CLEVELAND, Ohio — The Cleveland Clinic was health-reform neutral when President Barack Obama came to town a few weeks ago to hold a town hall meeting.
But Clinic President and CEO Dr. Toby Cosgrove now is taking a stand, saying he’s concerned that the reform debate has narrowed to health insurance rather than the entire health-care system, according to an interview published in Newsweek on Friday.
“In the beginning, we were talking about access, cost, and quality, and now it seems we are just talking about access and cost-shifting, because there’s very little in the program that seems to be going to reduce the cost of health care in the United States,” Cosgrove said in a question-and-answer version of Newsweek’s The Human Condition. “If you give access to another 40 million people, there’s going to be more cost.”
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Addressing the nation’s obesity and smoking problems would go a long way toward addressing the cost of health care, Cosgrove said. “Right now, 10 percent of the cost of health care in the United States is secondary to obesity, and that’s going up another $100 billion a year from smoking. I don’t think there’s any way to drive down the total bill without reducing those numbers.”
In terms of smoking, the Clinic walks the walk. In September 2007, the hospital system stopped hiring smokers because that practice belied its wellness-focused mission. At the time, Cosgrove said he considered obese workers protected by workplace anti-discrimination regulations.
Until reforms succeed in driving patients to cost-effective, integrated health institutions, “you’re not going to enhance the efficiency of the health-care system,” Cosgrove said.
How has the Clinic integrated? “There are two things that we’ve done,” Cosgrove said. “The first is integration of facilities and doctors. The days of the stand-alone hospital being able to be all things to all people I think is gone — it winds up being a duplication of effort and duplication of cost, and it doesn’t engender high quality.
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“Our system is 17 family health centers going to eight community hospitals going to a very high-tech central campus. Each one is connected by two things: electronic medical records and a transportation system. So you try to get the right person to the right place for the right problem.”
On July 23 when President Obama stopped at the Clinic, he met with Cosgrove and other leaders of the health system behind closed doors. Later at the public meeting, Obama praised the Clinic as an example of efficient, effective and progressive health care delivery.
What did the president say during his Clinic visit? “It wasn’t a photo-op. He wasn’t interested in seeing a lot of people; he really wanted to sit down and talk,” Cosgrove told Newsweek. “He was very interested in our electronic medical records and in our efforts to measure quality. I think he was learning. He asked fairly penetrating questions about how we make it all work.”
[Photo credit: Flickr user GE Company]
