What are the keys to healthcare reform? In the latest edition of Eyes On Obama's political podcast, we interviewed medical device inventor and entrepreneur Mir Imran to get his take on the current national healthcare debate.
Interview Part 1 of 2
Interview Part 2 of 2
EOO: You’re listening to the EyesOnObama Political Podcast. We’re here today with Mir Imran, an inventor and entrepreneur who has spent the last 30 years in the medical device industry. He holds over 200 patents and has started over 20 companies that have delivered therapeutic and diagnostic devices to the market, including the first implantable defibrillator. Mir, thank you very much for being with us today.
Mir Imran: Thank you for inviting me. It’s a pleasure to be here.
EOO: Maybe you can get us started by explaining what the fundamental problems are with healthcare as you see them.
Mir Imran: There are numerous problems, but if you stick to the top two or three areas which have the greatest impact on healthcare costs, two or three come to mind. The first is, because of the lack of centralized electronic patient records that are easily accessible to physicians and hospitals, there is a tendency for a dramatically higher amount of diagnostic testing and this probably results in a 20-30% increase in patient care. How many times I have been to a physician where he has ordered a blood test, and then you go to a specialist and that specialist orders the same blood test. It’s actually simpler for that specialist to write a script for doing another blood test rather than trying to have his staff get the previously performed blood test. So this would get eliminated if there was a centralized electronic healthcare system. The second and related issue is that of liability that these physicians and hospitals face, and therefore in order to protect themselves, they end up doing a number of tests that are generally not necessary, essentially to make sure that they don’t get exposed because of not having done some test. So tort reform is the other needed solution; that’s sort of the solution, but the lack of it is the problem. And then finally the third big area of cost is the increase in chronic diseases; obesity is at an all time high and continues to grow. And this has more to do with our lifestyle, with the food we eat, with the lack of exercise. So if we were to invest in education for our population, making sure our children eat healthier foods, lower calorie foods, and are physically active, a number of these chronic diseases that are draining the healthcare system would be dramatically reduced. So those are the three top areas that come to mind.
EOO: What about the 40 million uninsured Americans? What is their financial impact on the system?
Mir Imran: Their impact, the 40 million or so uninsured Americans have some impact on the healthcare cost but it’s not huge. These people are being treated in the current system so if they have some emergency situation, they are never turned away from a hospital generally. So they are getting treatment; what they’re not getting is preventive treatment and flu shots and those kinds of things that would reduce their trips to the emergency room. So there will be an impact of putting them into the system, with healthcare coverage, but the cost is not going to be as huge as those other three things I mentioned.
EOO: Given that the 40 million uninsured are not a primary cost center for the system, and they are already getting some care in the form of emergency room visits, does it make sense to provide a public insurance option?
Mir Imran: One point I would like to make these 40, 50 million people who are getting care through emergency rooms currently are a sizeable cost to the system, but it is an existing cost. So providing them with a separate insurance that provides basic insurance coverage will not dramatically increase the overall annual healthcare costs, but it will provide the peace of mind for these families that they have access to healthcare when they need it, rather than running into the emergency room for coughs and colds. And the other part of it that we have to remember is that recent legislation insures the children of people who don’t have insurance. So we are already providing coverage to a portion of these people. By providing healthcare insurance to the uninsured we bring them into the system so that they have access to high quality preventive care, healthcare education and just a tremendous improvement in the quality of life of these patients. So I think there is absolutely no reason why we should not do that.
EOO: So in the long run it may actually reduce costs by providing care when they’re healthier, as opposed for waiting for them to get sick to treat them.
Mir Imran: Absolutely. And I think there’s been studies done in the past that suggest the healthier the population is, the more productive. And for every dollar we spend on healthcare today, the nation gets 3 dollars back in improved productivity and contribution to our GDP.
EOO: Could you explain what the relationship is between the public option that you support and existing private insurance companies?
Mir Imran: Well, this is a complicated set of questions. As it currently stands, private insurance companies reimburse hospitals and physicians, and their reimbursement is based upon Medicare reimbursements. So there is a relationship between the amount of money; let’s say a heart procedure gets from Medicare versus private insurance. So there is a definite relationship there. The issue becomes that insurance companies tend to insure people selectively, so they are insuring people who are less likely to get sick, who don’t have major diseases. So they are biasing their selection of patients toward the younger people and not really covering the older patients who really cost the most in terms of healthcare dollars. I think one of the reasons they are so opposed to a government sponsored option is that they will have to compete with that option, and they don’t want to have a low-cost competitor. And I think that’s one of the fundamental reasons; I think in order to move forward we cannot do all this without doing some sort of insurance reform as part of this healthcare reform. We need to have guidelines for how they cover, who they cover and how much they charge, and creates a tighter relationship between what the government covers and what private insurers cover. Private insurers will always have the ability to offer services and coverage above and beyond what the government offers, so they can charge premium for those kinds of services. So I think it is a fallacy that with a public option, insurers will be driven out of business. I don’t think that will happen. If you look at UK for example, the two systems are in existence at the same time. There is a national healthcare system that everybody has access to. Arguably, it’s not the best system in terms of availability of healthcare; patients often wait for months for an MRI. But those patients who can afford private insurance, do get it and get faster, better service. So insurance companies in UK are doing quite well in spite of the fact that there is national 100% coverage of the entire population. So our insurance companies here are crying over nothing, because they basically don’t want to have a low-cost competitor; they want the system to be as is. This is why I think a reform is needed of the insurance companies. I think that healthcare and health insurance should be a fundamental service that the government provides up to a certain point. As I said, insurance companies can provide additional services that they can build for, and those people that can afford it buy into those additional services.
EOO: That makes a lot of sense. But it also begs the question of what constitutes minimum care. What is it that the government should provide in terms of healthcare to people, and are their models in other countries such as Canada, Britain or France that would be good for us to follow?
Mir Imran: Well, those systems have their pros and cons. The obvious attractiveness is that every citizen has access to healthcare, but there are deficiencies and issues with that. For instance, in the UK, patients routinely have to wait for months for an important procedure. So to give you an example, my uncle, who has BPH and large prostate, was having a lot of difficulty and pain. He could not get surgery, could not see a specialist for months because he was on a waiting list. If he had private insurance he would have had absolutely no problem in UK, but since he doesn’t have it, cannot afford it, he basically has to put up with the system. So there are pros and cons to it; emergency care is much more easily accessible, so those systems are really designed to respond to emergencies but not so much to non-emergencies.
EOO: So they have their challenges with chronic diseases as well.
Mir Imran: Absolutely. So this is a debate where there are no clear cut answers on what the boundaries of government’s responsibilities are for providing these basic services. What we really need to do is look at the healthcare that we have and ask ourselves, how we provide the best healthcare, most comprehensive healthcare at a reasonable cost. And focus not so much on minimizing what we offer our citizens, but trying to figure out ways to reduce wasteful expense, costs related to liability and focus on improving healthcare through education and management of chronic diseases. We should really be flipping the thing and looking at containment of costs and improving healthcare through education rather than limiting services that we provide.
EOO: You touched upon chronic diseases being a major cost center for the system. What should we do both on the policy side and on an individual level to reduce the cost of chronic diseases?
Mir Imran: I’m going to address this in a couple of different ways. Clearly chronic diseases are a huge problem and a growing problem for us. In the US about 125 million people have 1 or more chronic diseases, and this is staggering. So you might have patients with diabetes and hypertension, heart disease or stroke, or obesity and osteoarthritis, degenerative disk disease and some other inflammatory condition; inflammatory bowel diseases is very common. So the issue becomes how we can minimize and which one of these chronic diseases are controllable. I believe that obesity is the single most important controllable condition that we should focus on because it is the engine that drives so many other chronic diseases such as diabetes, heart disease, hypertension, osteoarthritis, certain forms of cancer, sleep apnea and so on. So there is just a huge list of disorders that are being fueled by obesity, and if we can bring obesity under control we will dramatically limit or reduce the growth of obesity or related chronic diseases.
EOO: So how do you go about doing that?
Mir Imran: I think there the focus should be on education from elementary school on, and some regulation of the food industry to prevent these $2 hamburgers that have 2000 calories. So I think we should force these companies to produce healthier foods because the health of the nation is at stake. So I think that education and some regulation of the food industry; I’m not suggesting that the government dictate every single thing to the food industry, but certainly limit the access of these high calorie foods to youngsters. Today in the US, 17% of children under the age of 18 are obese and that is staggering number. Most of these will grow up to be diabetics.
EOO: What about the cost of pharmaceuticals and medical devices? What role do they play in the healthcare landscape?
Mir Imran: Those are really important questions, so let me give you some of the facts about the cost of pharmaceuticals and medical devices, and then we’ll talk about how the system is misused or abused because of liability issues and so on. So medical devices in the US account for about $100 billion in hospital and physician and patient expenditures on the purchase of new medical devices every year. And these medical devices range from pacemakers and MRI machines to bedpans and thermometers and diapers, for that matter. So it is a really big range of devices. From the pharmaceutical side, it’s everything from over-the-counter pharmaceuticals to prescription drugs, and the pharmaceuticals count for about $300 billion. So about $400 billion of $2.5 trillion that we spent last year was spent on medical devices and pharmaceuticals. And I think going forward these two areas aren’t going to increase as rapidly as the rest of the healthcare is increasing. But the abuse happens not so much in the cost of medical devices but in the redundant treatment; for example an MRI might cost $1000 for a single MRI. Redundancy in this test can lead to escalation of costs, and electronic patient records could alleviate some of that problem and it’ll probably amount to about 20% reduction in the overall healthcare expenses if we eliminate redundant testing. That’s about $500 billion dollars as of last year’s dollars and more going into the future. So that’s a big number. The other piece of it is tort reform and it’s harder to estimate the impact of that. I think some of the redundant testing is because of liability concerns and some of it is because of not having access to recently done tests. So electronic medical records will reduce some of the redundant testing and tort reform would reduce further.
EOO: To end our conversation, could you summarize what you believe the Obama Administration and Congress should do? As our nation continues to debate healthcare reform, what are the policies and legislation that we should focus on?
Mir Imran: I think our president has had the right idea in terms of generally providing healthcare to the uninsured, and that can be done by a variety of means, whether it is expansion of the Medicaid system, or expansion of the Medicare system. So that in addition to people over 65, it covers uninsured people, somehow getting those people covered. The second step should be establishment of the national electronic healthcare records. And the third should be, which is probably going to be the hardest because of the attorneys’ lobby is very powerful, is tort reform; and that should be taken up as a separate measure.