St. Luke's Episcopal Health Charities marked its 15th year of serving underserved communities in the Houston area with a Crystal Celebration at the Hilton Americas-Houston ballroom on Thursday night, featuring a keynote address by Dr. Sanjay Gupta, a renowned neurosurgeon and the Emmy award-winning chief medical correspondent for CNN.
"They call [Gupta] the world's doctor," said Dr. Patricia Bray, executive director of St. Luke's Episcopal Health Charities. "He has the capability to blend medicine with public health, and that's something you don't find very often."
That approach aligns with the organization's broad definition of health, which encompasses a spiritual and mental focus, as well as primary care.
CultureMap sat down for a one-on-one with Gupta to discuss the future of medicine and the health care system, but we couldn't resist a quick question about working with Anderson "Silver Fox" Cooper.
"We bond over storms and wars," laughed Gupta, who considers the noted journalist one of his best friends.
CultureMap: A big factor in this month's election was whether President Barack Obama's Affordable Care Act would stand. Can you explain what we should expect from here, now that its fate has been sealed?
Dr. Sanjay Gupta: For people who have health insurance right now, and had it before the Affordable Care Act, I don't know how much of a change they're really going to notice. Some large companies might see an increase in premiums to some degree, you might see some change in benefits or a reallocation of benefits, but I think that companies are sort of handling a lot of that on their own.
"From a broad standpoint, this city, for example, does a lot of amazing things with regard to medical development. . . I don't think that they would like to come up with a new way to treat a cancer and only have five percent of the people have access to it."
For the people who have been uninsured, either because of a preexisting disease or because they couldn't afford it, they will see, I think, more changes. They'll either be able to buy heath insurance at the same price as anyone else who is their age and has their background in the community, or they'll get some sort of subsidy, depending upon what their income is.
There are also a lot of people out there, I find, who have health insurance but who also have an illness — like, lupus, for example, or an auto immune disease — and if you're moving from state to state . . . it can be hard to get health insurance again if you have that preexisting condition.
So I think that those people will also notice — it will be easier for them to be mobile.
The big question mark right now is that so much of getting more people insured is sort of dependent upon the states, and whether or not states decide that they're going to go ahead and expand Medicaid to get more people into the system. The deadline [has been pushed back to Dec. 14 from Nov. 16] and I think that a lot of states are still weighing their options — I think that they were waiting until after the election. . .
If they don't do it, the federal government will do it for them for a period of time, but I think that's a little bit of a question mark right now.
CM: The legislation has its supporters and critics. Do you see any weak points, or places for improvement?
SG: It's not universal health care, and it's not government-run, so I think that those are the two things that you have to establish at the beginning, because whenever people have the discussion they say "this is a government-run healthcare plan." It's not. This is in fact probably more insurance regulation than it is health care reform.
From a broad standpoint, this city, for example, does a lot of amazing things with regard to medical development. But if people don't have access to those things, I don't think that's what the people who create these things or think these things up want. I don't think that they would like to come up with a new way to treat a cancer and only have five percent of the people have access to it.
So I think that the fact that more people will have access to health care insurance is a good thing overall. How exactly we get there, how it moves forward — because, again, it's not universal health care — what happens if the states don't sign on. . . I don't know, those are tough questions, and I think that this plan is by no means perfect, but there hasn't been any meaningful health care reform in the country since 1965, when we established federal entitlements.
CM: The heads of Texas medical universities met for a conference last month to discuss the future of health care in Texas, which seems dire if we don't make meaningful change on the local and state level. What are the biggest challenges facing the United States health care system in general?
SG: I think the biggest challenge is cost. The most consistent criticism of the Affordable Care Act, at the federal level but also for the impact on the states, is that it costs a lot of money. And it's not secret that we don't have a lot of money right now. The economy is what it is, and every state has been affected by that, so suddenly having an additional cost upon people is going to be really tough.
I don't know how much of a concern it is for the average consumer who is healthy and has had health care insurance, which is the vast majority of people. This issue does not become a campaign issue, in part because most people say "That's not my issue. If I'm not on Medicare, and I'm not sick, and I'm able to get my health care insurance through my job, I haven't thought about this."
"With medicine, we love to be able to do something and immediately be able to see a response. With public health, you're basically saying, 'Look, if you do this, you'll see nothing.' "
But health care costs continue to go up, and part of that is because we treat people after they are already sick. We don't focus as much on prevention. Innovation costs money, which I'm a big proponent of, and costs have to come in line at some point.
To be fair, nowhere in the world have they been particularly great at reducing or controlling costs. Every country has the same discussion because health care is just an expensive thing. But I think that, in order to do what the Affordable Care Act set out to do, costs have to be addressed at some point.
CM: This ties in with the mission of St. Luke's Episcopal Health Charities, which focuses on public health as much as medicine. That's something that you're a proponent of — what is the importance of that approach?
SG: We're used to taking care of patients one at a time in medicine . . . But when you talk about broad swaths of the population, and everything from infectious disease to the obesity epidemic, we know that some much cheaper — and probably far more affective — things can make a huge impact on the public health of large communities, states, even the whole country.
It's tough. With medicine, we love to be able to do something and immediately be able to see a response. With public health, you're basically saying, "Look, if you do this, you'll see nothing," and it's very hard to prove a negative. If you eat right, if you exercise, if you take care of yourself, nothing will happen to you — nothing bad is the point, and that's just a much harder thing, psychologically and philosophically, to get into people's minds. That's why public health is hard.
I think that we have to do it. Whether it's going to be through compelling people within government or compelling people within the medical establishment, or just citizens who say, "This is enough, we can't continue to eat ourselves to death, take so many medicines, have so many procedures, do all of these things." Whatever it is, I think eventually that tide has to turn.
SG: One of the things I'm working on right now though ties into this, a documentary that's airing this Sunday about prescription drug overdose deaths . . . I started working on [Deadly Dose] when I got a call from the former president, President Clinton, about the fact that he had two friends who had both died of prescription drug overdoses, accidental deaths.
As you dig into it you learn that someone dies every 19 minutes in this country in this manner. You also come to learn that 80 percent of the world's pain pills are consumed in the United States. We prescribe enough pain pills each year to give every man, woman and child a dose every four hours for three weeks.
It's just a little microcosm of health care overall. We over-treat, we over-medicate, we over-prescribe, we perform too many procedures, and we see the consequences of those things. The United States health care system is one of the best in the world, but we've got to make sure that, just because we can do things doesn't mean we should, and we've also got to make sure that people who don't have access to some of the great things that we can provide can get it.