The New York Academy of Medicine: News & Publications: Dr. Arnold Relman Gives 158th Anniversary Discourse at Annual Spring Stated Meeting of Academy Fellows

Dr. Arnold Relman Gives 158th Anniversary Discourse at Annual Spring Stated Meeting of Academy Fellows

NEW YORK CITY, April 28—Arnold S. Relman, MD, Professor Emeritus at Harvard Medical School and former New England Journal of Medicine Editor, decried the state of the American healthcare system during his keynote speech at the Academy’s Spring Stated Meeting last night and explained what must be done to make care more available and affordable. The annual black-tie dinner event attracted 130 Fellows, Academy staff, and guests and included presentations of awards to leaders in science and government.

“Our healthcare system is seriously dysfunctional and getting worse,” Relman told the group, as it denies many uninsured people access to care. “Costs are rising steadily, seemingly out of control.” The nation spent a staggering $1.8 trillion on healthcare in 2004. “This burden is becoming incredibly intolerable to all who have to pay the bills,” including consumers, businesses, and the government, he said.

A crowd of 130 Fellows, staff, and guests gathered in the Academy library for the 2005 Spring Stated Meeting of the Fellows.

So why does our healthcare system fail us when we spend more money by far per capita than any advanced country in the world? “The primary cause is that we in America have allowed ourselves to believe that healthcare is just another industry, that the provision of medical care is a business, and that medical services are an economic commodity that is best distributed by market forces,” Relman said. Society at large sees nothing wrong with investor-ownership of healthcare entities like insurance companies and hospitals, many of which are on the New York Stock Exchange, he said.

Although the Bush Administration believes in an “ownership society” and free-market solutions—not just for healthcare, but also Social Security—Relman said healthcare should not be treated as a market-driven business. Society needs to see healthcare provision as its responsibility, rather than letting every person make their own healthcare choices and manage their own care dollars. The consumer-directed healthcare plans and tax-free health savings accounts now in vogue leave too much responsibility to the individual, which could result in fragmented and lower-quality caregiving. “When patients will come like shoppers in a mall for what they want, there’s no integration,” Relman said. These plans also fail to cure the basic problem causing healthcare inflation: the fee-for-service care provision structure. “Under consumer-directed healthcare, doctors will have the same incentives to overuse, overserve, overprovide,” Relman told the audience. “If you pay doctors by piecework , the incentive is for doctors to do more and more.”

The system will also be biased against lower- and middle-income earners, he predicted, because only wealthier people will be able to set aside much money in health savings accounts. Patients who are less well-off will be unable to save or highly reluctant to spend any saved funds, which will limit their doctor visits and medication purchases, Relman said.

Consumer-directed healthcare will run its course but is ultimately destined to fail, Relman said. “More and more people will become uninsured, and underinsured, and businesses are groaning under their healthcare costs,” he said. “I don’t think it will be too long before political pressure for a change in the insurance system will build to the point of action.”

Conversion of the delivery system will take longer, but economic realities will ultimately force reform in the next decade or two, he said. “A new day will dawn” that will bring a national healthcare system that provides coverage for all and a national budget cap on healthcare expenditures. Relman said a critical part of the change will be placing doctors on salary. That is a radical change from the current system in which doctors increase earnings by billing for specialized services. “The more specialized we become, and the more expensive the techniques are, the more money we make,” Relman said. “If we have a system in which doctors work essentially for a salary, are paid for their time and effort, and compete on the basis of quality, it would save an enormous amount of money and it would allow us to improve the quality of our healthcare services enormously.”

Relman has publicly discussed this idea before and has not yet been booed out of the room, he said. But people frequently ask whether doctors would really go the extra mile for their patients, if they were only earning a salary. “I say, yes, I think they will,” said Relman, a physician for more than 55 years and an honorary Academy Fellow since 1988. “That’s what good doctors do.”

The Stated Meeting is an Academy tradition started in 1847 to mark the anniversary of the founding of the Academy that year. Awards presented at the 158th Annual Spring Stated Meeting are as follows:

*Elizabeth H. Blackburn, PhD, received the Academy Medal for Distinguished Contributions to Biomedical Science. Dr. Blackburn is best known for her groundbreaking discovery of the enzyme telomerase, which explains the activity of the ends of chromosomes, and how to manipulate it to combat cancer. She is the Morris Herzstein Professor of Biology and Physiology in the Department of Biochemistry and Biophysics at the University of California, San Francisco. “Thank you very, very much for a truly wonderful honor,” she said. “I’m deeply moved and grateful.”

From left: Jeremiah A. Barondess, Peter F. Vallone, Arnold S. Relman, Samuel O. Thier, Elizabeth H. Blackburn, Lester Breslow, Jack D. Barchas.

*Samuel O. Thier, MD, received the John Stearns Award for Lifetime Achievement in Medicine. Dr. Thier is an authority on internal medicine and kidney disease and is widely acknowledged as a leading expert on managed healthcare’s impact on medicine. He is Professor of Medicine and Health Care Policy at Harvard Medical School. “Having had the opportunity to do what I’ve been able to do has been a privilege,” he said. “To be recognized for it, is an enormous pleasure.”

*Lester Breslow, MD, MPH, ScD, received with the first annual Stephen Smith Award for Lifetime Achievement in Public Health. Dr. Breslow is considered the pioneer of chronic disease prevention. He was among the first to show that following simple lifestyle habits could significantly extend a person’s life and reduce disease likelihood. Dr. Breslow is a Professor in the Department of Health Services and Dean Emeritus at the School of Public Health, UCLA. Breslow explained that Smith was a pioneer who sought to ensure that people’s living conditions were healthy. “It’s a double honor to be connected in this way to the illustrious New York Academyof Medicine, and to be associated in this way with Stephen Smith,” he said.

*Peter F. Vallone, Sr., received the Academy Plaque for Exceptional Service to the Academy. During his tenure as Speaker of the New York City Council, he worked in collaboration with the Academy to recruit promising scientists to New York City to work toward solving disease problems in urban populations. “Thank you very much for what you do every day to make life better,” he told the audience.

The New York Academy of Medicine, the country’s premier urban health policy and intervention center, focuses on enhancing the health of people living in cities through research, education, advocacy, and prevention.

Posted on 04/28/2005

Contact:
Malini Doddamani
Director of Communications
mdoddamani@nyam.org
212.822.7285

News Archive