NEW ORLEANS—Fixing our health care delivery system is the key to improving the overall quality of patient care in the United States, said former President Bill Clinton, in addressing the 2013 Annual Meeting of the American Neurological Association.
“We have the most cumbersome, inefficient, unjustifiable delivery system in the world,” he said. “We’re spending $200 million a year on administrative costs alone that we would not spend if we had any other nation’s financing system. We continue to pay for procedure rather than performance.
“We are just at the dawn of the potential of using what we have in information technology to widely disseminate more quickly some of the advances that you make and also to cut the unit costs of the routine delivery of health care,” President Clinton commented.
The Age of Interdependence
Much of President Clinton’s time since he left office has been devoted to the Clinton Foundation, which strives to improve global health and wellness and create economic opportunity in developing countries. “We live in the most interdependent age in history,” he said. “We can’t go hide in a cave and protect ourselves from the consequences of what is happening elsewhere.”
In September, the Somalia-based terrorist group Al-Shabaab killed 67 people in a shopping mall in Nairobi, Kenya, including Elif Yavuz, PhD, a pregnant 33-year-old woman who was working for the Clinton Foundation. About 40% of Al-Shabaab’s funding has come from the sale of ivory, which has further threatened the existence of Africa’s elephant population. “A woman comes from the Netherlands to Africa to help, goes back to America and gets an education, comes back to where she could do more good … and dies because she is walking in a mall where some people believe the best way they can assert their power is to kill a bunch of innocent [people]. That is global interdependence.”
Many underdeveloped countries lack the systems and infrastructure that Americans take for granted, according to President Clinton. The Clinton Foundation is working to help provide some of those systems, including negotiating contracts that have reduced the cost of AIDS drugs for about five million people. Another project involves helping Rwanda learn to operate a health care system without any foreign assistance by 2020, in which a number of US academic institutions are working for 7% overhead costs. In contrast, most American organizations typically charge a minimum of 35% overhead costs for such work, “and it’s a disgrace,” President Clinton said. “It’s the highest percentage in the world, and it’s totally unacceptable…. But that’s the sort of system-building work we need to do.
“There is nothing so difficult in all of human affairs than to change the established order of things,” said President Clinton, borrowing a quote from Machiavelli. “Those whose interests will be compromised are certain of their loss, while those who will benefit are uncertain of their gain. Welcome to the health care debate.”
The State of Health Care in the US
The October 1 debut of Obamacare’s Health Insurance Exchange Marketplace has been marred by website glitches, health insurance policy cancellations, and lower than expected enrollment, but problems related to the implementation of new health care policy are not unprecedented, noted President Clinton.
“Just a few years ago, when we enacted a much simpler change—the Medicare Part D prescription drug program for seniors—it was more unpopular on the day it was implemented than the health care bill, and there were terrible problems,” he said. “But we worked through it, and now if you tried to take that away, people would go ballistic. So what we should be doing is trying to help everybody understand it, make the best decisions they can under it, and identify the problems yet to be addressed.”
Reducing the costs associated with the current health care delivery system would free up more funding for research, said President Clinton. For example, he believes that Congress should set aside a certain percentage of the gross domestic product for frontier research in neuroscience.
“I was fascinated by what I read about some of the progress that is being made in amyotrophic lateral sclerosis [ALS],” President Clinton commented. “Stephen Hawking is a friend of mine, a man who has lived longer than anybody ever with ALS. Hillary and I had him deliver a lecture in 2000 that he prepared and then delivered through his electronic voice box, but most people can’t do that…. If you look at all of these things that you are here talking about, the idea of restoring movement to limbs based on what we’ve already seen in laboratory animals … all of this is important. I think the American people would want to pay for that, if you disaggregate the costs so you are not, in effect, being piggybacked on as you are now by administrative overhead costs, which are breathtaking. They are literally a dime on the dollar greater than in any other country in the world. I think there will be more money for this, not less.