Presidential Rx for Health

Past U.S. presidents have provided innovative leadership that shaped the landscape for our national health and science institutions.

President Lincoln established the National Academy of Sciences. President Truman’s foreign policies inspired the creation of the United States Agency for International Development (USAID). President Lyndon Johnson signed legislation that established Medicaid and Medicare. And President Clinton signed legislation that created the State Children’s Health Insurance Program (SCHIP).

Currently, our country faces significant health challenges including skyrocketing health-care costs, declining funding for medical and scientific research, and a lack of effective coordination and innovation in the government’s response to emerging health threats such as obesity and pandemic flu. Addressing these issues must be a top national and foreign policy priority for the next administration. With transformational leadership, President-elect Barack Obama has the opportunity to build upon his predecessors’ legacies and write a new national prescription for improving the health of Americans.

A key component of this presidential prescription is ensuring that all
Americans have access to quality health care. Forty-six million
Americans lack health insurance and, with the economic crisis on Wall
Street and Main Street, 72 million working-age people in the United
States report hardship in paying their medical bills. That’s why an
implementation strategy for the President’s health care plan is
urgently needed including establishing a National Health Insurance
Exchange that will link individuals and businesses to public and
private sector insurance plans that do not discriminate against
pre-existing conditions; provide parity for coverage of mental illness;
prioritize quality, prevention and chronic disease management; and
evaluate health outcomes through comparative effectiveness research.

Furthermore, with 70 percent of the $2.4 trillion U.S. health-care
budget attributable to preventable causes and only between 3 percent
and 5 percent spent on prevention, our president must also emphasize
the power of prevention by providing the leadership, role-modeling, and
necessary funding.

The new administration must also find ways to apply information
technology to improve health (e.g. electronic medical records,
e-prescribing, telemedicine) while protecting the privacy of patients’
health information. Today, only 10 percent to 20 percent of health
professionals and 25 percent of hospitals use an electronic medical
record, while an estimated 195,000 people die and 1.6 million are
injured every year in the United States as a result of preventable
medical errors. Information technology can accelerate access to
lifesaving resources, support evidenced-based care, empower patients,
and improve the quality and efficiency of health care as well as
decrease costs. A "Health e-Commons" government Web site could be
established where consumers and health care providers can find and
share best practices about the diagnosis, treatment and prevention of

In the spirit of participatory health care, this Web site would permit
people to exchange information and submit innovative ideas for
exploration and testing by the government and private sectors.

Another important priority is more effective coordination of federal
health initiatives to address the health challenges and opportunities
ahead. With health programs spanning over 45 different federal
agencies, the next administration and the American people would benefit
from an independent office in the White House – paralleling the Office
of Science and Technology Policy (OSTP) – that would support
presidential health and medicine initiatives, coordinate interagency
health efforts, and build strong partnerships across the public and
private sectors.

Currently, health issues are addressed in OSTP, the National Security
and Economic Councils, and the Domestic Policy Office. A White House
Health Advisor would direct this office. A President’s Health
Innovation Council might also be established with a multidisciplinary
group of senior leaders from academia, the private sector and
nongovernmental organizations to provide insights and breakthrough
recommendations on current and emerging health challenges and to
identify opportunities that will keep America at the forefront of
medical discovery and effective public health response.

Investing in biomedical, behavioral, epidemiological and
health-services research is another essential component. However,
scientific research has been flat-funded in recent years. In fiscal
2008, funding for the National Institutes of Health (NIH) is only $28.6
billion, which, when adjusted for inflation, is 18 percent below 2004

These budget cuts impact the conduct of research, the recruitment and
retention of the next generation of scientists, and threaten America’s
leadership, competitiveness and potential contributions to advancing
health and medicine in the 21st century.

Another element should involve empowering the U.S. surgeon general, the
nation’s top doctor, and expanding the U.S. Commissioned Corps. In the
recent past, years have gone by without a surgeon general in place.
Filling this critical job swiftly should be a priority for the next

The U.S. Commissioned Corps – a uniformed health service on duty 24
hours a day to fight international enemies including AIDS, chronic
diseases and bioterrorism – should also be expanded to include a global
division to provide expertise, technical assistance and rapid response
on international health issues. An ROTC mechanism should be considered
for the U.S. Public Health Service to foster recruitment of talented
young people into these "special forces" of public health.

Lastly, investments in global health, which contribute to humanitarian,
economic, and national security interests, can serve as an important
foreign policy tool for the next administration. The President’s
Emergency Plan for AIDS Relief (PEPFAR) has saved millions of lives but
now an evidence-based domestic plan is urgently needed.

However, besides PEPFAR, there is only minimal focus on global health
within the U.S. Department of State, where health matters are largely
concentrated in the Bureau of Oceans and International Environmental
and Scientific Affairs. While there is a science adviser to the
secretary of state, there is no equivalent post for health. Given the
importance of health diplomacy to our nation’s foreign policy, our new
president should consider establishing an assistant secretary of health
with an ambassadorial rank to serve as America’s health diplomat.

The next administration should also streamline and better integrate
funding mechanisms for global health programs that currently span many
federal agencies while coordinating and consolidating many of the
foreign health assistance programs into a restructured USAID.

By addressing these issues as well as ensuring that key federal health
positions are quickly filled with visionary, innovative and experienced
leaders, our new president could write a transformative prescription to
heal our country’s sick health-care system, helping to ensure a
healthier future for people in America and around the world.

Susan Blumenthal, M.D., former U.S. assistant surgeon general, is
director of the Health and Medicine Program at the Center for the Study
of the Presidency (CSP) in Washington, D.C. and a clinical professor at
Georgetown School of Medicine. Yi-An Ko, a recent graduate of Harvard
University, was a Health Policy Fellow at the CSP. This piece first appeared in the Washington Times.

4 replies »

  1. A great breakdown of the policy issue…who owns health policy? This debate is constantly confusing ‘access to care’ with ‘ability to pay for care’. The answer is to follow the money trail, as healthcare costs skyrocket, where is that money going? Why is it not being routed to care and research?