CEOs' Healthcare-Reform Priorities: Obesity and Tort Reform, But Not Universal Coverage

I missed it at the time, but a week ago the WSJ ran an interesting roundtable on healthcare reform with an unusual cast of CEOs -- WellPoint's Angela Braly, the Mayo Clinic's Denis Cortese, Pfizer's Jeffrey Kindler, and Novartis' Daniel Vasella. Rounding out the discussion was Sen. Max Baucus, who recently released his own 98-page outline for healthcare reform.

The discussion itself definitely started off on an odd foot, as the CEOs not only chose "fighting obesity" and tort reform as their two highest healthcare-reform priorities, they initially left universal coverage off their top-five list altogether, and only added it back once they realized how silly that looked. (As for fighting obesity and tort reform, both strike me as quite secondary to the question of escalating medical costs that are steadily rendering coverage unaffordable even as the care provided fails to make Americans much healthier.) But a few interesting comments emerged in the conversation that followed, which I've excerpted here:

Mayo's Cortese on obesity: It came up in the realm of prevention, but the obesity component so highly resonated with the group that it rose as a point all by itself. The issue of education, the issue of physical exercise, the issue of having physical exercise as part of the school activities all became important components of this discussion, because the estimates of unfunded liabilities that we have into the future, particularly for Medicare, do not include the impact of obesity. No one's really estimated that just yet.

Novartis' Vasella on tort reform: The vaccine [business] has completely changed because of litigation. Companies left the industry, and only with the bird flu did people start to ask, why aren't more companies in the vaccine business? And it turns out that the whole litigation issue around vaccines was a big deterrent for any pharmaceutical company to be in that field, and only when tort reform happened -- [when what people could get] was capped and it was made more difficult -- that really changed. Now more players are interested than they were before.

Mayo's Cortese on quality: When we talk about the No. 1 problem with regard to health care, most people would say we're not getting what we pay for.... So why don't we begin to measure the elements of quality, and those elements are actually quite measurable. They're the outcomes that you desire, particularly around a particular disease.... We would propose that you might start with maybe the top five diseases in the country. Those top five diseases probably account for roughly 60% to 70% of all the spending, especially in the Medicare environment.

Safety is another... element. Safety is easy. It should be zeros. The third is service: access for care, patient satisfaction, etc. These are all measurable. So making it an effort to really measure, define and measure value is crucial because we're going to propose that pay be related to the outcomes of those measurements.... So if we can move Medicare to an environment where they start paying for value, that would begin to drive the system. Medicare is starting to pay based on value, and there are many sources of those value-equation numbers.

Wellpoint's Braler: [W]e think the regional variation of health-care delivery and the cost associated with that actually helps us in that define and measure category, so we can see that there are places where health care is being delivered with higher value and we ought to strive for the models that produce those results.

Sen. Baucus: I believe strongly that the opportunity is here for us in America to finally have a health-care system that we can really be proud of.... My judgment is that we've spent way too much time with patchwork, fixing this part here and that part there, push on the balloon, it bubbles up someplace else, and we just are getting nowhere and we have what we have -- namely 40-some million people who don't have health insurance, 25 million underinsured, a reimbursement system that is out of whack. It rewards volume, not quality. We also are not addressing costs, because costs are going up so much in our country. Costs to individuals, costs to businesses. And also the cost to the federal government with the Medicare trust fund going through the roof....

I know the problem of obesity. I got to tell you, I think that's tepid. I just don't think the bully pulpit is going to be enough to sufficiently fight obesity. We're going to have to have incentives in here. We're going to have to have teeth in here.

PS: No, it's not an accident that you don't see any excerpts from Pfizer's Jeff Kindler, who didn't contribute much beyond bromides about the need to invest in healthcare and health professionals, including primary-care doctors.