Autumn 2009: Features

Portrait of Ruth Katz.

Ruth Katz

Courtesy Office of the President

Inside the Debate

Public and private perspectives on health care reform

See the perspective of health care executive Ninfa Saunders 84MBA below.

Ruth Katz 77L is chief public health counsel for the Committee on Energy and Commerce for the U.S. House of Representatives, where she has helped to shape landmark health care legislation being considered by Congress. Prior to her appointment in May 2009, she was the Walter G. Ross Professor of Health Policy of the School of Public Health and Health Services at George Washington University, where she served as dean from 2003 to 2008. She also has held positions at Yale’s School of Medicine. In addition to her Emory law degree, Katz has a master’s degree in public health from Harvard. She became an Emory trustee in 2006 and is a 2009 recipient of the Emory School of Law Distinguished Alumni Award.

How did you become interested in working in health care? Can you trace this to a particular experience, or was it a general, gradual interest?

I don’t remember ever not being interested in health care. My older cousin Michael was a doctor in the small town where I grew up, and he was a really big influence on me. For Michael, medicine was not a job, it was a calling. He really made a difference in people’s lives. I admired him and what he did, and I grew up wanting to do the same. In college and in law school, I came to see other ways that I could make a difference in health, that it was an issue that cuts across the board in lots of fields. I ended up combining law and public health to work toward some goals of social justice. I feel passionately that everyone in this country should have access to quality health care and, for that to happen, we have to do it efficiently.

What has changed most about the practice of public health during your career?

Since September 11, there has been much greater awareness and appreciation of what public health is. If the infrastructure is humming along, no one even thinks about the epidemiologists, the labs, the statistics, and the studies. It’s only when something goes wrong—9/11, the anthrax attacks that followed, the peanut butter scare—that people begin to appreciate how important public health and government are. So in the twenty-first century, a lot of people think about public health because of how fragile it sometimes feels. Altogether different than these changes are the changes in technology. With the advent of computers, the Internet, and increased access to information, public health professionals can get information much more quickly and act on it. Individuals are getting information quickly and asking good questions much earlier than we did twenty-five years ago.

From your perspective, what are the most critical issues at the heart of the health care debate taking place in the U.S.?

Reform is needed now because we have 47 million Americans who are uninsured and that number is growing. Moreover, even people with insurance are finding it far more expensive, and they are feeling like their coverage is more precarious. It’s also important that we try to ensure that we prevent disease and disability and emphasize wellness; that’s one of the provisions of the legislation that I have been working on, that there must be new investments in these areas. There must also be an emphasis on training more primary care doctors, as well as nurses and nurse practitioners, and public health professionals.

Why is there such vehement resistance to health care reform?

This is very complicated legislation involving a lot of different pieces and moving parts. If it were easy to do, we would have done it a long time ago. It’s complex, it’s hard, and it does involve change. But for people with insurance, it doesn’t pose the drastic changes that some people allege. That’s just rhetoric. In the end, I think the final product will result in a better place in terms of health care for everyone.

What are your priorities for shaping the future of health care, and how do you think your priorities differ from those of a professional in the private sector? Is there common ground?

There has been tremendous support for the public health component of this legislation. Everyone agrees that we need greater emphasis on prevention on both an individual level and across communities. I suspect that when it comes to prevention and wellness activities, the CEO of a private company or an insurance company or the state public health commissioner for Georgia all share a similar view on what the legislation should do. The public health component of this bill is an investment in how we become a healthier nation, and everyone would like to see that happen.

Portrait of Ninfa Saunders

Ninfa Saunders

Courtesy Ninfa Saunders

Ninfa Saunders 84MBA is executive vice president and chief operating officer of Virtua, a private health system based in New Jersey. She previously served as COO for DeKalb Medical Center and, prior to that, director of nursing resources for Emory for some thirteen years. Saunders recently was named one of the top one hundred most powerful people in health care by Modern Healthcare magazine.

How did you become interested in working in health care? Can you trace this to a particular experience, or was it a general, gradual interest?

I grew up surrounded by close relatives and friends who were physicians, nurses, pharmacists. I have always admired their intellectual capacity and their incredible ability to manifest that through their compassionate ministration of the sick and the disabled. I knew early in my high school years that I wanted to be a nurse, and I never wavered. My resolve to be in health care grew stronger when, during my freshman year in nursing school, my mom became critically ill and my dad temporarily became disabled.

What has changed most about the private health care industry during your career?

A multitude of things! A few pivotal ones come to mind. Scientific discovery and advances in medicine have been extraordinary. We can save lives today using invasive or minimally invasive interventions with incredible precision. Second, the ease and speed at which knowledge is transferred through cyberspace has positioned learning and accumulation of knowledge at the forefront of what we do. Third, the proliferation of clinical technology has facilitated system interoperability, access, and accuracy of information. Robotics have successfully secured a presence in health care and augmented the practice of medicine. Fourth, in spite of the country’s spirited discourse about the need to reform health care, our industry has made great progress on quality, safety, transparency, and accountability. Finally, consumerism has taken health care with a vengeance. Consumers today are sophisticated and are constantly comparing, shopping for, and demanding health care services.

From your perspective, what are the most critical issues at the heart of the health care debate taking place in the U.S.? Do you feel reform is needed?

At the heart of today’s health care debate are health care cost and access. Health care is our country’s largest and most rapidly increasing national expense, approaching close to 20 percent of GDP. This country can definitely benefit from health care reform. But as noted in a recent piece in the Atlantic Monthly, it cannot be simply a reprise of previous reforms. Historically, health care’s emphasis has been disease-based, as opposed to wellness- and prevention-based. At the heart of this debate is a cry for health care to focus on quality, not quantity, and rational care, not rationed care. Another key issue is access or affordable access. At the core of this are the supposedly 47 million Americans who are uninsured. This is a daunting number that needs to be qualified to truly understand the magnitude of the problem. When you factor in illegal immigrants, those eligible for programs like Medicaid, and those young adults who choose not to buy health insurance, the residual number is much lower than is commonly stated. The government proposal seeks to address the problem of access for this relatively small group through some type of public option at a high cost.

As an expert in the private health care industry, what are your priorities for shaping the future of health care, and how do you think your priorities differ from those of a professional in the field of public health? Is there common ground?

Fundamentally, with or without health care reform, my number one priority will be quality and safety. Next is a focus on prevention and wellness and reducing or managing costs. I do not believe that these priorities are any different from those of public health professionals.

What do you think are the key elements of a health care solution? Do they include a public or co-op option, and if so, do you think it is possible for those to coexist profitably with private insurers?

The key elements of a health care solution are access to affordable and rational health care, increased focus on wellness and prevention, innovative use of technology, and tort reform. The critical role of a robust technology platform must not be underestimated. Another integral piece of any health care solution must be tort reform. We operate in a litigious environment that promotes defensive medicine—a practice that contributes to unnecessary over-utilization of health care services and misallocation of resources. As for a public or government-run option—whether the solution is a public plan, a co-op or some other venue, the fundamental issue is a need to reform the manner by which we justify care and pay for the current health care construct and for that which is being proposed.

Back to top

Autumn 2009

Of Note

Features

Campaign Chronicle

Register