Health Care Life Support

For over 20 years, many faculty and staff have worked to shape health care policy in America. Today, they are concentrating their efforts on the more formidable issue of health care reform. Alan Hillman, director of the Center for Health Policy at the Leonard Davis Institute, is one of many University faculty members who have been active in shaping health care policy in the country. Hillman served on a 500-person task force organized by President Clinton in the beginning of 1993, charged with designing the now-defunct health care reform legislation. Hillman, who is also a Wharton and Medical School professor, said he has found it difficult to reconcile the conflicting medical and economic perspectives on health care, especially where patients are concerned. "It is the most important challenge of all to find a way to deliver cost-effective, high quality health care," he said. According to Hillman, the Leonard Davis Institute is devoted to bringing faculty from across the University together to conduct research on health care policy. "What we have decided to do is take research done by faculty and translate it into information that can be useful to anybody who needs to make a decision about health care policy," Hillman said. Information from the Institute has been used by corporations and legislative decision-makers on federal, state and local levels, Hillman said. But, according to Hillman, students at the University are not as aware of the health care situation as they should be. "Penn students, by and large, are a little bit naive about health care and what it means," he said. "[But] I know for a fact that health care courses are becoming more popular, which I think is terrific." Wharton and Medical School professor William Kissick has also devoted his life to studying health care, examining both the medical and economic dimensions of the issue. Kissick, who has been teaching in both schools since 1968, said he tries to look at health care "from both sides of Spruce Street." "In the Medical School, my colleagues tell me that no cost is too great to save a life or treat disease," he said. "Then I cross Spruce Street to the Wharton School and my colleagues say resources are limited and choices must be made." In his book, "Medicine's Dilemmas: Infinite Needs versus Finite Resources," Kissick explains that the United States can not provide a universal health care program that both contains health care costs and maintains the highest-quality care. "The golden rule of health care in our society is that everybody deserves access to the highest quality health care attainable, provided that somebody else pays," Kissick said. He added that the United States must restructure the delivery of health services in order to achieve a reasonable balance between access, quality and cost-containment in health care. In 1964 and 1965, Kissick helped draft the Medicare legislation that currently provides health benefits to people over the age of 65. He also helped establish a graduate program in health care management at the University in 1970, increasing the communication between the Wharton School and the Medical School. Since then, the University has awarded approximately 100 physicians with a master's degrees in business administration. "There is no university in the country that can touch that," Kissick said. Like Kissick, William Kelly, chief executive officer and dean of the Medical School, has been a consultant to President Clinton and Hillary Rodham Clinton this past year. Kelly was a member of a group of academic health center leaders assembled to work with Mrs. Clinton to make sure that the centers were treated fairly as the task force on health care reform developed its report. The progress that has been made in human health care in the United States is due to the "tremendous strength of the faculties of this nation's leading academic health centers," said Kelly. The University will continue to play an important role in the area of health care reform, he added. "It's an extremely important area for us and one that we will continue to be working [on] closely with many people in Washington to try to achieve a good outcome for the health of the American people." Linda Aiken, director of the Center for Health Services and Policy Resources at the University, is intensely involved in studying the health care system from a different angle. A professor in the School of Nursing and the Department of Sociology, Aiken has conducted policy-related research on the organization and financing of health care as it relates to innovative nursing programs. "Since we are in a cost-controlled environment, hospitals are reducing their staff and trying to figure out better ways to be more cost efficient," she said. "There is concern that as a result of some particular strategies, the patient's care may be adversely affected." With the reduction of hospital staff and the increasing costs of going to see a doctor, more and more people are denied access to health care. This problem is the most serious in the poor, inner cities. "Nurse practitioners offer great potential because they are able to go into inner city areas and set up storefront practices," said Aiken. "They can establish practices that can survive in inner cities unlike physicians who require much more expensive, labor-intensive practices." "[The University] is doing all the nursing research related to healthcare reform and has very high visibility on that issue," she said. Aiken also served on Clinton's task force as the senior policy advisor on the infrastructure to run a reformed health care system. She dealt with work force issues, involving the doctors, nurses and others who provide care. Aiken said the major reason we do not have health care reform today is that we cannot agree on how to finance an expansion of insurance coverage to people who do not have it. "The issue is that some people are not in the current system, and if you want to bring them in, it costs money," Aiken said. "There were two major options for paying for it: One is you raise taxes and the other is that you require employers to cover their employees." According to Aiken, there was not a strong enough political consensus to do either of those two things. Nursing Dean Norma Lang, yet another consultant to the Clinton administration on health care reform, also identified limited access and high costs as two of the most serious problems with the American health care system. "People are still having difficulty having their health care needs met," Lang said. According to Lang, many students do not expect the problems with the current health care system to affect them. She said that they often do not consider the lack of universal health care coverage to be a threat. "Penn students and younger people tend to be healthier and don't worry too much about that," Lang said. "[But] even for students who will be graduating, it's not an automatic thing that they are going to be able to find the coverage out there for themselves." Lang said, as a consultant to the Clinton administration, she made sure that these issues of access and cost stayed on the agenda. She also contributed her expertise to explain what nurses can do to solve some of the problems. "[We] are a major producer of graduates in the nursing program that have the skills to help people receive care in a cost-effective way," Lang said. "One of the biggest impacts nursing can have on the health care system is trying to bring back a more holistic approach to the care of a patient," Nursing junior David Glidden said. Not every aspect of the University's involvement with health care reform has had to do with analyzing and shaping policies. Joseph Cappella, a professor in the Annenberg School of Communications, has done research examining the media's role in the health care reform debate. Cappella, who teaches social psychology of communication, said he and Annenberg Dean Kathleen Hall Jamieson have studied various formats of news coverage on the health care debate in an attempt to determine the effect those formats have on people's attitudes. Cappella and Jamieson investigated whether some types of coverage raised people's cynicism about the various participants in the debate. "What the research showed was that the kinds of formats [used in the health care debate] that are typically called 'horse-race' kinds of coverage in campaigns would increase people's cynicism," Cappella said. In a campaign, "horse-race" coverage looks at who is ahead and who is behind, according to Cappella. The coverage focuses on the superficialities of performance and style of the candidates. Policy-oriented coverage typically does not elevate cynicism, he added. "The surprising thing to us was not about the 'horse-race' coverage but about the more policy-oriented coverage," Cappella said. "What we found in our study is that this policy-based coverage that we used in our experiment also raised cynicism," he added. Cappella said he and Jamieson speculated that because a lot of press coverage tends to be oriented toward conflict and disagreement, people become cynical. "After you get a long dose of coverage which primarily says, 'this won't work, this won't work, and this won't work,' you might begin to think that nothing will work -- that there isn't any real solution to the problem," Cappella said. According to Cappella, people are also concerned that the media may be influencing the direction of the health care reform debate. "We have been trying to keep the media honest [and] in effect provide them with some feedback on the way in which they have been covering this very important debate," he added.