Next, we're going to travel all the way to Baltimore to
the Johns Hopkins Bloomberg School of Public Health to speak with Dr.
Gerard Anderso.
A professor there and the first author of the paper I site more than
any other during this course, The Rising Tide of Chronic Disease in America.
Gerard, thank you so much for being with us today.
It's a thrill to meet you.
>> I'm glad to be here.
>> Great. A decade ago, you and
your colleague Jane published what I view as a seminal paper,
A Growing Version of Chronic Disease in America.
The students of the course, if they've been paying attention,
are quite familiar with it by now.
And, it opened my mind to the aggregate problem of
chronic disease in a way that really, no previous paper had done.
Which is why I view it the way I do.
So we're ten years later, have we made progress?
Where are we?
>> Well, we have made progress.
I think what you knew already is that, you saw that patients
of that chronic disease, but you didn't know how many patients there were.
And now, we know that there are 150 million Americans, almost one out of
every two Americans, that have one or more chronic conditions.
And that is sort of the new information that we were trying to bring ten
years ago.
Now what we're trying to do, now that we have the attention of policy makers,
is to start changing In the delivery system.
That starts with prevention, but it goes to care and cure for
these chronic conditions.
And there, we're making a lot less progress.
I was more optimistic ten years ago than I am now.
Most everything that we've tried recently has just not worked very well.
>> Well, here in the last few years,
we've tried to make the healthcare industry adopt Health IT.
And we've tried to create health information exchanges.
We're still really early in that, but
are you optimistic that that will happen and that it'll make a difference?
>> Well, it is happening, so I'm very optimistic that it will happen.
What I don't think we've solved very well so
far is that dashboard problem of a doctor.
I have ten minutes to take care of a patient, and
she has seven things wrong with her.
She's seeing nine other doctors, and I have ten minutes.
If I spend most of that time looking at her medical record,
I now have five minutes to talk to her.
And so the challenge is, how can we get that information
out to the physician in a timely fashion for that complex patient.
For the patient that only has diabetes, it's pretty easy.
But for that patient who has diabetes, and congestive heart failure,
and beginning Alzheimer's, and arthritis Brightest.
And seeing all these different doctors, and
taking lots of different medications, that's the challenge.
>> I hope the students remember that comment because that's
basically what we're going to talk about in Lesson 6 of the course.
>> Great!
>> Well, you also mentioned incentives.
Clearly, the healthcare system has never been incented.
Do you see that working?
Are you optimistic that that's actually going to happen in this
endlessly complex adaptive healthcare system?
>> So I was just amazed when I started this work in the 1990s.
That Australia had tried care coordination programs, and
they had all failed.
And then, I support the United States can do it differently,
or the UK could do it differently.
And so, I've been looking around the world for
those models and I just don't see them yet.
We know what we need to do which is to get everybody on the same team,
probably with a nurse practitioner, talking to all the doctors.
But we haven't been able to figure it out.
So almost all of the demonstrations that we've tried,
both in the public sector and in the private sector, just haven't been able
to save money, improve outcomes, and improve satisfaction.
We just don't have very many of those things that hit
all three of them very well.
And we're still working.
And so, I'm optimistic that we will find it.
But so far, we just haven't been very successful.
>> Your paper actually ends on an optimistic note.
You point to the re-engineering of the healthcare system
a century ago around new knowledge in public health.
Is it so fundamentally different now that that optimism might be misplaced?
>> No, but I think if you read it a little more carefully,
what you'll see is I said we move in 50 years from a system oriented
around infectious disease to one that's oriented around acute illnesses.
And then, we got that done by about 2000.
And I said it's going to take us 50 years to reorient
the healthcare system around chronic disease.
We have to start with the evidence base.
We have to know how to take care of somebody who has seven things wrong with
her when the NIH and the FDA exclude all those people from clinical trials.
We don't have the educational system in the medical schools oriented
around that.
We don't have the financing.
And so right now, there isn't a real strong incentive for
hospitals and doctors to really go after these people to take
care of them in an effective way.
In fact, because they dont know how to do it,
they want to run away from them in most cases.
But this is where the money is.
Two-thirds of Medicare spending is by people with five or
more chronic conditions.
We've gotta get the system right for these people.
We just don't know how to do it yet.
>> So I can't speak to 50 years ago.
But 40 years ago, I was a medical student first getting into this.
And I remember going into meetings.
And they would say, well, here's where we are.
And if these trends continue, and we don't do anything, by right about now,
health care will be consuming 20% of the gross domestic product,
a number that's absolutely not sustainable.
>> Right. >> Now, I've seen projections
from OMB and others that if we don't do anything, it'll be 40% in 50 years.
Do we have 50 years?
>> Well, when I started working and
trying to control healthcare costs in the 1970's, I said that we'll never
be able to sustain 10% on GDP on healthcare.
Now, it's close to 20.
So, I've stopped making projections as to whether or
not we can afford to do something.
What we know is that by the time it gets to almost 30%,
which isn't that far along, almost all the growth in the economy.
All the productivity growth in the economy will, in fact,
go to support the growth in healthcare, and that's probably not sustainable.
But, we don't know what's going to turn this ship around.
Maybe it's IT.
Maybe it's changing the financial incentives.
But since everybody's making so
much money in healthcare and jobs are important and
financial security is important, it's going to be a really tough change.
>> So, many of us speculate that
eventually with our backs against the wall
we'll adopt a single payer system like every other country on Earth.
You think that's going to happen here in the US?
>> I was more optimistic in the 90s than I am today.
Basically, Americans love choice.
All you have to do is go to the grocery store and go down the cereal aisle.
>> And look at 40 to 100 different choices of cereal.
Whereas if you go to France, you will see two or three in most cases.
Choice is what makes America, and
it's going to be really hard to get the private insurance industry out of it.
We can't even get right now many of the states to embrace Medicaid.
So, if they can't embrace Medicaid, which is free money.
To them, why would we think that they would go to a single pair?
I mean, I think it makes sense.
It means that we pay a lot more for healthcare than other industrialized
countries because of this choice, but America seems to really like choice.
Well, thank you very much.
It's been a pleasure.
>> Thank you.
>> And maybe we'll be able to get together in ten more years and
see what's happened.
>> Hopefully, it'll be more optimistic that time.