David L. Callender, M.D., President of the University of Texas Medical Branch at Galveston (Credit: Nick de la Torre)
David L. Callender, M.D., President of the University of Texas Medical Branch at Galveston (Credit: Nick de la Torre)
Arthur
Arthur "Tim" Garson, M.D., Director of the Health Policy Institute at the Texas Medical Center
George V. Masi, President and CEO for Harris Health System
George V. Masi, President and CEO for Harris Health System
Lois M. Ramondetta, M.D., Professor in the Department of Gynecologic Oncology and Reproductive Medicine at The University of Texas MD Anderson Cancer Center; Chief of the Division of Gynecologic Oncology at Lyndon B. Johnson General Hospital, Harris Health System (Credit: Nick de la Torre)
Lois M. Ramondetta, M.D., Professor in the Department of Gynecologic Oncology and Reproductive Medicine at The University of Texas MD Anderson Cancer Center; Chief of the Division of Gynecologic Oncology at Lyndon B. Johnson General Hospital, Harris Health System (Credit: Nick de la Torre)
Peggy Smith, Ph.D., Director of the Teen Health Clinic and Professor of Obstetrics and Gynecology at Baylor College of Medicine (Credit: Scott Dalton)
Peggy Smith, Ph.D., Director of the Teen Health Clinic and Professor of Obstetrics and Gynecology at Baylor College of Medicine (Credit: Scott Dalton)
Ronald A. DePinho, M.D., President of the University of Texas MD Anderson Cancer Center (Credit: Nick de la Torre)
Ronald A. DePinho, M.D., President of the University of Texas MD Anderson Cancer Center (Credit: Nick de la Torre)
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The TMC’s Health Care To-Do List for the Next U.S. President

The TMC’s Health Care To-Do List for the Next U.S. President

14 Minute Read

Everything gets politicized during campaign season. But health care has been in the hot seat since 2010, when President Obama signed into law the Patient Protection and Affordable Care Act, also known as ObamaCare.

At the Texas Medical Center, the triumphs and challenges of health care in America are present all day, every day, to patients, researchers and health professionals. In this election month, Pulse posed one question to several members of the TMC community:

If you could direct the future leaders of the country to fix one major problem in health care, what would it be?

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DAVID L. CALLENDER, M.D.
President of The University of Texas Medical Branch at Galveston

“From my perspective, the biggest problem is equitable access to health care. We know today that a patient’s environment and their socioeconomic status has a huge impact on health. We don’t exactly understand why, but there’s some great research to help
us understand how the environment interacts with our genetic code and our behavior. I’d love to see our state think more about that, and work with the federal government, CMS [Centers for Medicare & Medicaid Services] in particular, to explore how we could more broadly engage those populations that don’t have great access to care. Perhaps we just approach it as a set of projects—something to improve access and test what we’re doing. Some patients are so economically and financially challenged they can’t even get to a treatment site. Maybe we need to think about how to get to them. Everybody has a cell phone. Can we use technology more effectively?”

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RONALD A. DePINHO, M.D.
President of The University of Texas MD Anderson Cancer Center

“Cancer prevention should be one of the most important public health priorities of the federal government. Up to 50 percent of all cancers could be eliminated by implementing evidence-based initiatives in policy, public and professional education, and services at the community level.

The next president of the United States should consider establishing a significant national effort to address one of the great disease challenges of our time through wide-ranging prevention strategies. Effective programs would address improving the rates of HPV vaccination for boys and girls, keeping tobacco and nicotine products out of the hands of minors, providing smoking cessation treatment for those who wish to quit, educating adults and children about sun safety to prevent skin cancer, and encouraging cancer screening for early detection.

With growing momentum and awareness of the national Cancer Moonshot program, our country has a real opportunity to effectively address the needless suffering experienced by millions of Americans from cancer. The time to act is now to address great health challenges of the nation through disease prevention.”

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REBECCA ESPARZA
Cancer survivor

“I was diagnosed with ovarian cancer in 2001 at age 30. At the time, I had no health insurance because I was self-employed, and when I had left my previous employer I opted not to take COBRA. So, as a freelance marketing consultant, I approached insurance companies about being covered for health insurance and they said, ‘We’ll cover you, but not anything gynecological-related because you’ve had three previous gynecological surgeries in the past three years.’ I decided, why get insurance if the thing I’m going to need insurance for will not be covered? And then, three months later, I was diagnosed with ovarian cancer.

So, I cashed out my savings that I had accrued in the five years I was with my previous employer, and I had my surgery. But I had no way to pay for treatment. So for about six weeks, I went without treatment while I tried to navigate the social services system. I finally figured out that in my hometown, I could get chemotherapy done through the Nueces County Hospital District. They basically saved my life, because there was nobody else who was willing to give me chemo with no health insurance. I had to declare myself indigent. I had to stop working. I had to stop all my freelancing and move in with my parents. And that qualified me as indigent. By the time they started my treatment, the cancer had already spread to my liver and the lining of my stomach; it’s a very aggressive cancer. It took about five cycles of chemotherapy, but by the fall of 2002, I was declared in remission.

Once I healed, I started to become very active in the cancer advocacy world. I’m an advocate for the American Cancer Society Cancer Action Network, called ACS CAN; Livestrong; the Ovarian Cancer National Alliance Research Fund; and various different cancer organizations. Since 2003, I’ve traveled to Capitol Hill at least 25 times to meet with our legislators to let them know that we want to make cancer a national priority. Every time we visit we have a different thing that’s on our agenda, something different that we want to focus on. I’m just not giving up. And they know I’m not giving up. They know that I have cancer as a priority. Because if we don’t speak up, it’s like we don’t even exist.

In my ideal world, everybody would qualify for health care. I had marketplace insurance for about two years, and I was thrilled with it. Thrilled with it. Because I was no longer discriminated against because of my cancer history. There were no more pre-existing condition clauses in health insurance, and I thought it was utopia, basically. Fast forward to last November, and the new marketplace insurance plans come out, and all of a sudden my plan is no longer on the system.

It took a couple of weeks of digging and researching, but come to find out that the insurance companies say that they lost money on marketplace plans, so they were able to find a way to exclude pre-existing conditions. They figured out a way to discriminate against cancer patients in Texas, after all. They took out any marketplace plan that covered MD Anderson. So can you imagine, my heart sank when I figured that out.

I felt betrayed. I felt like an outcast again, like they were discriminating against me again. MD Anderson said their hands were tied, but I hold them accountable, too, because it’s a two-way street. I know it is. They were pointing their fingers at the insurance companies and the insurance companies were pointing their fingers at MD Anderson. Both of them have some culpability here. Long story short, Humana ended up coming up with one plan, off marketplace, that would cover MD Anderson.And it came down to the wire, but I ended up deciding to take that plan, because I never know what the future holds for me.

But there are also blessings in this muddy mess that has been created because of my health. Multiple, multiple blessings. And my surgeons at MD Anderson are part of that blessing, for sure. I feel like I’m getting the best care in the world. And right here in my back yard. It’s a three-and-a-half hour drive from home. Can’t beat that.

The big CEOs of these insurance corporations, I don’t think they really care. The legislators, they care to a certain extent, but if it doesn’t involve them or their family members, if it doesn’t really affect them personally, they feel bad but, you know, I get the, ‘Oh, poor thing, we sympathize with you and we’re on your side and you keep fighting.’ I get the same stuff every year, and I’m thankful that they’re supportive of me, but put your money where your mouth is. Support this legislation. Start being a co-sponsor of some of these bills. Be my champion on the House floor.”

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ARTHUR “TIM” GARSON, M.D.
Director of the Health Policy Institute at the Texas Medical Center

“A disturbingly large number of Americans do not have access to affordable health care. Since health care isn’t affordable, how do you make it affordable?

One way is you actually reduce the cost to the person with health insurance. You come up with some way to pay 100 percent or close to 100 percent to people who have no coverage—as in Medicaid expansion. There are a lot of political issues in Medicaid expansion, but figuring out how to use federal dollars to support people who really can’t afford to buy health care is important. One could figure out how to take those dollars and, instead of putting them into the Medicaid plan, put them into private plans that would cover people who have limited access to health insurance or don’t have enough money.”

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STEPHEN H. LINDER, PH.D.
Director of the Institute for Health Policy and Distinguished Teaching Professor in the Department of Management, Policy and Community Health at UTHealth School of Public Health; Associate Director of the Health Policy Institute at the Texas Medical Center

“There is a tendency to view the health sector as independent of other sectors. But what if we start considering health in relation to other things? For example,
transportation is essential to people’s well-being, adequate housing is essential to people’s well-being. Education also plays a key role in health—not just early childhood education, but education all the way up through adolescence into high school. There’s clearly an adverse effect on people who have a limited education, as it is more difficult for them to get good jobs and function in the economy. So that’s a health issue.

We’re beginning to see that health issues cannot be solved by simply giving people more access to care. If a person doesn’t have a job and the stress is exposing them to lots of chronic illnesses, then simply treating the chronic illness doesn’t remove the cause.

The idea of going upstream and focusing on ways of preventing illness earlier leads us into considering other sectors and the contributions they make to health. It’s a complex web.”

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GEORGE V. MASI
President and CEO for Harris Health System

“This is going to be an extremely pivotal national election. The candidates have stated their positions as they relate to health care benefits and insurability. The Affordable Care Act is at the center of the discussion. Mrs. Clinton has indicated that her direction would be to further expand access to care through the Affordable Care Act. Mr. Trump has stated that, under his leadership, the Affordable Care Act would be repealed and he would take the country in a different direction in terms of health care. Locally and across Texas, the Affordable Care Act has expanded the health care safety net to a large number of people in this community. We have been able to expand access to primary care, dramatically expand access to outpatient mental health care, and decongest our emergency rooms. If the Affordable Care Act were to be repealed, it would be nothing short of catastrophic for Harris Health System.

Harris County taxpayers currently provide about 47 percent of the Harris Health System budget. If the Affordable Care act is repealed, we would be even more reliant on the Harris County taxpayers. Taxpayers are currently in a double-bind because in Texas, our tax- payers are already paying for Medicaid to be expanded with their federal income tax. As a state, we have opted not to expand Medicaid and, because of that, the $6 billion that has been paid by Texas taxpayers and earmarked by the federal government for Medicaid expansion is distributed to other states that have expanded their programs. The double-bind is that Harris County taxpayers are paying twice for health care through the federal government and the local government.”

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KIMBERLY MONDAY, M.D.
President of Harris County Medical Society and member of the Harris Health System Board of Managers

“The biggest issue is the lack of interoperability of electronic medical records. Our system is incredibly fragmented. There’s a federal mandate that encourages doctors to use electronic health records and most of us have complied. But there are different vendors that sell the medical records systems. So you have probably 100 medical records systems and they don’t talk to each other. And there’s no incentive for vendors to be compatible because it’s proprietary.

I can be next door to another physician and I don’t have access to what they’ve done. They don’t have access to what I have done. There are ways around it, but the amount of time it takes to access other platforms is ridiculous. It’s a matter of the hospital or physician and what platform he or she will be on. There are big systems hospitals use, but they are expensive to purchase, so many physicians are on smaller platforms. There’s no single place to get your medical record. As a result, it’s a tremendous amount of work to keep up with your own medical record.”

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LOIS M. RAMONDETTA, M.D.
Professor in the Department of Gynecologic Oncology and Reproductive Medicine at The University of Texas MD Anderson Cancer Center; Chief of the Division of Gynecologic Oncology at Lyndon B. Johnson General Hospital, Harris Health System

“I believe in universal health care. I believe that health care is a human right. I don’t believe people should have so much trouble getting it. People come to the table with different levels of health literacy and navigation ability. It’s a shame that some people have such a hard time getting basic health care.

I am still seeing a ridiculous number of cervical cancer patients in the county with advanced disease. It still blows my mind. I call it the ‘what the @#$%’ cancer because, what happened in our society to end up like this? Did we really fall so far behind in education in elementary school and middle school on how to take care of yourself and forget to mention how to take care of your reproductive organs?

There are a lot of places to get pap smears in the city, but somehow people don’t know that they even need them or don’t make time for them. I have a woman, young, in her 30s, with stage four cervical cancer. To see these patients not only have their quality of life destroyed, but their whole life in general destroyed by something that was preventable by getting a vaccine that’s safe and effective, is so frustrating.

How is it that we have so many difficulties with educating young people about protecting their reproductive organs and their lives? We have such low vaccination rates and such low pap smear rates and death and quality of life affected for no good reason.

I think we could get up to 80 percent vaccination rates for boys and girls. It’s not going to be an immediate fix. It’s going to take 10, 20 years, but at least then we will have less death and destruction from HPV-related cancers.

The two biggest problems in my world are obesity, which is the main cause of endometrial cancer, and HPV, which is the main cause of cervical cancer. That means we start in elementary school with better foods and education about how to take care of yourself throughout school. That is key.

I feel like we have an opportunity to lead the nation in how to solve problems if we could fix one big problem and that is the academic competition between Baylor, MD Anderson, UT and Harris Health. We have this massive population of under-insured patients that are seen in one big Harris Health System, but managed completely by different academic groups.”

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PEGGY SMITH, PH.D.
Director of the Teen Health Clinic and Professor of Obstetrics and Gynecology at Baylor College of Medicine

“I really keep my eye on Austin as opposed to the national stage, because those are the laws that impact me and the work that I do. As a state that has no personal income tax, we are very dependent on two things: property tax to pay the way for certain issues—including health care and education—and the sales tax that generates the revenue for a lot of the programs in the state. If you look at the state budget, there are two important things to remember: first of all, constitutionally and unlike the federal government, we must balance our budget and that can be very easy or it can be very hard, depending on our cash flow. If you look at our budget as a pie, anywhere from 70-80 percent of our revenues are either constitutionally or federally locked in. So we have very little wiggle room in terms of health care.

This year, our revenues from sales tax are down by about a billion dollars. When you factor that in, because of the balanced budget requirement, all programs are going to be affected. We have to see how that will play out.

Texas has opted not to expand Medicaid; that dog will not hunt again in this next election. Maybe the legisla- tors can come up with a way to repackage that sort of approach in a way that is palatable to a conservative House and Senate. It puts more of a burden on places like Ben Taub and some of the other hospitals and programs that serve individuals who require uncompensated care.”

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