Danielle Lee: Good evening Jacksonville and happy Saturday. I am Danielle Lee and welcome to The Conversation with Dr. Ali Kasraeian. As always, you too can join the conversation. Give us a call, 340-1045. Dr. Ali, how are you today?
Dr. Ali K.: I am good. I am good. Happy November.
Danielle Lee: Happy November. It’s a nice cool November today.
Dr. Ali K.: It is. Before we get started, November, whether you follow the give and grow campaign from Zero Cancer or the Movember movement, be mindful that the gentlemen in our lives should be, have begun the process of growing a mustache in celebration of multiple different things. You know prostate cancer is a big one that this month, the Movember month, pays mind to. Testicular cancer is another one, but very importantly over the past several years mental health issues have been brought into the forefront with this month. If you see a gentleman that previously did not garnish a spectacular mustache this month, ask them why and it may begin a very very wonderful conversation, and hopefully raises awareness and funds for the management and treatment and most importantly the research for all three of those factors, which affect men and women in this world. Again, not prostate cancer, but the other aspects of things, the mental health aspect do affect all of us so it’s important for us to be mindful of that.
Danielle Lee: Normally I just go check my wrist. I actually had a little wristband that I wear for the month of November ever year. I took it off during yoga. I do have it, so I understand November.
Dr. Ali K.: I was about to say that you’re going to begin growing a mustache.
Danielle Lee: No, no. We’re not going to do that.
Dr. Ali K.: Good. Good for all of us.
Danielle Lee: All right what have we got going on today?
Dr. Ali K.: Today I have a dear friend and person that I learn a lot from all the time. Dr. Carolyn McClanahan is in studio today. Friend to the Conversation and expert in healthcare policy among many many other things. Today we’re going to talk about the past, present and possible future of healthcare in the United States as we had a very, very interesting election last week.
Danielle Lee: And still kind of.
Dr. Carolyn M.: It’s still out there.
Dr. Ali K.: As Florida continues as usual. Seems to be par for the course for the Florida aspect of elections over the past, as long as I can remember. It seems Florida brings controversy to the electorate pretty much every election over the past few-
Dr. Carolyn M.: Decades.
Dr. Ali K.: Under 20,000, yeah. Yeah, I keep trying to make it a small number, but as my mind races it’s not. Dr. McClanahan, thank you for joining us.
Dr. Carolyn M.: It’s a pleasure to be here with you as always.
Dr. Ali K.: When we talk about this you always kind of joke around that the soap opera continues. When healthcare seems to be a little bit quiet and then settles it’s really at the eye of the storm before something is emerging. Here we sit again a divided Congress and past couple years where a Republican heavy government federally was not able to make many changes in terms of a, I don’t want to say a permanent, but at least a direction towards which our nation would be headed in terms of healthcare delivery.
Dr. Carolyn M.: Right.
Dr. Ali K.: Past, present, future to beam, where are we at now. Over the course of this hour we want to talk about what your thoughts are about where will be, but what’s the first thing that came to your mind over the election process and its implications on healthcare policy? Although, I don’t think you were too surprised.
Dr. Carolyn M.: Well I was happily surprised by the election. I’m not really surprised. I think what happened is what I expected to happen. I want to step back just a teeny bit to remind people where we’ve been. It will take me about two minutes.
I’ve been educating people on health policy, talking about this around the country, for over a decade now from before the ACA was passed. What the GOP wanted to do is basically take us back to pre-ACA and they didn’t really have a good plan that was going to actually fix the healthcare system. This is why even though they had control of the House and Senate and the Presidency that they couldn’t get anything passed because there was still enough people with enough sense to know we don’t want to go back to the dark days of insurance where people couldn’t get coverage. With this election, I think it will stall any more attempts to repeal the Affordable Care Act. They will continue to try to sabotage it, which is what they’ve done all along, which has made it not work well. It had some issues. It could have worked well had it been implemented well.
So what’s going to happen now? I wish I, predictions are hard. I think that you will get people starting to reach across the aisle to fix some of the problems in healthcare, but I do not think for the next two years we’re going to see any overriding legislation that’s going to overhaul our entire healthcare system.
Dr. Ali K.: One question with regards to that. Obviously a lot of people are predicting that things will be attempted, but not necessarily, the problem will not necessarily be solved. One question I always have with this discussion is the expectation that we can change the health of our nation in one election cycle and one presidency.
Dr. Carolyn M.: Right.
Dr. Ali K.: We have a nation of people who about 64%, 65% of people are overweight or obese, 34%, 35% are obese with a lot of medical issues from that standpoint. Where do you think the understanding that whatever we do now has to be with the mindset that this is going to take generations to make us as healthy as we expect to be with one law or one change in how we deliver healthcare?
Dr. Carolyn M.: Right. Well you’re bringing up a good point because what we have been addressing with all the legislation is not how we deliver healthcare, it’s how we pay for healthcare. There are two issues we really have is how are we going to pay for healthcare, but to me the bigger issue the nobody is addressing, that’s a politician anyway, is how we fix the healthcare system, how we fix healthcare delivery. For example, just like you said, because of payer models through the years and how our healthcare system is run, we have decimated primary care. We have not enough primary care doctors. We do a very poor job of delivering primary care because it’s delivered in a system that is based on insurance. When you think about it, primary care is not insurable because everybody needs it. We’ve made it costly and inefficient, and that has put us down the road of poor health because we’re not doing a good job taking care of our health.
I say in this country we’re fantastic at treating things like rare illness, cancer, trauma, but those aren’t most of the problems. The majority of problems people have are primary care illnesses, hypertension, diabetes. We do a horrible job treating that. Other countries, European countries, Australia, do a fantastic job, but the big difference is they have a good primary care system.
Dr. Ali K.: The other thing that you bring up that we talk about all the time is the idea of applying that comparison to countries that may have 10%, 15%, 20% of our population and are generally fairly healthy, and they’re active, and they do pay attention to preventing illness as opposed to treating illness. Are those comparisons valid? If so, or if not, how do we make the comparisons more of an apple to apple comparison as opposed to an apples to oranges where it opens a lot of room for the naysayers for this idea of being healthier before you get to the doctor and needing care?
Dr. Carolyn M.: Right. Well there are determinants of health that we’ve not addressed in this country also. It’s like in Jacksonville it’s a huge problem. We’re not a walking friendly city. We’re not a biking friendly city. We’ve created this country around cars, which is subsequently made us not use other forms of transportation. To fix the health of this country we not only need to just fix primary care, we need to fix what’s our nutrition, how are we delivering nutrition, how are we getting people active and out just like they do in Europe. You can’t really compare us to Europe, but that doesn’t mean you can’t try something to fix us.
Franklin Roosevelt had a fantastic approach to fixing the problems in this country during the Great Depression. He would give his Sunday address, his radio show, and he would talk about the good things that they were doing, but he would also talk about the mistakes that they were making and how they were trying to fix mistakes. Politicians don’t do that anymore. He had this great quote, I forget which speech he gave it in, but he said, “When something bad is going on and you have to fix it, sometimes you have to try things that haven’t been tried. You have to experiment. You have to be okay failing.” In our country we don’t accept failure anymore. We’ve got to get our politicians to get us on a road to health by fixing all these underlying problems that are causing us to be unhealthy.
Dr. Ali K.: One thing I saw, and we’ve talked about on this show, is one of the criticisms from the Republican side to the Democratic side during the implementation and actually the passing of the ACA or Obamacare, the Affordable Care Act, was that it wasn’t bipartisan.
Dr. Carolyn M.: It was.
Dr. Ali K.: Right, and it went through very quickly, which is about 18 to 24 months of processing before it actually went in.
Dr. Carolyn M.: Right.
Dr. Ali K.: Then when it was their chance to put something forth it was much quicker and much more-
Dr. Carolyn M.: Clandestine.
Dr. Ali K.: -Unipartisan. Yeah. So with regards to that, and again not throwing blame on either side of the fence because obviously-