The nomination of Alex Azar says a lot about our broken health care system

(This is the unabridged version of the Op-Ed piece that appeared in The Hill 12/17/17)

When discussing Trump’s nominee for Secretary of the Department of Health and Human Services (HSS), the New York Times described Alex Azar as follows:

In addition to his experience as a pharmaceutical executive, Azar brings to the job impeccable credentials as a conservative lawyer.

A graduate of Yale Law School, he was a clerk for Justice Antonin Scalia on the Supreme Court in the early 1990s and spent two years as a young lawyer working for Kenneth W. Starr, the independent counsel who investigated President Bill Clinton.

These are clearly excellent credentials for a supreme court nominee or special prosecutor, but what makes Azar qualified to run America’s public health care system?

Sure, his experience as president of a major pharmaceutical firm gives him some insight into the Food and Drug Administration, but what does he know about public health, health care research, health insurance or health care delivery?

Yet, surprisingly, his qualifications for this position are not much weaker than most of his predecessors. Of the 23 Secretaries of HHS since the agency was established, only three have been physicians. Most of the others were lawyers, businessmen and career politicians. What clearly is not a priority for the job of chief of government health care, is any experience in health care.

This begs the question: If lawyers run our legal system and bankers run our banking system, why aren’t health care professionals running our health care system?

The answer is that our health care system does not have an infrastructure amenable to such leadership. Over the past 100 years it has developed into a chaotic disarray of private and public mini systems with no effective oversight.

HHS has grown to fill this void, not by design but by default. As the oversight body of the public health insurance (i.e. Medicare and Medicaid) and public health agencies (i.e. FDA, NIH and CDC), HHS’s influence in health care delivery has grown over the years.

But since it only has direct influence over the approximately 100 million people who are covered by Medicare and Medicaid (of 325 million US population), HHS’s effective oversight of our health care system is limited.

Its influence over individuals covered by private insurance is up to the individual insurance provider and its influence over the VA and uninsured individuals is non-existent. This means that any policy change or long-term plan initiated by HHS only applies to a minority of our health care system. How it might affect the rest of the system is unpredictable.

The need to negotiate this complex landscape may be why most administrations have chosen HSS secretaries based on their political experience rather than their credentials for running a health care system. Unfortunately, this limited authority and misaligned expertise are major reasons why our health care system is so inefficient and ineffective; and why efforts to reform it have been so difficult.

It is time to think outside the box on our health care system and how to reform it.

Over a century ago, the United State’s banking and monetary system was in a similar mess as our health care system is today. The creation, by Congress, of the Federal Reserve System in 1913 consolidated oversight of the banking system under an independent board, run (and led) by well qualified bankers/economists.

This unified oversight allowed for the creation of a modern financial infrastructure and has been credited as a major factor in making our economy the strongest in the world. So, why not do the same for our health care system as we did so successfully for our banking/financial system?

Of all the proposals for healthcare reform in the past 20 years, only one, called EMBRACE (an acronym for Expanding Medical and Behavioral Resources with Access to Care for Everyone) proposes the establishment of an independent Federal Reserve-like National Medical Board (or NMB). As the Fed unified the American banking system, the NMB would unify our chaotic healthcare system and create a modern infrastructure designed to utilize modern healthcare innovations. EMBRACE also details a science based, fiscally responsible protection system for the entire population, that uses both public and private insurance to achieve truly universal health coverage. And the entire healthcare system would be overseen by healthcare professionals rather than by health insurance executives, lawmakers or the politically connected.

So, as Congress moves to approve yet another unqualified businessman to run our dysfunctional health care system, maybe it’s time to consider real health care system reform. A comprehensive reform that would transform our health care system, as the Federal Reserve Act transformed our banking system, into the best in the world.

Gil Lancaster MD is a co-founder of healthcare Professionals for healthcare Reform, a former member of the American College of Cardiology’s Board of Governors and author of “EMBRACE: A Revolutionary New health care System for the Twenty-First Century.” He is a practicing cardiologist, an Associate Clinical Professor of Medicine at Yale University School of Medicine and a co-founding member of a non-partisan group of health care professionals who developed and published the EMBRACE health care reform proposal.

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