This June, Donna Shalala will complete her tenth year as President of the University of Miami. Before coming to UM, she served as President Bill Clinton’s U.S. Secretary of Health and Human Services for eight years. Today, she continues to be a leading expert on health care. She is even purported to have read the entire 1,000 page Affordable Care Act, so that if an expert asks she can truthfully respond: Yes, I did indeed read it.
We spoke with President Shalala through e-mail, sat in on class lectures and had a few brief in-person conversations with her to bring you one step closer to understanding the overwhelming challenges facing the American health care system, while also learning a little more about our President.
Distraction: What’s one thing that most people don’t know about you?
Donna Shalala: I was once the designated Cabinet member to run the Presidency while the President made his State of the Union address; I sat in the oval office and put my feet up and invited my staff to have pizza in the Roosevelt room. Did you know that they actually deliver pizza to the White House? But you have to go to the gate to get it.
D: What do you think about the reconstruction of the Wellness Center?
DS: I use the Center at least three times a week. The expansion is exciting and necessary.
D: How does the health care reform bill specifically affect students?
DS: The new bill expands insurance to age 26, whether or not you are a student.
D: What is one of the biggest issues with our current medical system?
DS: In an economic downturn, those with the low paying jobs are hurt first. A job in this country doesn’t guarantee health care. The working-poor fall through the cracks of the system. They make too much to qualify for Medicare or Medicaid but make too little to pay for private insurance. Those on welfare actually have health insurance. So as the working-poor become sick and delay medical care because of the costs, their eventual hospital or treatment bills are even more expensive. To understand health care reform, you really need to understand people’s lives.
D: How do you recommend reforming medical malpractice lawsuits?
DS: There are alternatives to going to court or going to trial such as having medical experts determine whether malpractice truly occurred. Often times, the people that are making these complicated health care judgments are not educated in medical issues. It can be really hard for doctors to prove that they haven’t done anything wrong. No one deliberately does something wrong. For example, if a woman with a high-risk pregnancy comes to a hospital without any pre-natal care and the doctor delivers the baby with complications, that doctor is then stuck with a malpractice suit. It’s not the doctor’s fault or the mother’s fault. It is the result of medical error.
D: With all of these obstacles, what is the incentive for people to go to medical school?
DS: More people are applying to medical school than ever before, so I don’t think this is an issue. But there is enormous pressure in this country to establish more medical schools. We have to make medical school more affordable.
D: With new and improving medical technology, you would think health care costs would go down. Why isn’t this so?
DS: More technology and scientific breakthroughs drive up medical costs because adopting and implementing the new technology is very costly. Breakthroughs like vaccines and sanitation measures save dollars but those are low tech improvements. Technology to treat heart transplants and injuries involving orthopedics cost a lot of money.
D: How will the health care reform bill affect family doctors and small practices?
DS: There is no question that there will be fewer individual doctors and private practices on their own. The bill encourages doctors to work together and go into practice together but I don’t think that’s a bad thing.
D: What is the fundamental hold-up with the health care reform bill?
DS: It comes down to distrust of government. The growth of government runs smack into a philosophical stream that’s been running since the beginning of the country. People are afraid of the expansion of the government. But to get universal coverage, you have to have some sort of organization to organize it and subsidies to fund it – this resulted in our country’s patchwork of private and public health care in an attempt to cover everyone.