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Congress Needs To Address Deeper Issues Hurting Health Care, Pearl Says


Let's hear now from someone who has been watching the health care debate very closely and has advice for both parties. It is Robert Pearl. He's chief executive of a big health care insurer and provider, the Permanente Medical Group. He's also a doctor. Now, Pearl has concerns about the bill that was just passed by Republicans in the House and also about President Obama's Affordable Care Act. He says neither address the deeper issues hurting health care in this country.

ROBERT PEARL: The House bill and the ACA focused a lot on access, but the real opportunity and actually the real risk is at the delivery system level.

GREENE: Pearl says if we're serious about making health care affordable, everyone needs to look at current assumptions about how patients are served. Now, we should say Pearl's company, Permanente, oversees care at Kaiser Permanente facilities. Kaiser Permanente is not affiliated with one of NPR's editorial partners, Kaiser Health News. Dr. Pearl, who has written a new book on what ails the American health care system, told our colleague Rachel Martin that the problems start with basics.

PEARL: One of the biggest problems is that we fail to do the prevention we need to do. What we know is that half of the people who die from colon cancer this year could have been saved had they had a test, whether it's colonoscopy, what's called a FIT test. What we know is that hypertension in the United States is controlled 55 percent of the time. There are organizations like Kaiser Permanente that control it 90 percent.


But doesn't that get back to the issue of health care reform? And the Obama administration argued - central to its argument was that you had to focus on prevention, that that has to be included in coverage.

PEARL: That's the first piece. But as an example, if you don't have a comprehensive electronic health record, half of the doctors in the United States don't even have an electronic health record. What comprehensive means is that every physician you've seen has the totality of your information, so it's at the delivery system level. What we know in the United States is that a lot of the things that are done simply add little or no value.

MARTIN: OK. So you say the delivery system is broken. And you suggest ways to fix that, including modernizing the medical records system. What is the responsibility of doctors?

PEARL: I think that just as stuck as the patient is. What we know is that doctors today spend half of their time trying to do the kinds of things that are required for billing. What we know is that almost half of the physicians report being burned out. It's hard to be able to focus on those things that are going to improve patient care, rather than simply generating significant revenue. The changes are not going to be easy.

MARTIN: Does that mean the debate over health care insurance and health care reform is misplaced? I mean, when you look at the legislative battles to fix or completely scrap the Affordable Care Act, do you think that it's just - it's not helpful because you have to make these other reforms you're talking about first?

PEARL: Both need to happen. What we know is at the insurance level, that the care has to be, first of all, available to all Americans. Number two, though, it's not enough just to have insurance. The insurance has to be affordable. If you look at the reimbursement system, if you look how doctors are paid, we pay a lot more to pull that clot out than to avoid it in the first place.

MARTIN: What is the role of insurance companies? I mean, if we talk about the collective goal is to create health insurance that is comprehensive and affordable, what sacrifices are insurance companies prepared to make to get there?

PEARL: The insurance company's role is to make sure that the insurance product is going to be available, but the real opportunities are going to be to change that delivery system. I think that what needs to happen with the...

MARTIN: So it's not their fault right now is what you're saying, that the insurance companies aren't culpable in the escalating premiums.

PEARL: I think the key part is that the system is what is at fault. Now, one area where I am very passionate that it is very problematic and broken right now is what's happening in the drug world. We're seeing the drug costs now exceed the in-patient hospital costs. And I think that this is the type of process that does need to be addressed.

MARTIN: Why can't we get health care right in this country? Why does it seem since the time of Harry Truman at least, all Americans can do when it comes to health care and those systems is to fight and disagree, and it dissolves into partisan politics?

PEARL: I can't tell you exactly why we couldn't get it right in the past. I think right now what's happening is that we're clinging on to a 20th century or actually a 19th century cottage industry, fragmented, paid on a piecemeal or fee-for-service basis, technology from the last century. And we're still clinging to this old model. And we've got to accelerate change. I think that we can do it. We just have to do it sooner than it otherwise would happen on its own.

MARTIN: Robert Pearl is CEO of the Permanente Medical Group. His new book is called "Mistreated: Why We Think We're Getting Good Health Care And Why We're Usually Wrong." Dr. Pearl, thanks so much for your time.

PEARL: Thanks Rachel, appreciate it very much. Transcript provided by NPR, Copyright NPR.