Academic Exchange: Describe the work you did on the health care act.
Ruth Katz: My primary responsibility was for the public health-related provisions in the bill. These sections didn’t receive nearly as much attention as those on health insurance, quality of care, Medicare, and Medicaid. More specifically, I focused on prevention and wellness initiatives designed to help us become a healthier nation.
AE: What impact could such initiatives have on the country?
RK: These initiatives could help transform our health care system from one that focuses almost exclusively on acute medical care to one that also emphasizes preventive care. Sooner or later everyone gets sick or has chronic disease. We must ensure that Americans have access to health care services when that happens. But we must also prevent and postpone illness as best we can for as long as possible. This will allow people to live longer, more productive lives and help reduce medical costs in the long term. In turn, we should improve our standing among the nations around the world in terms of various health and health care indicators. We are not where we should be in those rankings. This legislation will help us get there.
AE: What aspect of the national debate about health care did you find most intriguing?
RK: The legislative process itself. Health reform is an extremely difficult and complicated thing for any administration to achieve. The country has been at it since the Truman administration. The process of trying to cobble together a piece of legislation that a minimum of 218 House members would support—especially in a very difficult political environment—was not only challenging but incredibly exciting and rewarding. It was literally a once-in-a-lifetime professional experience.
AE: How will the health care act change our understanding of disease and wellness?
RK: We know a lot about what we need to do to be and to remain healthy —ongoing exercise, good nutritional choices, not smoking, appropriate use of preventive health services such as vaccines and mammograms, etc. What we don’t understand as well is how to get people to actually do these things and then stick with them. We need more public health research so we can learn about what really works. Once we know that, once we have the evidence, we need to get that information out to communities and public health departments so they, in turn, can develop programs that are tailored to meet the needs of their own populations. The health reform law provides $15 billion over ten years for prevention and wellness activities that will help make all of that happen.
AE: What impact will the health care act will have on our medical culture?
RK: Hopefully, the implementation of health reform will help shift our medical culture towards a greater emphasis on not only prevention and wellness, but also quality of care. That concept means different things to different people, but it is definitely not code for health care rationing, as some people have suggested. Instead, it is all about trying to ensure that, based upon the evidence, patients get the best possible care they can.
AE: What are the greatest challenges to implementing various parts of the act?
RK: Incredible challenges lie ahead. This is a complicated law with lots of moving parts. We have hard deadlines to meet. Implementing rules and regulations must be developed. States, private insurance companies, academic health centers, and other health care providers need to get prepared. The list goes on and on. Among the most immediate challenges we face, however, is our communication efforts with the American public. We need to keep everyone informed about what the new law does and doesn’t do, and how it will work for them.
AE: What role can universities and scholars play in the discussion?
RK: Universities, especially those with academic health centers like Emory, can lead the way in embracing health reform and helping to make it a reality in all of its many parts—from the law’s numerous opportunities for research to its focus on quality of care. Down the road, they can also help evaluate the law’s effectiveness in achieving its many goals. And in between, universities and academics can help those responsible for implementing the law think through potential mid-course corrections. And those should be expected. Health reform is not a perfect law, but in my view it is a giant step forward in ensuring that all Americans have access to the quality health care they need and deserve.