University of  Arizona News, Published May 27, 2009

By Ginny Geib, UA College of Pharmacy

Helping set the stage for a community town hall discussion on national health care reform in Tucson May 26 were Richard Carmona of The University of Arizona Mel and Enid Zuckerman College of Public Health and J. Lyle Bootman of the UA College of Pharmacy.

The Health Care Town Hall sponsored by U.S. Rep. Gabrielle Giffords drew approximately 1,000 Southern Arizonans to Sahuaro High School for a wide-ranging discussion of issues surrounding how health care is financed and delivered in this country. Congress expects to take action “before the August recess” on several legislative proposals, Giffords told the audience.

In responding to the Congresswoman’s invitation to provide overviews of the current state of American health care, Carmona, the most recent U.S. Surgeon General, declared that currently the country has a “perversely incentivized sick-care system” rather than one that supports disease prevention, educates citizens on the consequences of their own behaviors and provides access to quality care to all populations.

Bootman, dean of the UA College of Pharmacy and a member of the National Institute of Medicine, said much of the current debate centers on “whether health care is a right or a privilege.” An estimated 47 million Americans lack health coverage, he said, with the cost of providing services rising from 7 percent of Gross National Product to 16 percent over the last 40 years.

Following up on Carmona’s emphasis on disease prevention, Bootman told the audience that 15 chronic conditions accounted for 56 percent of all increased health care spending over the past 20 years, and that one-third of total health care costs are associated with just five conditions (heart disease, pulmonary diseases, mental health disorders, cancer and hypertension).

Following remarks by Bootman and Carmona, Giffords introduced 14 representatives from Tucson-area business groups, health care providers, nonprofit organizations, community service agencies and other interest groups to share their perspectives.

Topics included examples of the need for better mental health coverage, using case managers more widely to improve access to services, how health coverage affects an employer’s competitive edge in government bids, the inadequacies of health services in rural areas, cost-shifting by payers, reimbursement to providers and the complexity of Medicare plans.

Several presenters supported universal coverage and a greater participation by government in payment and delivery, with one declaring that guaranteed health care is a right. Another presenter drew both applause and disapproval from the audience when he called for patients to pay directly for their services.

Giffords entertained a dozen or so comments from the audience before ending the forum, which lasted more than two hours. One speaker urged the representative to make sure the concerns of family members providing long-term care to loved ones were included in any reform legislation, a physician pointed to the federal employee benefits system and Medicare as models that work well and others argued for the special needs of the disabled, retirees and people with lifelong conditions such as diabetes.