Q&A with A. Hugh Greene
A. Hugh Greene Online Interview
By Vanessa Wells
In the February issue of Florida Doctor – North, we discussed a variety of topics with A. Hugh Greene, the CEO of Baptist Health. Here is the rest of the interview complete with insight into Mr. Greene’s thoughts on healthcare reform and its impact on the industry.
On Healthcare Reform…
You are one of the most well versed people around who really has a grasp on the state of healthcare reform at the state and national level. What are your thoughts on what’s happening with reform right now? Do you think the current law is perfect?
I am generally supportive of this law. Let me start with the premise that the current healthcare system is not sustainable. It’s my belief that something needs to change and the status quo is not acceptable. The incentives in the system need to change which will affect the way we deliver healthcare.
There are two things that have fueled healthcare reform and that is exactly what this law intends to address. The first thing is the ever-increasing number of uninsured people who don’t have access to the system. The second thing is the ever-spiraling cost of providing healthcare. Enforcing those two things run in tension with one another because when you start covering everyone, it costs more. Fundamentally , the bill attempts to expand coverage to all Americans and address the cost issue long-term. I think it’s a terrible shame that nearly 50 million Americans in the most sophisticated democracy in the world don’t have access to healthcare. On the other hand, the cost trends of delivering healthcare are not sustainable long-term. We’ve got to address the issue of cost.
Furthermore, I stress there is a lot of hyperbole about this law that is not true. I don’t think the administration has done a very good job of communicating the law to the public. They passed the law but they really didn’t adequately communicate the benefits of the law to the American public. What’s interesting is polls indicate that less than 50 percent of Americans support this law. Yet when you isolate pieces of this law, they support those individual elements. I think if the public understood the bill a little better, they would discover that a lot of their fear is unfounded. Having said that, I’d like to address your next question.Absolutely not, the law is not perfect. There are problems with this law and there are things that need to be changed. Part of what unfortunately occurred is that this law did not go through quite the same scrubbing at a conference level in Congress as do many pieces of legislation. That’s pretty remarkable since it is by far the single most significant piece of healthcare legislation since 1965 when Medicare passed. By the way, there are very few laws passed in Congress that have the scope and complexity of this law. The fact that it didn’t quite go through the same process has left it with some unintended consequences and no one in Congress is eager to revisit the legislation for obvious political reasons.
I will give you a few examples where the law needs to be tweaked. I think over time some of the potential problems will be naturally corrected. That’s the optimistic view.
The fact that they didn’t take advantage of any malpractice reform is a huge oversight. People don’t understand why they haven’t addressed that issue. The reason they couldn’t get it done is because they couldn’t get the votes. That’s what it came down to.
Within the insurance division of this law, there is also a lot of concern being voiced over this whole rate banding issue. This is forcing the way the insurance companies actuarially project cost. Overwhelming, people in the industry are saying that the unintended consequence of this is that younger people are going to pay disproportionally more than older people. They will be essentially subsidizing the cost of the older population. Clearly, we need to revisit this and address this issue. It’s a very complex law with huge implications. I worry about the taxes and fees required to fund it. Healthcare reform is projected to cost us nearly a trillion dollars over the course of 10 years which in itself is a concern. .
Has healthcare reform impacted the consolidation of the industry?I think healthcare reform has accelerated the consolidation trend. Our healthcare system historically is very fragmented and disjointed. The consolidation by which health systems are acquiring physician practices possibly has the -potential of better integrating the system. One of the questions going forward is who is going to be the integrator? Will it be health systems or insurance systems or both? You’re seeing all kinds of consolidation occurring and I think that’s an expected outcome It is clear we are all going to need to work together. In the past, all parts of the delivery system – doctors, diagnostic centers, surgery centers, hospitals, urgent care centers – were all operated in separate silos; they all contract separately and are rewarded on the basis on their volume independently. That’s going to go away with this law. Naturally, the system has to come together.
To read the article that appeared in the magazine, click here.