Shalala talks on hospital woes

The Health and Human Services secretary spoke on campus yesterday. U.S. Secretary of Health and Human Services Donna Shalala stood literally on the front lines of the health care policy debate last night as she discussed the challenges facing modern medicine in the Dunlop Auditorium. The stage where she spoke sat at the heart of the troubled University of Pennsylvania Health System, which posted a $198 million deficit for the last fiscal year that hospital officials blame on decreasing Medicare and private insurance payments. In front of almost 350 Penn students, faculty and medical professionals who attended the forum -- sponsored by the Leonard Davis Institute of Health Economics -- Shalala refused to allow the government to be blamed for the Heath System's current financial woes. But she did say the government could play a more active role in supporting academic medical centers. "Penn's situation has to do with where it is and what its market looks like," Shalala said, noting that private and federal cost containment has strained research hospital budgets. "But government has a responsibility to both maintain and enrich this network of academic health centers because, for us, they are both on the cutting edge of research and they perform a fundamental role in the training of all the physicians, nurses and Ph.D. students," she added. "One clear way of intervening is to make sure we pay properly for the additional cost of academic health centers." Since Shalala joined the Clinton cabinet in 1993, she has been responsible for overseeing Health and Human Services' $381 billion budget and is the chief administrator in a wide variety of government programs -- including Medicare, Medicaid, the National Institutes of Health and federal and children's welfare programs. Throughout the 1 1/2-hour talk, Shalala -- the longest-serving secretary of Health and Human Services in the department's 19-year history -- fielded a number of questions from the audience. Davis Institute faculty fellows and Penn students asked Shalala to address a a variety of topics -- ranging from the patient's bill of rights to long-term medical care for senior citizens to dealing with the more than 44 million Americans who lack health insurance. "We don't have the politics for universal health care insurance," Shalala said. "And giving people a contribution so they can purchase health insurance doesn't necessarily guarantee them quality health care." She cited research indicating that government subsidies are less likely to induce people in lower income classes to purchase health insurance. Those people, she said, are more likely to prefer putting the extra income toward family activities, such as trips to restaurants and the movies. "I ask people all the time who have incomes under $25,000 what kinds of subsidies we would have to give them to get them to purchase health care," she said. "And I have to tell you, it would almost have to be provided free." Shalala also said that the organ donation system must be reformed so that people in need of organs may receive them -- regardless of the size of their nearest transplant center. "Where you live should not determine whether you live or die," Shalala said, pointing out that those who currently live near smaller transplant centers are less likely to receive a needed organ. "Organs are, in fact, a national resource." Shalala was the third member of the Clinton cabinet to speak at Penn in the past year. Last week, U.S. Attorney General Janet Reno gave the keynote address at a Fels Center of Government crime symposium. And former Treasury Secretary Robert Rubin delivered the Commencement address in late May.

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