Dear Mr. President-Elect: Fix Health Care

Dear President-Elect Obama,As you can see from the results of the online poll we ran earlier this year on www.drugstorenews.com, most of our readers believed that John McCain would have been a better president, at least as it relates to the issues that matter most to retail pharmacy (see story, page 24).

Much of that is water under the bridge now, and, in fairness, retail pharmacy leaders have come out publicly in support of your victory and have stated their eagerness to work with your administration to improve access and affordability to quality health care that is focused on the needs of the patient.

There is a lot of pressure on you now to figure out the mess our economy has become. But I assure you that long after this recession has ended, the problems that have plagued the U.S. healthcare system will continue to drag down our nation’s economy for years to come, until someone with enough brains and guts does something to change it. Last year, healthcare spending represented 16 percent of the gross domestic product. In the coming years, it is projected to reach as much as 20 percent. It is somewhat chilling how much of the national economy is driven by treating sick people; it is eerily ironic that despite all of that, the United States is among the unhealthiest of all modern developed nations.

As you ran on a platform of change, I believe health care affords you a unique opportunity not only to live up to that promise, but also, to prove a lot of people wrong. I also believe—particularly given your past support of retail pharmacy—that any plan you consider will acknowledge and reward the important role of community pharmacy.

First—and I am pretty certain you have figured this out already—there is a great deal of fear and trepidation across just about every sector of American business that universal coverage will do more to further screw up health care than fix it. While on one hand, it might seem noble to guarantee 300 million Americans health insurance, it makes as much sense as, say, putting every American on food stamps or feeding them out of soup kitchens that were set up to serve the poor. It is an unnecessary use of taxpayer dollars at best, and it is an abuse of the concept of a social welfare net at worst. The net is there to catch those that fall through the cracks, not to bear the weight of an entire nation.

And this isn’t all about charity either. It is economically imperative that we focus on the 47 million Americans that either don’t have healthcare coverage at all or don’t have enough of it—not the 250 million of us that do. Because the upstream costs of treating the healthcare-have-nots of America is one of the biggest drains we have on our healthcare system and the economy.

Programs like Medicaid, which is crumbling under the weight of its current structure, need to be retooled, with incentives realigned to put the emphasis on preventive care, keeping this group healthier and helping them better manage existing conditions and reduce comorbidities.

And it’s not just programs for the poor that need to be rethought. Generally speaking, the problem with health care in America is that the system is created to work backward from treating the illness rather than starting from the premise of keeping the patient healthy. This is an area where I am confident that community pharmacy can have a major impact not only in reducing costs but also improving patient outcomes.

As you wrestle with the challenge of how to fix health care, I urge you to consider the following very carefully:

Medication therapy management. There is a real value to the American healthcare system in an expanded role for pharmacists in helping patients with chronic conditions manage their medications. For instance, for every dollar the city of Asheville, through the Asheville Project—a diabetes management program now in its 12th year of existence, which has since been replicated in various forms in other cities across the country—spends on prescription drugs, diet, exercise and lifestyle counseling, it saves $4 on things like emergency room visits, dialysis, amputations and various other complications related to the disease.

Compliance and adherence. Healthcare spending reached $2 trillion last year, and it is estimated that roughly $1.3 trillion of it went to treat the seven most chronic conditions in America and $177 billion in costs associated with poor drug adherence and compliance. This is an area where the community pharmacist plays an indispensable role, and pharmacy reimbursements should reflect that important function rather than just the cost of the pill and a fee to dispense it.

Retail clinics. Simply stated, there are not enough family physicians in America to treat all of us. Nearly 1-in-5 Americans have absolutely no relationship with a primary care provider. Yet onerous state requirements governing scope of practice, physician oversight and other requirements vary from state to state, limiting the ability of clinics to expand. How can this be a state issue? As Take Care Health co-founder Hal Rosenbluth, now president of health and wellness for Walgreens, has asked on several occasions, “If an NP can perform an emergency tracheotomy on one of our troops in Fallujah, why does she need multiple doctors looking over her shoulder to diagnose pink eye in Peoria?”

Create a healthcare IT infrastructure. Electronic prescribing is an important first step in transforming health care from a highly fragmented, perhaps too robust and rapidly growing sector of our nation’s economy, to an actual system where providers and other key stake-holders actually communicate with each other. Getting back to patient compliance and adherence, a pilot conducted by Walgreens and SureScripts showed an 11 percent increase in the number of new prescriptions that actually made it to the drug store as a result of e-prescribing. The next step: establishing a standardized, electronic medical record so that a patient’s medical history no longer exists in multiple manila folders spread across the file cabinets of every physician that has ever treated them.

Drug reimportation. Not an answer, as it does nothing to fix what is wrong with health care in this country; it just imports another country’s price controls and takes particularly at-risk patients out of the drug store where the pharmacist has any chance to make a positive healthcare intervention.

You ran on a platform of change and made this country believe that you can. Here is your chance to change something and plant the seeds of what could be your legacy.