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President Kim on Health Care
President Kim does a great job with a non-specialized audience, and his speech yesterday on the reforms needed to maintain the viability of the American health care system was no exception. He started with a good tour d’horizon of the exploding costs of ministering to Americans: in 2018 more than 20% of GDP will go to health care, and that figures will rise to 50% in 2080 if present trends continue.
However to a listener who follows the subject in magazines like The New Yorker and other outlets of the mainstream media, there was not much new in President Kim presentation. He devoted most of his lecture to the disparity in Medicare/Medicaid payments between municipalities (as discussed in The New Yorker on June 1, 2009), the importance of focusing health care efforts on at-risk areas (The New Yorker from January 24, 2011), the need for doctors to follow treatment checklists in serving patients (the New York Times from December 30, 2007), the frequency of costly errors by medical professionals (the New York Times from December 18, 2002), and the differing intensity of treatment for various medical conditions, like back surgery, in different regions of the country (the New York Times from January 30, 1996).
He also observed that hospital administrators have little understanding of the actual cost of their doctors’ various treatments. To your humble servant, that fact was not news either. I recall presentations in the early 1980’s at my erstwhile employer, management consultants Bain & Company, on how Bain was helping poorly managed hospitals understand their costs for the first time: which treatments were very profitable and which were not (some were even great money losers, to the surprise of the doctors in question). That an absence of cost accounting in the health care field is still an issue in 2011 does not say good things about the intellectual rigor of doctors and hospital administrators — especially given that the New York Times reported on the need for medicine to adopt modern business practices like cost accounting in a story published on April 16, 1922 (not a typo).
The only reform that President Kim proposed that has not been previously commented upon at length in the popular press was his belief that a Presidential-level initiative is needed to reform the delivery of health care. Terming Obamacare “just fantastic,” Kim called for a “major effort” by the federal government to tame health care expenditures. He said the nation needed something along the lines of JFK’s call for a national effort to put a man on the moon, or George Bush’s challenge to provide AIDS drugs to 2,000,000 Africans within a short period of time.
Kim stated that he had personally talked to “a great number of Senators, both Democrat and Republican” about this issue. He observed that they all were surprised that the federal government did not already have a national institute — something similar to the NIH — that is devoted to studying health care delivery. I expect that President Kim has spent a considerable amount of time with our elected representatives making the case for this idea. However, in his speech yesterday, he did not say whether, in his conversations with Senators, he had put forward the name of an individual who might energetically lead such a well funded government body. Anyone? Anyone?
Note: Interestingly, there were almost no students in attendance. The first three rows of Moore Theater were occupied by undergraduates enrolled in the summer term “Contemporary Issues in American Politics and Public Policy” course, but beyond that, I estimate that well over 90% of the audience had hair grayer than mine. In the College course that I am auditing this summer, none of the students said that they planned to attend the speech by Dartmouth’s President. Perhaps their tolerance for recycled material is lower than that of Hanover’s senior citizens.
Addendum: The D’s report on President Kim’s speech was quite different from my own.
Addendum: One of the College’s top professors writes in with a comment:
Thought your post today made a number of relevant points in an artful way. Loved the article from the NYT in 1922. Regarding the Presidential-level initiative, why am I not surprised? This is how he runs Parkhurst — pay little attention to the design of the large bureaucracy that should be tasked with accomplishing the objective, but reserve the prerogative to intervene from above (only) when the design problems interfere with something the president wants to accomplish.
As does another keen observer of all things Dartmouth:
Good post this morning. Given the exorbidant inflationary spiral of costs in higher education (with Dartmouth as Exhibit A), perhaps President Kim could create an initiative to do at Dartmouth what he is lobbying Senators and Congressmen to have done in America’s health care delivery? That might even provide a natural launch pad for those elected representatives to then entrust to him a similar exercise for the much larger, more complex and potentially lethal U.S. health care delivery system.
And a perceptive student:
I really enjoyed the post. That’s exactly what I expected from Kim’s speech. Perhaps his emphasis on improving “healthcare delivery” was just a way for him to advertise his new Center for Health Care Delivery Science. I am glad you included the note about the lack of student attendance too. Kim must be embarrassed comparing his crowd with the mobs of students who have showed up for the other speakers in the series. I think the students are sending a clear message to the President that his popularity and allure are quickly fading.
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