that we don’t have all this uncompensated care is another aspect of it. One thing that’s a long term payoff, but that we have to start right now, is wellness programs. We need a national, coherent prevention strategy that’s going to be a long term investment. If we don’t do that, obesity is going to reverse longevity in this country. And of course we talked earlier about tobacco. Diabetes, heart disease, high blood pressure – these are all elements that we can control if we tackle the prevention and health promotion aspects of them. And so those are all ways that we can deal with the health care system.

Question: Why isn’t there more focus on preventative care?

Bill Novelli: Right now it’s very, very fragmented. So you’ll have wellness programs at the worksite. You’ll have the government doing two or three things. You’ll have states doing several things. So we have this fragmentation. We don’t have any . . . any national system for it. So that’s . . . that’s one major problemAnother problem is that the payout . . . the payoff is long term. So a company may say, “Well, do I really wanna invest a lot of money in keeping my young workers well? Because in five years they’re going to be working at another country . . . company.” Where a congressman will say, “Well I’m worried about the budget this year. Do I really wanna vote for something that’s gonna be expensive and has a 10-year payout?”So it’s this long term investment that’s being missed.

Question: Whose responsibility is it?

Bill Novelli: It’s all those things. What we need is we need government and the private sector to come together on this. I do not think government can be the answer to prevention and wellness; but I don’t think you can just do it in the private sector either. We need a public-private partnership – some kind of a . . . of a wellness program that’s well-funded, that’s sanctioned by Congress, that everybody buys into. And when I say everybody, I mean everybody. I’m talking about the fast food and the processed food industries. I’m talking about educators, because we’ve gotta do something about wellness in the schools. I’m talking about everybody.

Question: Should the government be doing more?

Bill Novelli: Yeah we need to sanction this thing. It needs to be official. It just can’t be some casual . . . some kind of an informal thing where we ask everybody to come to the table. We need something big. You know one parallel example that some people have talked about is the federal reserve. You know could we take that kind of example and that kind of an analogy? Could we do some kind of a fed for wellness? So that’s the kind of thinking that I . . . that I think is important.

Question: Is health care a universal right?

Bill Novelli: Health care is a universal right. Yes I do believe that. But I think we also have personal responsibilities to say well. You know it doesn’t do to say, “I’m 65 years old,” and you go into a physician and say, you know, “I’m starting Medicare tomorrow. I’m obese and I smoke. Now take care of me.” We have a personal obligation as well as a right to . . . to healthcare.

Question: If health care is a universal right, who should provide it?

Bill Novelli: Well I think health care, again, is a public-private sort of thing, You know there’s this great ideological argument about the single payer versus, you know, let the marketplace prevail. The answer is in between. Right now in California, they’re looking at a plan whereby they would have people be required to buy health insurance; that have the health insurance companies stay in the game, but have to insure people and not be able to cherry pick and leave out those with illnesses. They would have the individual corporations be involved in it. And they would have a sense of personal responsibility involved. So if that ever came to pass, that would be a good model for us.

Question: What other models could we look to?

Bill Novelli: Well I think there are other models in other countries. And I have looked at these models. AARP has looked at these models. The thing is that we are unique. We are unique in terms of our social and our economic systems; and how we treat capitalism; and how we think about government. But we can learn from other countries. But we have to fashion a unique American answer, I think.

Question: Does the pharmaceutical industry have a responsibility to Americans?

Bill Novelli: The pharmaceutical industry has an important role to play in American health. First of all, this is a lifesaving industry. This is the industry that we hope is going to be able to control Alzheimer’s and Parkinson’s and these other diseases of . . . of the elderly. So we are dependent upon the pharmaceutical industry. But at the same time, prescription drugs cost too much in this country, and we have to really move to generics. We have to get costs so that they’re affordable for people. We have to figure out a way so that the pharmaceutical companies can make a reasonable profit, and people can afford their drugs. And right now we’re not there.

Recorded on: 9/27/07


The American health care system is indeed broken, says Bill Novelli.

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