Christopher C. Porter, MD
Yesterday, Dr. Ezekiel J. Emanuel presented a rare insider’s look at health-care policy and research in a rapidly evolving environment. Dr. Emanuel, an oncologist, is on leave from his post as chair of the Department of Bioethics at the National Institutes of Health Clinical Center to serve as a special advisor for health policy in the Office of Management and Budget of the White House. The presentation provided “rare, interesting, and useful insight into the development of health-care policy,” said Dr. Evan Sadler, president-elect of ASH.
The Joint Symposium, hosted by ASH and the European Hematology Association, was titled “Health-Care Reform and New Rules for Clinical Trials – A Physician’s Perspective from Inside the White House.” Dr. Emanuel touched on broad-ranging issues from the extent of health-care spending, to quality metrics, to physician compensation for patients enrolled in research. He also indicated the administration’s interest and commitment to substantial reform to rules governing human subjects research.
Dr. Emanuel began by speaking about why the passage of health-care reform was so urgent. He emphasized that although health-care spending in the United States far outpaces that of other developed countries, health-care delivery and outcomes are not necessarily superior in the United States. For example, mortality rates for asthma in the United States are more than double the average of those in other developed countries.
He went on to emphasize that the passage of the Affordable Health Care Act (ACA) was a “world historical event,” and described some of the provisions that are included. He said the reform was based on President Obama’s promise to citizens: “If you like what you have, you can keep it.” This meant “keeping the basic structure of the overall health-care system with employer-based coverage, Medicare, and Medicaid, and adding to it.” He also dispelled several myths about health-care reform, including the cost burden on U.S. citizens.
He then suggested some ways that physicians can begin to prepare for the provisions of the new law. First, he said that physicians should “get wired,” by setting up electronic medical records in their practices. Second, he suggested that physicians and organizations such as ASH should develop quality indicators, treatment guidelines, and bundled payment structures that will suit their needs most effectively.
Dr. Emanuel ended by highlighting how this legislation will impact health-care delivery in Europe and the rest of the world. He emphasized that comparative effectiveness and patient-safety research will likely be applicable worldwide. Further, he suggested that European policymakers may be able to learn from the U.S. experience in delivery system and physician-payment reform.
Drs. Ulrich Jäger, president-elect of the European Hematology Association, and George Weiner, chair of ASH’s Committee on Government Affairs, then posed several questions to Dr. Emanuel. Dr. Emanuel was most pleased with the question of what ASH and members of ASH can do to clarify the provisions of the ACA. He answered by asking physicians to “focus on patients and providers” and emphasize how the law makes “their care better.”
In addition to more than 150 scholarly articles on bioethics and health policy, Dr. Emanuel is the author of several books including Healthcare, Guaranteed, in which he outlines a plan to restructure health-care delivery and quality. Dr. Emanuel has chaired numerous national committees, including the Ethics Committee and the Task Force on Conflicts of Interest of the American Society of Clinical Oncology. Among his numerous awards, Dr. Emanuel was elected into the Institute of Medicine in 2004.
Dr. Porter indicated no relevant conflicts of interest.