Neither of the two candidates for president understand how public-private fragmentation of responsibility and funding put our fundamental health infrastructure at risk. It is feasible. We are paying for the uninsured now. Every time they go to an emergency room, the rest of us pay through our own insurance. Sen. Obama’s plan is sensible and thoughtful. It builds on the existing system and is affordable if phased in. He will need to build major consensus among stakeholders. University of Miami President and former Clinton Cabinet member Donna Shalala served as a Peace Corps Volunteer in Iran in the 1960's.
Donna Shalala knows the ins and outs of America’s health care infrastructure
Questions for Donna Shalala
By ALEXANDER BURNS |
10/7/08 4:49 AM EDT
As the longest-serving secretary of health and human services, Donna Shalala knows the ins and outs of America’s health care infrastructure.
Appointed by President Bill Clinton in 1993 after serving as chancellor of the University of Wisconsin-Madison and chairwoman of the Children’s Defense Fund, Shalala ran the Department of Health and Human Services through all eight years of the Clinton presidency, playing an integral role in launching welfare reform, the State Children’s Health Insurance Program and other initiatives.
Since leaving government in 2001, Shalala has been president of the University of Miami and is still regarded as one of the country’s foremost experts on government and health care. In 2007, she co-chaired a commission on veterans’ care with former Senate Republican leader Bob Dole.
With the presidential election just a month away, Shalala shared some thoughts about the health care challenges facing the next administration — and the inadequacy of both presidential nominees’ approaches to public health.
Here is her e-mail exchange with Politico’s Alexander Burns.
Q: Having served as the nation’s top health care official, what are the worries that keep you up at night? What’s the biggest threat to our public health that no one’s talking about?
A: It is just not sexy to talk about how fragmented our response to emergencies is: hurricanes, earthquakes, disease outbreaks, drug safety, chemical and bioterrorism attacks. FEMA is not sophisticated enough to handle all of them. The Department of Homeland Security is just not the right organization to be a leader. It further fragments response.
We need a fresh look at how we organize — our reporting systems, etc., and resources. I do not favor a total centralization to the feds — emergency responders on the ground are key, but the system gets weaker as you go up the line. We need to use modern technology and rethink the entire system to make it seamless.
Q: How well-protected are our food and water resources? How actively is the government shielding them from terrorist threats?
A: It is government — not a single entity — that is protecting our food and water resources. Multiple federal agencies, the states and local public health agencies. It is not a seamless system, and [it is] totally dependent on individual doctors, hospitals and clinics reporting illness so they can be fit into a pattern by public health officials.
Q: Do you think the presidential candidates understand public health issues in these terms?
A: Neither of the two candidates for president understand how public-private fragmentation of responsibility and funding put our fundamental health infrastructure at risk. It is feasible. We are paying for the uninsured now. Every time they go to an emergency room, the rest of us pay through our own insurance.
Q: Do you think it’s feasible for the next president to enact a national health care program? Have Barack Obama and John McCain released any proposals in this area that strike you as particularly worthwhile?
A: Sen. Obama’s plan is sensible and thoughtful. It builds on the existing system and is affordable if phased in. He will need to build major consensus among stakeholders.
Q: Are there any health care or public health initiatives on the state or local level — such as Mitt Romney’s health insurance effort in Massachusetts or San Francisco’s experiment with universal access — that you think could be implemented on a larger scale?
A: Very few states can afford to close the gap. But using the Medicaid waiver authority experimenting with states to close the gap will provide enough learning for national legislation. That’s what we did to get welfare reform. We used the waiver authority of HHS to do 40-plus state experiments; out of that came an emergency consensus. I would not encourage just the Massachusetts model. Rather, encourage the states to try different approaches, including non-insurance ideas.
