Kathleen Sebelius, the nation's top health-care steward, sat at a laboratory table amid skeletons at the University of the Sciences in Philadelphia on Friday and said this country's public-private partnership in delivering health care has to remain balanced if it is going to work for all Americans - and not just corporate America.
Sebelius is secretary of the Department of Health and Human Services, which oversees Medicare, Medicaid, and the Food and Drug Administration, among other agencies.
Her balancing act is a tough one. Some doctors and hospitals want the government to pay every bill immediately at their set price without any paperwork or snooping. Lawyers want to be free to sue anybody, anywhere, for any amount. Insurance companies want everyone to pay for their services and would prefer to cover only healthy people who don't file claims. Pharmaceutical executives want quicker seals of approval from the FDA, no foreign competition, and the freedom to charge anyone whatever they can for a drug to help grandma live forever.
Those groups spend millions of dollars lobbying politicians and advertising to patients to make their case. All of them want to make more money than they did yesterday and be taxed less. Many of them think members of the other groups are crooks.
Does Sebelius ever shake her head at the inherent conflict in this picture?
"Sure!" she said with a laugh. "I ran a regulatory department for eight years. I used to say that the model for the insurance industry was privatize the profits and socialize the loss. I think that is a strategy that some industries think is perfectly appropriate. The moment that something turns a profit, it's, 'We'll take it from here and you need to get out of the way. Up until then, we're happy to have you put your dollars in, your risk in, your pipeline in.' Is that a good way to make money? Sure. Is that a very reasoned approach to how this partnership needs to work? Not very."
Sebelius spoke with The Inquirer after a health-care fraud summit, at which she announced that Medicare would on July 1 begin using predictive-modeling computer software to help it catch criminals trying to bilk U.S. taxpayers before the government writes a check.
Sebelius, 63, understands the history behind this odd partnership and has grown up with key parts of it. Her father, John Gilligan, served in the House of Representatives and helped craft the Medicare law that passed in 1965. She was the Kansas insurance commissioner before becoming governor.
In welcoming about 320 health-care fraud fighters, she related the story of how Pennsylvania Hospital became the first in Philadelphia and America in 1751, after Ben Franklin had surprised the reluctant colonial assembly by raising more than 2,000 pounds from private citizens, thereby earning a match from the assembly. Some of those citizens figured the public good was served with shared sacrifice. Now, 260 years later, Medicare pays about 4.5 million medical claims per day for Americans, most of whom are 65 or older. (Medicaid pays medical bills for the poor.)
But some U.S. citizens fail to realize that federal taxes pay those bills. Perhaps the political quote of the year in 2009 came from the South Carolina man attending a town-hall meeting who told Republican U.S. Rep. Bob Inglis to "keep your government hands off my Medicare." Inglis told the Washington Post, "I had to politely explain that 'Actually, sir, your health care is being provided by the government,' but he wasn't having any of it."
Building on that, Republicans in the House have proposed shifting Medicare to a system of giving seniors vouchers to buy insurance. Sebelius is among the Democrats who oppose this because it would shift costs to seniors, who might not realize it until they cannot get services or face huge bills. The current system rewards those providing services, so more services are provided. Sebelius and others in the Obama administration say the new health-care law of 2010 tries to push the system toward better care so patients are cured sooner. While that would be the obvious goal for patients and their loved ones, it could mean lower revenue for some private businesses than they get from the current system.
By successfully - and publicly - combating fraud, Sebelius can lower the cost of health care and reduce the excuses of all those involved who think somebody else is getting richer. Perhaps it will even engender a bit more colonial-era shared sacrifice and common good.
"For the business community and taxpayers, the notion that we're getting serious about criminals stealing their money and taking it out the door, as opposed to having it there for future generations, is a very important piece of the puzzle," Sebelius said. "They would say in the past, 'Nobody is doing anything about this.' Those days are over."