JIM LEHRER: And now the first in a new series of conversations about health care reform. We’ll be getting the views of some leading players and thinkers about what kind of changes they would like to see in the health care system.
We begin by picking up on some of the very ideas raised in Betty Ann’s piece just now about costs and care. Judy Woodruff has our conversation.
JUDY WOODRUFF: And for that, we turn to Dr. Toby Cosgrove, the CEO of the Cleveland Clinic. The president visited the center last month as part of his health reform efforts.
Dr. Cosgrove, thank you very much for talking with us.
DR. TOBY COSGROVE, Cleveland Clinic: It’s a pleasure to be here. Thank you.
JUDY WOODRUFF: We just heard at the end of that piece by Betty Ann Bowser, in essence, an agreement that if you had more collaboration by doctors, as we’ve seen at these clinics, including yours, overall quality would improve, costs would go down. You agree with that?
DR. TOBY COSGROVE: I absolutely agree with that. And what we really have got to put into the health care discussion is how we drive quality and how we bring the total bill for health care down.
And one of the very important ways to do that is to integrate the health care system and make it more efficient. And that means integrating not only the doctor with the hospital, which you saw a great example of here, but also integrating hospitals, so not all hospitals are expected to be all things to all people, but rather to serve the community in a way that the community needs to be served, and then have the high specialty things located in places where you can get maximum practice and maximum efficiency.
JUDY WOODRUFF: Do you think it’s realistic to expand the model to the entire country, to take what Billings, Montana, is doing, to take what the Cleveland Clinic is doing, and expand it to over 300 million people?
DR. TOBY COSGROVE: I think it’s perfectly possible to expand that. It’s not going to happen instantly. One of the things we’re seeing is we’re seeing an increasing number of doctors wanting to be in multi-specialty practices and in big group practices.
Very few physicians — in fact, only 10 percent of people who are less than 40 — are going in to practice by themselves or with one other individual. They’re being driven in that direction by the difficulty in setting up and running a practice, the expectation about electronic medical records, about the economics of running a practice, and by the fact that the knowledge has expanded hugely and it’s very difficult for one individual to surround an entire field by themselves, and so they want to have colleagues.
And, finally, they’re being driven there because doctors are not so interested any more in being on call 24 hours a day, seven days a week. They want to have some sort of personal balance in their lives.
JUDY WOODRUFF: So you think this worry is overblown that doctors are still more interested in their independence and in keeping their pay scale high?
DR. TOBY COSGROVE: I think that we now pay physicians well, but they’re not — they do not have an incentive just to drive volume. And they get paid for a year’s salary. They get paid in conjunction with what a specialty would be paid on average across the country, but they don’t have the obligation to drive more volume or do more tests. I think that is the difference.
Keeping costs down
JUDY WOODRUFF: Now, I've seen you quoted recently that you're worried that there's not enough focus in this health care reform debate over keeping costs down, reducing costs. What do you mean by that?
DR. TOBY COSGROVE: The discussion has moved, essentially, from improving quality and improving access and in decreasing cost to one that's really about insurance reform and increasing access.
And if we add 40 million more people to the health care system in the United States, you're going to see costs go up. And we need to take costs out of the system by decreasing the total cost of providing care by integrating and, secondly, by reducing the disease burden in the United States, and by that I mean right now we have an epidemic going on around obesity. We have a lot of people smoking.
Obesity now accounts for 10 percent of the health care costs in the United States and $147 billion, and smoking accounts for $100 billion. We could provide a lot of health care if we didn't have those two big problems.
JUDY WOODRUFF: What is essential, as far as you're concerned, in any health care reform proposal that is passed into law?
DR. TOBY COSGROVE: Well, I think what we need to do -- clearly, we need to have access for everybody. I don't think anybody disagrees with that. We want to have people covered for their health care.
And then I think we need to put the impetus and the incentives in place so we begin to develop the sort of health care system that you've heard described and put the right incentives for doctors to not order too much or not practice defensively and so that we get the efficiencies of health care system to its best of our ability.
JUDY WOODRUFF: And what worries you the most about what you're hearing in all of this debate that's underway right now?
DR. TOBY COSGROVE: Well, the thing that worries me is those two things have been left out. We haven't talked enough about how we're going to drive to the health care system that is efficient, and we have not talked enough about how we're going to deal with this large portion of the health care bill that is a result from behavior of patients, in other words, inactivity, smoking and obesity.
Town hall protests
JUDY WOODRUFF: The president came to see the Cleveland Clinic a few weeks ago.
DR. TOBY COSGROVE: Yes, he did.
JUDY WOODRUFF: Are you still talking to folks in the administration about what they're doing, what they're focusing on?
DR. TOBY COSGROVE: We haven't had a lot of discussion. We have had some follow-up discussions with them, and we've had some follow-up discussions with members of Congress to try and bring attention to those two issues that I'm concerned about.
JUDY WOODRUFF: And what do you make, Dr. Cosgrove, of these rallies that are -- these protests that are appearing, cropping up at the town meetings that members of Congress are having around the country?
DR. TOBY COSGROVE: Well, I think everybody is concerned about change, and I think with change brings anxiety. I think some of that you'll see coming out.
I think we have to change as a country, though. I don't think there's any question about that. And we have to be sensitive so that people are incented to head in the right direction and it is a fair disbursement of medical care.
JUDY WOODRUFF: So, at this point, are you feeling how about how this is going to turn out?
DR. TOBY COSGROVE: Well, as I said, I think we're going to see a bill. I really don't know what will be in the bill. I hope that we will have an emphasis on efficiency for delivery and on reducing the disease burden in the United States.
JUDY WOODRUFF: All right, Dr. Toby Cosgrove, the Cleveland Clinic, thank you very much.
DR. TOBY COSGROVE: My pleasure. Thank you for having me.
JIM LEHRER: On our "Patchwork Nation" site, read a post about why the number of uninsured people in America is growing and see which communities have been most affected with our county-by-county map. You can go to newshour.pbs.org to see it.