Summary: At the end of her talk before the National Press Club on April 6, 2010, Health and Human Services Secretary Kathleen Sebelius was popped a question on “acupuncture, meditation and other alternative healing methods.” Sebelius responds positively, if perhaps with some misunderstanding, linking these therapies to consumer choice, to comparative effectiveness research (CER) and to potential cost-savings. Here are Sebelius’ comments, plus some additional comments on CER and alternative medicine from former Democratic Nationla Committee chair Howard Dean, MD as reported in Elsevier’s In Vivo blog for the pharmaceutical industry. Those who want Sebelius’ whole speech, it’s here. Take a look.
HHS Secretary Kathleen Sebelius spoke on health care issues before the National Press Club on April 6, 2010. She fielded questions afterward. One pertained to her personal views about alternative health care. Here are here comments, plus some analysis and comments from Democratic National Committee chair Howard Dean, MD, that were sparked by Sebelius’ remarks.
QUESTION: “What is your own view of of using acupuncture,
meditation, and other alternative healing methods in health
SEBELIUS: “There clearly are plans in place
— and I anticipate there will be plans offered in the new
exchanges — which will give patients a wide variety of choices.
“And I think that, while there’s likely to be a definition of
what is a preventive care plan, insurers are likely to compete
based on choices for
“And, you know, there is some pretty interesting data about cost
effectiveness that we will continue to monitor. I think our
comparative effectiveness research will continue to look at a
variety of alternatives for expensive care, whether or not
earlier interventions or more homeopathic therapies or a variety of
choices are ones that really do lead to better health
outcomes at a lower cost, and I think those are often consumer
choices and also wise health care choices.”From a transcript purchased April 22, 2010 from Highbeam Research._________________________________________
Comment: I thank Nancy Gahles, DC, CCH, president of the National Center for Homeopathy, for sending me the link. Since we have but these few utterances – I am not aware of any other public comments by the Secretary on this topic – let us treat them as the words from on high that they are, and
parse them out.
First, there appears to be some misunderstanding on the Secretary’s part. Her use of “more homeopathic therapies” suggests that she could stand a bit of education on the categorizations of non-conventional treatments. One wouldn’t typically classify acupuncture and meditation, the only other therapies directly mentioned by the questioner, as “more homeopathic,” although one might, in a pinch, make the case.
Not to quibble: Sebelius’ views are a positive spin on the apparently relatively unknown for her. They are reminiscent of Obama’s own comments on acupuncture and other alternative approaches while campaigning in 2008 just across the border from Sebelius’ home state of Kansas. She touches on similar points.
Sebelius links alternative healing practices with both patient choice and preventive care. While this may seem like a no-brainer, this is quite a positive view for aging codgers in this field who recall that 20 years ago the terms coming from various federal agencies might have been “quackery” and “fraud.” And there are anti-CAM people today who will likely still deride the Secretary for this positive spin.
Sebelius then moves from prevention toward cost-effectiveness. Her connection of alternative healing approaches with the Obama administration’s comparative effectiveness research (CER) initiative is well-informed. The Institute of Medicine included complementary and alternative medicine on the list of likely targets for CER. (See CAM listed in reports from Obama team and IOM as possible areas for CER.) Josephine Briggs, MD, director of the NIH National Center for Complementary and Alternative Medicine is on a small NIH-wide committee on CER.
The tenor of Sebelius’ comments is dismissed on the In Vivo Blog for Biopharmaceutical Industry Intelligence and Analysis, published by Elsevier. In a posting entitled “Comparative Effectiveness Research and Alternative medicine: Bring It On,” the writer states:
“… don’t let Sebelius’ astute political sensibility cloud the issue too
much: politicians have learned that you don’t get very far by
questioning the value of alternative medicine as a whole.”
The blogger makes a couple of concessions:
“Now [Sebelius charge to apply CER to alternatives] may sound pretty ominous. There is no doubt that plenty of
alternative medicines are ‘less expensive’ than, say, Avastin.
And it is certainly possible that a federal center could conclude that
acupuncture is in fact more effective than opioids for some forms of
chronic back pain, or something like that.”
But the basic perspective: When all is
researched and compared, pharma will come
out looking pretty good.
Howard Dean’s views
The blogger then notes that the day after Sebelius’ talk, former Vermont Governor and former Democratic National Committee chair Howard Dean, MD, was queried about her comments. Dean volunteered some of his own perspectives on alternative medicine. After blasting two chiropractors opposed to vaccination who Dean had encountered as governor, Dean reportedly went on as follows:
“I do think that what is good for the goose is good for the gander,”
Dean said. He praised the approach taken by Senate Health Committee
Chairman Tom Harkin (D-Iowa), who is an advocate for alternative
medicine but who sponsored legislation mandating “a fundamental study of
alternative medicines with the view that they wanted to cover
alternative medicines if they worked, but if they didn’t then they
shouldn’t have to cover them.”
“We need to hold alternative
health care to the same standards that we hold ‘regular’ medicine or
whatever you call us,” Dean said.
Alternative therapies shouldn’t
be dismissed just because “we don’t know why they work. We have to be
more open minded. Just because we don’t know why something works,
doesn’t mean we shouldn’t let people use it.”
“But I don’t think
you ought to be able to advertise stuff that is hocus pocus. Whether it
is the medical stuff that is hocus pocus or the alternative stuff that
is hocus pocus. There ought to be some standard that applies to
Sebelius seems to think that there is some evidence out there that suggests alternatives will come up looking good in this emerging competition. The voice of Big Pharma at In Vivo thinks little is at risk. Probably depends, like so much research, on the framing of the questions. Not a moment to soon, the
quickly influential Institute for Integrative Health,
founded in mid 2009, is at this moment managing an online conversation among an
international group of integrative care researchers on the best methods
for CER relative to integrative practices.
Therapies take your mark. Get set. Now how do we judge who has won?
Send your comments to
for inclusion in a future Integrator.
Full Transcript of the Sibelius Talk
with section bolded
SECRETARY OF HEALTH
AND HUMAN SERVICES KATHLEEN SEBELIUS
REMARKS AT THE NATIONAL PRESS CLUB
ON HEALTH CARE
APRIL 6, 2010
SPEAKER: KATHLEEN SEBELIUS, SECRETARY OF
HEALTH AND HUMAN SERVICES
[*] SEBELIUS: Well, thank you very much, Alan. It’s my
great pleasure to be here. I understand that this date had a bit ofthe bill passed, and
so it’s been rescheduled just a few times, but glad to have theof you.
And I have to applaud you to — for having a Kansan as your
president. I like Kansans who run things. So it’s good to see Alan
again. And, yes…
But pleased to have a chance to visit with all of you. You
know, when the conversation about reforming our health
insurance system began nearly a year ago, there was some pundits who
thought the days of America solving big problems were
actually over. They wondered whether transformative legislation like
Social Security or Medicare was a part of a bygone era, like soda
fountains and five-cent matinees.
But last month, I think those pundits got a definitive answer.
After decades of asking, when are we going to fix our broken health
insurance system, we finally have an answer, which is starting right
controversy. I promised to come as soon as
chance to visit with all The law that President Obama has signed will give Americans
more control of their health care. The
mom who worries that she’ll have to skip her next round of
chemotherapy because her insurance policy puts a lifetime cap on
her benefits can stop worrying. This law makes those caps and other
unfair insurance practices illegal.
factory worker who up until now puts off retirement
because he knows his diabetes makes it impossible for him to get health
care coverage as an individual on the open market
can have some peace. This law will end insurance practices that allow
insurance companies to discriminate based on pre-existing
entrepreneur who’s been afraid that she wants to buy
insurance but can’t find an affordable policy will finally get some
relief. This law will create a new consumer-friendly health
marketplace where she can band together with other consumers to
negotiate lower rates just like Fortune 500 companies do.
And the parents, like me, who believe that we need to reduce
our long-term debt so our children will have the same
opportunities we had to feel confident knowing this law just doesn’t pay
for itself, it actually reduces the deficit by more than $100
billion over the first 10 years and over $1 trillion over the
next 10 years.
Now, I want to be clear: The Affordable Health
Care Act is not a magic formula that will cure all the
problems in the healththe benefits to kick in. And if you look at history of
major social legislation, like Medicare, you’ll see that there are
always revisions and adjustments along the way.
But this law, in and of itself, is the biggest
expansion in health care coverage since Medicare, the
biggest middle-class tax cut for health care in
American history, the most aggressive cost-cutting law in health
care that we’ve ever had, and the most ambitious health
care innovation legislation that we’ve ever seen passed, all
rolled into one. I’m convinced that the more Americans learn
about this legislation, the more they’ll like it, but our work
didn’t end when President Obama put down his pen. In some ways, it has
We have a great framework. Now we have to carry it out
effectively. And to do that, we need to do several things at the
same time. We need to communicate clearly with the American
Many of our friends and neighbors still have questions about
what’s in the law, and it’s understandable. Given the
complexity ofthe health care system,
which makes up over a sixth of our economy, it would be
surprising if people didn’t have some questions about what happens. And
it didn’t really help that they were bombarded by nearly $200 million of
ads over the last year, many of which were intentionally
So for these Americans, our department needs to serve as a
nationwide health insurance reform help desk. If they
have questions, we’ll have to have the answers. If people aren’t
sure what to believe, we’ll have to have the facts.
And we know the only way the law will reach its full
potential is if Americans understand and take advantage of the
new benefits and choices that are actually going to be available to
So here are some of the facts. If you like your
doctor, you keep your doctor. If you like your health
plan, you keep your health plan. The law builds on
the health insurance system that we have and makes
three key changes.
First, it makes sure that every American who has an insurance
policy gets some real security by creating a series of
Second, it makes insurance more affordable for millions of
Americans by creating a new insurance marketplace called exchanges and
by providing tax credits for those who need additional financial help.
And, third, it starts to bring down costs for families, businesses
and governments with the broadest health care
cost-cutting package ever, one that includes every serious idea for health
savings that was proposed over the last year of debate.
And that’s the basic outline.
Now, one way to carry out the law would be to make all the
changes immediately, but that is likely to totally overwhelm our health
care system, and it wouldn’t give us enough time, for example,
to work with states to design a new functional health
And since the president’s goal from the outset was to
strengthen the current health insurance system for
all Americans without disrupting it, we took a different approach. The
law implements reforms quickly, but not all at once. Instead,
they’ll fit together like puzzle pieces, one neatly fitting into the
We know we had to give some immediate relief to millions of
Americans struggling with the current health care
system. So for many of them, there really is help right away.
For example, starting on June 15th of this year,
seniors who have hit the donut hole, the prescription drug
gap, will get a $250 rebate check sometime between now and the
end of the year to help them afford their medicines this
year. There’s a new tax credit available in 2010 to help small-business
owners, like the man who wrote me and said, “As a small-business
owner, I’m near the breaking point. With guaranteed annual
increases 10 to 15 times inflation, eventually I’ll go out of
business or be forced to cancel insurance altogether.”
system. It takes time for
commonsense rules that require insurance companies to treat you fairly.
marketplace. At the same time, we’re adding new protections that
make insurance stronger for Americans who already have it. The
new rule ends lifetime caps on benefits, and that takes effect
this year. So does a rule preventing insurance companies from canceling
your coverage when you get sick, which happens to people each and every
new health reform law also makes it easier
for Americans to get insurance. Right now, it’s totally legal for
insurance companies to refuse to cover children who have a pre-existing
condition. In other words, we have an insurance system right now that
often excludes young people, sick kids, who need it the most.
Starting this fall, that practice is outlawed. Their benefits will have
to be covered, and the children themselves will have to be
covered on policies.
We also are creating a high-risk temporary pool program that’s
available to adults who are currently shut out of insurance
because of their pre-existing condition.
And young adults who need coverage will be able to stay on
their parents’ insurance until they’re 26. All of that happens
During the early years of implementation, we’ll be
working with providers across the country to turn Medicare into a
quality-driven, high-value health care purchaser.
When seniors walk into the hospital or the doctor’s
office, they should get the best care possible each and
And we run the world’s largest health
insurance program, so Medicare has a lot of clout when it leads
by example. History has shown that if Medicare can find smarter ways to
pay for care, other insurers will copy them, and we’ll all get
Under the new law, Americans will start getting more control
over their health care this year. By this fall,
it’ll be easier for seniors to get medicines, easier for families and
young adults to get coverage, easier for small businesses to cover their
workers, and every American who has health insurance will
have more security.
Now, if you have questions about what happens this year or want to
see the whole list of first-year benefits, I encourage you
to visit our Web site early and often, healthreform.gov.
What’s going to make these 2010 reforms even more effective is that
they really build on some significant improvements that were
made to the health care system in 2009.
It’s part of this story that a lot of people have already
For example, one of the first bills that President
Obama signed into law was the CHIP reauthorization act. And by the
end ofthe CHIP program and in Medicaid. We have
5 million more we think are eligible and not yet enrolled, so that’s a
major effort underway.
Then, with the passage of the Recovery Act,
again early in 2009, which was primarily a job-creation bill, but also
one of thehealth innovation bills
in American history. Under the Recovery Act, we funded proven
local health and wellness strategies to help give families
more health choices in their neighborhoods, expanded —
almost doubled community healthcare to 19 million Americans a
year, invested in the National Healththe primary care workforce,
especially in underserved areas, and made an historic investment in health
information technology, which helps patients fill out fewer forms and
helps providers deliver better care.
I saw an example of that kind of improved care
in 21st century health delivery yesterday when I was in
Cincinnati and visited Children’s Hospital. They have a very innovative
technology system throughout the hospital dealing with some of
the sickest kids not only in the Ohio region, but they
gather children who come there from across the country and from
international sources, because they are renowned for doing some very
I visited the neonative intensive care unit, and part
of why they’re having such success is their use of
electronic healthof hospitals would love to replicate, and they do it with an
automated check list that appears at every incubator, at
every crib, reminding providers of the various steps that
have to be taken to keep the hospital setting as safe and secure
as possible. So our goal is to spread these outcomes across the
Today, I’m happy to announce the last round of our health
information technology grants, which help create 60 health
I.T. extension centers around the country. Think of
these centers like Apple Geniuses for health I.T. So if a
small provider group or if a doctor’s office wants to switch to
electronic records, they’ll have a health extension center
close at hand, boots on thethe expert advice and
technical assistance they need to get that system up and running.
So those building blocks of 2009 are now the template
that the new reform is added to in 2010, and we end up beginning
to see the health care system where it’s
easier to get coverage, easier to afford care, easier to find a
doctor, to make healthy choices, to access your own health
information, a health care system where Americans
are going to get a lot more health for the
investment we’re currently spending.
last year, we had already enrolled 2.5 million previously
uninsured children in biggest centers, which currently
provide high- quality primary
Service Corps to strengthen records. They have had 1,000 days in
this hospital without any safety incidents, which is a record that a lot
ground to help them
implement these new strategies, getting The changes also create the foundation for 2014, when
some of the major features of the new law
kick in. That’s when thehealth insurance
exchanges become operational and tax credits become available for
individuals and families to help buy insurance coverage.
This is a huge breakthrough for health care
consumers, some of whom don’t have coverage at all, some of
whom are desperately underinsured.
For the first time, the question so many people write
to me — “Where can I find affordable insurance?” — will have an
easier answer for every person in America. Instead of having to
visit dozens of different Web sites and try to shop in a market on
your own, there will be a one-stop shop where the benefits for
different plans will be clearly listed and costs will be able to be
compared. That’s part of the new law.
And as America’s help desk (ph), we want to make sure every
American knows about the benefits and choices that come out ofthe next several months, we’ll be reaching out
directly to Americans across the country to make sure they know
how to take advantage of the benefits in the new
We’ve already begun to educate seniors about prescription drug
assistance. We’ve put out a series of fact sheets that explain
step by step to small-business owners how they can collect their health
care tax credits this year.
And soon we’ll have similar fact sheets for employers who want to
take advantage of a new reinsurance program that also hits this
year that will help them provide coverage for early retirees.
Again, bookmarking the Web site healthreform.gov will give
regular updates on these reforms as they’re implemented and put
in place. You can go there to read the fact sheets, to get
questions answered, and watch weekly Web chats, where we’ll take
questions live from around the country.
We’re also working with a lot of the stakeholder
groups to broadcast information about the bill more widely. And
we realize that a number of the populations we need to
reach may not be so tech-savvy, so we’re going to be reaching out
through partnerships and collaborations.
For years, Americans have struggled with a health
insurance system that was opaque, unnecessarily confusing, and often
overwhelming to navigate. Our goal, as we implement this law, is to be the
opposite of that, to be as clear and transparent as possible. As
soon as we know something, we’re going to tell you.
But ultimately, we recognize that actions do speak louder than
words. And no matter how good a job we do educating Americans about the
benefits for them in the bill, it won’t be much use unless we
also implement those policies responsibly and effectively. And the
president has already said to me many times we need to get this right.
it. So over The letters I get every day make it clear we have no time to
waste. So in the week since the president signed this
historic legislation into law, we’ve already started acting. We’re
restructuring the Centers for Medicare and Medicaid Services
so it’s better prepared to take on the new
responsibilities under health insurance reform.
Last Friday, we began working with states — some of my
former colleagues as governors — to create high-risk pools that will
help uninsured Americans with pre-existing conditions that they need to
Now, today, we’re sending new guidance to Medicare Advantage plans
which include stronger cost-sharing protections for all seniors.
And later this week, we’ll open new Medicaid options to cover
Unfortunately, some of the scam artists are moving
just as quickly. We’ve already heard reports from at least a
the new law and setting up 1-800 numbers, going door to door in
senior centers, trying to sell fraudulent insurance. It’s the
kind of criminal activity which preys on Americans who are
the most vulnerable in our health care
system, and it’s totally outrageous.
It’s why I sent a letter today to my former colleagues, state
insurance commissioners, and to our country’s attorneys general asking
them to investigate and prosecute these kinds of scams and also
to put seniors particularly on notice that Medicare sales aren’t
conducted door to door on a usual basis.
states to report crooks trying already to capitalize The kind of communication and collaboration will be a
key to making the law work for every American. Over the
next few years, we’ll be working with providers, employers, consumers,
and seniors to get the law right.
Many of the reforms are really carried out at the
state level. Now, I did serve for eight years as an insurance
commissioner, and I know how tough and effective state regulators can
be. And it’s why the states are presumed to have the
responsibility to oversee the development of insurance
exchanges, to provide the regulatory oversight, and the
law provides resources and assistance to states, but
when it comes to the specifics, we assume that the people on
thethe job best.
I’ve also served as governor, and I understand the kinds of
budget challenges that states across the country are facing.
And what I’ve said over and over again is that this bill actually is an
incredibly state-friendly bill.
There’s no question that as the market begins to expand in
2014, a part of the law makes that health care
coverage a partnership between the states and federal
governments. But for the three years following 2014, the
federal government picks up 100 percent of the bill. And
after that, states start paying a share, which rises to the top
total of 10 percent by 2020.
So there are some new costs in insurance expansion borne by the
state, but I would argue that those costs are far balanced by new
benefits to states, including less spending on uncompensated care,
which states spend on each and every day, savings from reduced
insurance paperwork, more resources from the federal government
to cover children in every state, more money back from drug clawback,
more money to crack down on fraud and abuse. And that doesn’t
even count the people who get better care, live healthier
lives, and end up as more productive workers.
So as a former governor, I can say unequivocally, if my state had
been offered this deal during my seven years as governor, I would have
taken it in a heartbeat.
At HHS, we intend to work closely with the states as the
lead federal department for implementing the bill. So in
closing today, I want to share just a couple of the
operating principles for making sure the full benefits of
this law reach all the American people.
First, we will be transparent. And that just doesn’t mean sharing
what we know. It also means making it as convenient as possible for
American people to access that information.
Today, just for example, we’re announcing the
first-time-ever release of Medicare data, something we’re calling
our Medicare Dashboard. This is an online tool that will make it much
easier for Americans to search and sort aggregate Medicare data with
full protections of patient privacy.
We’re launching today Medicare’s inpatient hospital data, where
you’ll be able to sort by state, by condition, and by hospital, making
price comparisons for the first time ever. But it’s just the
first step of many we’ll be giving consumers and purchasers and
providers the health information they need to make
Secondly, we believe we have to make every dollar count.
Eliminating waste and fraud in our health care
system is a key part of the law. It’s also a principle
we’re going to apply to every step of implementation. And one of
the ways we intend to save money is depending heavily on
people and systems that are already in place, not starting with the
assumption that we have to build a new bureaucracy.
Our department has incredible talent, great resources, and
expertise in the health care system. So as
we move forward, we rely on our existing resources as much as
possible to fulfill our new responsibilities under the law.
Third and most important, we don’t ever want to lose sight of
why we pursued this legislation in the first place, fought so
hard for it, and are celebrating it as an historic accomplishment.
Over the last year, I’ve read letter after letter from
families and small-business owners who feel totally powerless in the
existing health insurance system we have. Their premiums
continue to go up, sometimes by 30 percent, 40 percent or 50 percent a
year, and they don’t understand why.
They’d argue with their insurance company, but they’re afraid their
coverage will get canceled or they’ll be penalized. They’d switch to
another plan, but they don’t have any choices or options. And sometimes
with pre-existing conditions, they absolutely know they can’t get
Even Americans who have good insurance through their jobs worry
about next month or next year, worry about their kids, worry about their
families. They seem more and more of their paychecks being
eaten up by rising premiums every year, and they know how quickly the
partial security they have could disappear if they lost their job or
switch jobs or retired.
So our goal is to put these Americans back in charge of
their own health care, providing information and
education if it’s needed, setting basic guidelines that will help foster
a competitive insurance market, serving as an umpire to make sure
insurance companies treat all Americans fairly, and providing targeted
resources to help empower consumers.
But, ultimately, this isn’t about us. It’s about the
American people. It’s about giving Americans more choices, more
security, more control.
And there will be bumps along the way. There are going to
be some twists and turns. It won’t be easy. But after decades of
So, again, I’m pleased to be with you and would be happy to take
your questions if you have some questions for me. Thank you.
MODERATOR: And thank you for your address, Secretary.
First of all, I want to apologize in advance if I refer to
you ever as “governor,” as I asked you governor questions so many times
during my years at the Wichita Eagle, and understanding the
Kansas identification. We’re all proud of the great
state ofthe national
championship last night, just for the record, and I’m sure your
family in Ohio and my family in Minnesota were also following the
fate of Kansas very closely, as well.
standing still, we are finally moving forward. Kansas, which should have been playing for SEBELIUS: That’s right.
MODERATOR: So leading into this, your experience as a governor of
the state of Kansas, and your first statement that you
would have jumped at this opportunity had you been governor of
the state when this plan came through, several governors in
several states haven’t jumped at this opportunity. In fact, they
are suing the government, trying to stop this plan.
Kansas is not one of them, but several states are. And with
them gearing up for a big legal battle, why do you think this happened?
And do you fear that these lawsuits could slow the progress of
: Well, I think that the vast majority of
lawsuits have been filed by attorneys general in states where they have
also some interest in higher office.
And in consultation with our legal team and their consultation with
the Justice Department — first of all, we are confident
that theon solid constitutional ground, on
firm grounds. I’m going to let the lawyers go debate the
I think our job, really, is to focus on talking to the
American people about what really is in the bill, how the
law will work to their benefit, what’s available for them, and that’s
really where we’re going to spend our time and energy.
But we’re confident that the legal standing of the
law is solid and that this has more to do with politics than with
MODERATOR: And at the same time there were
challenges often coming from the conservative side of the
spectrum, you also have people, often, on the more left
hand of the spectrum saying, well, this plan is the
start, but it could go further directions.
And I’m wondering to what extent you would characterize this health
care reform plan as a start and if there are maybe additional
steps in health care reform that should be taken
once this becomes implemented?
SEBELIUS: Well, I think there’s no question there was a
wide spectrum at the beginning of the
debate. Certainly, people who felt what would be advisable in the
United States was scrap the current sort of third-party
insurance system and start again, have a single- payer system mirroring
what a lot of other developed countries have, others who said
what we really need to do is have a total market-based strategy, take the
rules off insurers, get rid of the barriers that
currently prevent them from operating in a creative way, and the
market strategies will really solve the situation we’re in.
I think the president and Congress chose what is a
middle-ground approach, a kind of commonsense approach, not
dismantling the market for the 180 million Americans who
currently have employer-based health insurance that works
pretty well and they like it, and not dismantling the insurance
rules, but figuring a strategy that builds on the current
system, made it stronger, and also opened up the private market,
creating new marketplaces for the 30 million Americans who don’t
have coverage currently.
I am sure over time this law will be revisited. You know, my dad
was in Congress in 1965 when Medicare was passed. He served on the
Energy and Commerce Committee. Medicare has changed a number of
times in the 45 years that it has been in place. I would
suggest we wouldn’t recognize what the law looked like.
But the template of saying, once you reach 65 or once
you are severely disabled in this country, you should have guaranteed health
care is a principle that has been under constant improvement. I
think the principle of saying all Americans should have
affordable, available health care is one that we
will continue to work on, but is a significant step from any
place we’ve ever been before in the United States.
What concerns do you have that the insurance industry will evade,
rather than comply with the law, looking for loopholes? And what
steps will HHS take if this happens?
: Well, I think that there is a — a principle that
has been in place in health insurance for a number of
years which isn’t terribly complicated. It is a whole lot cheaper to
insure people who promise not to get sick than people who do get sick.
It’s the same principle used in property casualty coverage,
where you don’t want to come and insure homes in Tornado Alley, like
Kansas. You’d rather find a place where storms don’t hit.
I think that working with the insurers to actually look for
ways that we develop a new business model is going to be very important,
and it’s going to require oversight and vigilance. It means changing the
It also means that insurance companies will be competing on the
basis of price for new customers and have to be, I would say,
not basing their customer selection on cherry-picking the
market, on eliminating certain groups and individuals.
Insurance commissioners at the ground level will have
the initial responsibility for oversight consumer protection.
We have urged them already. In some states, there isn’t the full
benefit of the legal authority to have rigorous rate
review, to have actuarial studies done before rates are increased. You
can see around the country some states have been very aggressive
in limiting the kinds of rate increases that have been
allowed. Other states have not at all.
So I think it’s going to require states stepping up, becoming more
vigilant on rate review, more vigilant on consumer
protection. And we’re certainly going to be a working as a backstop to
But the tradeoff of having additional customers for the
private market means, I think, that the new rules will be
followed and will be vigorously enforced.
QUESTION: One member of the audience asks, how did the
student loan direct pay program get into the health
: Well, it turns out that the history of
reconciliation bills often have included in the past education
and healthof the measure of
reconciliation, is if there is a significant impact on the
measures together. They both have significant
budget impacts. That’s really kind The student loan and community college reinvestment bill had
been passed by the House of Representatives, was being
considered in the Senate, and I think that members of the
House and Senate thought that it was an opportunity, really, to
accelerate passage of what in and of itself is an historic
piece of legislation.
About $68 billion over the first 10 years will be saved from
eliminating the third-party loans that currently are going to
benefit students who want to attend college and reinvesting those funds
in doubling the Pell Grants, in raising the threshold of
the Pell Grants for the first time in about 15 years, in
limiting the payment of loans.
One of the most inspirational pieces of the
puzzle is that a student will never have to — or a graduate will never
have to pay more than 10 percent of his or her income in order
to fully pay back the loan, encouraging people to take on
jobs that may not pay as much in terms of salary. Social workers
or teachers will — will not be eliminated from taking on those
If you, after 10 years, have paid to the full amount, you’re
considered finished, completed. They don’t want students to —
graduates to continue to pay after a decade.
If you provide some public service or military service, you’re
considered to have your debt paid in five years, again, encouraging
So this is a major investment that I would — I would highly
recommend to the Press Club, if you haven’t had Secretaryof legislation. It is one
worth — a conversation worth having.
MODERATOR: Can you help us get Secretary Duncan here?
Duncan here, to talk about this piece SEBELIUS: Sure.
MODERATOR: We appreciate it. Could you tell us a little bit more
about the low-income Medicaid possibility that you’d spoke of in your remarks?
SEBELIUS: Well, starting this year, there are opportunities
for states to immediately begin to cover the so-called childless
adult population, where a lot of uninsured Americans fit into
There are states who have moved ahead already and are covering that
population, but getting no federal assistance or help for doing that.
So the first step is likely to be that states who are currently
providing state-only funds for that population will be able to pull down
some federal assistance and hopefully expand the population.
Others may well, since it’s a Medicaid match of 60 percent
federal dollars to 40 cents of state dollars, may well look at
earlier expansion prior to the 2014 deadline, so the
opportunity to draw down some federal funds for this population begins
MODERATOR: Also mentioned in your remarks, the national
high- risk pool program. The health care
law calls for this program to be in place within about three months, and
many questions need to be answered about how it’s going to work in theof existing state high-risk pools, states that lack
pools but want to develop them and states that have no plans to develop
pools. For those Americans interested in the more reasonably
priced coverage the new federal high-risk pool promises to
provide, how soon do you realistically think they will be able to secure
SEBELIUS: Well, I think we will have pools up and running
this year in 2010. And about 34 states right now run high-risk pools
that often are quite expensive. Even though they’re pegged to some sort
of market rate, they still are often too expensive for many
individuals. I think there are only about 200,000 people around the
country total who are involved in the high-risk pool.
So what we anticipate is that a lot of states will set up a
parallel pool for this new population. The price will be pegged at
100 percent of market rates, so still not terribly inexpensive,
but much better than often someone with a pre-existing condition could
get, quote, “on the marketplace,” if they could get
insured at all.
And if a state chooses not to run their own program, we will have a
federal fallback, either several at the regional level,
one national. We haven’t decided until we hear from states.
But I’ve already written to governors and insurance commissioners
giving them an outline of the program, asking who intends
to participate. We intend then to quickly work one-on-one with
each of the state groups to figure out how exactly they
want to set it up, how quickly they can get them up and running, and
then we will actually be the backstop for Americans who don’t
have a pool in their own state, but want that kind of coverage
MODERATOR: Next week at the Press Club,
we’re not going to have Arne Duncan quite yet, but we are going to have
Dennis Quaid, who’s going to be talking about the prevention of
potentially deadly medical errors because of some of the
personal tragedies he has experienced. This questioner asks, is there
anything in the new law that addresses the problem of
medical errors in hospitals, prescription drug mistakes, such as back
coding (ph) for medicines?
: Well, I think there — there are lots of
quality improvement measures in the new law, but — but two
particular investments that I think can have a huge amount of
impact on hospital errors.
One is the transfer from paper records, paper coding, to
electronic records. There’s no question that having the ability
to pull up a record and have a provider have to enter a prescription
order into an electronic record that absolutely blocks a counter-
indicated drug or puts a red flag up so that you really cannot have the
wrong medicine ordered for that patient population.
In a hospital like, again, Cincinnati Children’s, where I visited
yesterday, they also have a bar-coded dispensing system where you cannot
release the drug from a prepackaged system unless it’s bar-
baby I was visiting, along with his mom, is four weeks
old. He has a wristband that is bar-coded. So the nurse
indicated to me she has to bar-code his wrist and bar-code the
dispenser or the drug is not released, to make sure it’s the
right patient, theat the right time.
So that in and of itself, I think, is — is a huge step forward.
About 20 percent of hospitals have some kind of
electronic record, but not nearly enough, and it’s part of what the
investment is about.
There’s also a lot of information and research going on
about how to work on hospital-associated infections, which is
another huge issue. A hundred thousand people a year die in American
hospitals not because of what brought them to the
hospital, but what happens to them while they’re in the hospital.
Hundreds of thousands more have very costly, very consuming
injuries because of that same situation. It’s a challenge we
have taken on with the American Hospital Association.
There are some pretty simple checklists that have been shown to
dramatically reduce hospital-associated infections, cut them two-thirds,
don’t require new equipment, don’t require any fancy training.
They’re just not implemented in hospital after hospital. They’re
not in place in way too many of our medical care.
We currently pay the same amount for incidents whether or
not something happened related to hospital safety or not. We still were
paying up until last year for so-called “never” incidents, where, you
know, the wrong limb is amputated, the wrong drug is
given, a patient is dropped on the floor. You would get the
same payment out of the public insurance system as the
best possible result.
So we can use, I think, the payment system to begin to drive
and put in place incentives — initially incentives to promote better care,
but eventually disincentives for bad care, and I think we’ve got
to start doing that very quickly.
QUESTION: There’s a serious shortage of gerontologists,
which is a concern as the population ages. How can this problem
be solved? And what role do you see HHS playing?
SEBELIUS: Well, I’d say there’s a shortage of
certainly doctors with a specialty on the aging
population. There also is a shortage of primary care and
family care docs who often have that same skill.
We have already begun to change the payment formula in the
Medicare system to more appropriately compensate medical providers who
choose a range of family primary care services. We
will continue to accelerate that. We are also part of theof the Recovery Act, in
terms of workforce initiatives, and part of this bill
helps us build a more ample primary care workforce and — for the
future, which, again, I think is — is critically important, and paying
more scholarships to providers who work in areas where we see a growing
need, and certainly gerontology is one of them.
QUESTION: What is your own view of using acupuncture,
meditation, and other alternative healing methods in health
SEBELIUS: There clearly are plans in place
— and I anticipate there will be plans offered in the new
exchanges — which will give patients a wide variety of choices.
And I think that, while there’s likely to be a definition of
what is a preventive care plan, insurers are likely to compete
based onof choices for
And, you know, there is some pretty interesting data about cost
effectiveness that we will continue to monitor. I think our — our
comparative effectiveness research will continue to look at a
variety of alternatives for expensive care, whether or not
earlier interventions or more homeopathic therapies or a variety of
choices are ones that really do lead to better health
outcomes at a lower cost, and I think those are often consumer
choices and also wise health care choices.
MODERATOR: This audience member asks for your thoughts on
raising the Medicare and other health care
plan eligibility age gradually to 70 to help keep costs down.
investment act in 2009 — part coverage? having a more wide range SEBELIUS: Well, one of the groups that the
president has now put in place by executive order and is likely to be
convened in the not- too-distant future is an entitlement
commission looking at Social Security, looking at
Medicare. I assume Medicaid will be part of that.
And so the rules of those various long-term
government programs, the eligibility ages, the kind of
benefits provided versus the costs of the program,
I think, will be a topic that will be robustly debated and discussed by
the entitlement commission, and I think it’s very appropriate.
Much of our long-term deficit in this country is directly
related to the various entitlement programs that we have, so it’s
likely to be appropriate to look at everything from, you know,
age of entry to, you know, what the benefit package looks
like, how long people qualify, whether or not there’s any contribution
based on income, and I think all of those issues will be
part of theof the entitlement
MODERATOR: Part of the health care
reform package is an emphasis on preventing disease and
disability. Such an emphasis would result not only in significant
monetary savings, but also in greatly reduced suffering. Fattening
foods and sodas are known to increase health care
costs, yet regulating or taxing them is highly difficult politically.
Does HHS and the government need to rethink its approach
toward food regulation and taxation in light of health
SEBELIUS: Well, there’s no question there’s a major
emphasis in health perform — and I would say that also
started as part ofthe Recovery Act — in prevention and
In spite of the persistent reluctance of the
Congressional Budget Office to score anything related to prevention and
wellness, I am a believer that it doesn’t take much of a rocket
scientist to understand if we’re spending 75 cents of every health
dollar on prevention, rebalancing those numbers a little bit and
trying to get at some of the underlying causes for
chronic disease would actually save money in the long run.
One of the reasons that Congress put a major
first-time prevention and wellness investment out the door in the
Recovery Act was just to get at long-term health care
costs and healthier Americans.
And it’s focused on two areas, obesity and tobacco
cessation. We did pretty well on tobacco until the last
five or six years, when we’re about 20 percent. Young smokers, old
smokers, it hasn’t gone down at all. Tobacco is by far the
number-one leading cause of preventable disease and death in
this country, so going after that again.
There’s a whole range of issues dealing with obesity. And
certainly at the state and local level, the
consideration of taxes onon fatty
foods, on snack foods is one of the policy choices
that people are beginning to look at.
We have put 36 grants out the door just in the last
two weeks that are going to communities across the country to
look at on
We really don’t know a lot, particularly — we know about tobacco.
We don’t know a lot about obesity-related strategies that have really
been effective over time. There haven’t been a lot of tests.
There hasn’t been a lot of research. So we’re really hoping to
learn a lot more about what policies really work, what works at the
There also is a huge effort underway as part of the
first lady’s “Let’s Move” campaign, which is — has the goal of
eliminating childhood obesity in a generation, a very important goal of
looking at all of the kinds of food
And one of them is the choices available to kids in
cafeterias and in vending machines in schools. We — the secretary
ofthe secretary of agriculture
— are very much at work to redo school nutrition standards.
We’re working with the Food and Drug Administration to look at
food labeling standards. Part of the bill requires now
posting ofon fast-food menus that will be
available and easy to read for consumers.
So there’s going to be a lot more information, a lot more policy
effort coming from lots of different directions on trying
to get to some of the underlying causes of chronic
MODERATOR: Given your years as a state insurance commissioner and
your interaction with the industry as secretary of
HHS, do CEOs of health insurance companies make too
SEBELIUS: Well, they make a lot more money than I do. You
know, that’s a shareholder decision, I think.
What is troubling is the disconnect between, on one
hand, arguing for enormous rate increases and what appears to be
excessive salaries, overhead costs going forward.
WellPoint became kind of the — the prime
example of this, where their fourth quarter 2009 profit statement
showed a $2.7 billion profit, and within 10 days, they had filed up to
40 percent rate increases for the California market, so their —
and announced that the CEO got a 51 percent rate — I mean,
So there does seem to be a disconnect, which is why I asked the
top five health insurers to give us the data. Let
us put it up on a Web site. If their rate increases are
actuarially justified by health care costs, which
is what was the verbal exchange, then give us the
information, let us make it transparent and begin to educate the
American public what’s really going on.
So far, we haven’t gotten that information, but I look forward to
taking a look at it.
MODERATOR: When will the Centers for Medicare and Medicaid Services
have a new commissioner in place to spearhead theof the health care reform bill?
SEBELIUS: Well, the president will make a decision
about naming a new administrator. What we are doing, though, currently
is building a team with the anticipation of a more robust
role for Medicare and Medicaid.
Some — a key member of that team is here, Marilyn Tavenner,
who you heard introduced earlier, who we stole from the state of
Virginia, and we’re thrilled to have her. She is the principal
deputy at CMS.
We have added Tony Rogers, who came to us from the state of
Arizona, running their Medicaid system and health
strategy system. He will become head of the new Center
We’ve added Peter Budetti (ph), who will be focused on fraud
and abuse, and those are all brand-new positions, administrative
positions, and really will help us have a much more robust innovation
and quality strategy, a very enhanced effort on cracking down on
fraud and abuse, and an ability to really deal with a lot of the
Medicare challenges that the bill has presented, moving Medicare
to a much more value-purchasing operation.
With the $400-plus billion that we spend every year, we have
an opportunity to really help change the delivery system in a —
I think, a pretty significant way, to the benefit of
beneficiaries and consumers across the country.
MODERATOR: Many of the questions addressed today are
about the future of health care
reform. People are always looking ahead. But, of course, this
has been a very bruising political battle that’s just been taking place
over the past several months. There was Obamacare, and death
panels, and misinformation, and bricks, and late-night votes, and
This person writes, “I’m concerned about the widening gap
between Democrats and Republicans made worse by the health care legislation.
What is HHS planning to do to try to bring everyone together again?”
SEBELIUS: Well, I’m concerned about it, too. I don’t think
it — it bodes well for our future when we can’t have a robust debate,
but also a resolution of major challenges in some sort of a
And, you know, I am disappointed that, from the outset of
this debate a year ago, before I was ever even appointed secretary,
there were already sort of political battle lines being drawn
and people saying, “We will never participate in this conversation,”
which I don’t think is healthy going forward.
I am also convinced that, once we have an opportunity, not just the
Department of Health and Human Services,
but working with stakeholder groups, working with consumer advocates,
getting information, when people understand what exactly is in the law, what it does, what kind of
timetable the implementation strategy is taking, that there will
be a lot of
Will that help our next round of debates? I don’t know. I
hope so. I — I am a believer that finding some common ground is
important going forward. I was a, you know, Democrat elected in an
overwhelmingly Republican state and found building coalitions to be
something that is critically important. We’ll go right back to work
and, you know, try to do that.
One of the things I think that got lost in the
shuffle along the way, which is somewhat remarkable, is that
there are groups and organizations — among them the American
Medical Association, representing the health care
providers in this country — who have historically opposed any kind of
health reform legislation, including Medicare, vigorously
opposed it, and yet they were at the table with this
There were lots of business groups, some definitely opposed,
but some who came to the table, I think a recognition that we
really had a broken system and that we had an opportunity to make some
significant changes, and people didn’t want to lose that opportunity.
So I think, at the end of the day, that
will be the common ground, that we have not lost that
opportunity, and now we need to, you know, bring people back together
about how we work together an implementation.
MODERATOR: We are almost out of time. But before asking the
last question, we have a couple important matters to take care of. First,
to remind our members and guests of future speakers, on
April 12th, as mentioned earlier, Dennis Quaid will be discussing the
prevention of potentially deadly medical errors. On April 15th, Secretary Napolitano of
Homeland Security will be here discussing the state of the
nation’s and the world’s aviation security system. And on April 19th, Congressman Sander Levin, the new
chairman of the House Ways and Means Committee, will be
speaking on financial reform and other topics.
I also would like to present today’s speaker — thank you very much
for your time here today. Here is the legendary National Press Club mug.
SEBELIUS: Lovely. Thank you.
MODERATOR: And now for the last question. Given the
debate and your position, what was your biggest challenge to staying
healthy during the months of stressful health
care bill deliberations?
SEBELIUS: Well, I’m a runner, so I — and I figure, as long
as no one’s chasing me, I will continue to run. And that helps us sort
out my days, too. I go down on the Mall, hum a little
“God Bless America,” and believe that the sun will come up. And
sure enough, it has.
So I’m pleased, again, to be with you today. And thank you for
inviting me. And hopefully, you all will visit our Web site,
healthreform.gov. We’d love to have your input about what’s working and
what’s not working, in terms of information that you’re finding
it hard to find or digest.
We want to make sure this is a work of continuous
improvement. Under the great leadership of Dr. Jeanne
Lambrew, our work will go on. And we have a lot to communicate
with to the American people and would love your help and support
as that goes forward. Thank you very much.
MODERATOR: And thank you, Governor — I mean, Secretary.
for inclusion in a future Your Comments Forum.