Georgia Physician Magazine

Georgia's Newt Gingrich on Healthcare

Among Gingrich's healthcare ideals are a pro-technology and a patient-centric approach.

Ten years ago, then-Georgia Congressman Newt Gingrich crafted a document called the "Contract with America," calling for tax cuts, a balanced budget, increased defense spending, welfare reform and other changes. Today, the former Speaker of the House maintains his own brand of activism, devoting much of his time and attention to the issue of healthcare.

Gingrich is founder of the Center for Health Transformation (www.healthtransformation.net) and, last year, authored "Saving Lives and Saving Money." In October 2004, Gingrich and former Nebraska Democratic Sen. Bob Kerrey were asked by the National Quality Forum - a nonprofit group comprising public and private health organizations, and drug firms - to co-chair the National Commission for Quality Long Term Care, which is purposed to improve the quality of long-term care and to find ways to finance such care for a growing population of aging baby boomers.

Gingrich is a big supporter of Medicare drug benefits. He believes that the federal government should pay for pharmaceuticals that can keep people healthy and productive.

Finally, Gingrich advocates health savings accounts, which would allow individuals to accumulate money tax-free to pay for qualified medical expenses and long-term care insurance. These accounts would give consumers more control over their healthcare and introduce a competitive dynamic that could help bring costs down and quality up.

Cut and dry
Georgia Physician asked the former member of the U.S. House of Representatives (1978 to 1999) and Speaker of the House (1995 to 1999) some straightforward questions about his healthcare ideals. Following is what Gingrich had to say.

Georgia Physician: If you were really, really sick, where would you want to be treated?

Newt Gingrich: It would depend on the sickness. I would want to consult a number of places, and select the "best of breed," that is, the facility with the best outcomes. A firm called HealthShare (Acton, Mass.) puts Medicare outcomes data through an expert system. You can see which hospitals offer the best outcomes. Sometimes those that do are less expensive than those that provide poor care.

The second thing I'd look for is whether the hospital operates an electronic ICU, in which the patient is monitored 24 hours a day by an ICU doctor or nurse. Several healthcare systems have this, including Sutter Health, Sentara and Columbia-Presbyterian. They're saving more than one life per bed, per year, and they're getting people out of the ICU almost a full day earlier than others. It's about avoiding mistakes and instituting better practices.

Another point I'd make - and the Institute of Medicine has written about this - is that a person is 2,000 times more likely to die in a hospital from a mistake than in a civilian airline crash.

And finally, if you have a choice of hospitals in which to receive treatment, go to one that is integrated electronically, such as Mayo Clinic. I have a very simple principle: Paper kills.

GP: In the ideal U.S. healthcare system, describe the responsibilities of the federal government, state governments and the individual in terms of financing and delivering high-quality care. How does that vision differ from today's reality?

Gingrich: The government has a strong regulatory interest in public health. In fact, the government has under-performed in this area. We don't have the same kind of regulatory strength in healthcare as we do in aviation and pharmaceuticals. I'd like to see a stronger government role in setting minimum standards.

Second, the government has to play a role in setting the rules of the game. [Some time ago], automakers were required to publicly post how much their cars cost. As a result, in 1999, 14 percent of car shoppers went online to check out prices before buying a car, and they saved on average 2 percent by doing so. By last year, 64 percent of the country went online to check out car prices. So I start from this premise: We should give the public a system of knowledge so they can go online and learn about healthcare costs and quality before making a decision about where to be treated and by whom. One of our projects - the Right to Know Project - would ensure that this happens.

We should allow interstate purchasing of health insurance, so everyone has access to a marketplace of choices. Our goal should be 100 percent coverage by health insurance. Candidly, for people over a certain income level, we have to mandate this. Half of the increase of the uninsured population is due to people with incomes of more than $50,000. They're calculating that they won't get sick, and that if they do, they won't pay the bill. That's plain wrong.

Humana has it right. If the consumer needs a certain kind of drug, they cover it. Yes, they have incentives for choosing the least expensive one. But they believe that taking properly prescribed pharmaceuticals keeps people out of the hospital. Medium- and small-sized companies with health reimbursement accounts and health savings accounts are averaging a 44 percent reduction in premiums. A smart employer would take that savings and give it employees as a tax-free savings account, which they could use to take care of themselves.

GP: One of the programs cited by the Center for Health Transformation is SilverSneakers in Tempe, Ariz., which encourages older adults to increase their levels of physical activity. Why did you cite this program?

Gingrich: We have to think of our health as having physical, mental and spiritual components. One of the great things about SilverSneakers is that it achieved a 63 percent reduction in depression among women. Why? Because when they're isolated and alone, older people get depressed. We're social animals. SilverSneakers brings them together three times a week. People are exercising and being social. So their mental and spiritual well being is higher. And it turns out that if you're happier, if you're interacting with other people and your energy level is up, you're healthier. What I'm trying to do is re-integrate the complete human into a health-oriented program. We're putting together a diabetes coalition aimed at the same concept.

We need an entirely new approach to the way we compensate healthcare providers. If I want to minimize hospitalization, how will I compensate everybody? There is a project in Americus, Ga., in which doctors get paid to give information prescriptions. Diabetics, for example, are sent to online services such as MEDLINE (a National Library of Medicine database) to learn more about diabetes.

The point is how do you build a system in which you compensate providers for answering e-mails and managing relationships with people before they become patients?

GP: What is the future of managed care in this country?

Gingrich: With rare exceptions, no company I know of has enough information to truly be a managed care company. That said, Kaiser Permanente does approach this quite systematically. They have an integrated health information system, which I believe is the model for the future.

Every individual in America should be part of an integrated information system, including an electronic health record that is routinely scanned by an expert system. We're experiencing an explosion of biological knowledge. We know that specific genes can be precursors to health problems. If we can match an individual's DNA profile with these genes, we can catch medical conditions sooner. If we know that an individual is susceptible to a particular condition, we can recommend that he or she eat particular foods.

If you asked Americans if they would like to be coached in how to live the longest life possible, they would say, "Yes." [Japanese people] live healthy, active lives, an average 10 to 12 years longer than Americans. It's almost entirely a function of activity, attitude and nutrition. My argument is this: I am all for this country getting actively coached on health issues.

Ironically, some of the laws that Congress has passed - such as the Stark Amendments and the Medicare anti-kickback statute - have inhibited the growth of electronic information systems. Doctors don't have the capital to invest in them. So we've under-invested in doctors for reasons that now appear to be anti-technology and just plain wrong. nGP