At a recent workshop hosted by the Institute of Medicine, Dr. Elliott Fisher of the Dartmouth Institute of Health Policy and Clinical Practice demonstrated that a sizable percentage of decisions made by health care professionals are discretionary and are within the range of what is popularly called “evidence-based medicine.”  His fundamental argument is that we cannot contain health care costs significantly by making health care practices conform to “evidence-based medicine.”  Instead, we will need to create systems in which the health care community selects less-costly, but equally-effective, approaches, over more-costly approaches. 

The Dartmouth Atlas survey, which I strongly recommend that everyone interested in health care transformation read, proves that there are wide variations in health care cost among American communities with not only no better outcomes, but, in some instances, slightly worse outcomes in the higher-cost communities.  A recent posting of an article entitled “The Cost Conundrum” in The New Yorker profiles McAllen County, Texas, one of the two highest-cost areas, the other being Miami.   In it, the report Atul Gawande, demonstrates the local health care provider community is oblivious to how out of line its practices and costs are, but the reporter also notes that nothing the practitioners do would ever be prevented by an evidence-based medicine system.

(more…)

The June, 2009, issue of The Atlantic Monthly had a provocative article entitled “Do CEOs Matter?” by reporter Harris Collingwood. What prompted it was the recent story about the leave of absence taken by Steve Jobs of Apple Computer and the stock market reaction to stories by Jobs’ health problems.

As a former CEO, and as a student of leadership in business and other sectors of our country, I believe that individual leaders matters at all times, but in varying degrees at different times and under different circumstances.  Certainly, at particular points in an organization’s history, there are crises that demand unique leadership capabilities.  For example, I cannot imagine that IBM or Xerox would have survived the threats to their survival in the 1990′s without the inspired leadership of Lou Gerstner and, in Xerox’s case, the inspired leadership of my good friend Ann Mulcahy.

(more…)

Our country has spent hundreds of billions of dollars over many decades to reduce or eradicate poverty.  Governments at all levels have been part of the effort.  There are many explanations as to why these efforts have succeeded, if at all, only marginally.  As a member of the National Urban League board, and its former chairman, and as a person who has worked closely with many community-based non-profit social service organizations in Southwestern Connecticut, I have some thoughts on the subject.

The National Urban League, which will celebrate its 100^th anniversary in 2010, is a wonderful social services and civil rights advocacy organization, which has developed its programs through the benefit of rigorous research, experience from nearly 100 years of service delivery at its nearly 100+ affiliates, and incredible insight from leadership teams headed by great leaders like Whitney Young, Vernon Jordan, John Jacaob, Hugh Price, and the League’s current brilliant and accomplished leader Marc Morial.

(more…)

In an Op-Ed piece in the Tuesday, May 12, issue of The Wall Street Journal,   entitled “Schumer’s Shareholder Bill Misses the Mark,” attorneys Martin Lipton, Jay Lorsch, and Theodore Mirvis accurately and insightfully point out the fundamental flaws in the shareholder rights legislation proposed by Senator Chuck Schumer.

Senator Schumer ‘s bill is designed to override state corporation laws that vest the primary power for leading any state-chartered corporation to its board of directors.  In a number of ways, including banning staggered boards of directors and reducing barriers to shareholders nominating their own candidates for directors, Schumer’s proposed legislation would significantly transfer power from directors to shareholders.  The simple, but flawed, rationale is that, since shareholders own the company, they should have more power to manage it.

(more…)

I have been blessed to have been a part of three families in my life, the one into which I was born, the one into which I married 30 years ago, and the one my wife Joyce and I formed when our first son was born in 1986.

 I have gotten to know my mother-in-law Joan McNagny very well over the last 30+ years and have a great admiration for what she has done with her three children and their lives. She has been exceptionally supportive of not only her children, but of the spouses of her three children, as well as her nine grandchildren.

I also have gotten the opportunity to observe my sister Trina who became a mother of four, and a grandmother with 11 grandchildren, and who has been exceptional in both roles.

(more…)

In the Spring 2009, issue of the Harvard Public Health Review entitled “Stealth Tobacco”, there was an article about the response of the tobacco industry to the increasingly heavy regulation and prohibition of cigarettes.  The industry has been very resourceful in marketing tobacco in forms and packages that are designed to reduce the public opposition to the sale and use of tobacco products.

Tobacco marketers have figured out that the public is more ready to prohibit tobacco ingested through smoking processes because of the second-hand smoke issue.  As a result, they have aggressively marketed smokeless tobaccos that are chewed, either in traditional chewing tobacco products or in more innovative products that package nicotine in lozenges, mints, and other orally-ingested forms.

Although these tobacco products do not pose the public health risks to those in the vicinity of the tobacco user that cigarettes, cigars, or pipes pose, they have all of the same negative consequences for the user, including the same addictive properties we associate with smoked cigarettes.

As I have said many times, I do not oppose a mature adult’s freedom to smoke or otherwise ingest tobacco, but I believe more strongly that these alternative forms of tobacco ingestion should be heavily taxed, that sales to children under 21 should be prohibited, and that health insurance plans should not only be permitted to charge tobacco users more for their health coverage, but should be required to do so.

The federal government, which has talked a lot about the need for health care reform to address prevention and wellness issues, has a golden opportunity to take a strong stand on this issue, and adjust Medicare, Medicaid, VA, and DOD participant co-payments or premiums to discourage tobacco consumption, and to direct states receiving federal funds for Medicaid and SCHIP programs to do the same. 

The federal government has recently increased the excise tax on cigarettes from $.39 to $1.01 a pack.  It needs to make sure that it heavily taxes all forms of tobacco ingestion, and that states bring tobacco taxes up to a minimum level.  By way of comparison, New Jersey has the highest tax on cigarettes, $2.58 a pack, while South Carolina is at $.07 per pack.

I am sympathetic to the argument that an excise tax on tobacco is highly regressive, as is any other sales tax.  I also recognize that we are dealing with addictive behaviors.  Therefore, I would require both the federal government and the states to use all the increased revenues from these taxes for smoking cessation programs, not to reduce budget deficits.  Over time, the lower-income population would find that its discretionary income would rise because it would not be spending scarce funds on tobacco products, and would see a broader improvement in health and quality of life.

I would adjust Medicare and Medicaid payments to reward physicians and other providers that are actively promoting smoking cessation as part of their primary care interactions with patients, and to reward broad integrated care organizations that are attacking this issue aggressively.  Tobacco cessation counseling is a high-level skill and requires a highly-customized and individualized approach to each person who is being counseled.  We need to make sure that the financial benefits of undertaking this activity are given to those who do it.

Finally, I favor the regulation of the marketing and sale of tobacco products by the FDA, because, over time, that regulation will be able to curtail the sale of tobacco products to minors.  Pitney Bowes was in the cigarette tax collection business until the early 1980′s, and I learned from those in that business that the technology to track individual tobacco product sales is available and affordable.

I applaud companies like Wegmans, the Rochester New York-based retail grocery chain, which has decided to stop selling cigarettes and other tobacco products in its stores.  I would like to see the major pharmacy retailers do the same, even though tobacco products are among their most profitable retail products.