Dr. Cecil Wilson, president-elect of the American Medical Association, on the impact of health reform on health care, medicine and society.

Mark Masselli: This is Conversations on Healthcare. I am Mark Masselli.

Margaret Flinter: And I am Margaret Flinter.

Mark Masselli: Margaret, as the debate continues I think most people are eager
to take a look at the Healthcare Bill themselves. Every party I attend I am being
asked what’s in that bill. Well, for those of you who would like a copy of
Reconciliation Act of 2010 it's now available. Just go to the library of congress
website www.thomas.loc.gov all 900 pages at your finger tips.

Margaret Flinter: Well Mark, I have to admit that I printed out a copy of the whole
bill. I really want to go through it line by line and I hope Americans will give it a
read even if it's just a few of those pages or people just search for the items that
are of particular interest to them. We know the country is still all over the place
on how they have view this Healthcare Reform. It’s certainly one of the things we
will have to wait and keep assessing as it unfolds but we just can't encourage
people enough to understand what’s in the bill.

Mark Masselli: Now, we want them to be green so we were not encouraging
everyone to print them out. But I think you are right about having to have people
take a look at this bill in detail and the polls are all over the place but there was
one poll that the Commonwealth Fund did and they were taking the opinion of
healthcare leaders and policy makers and they found that this group of people
were very optimistic about the new healthcare legislation.

Margaret Flinter: Well, it was a pretty select group of leaders who really
understand healthcare and I think they came at it from this perspective. If we
successfully cover the uninsured we will as the Institute of Medicine has set for
years have taken the first and most important step towards ensuring access and
affordable healthcare. Now those folks did note that in the short-term there are
some issues the nation’s supply of Primary Care Providers, the ability of the
states to actually implement reform and also enforcing that individual mandate.
These are all areas of concern that people who understand the legislation still
have.

Mark Masselli: You know and they really do and I think it's best characterized by
Karen Davis’ statement who is the President of the Commonwealth Fund and it's
been guest here on Conversations. When she said you know that US will now
join all other major industrialized countries with the system for ensuring access to
essential healthcare.

Margaret Flinter: And, that’s something certainly that the healthcare economists
have been fighting for a long time, many of them as both in economic rationality
issue and also as a moral issue. So I think we conclude it's a new era in

American Healthcare. We have a lot to look forward to and at the end of the day,
Healthcare Reform is all about making Americans healthier, building healthier
communities, building a healthier America.

Mark Masselli: Speaking of making Americans healthier, First Lady Michelle
Obama’s Let’s Move Campaign which is designed to give parents support they
need, provide healthier foods in school and help kids be more physically active is
really the forerunner of the preventative focus that’s embedded in that Health
Reform Bill. And on Monday, the First Lady and the President hosted the annual
White House Easter Egg Roll, I wish I was there but with the twist or theme I
should say to promote health and wellness. They called it Ready, Set, Go! The
event featured music, sports, cooking stations and of course the Easter Egg Roll.

Margaret Flinter: Well, I am glad they cut the Easter Egg Roll. Eggs are a
perfectly healthy food and all these activities the fitness, the healthy eating and
social interaction, all these things encourage kids to be more active. And they
follow the First Lady’s National Campaign Let’s Move which is all about curbing
child to obesity which everyone knows we have got to do.

Mark Masselli: Speaking of keeping us healthy, our guest today has an
interesting purge on the impact health reform is having on healthcare medicine in
our society. President elect of the American Medical Association Dr. Cecil Wilson
is here to talk about the AMA support for the bill and how the much needed
change in our healthcare system will improve how doctors practice medicine. Dr.
Wilson will assume the office of the AMA Presidency in June 2010 just as the
benefits of the Healthcare Reform Legislation start taking affect.

Margaret Flinter: Well, I think Dr. Wilson is probably going to have one of the
most interesting presidencies of the AMA in recent history, we wish him well. No
matter what the story, you can hear all of our shows on our website
chcradio.com. You can subscribe to iTunes to get our show regularly
downloaded or if you would like to hang on to our every word and read a
transcript of one of our shows, come visit us at chcradio.com.

Mark Masselli: And as always, if you have feedback, email us at chcradio.com ,
we would love to hear from you. Before we speak with Dr. Wilson, let’s check in
with our producer Loren Bonner with headline news.

Loren Bonner: I am Loren Bonner with this week’s headline news. The Easter
Egg Roll hosted by the White House on Monday focused on something that
President and First Lady can't get enough off promoting health and wellness.

First Lady Michelle Obama: We have got football, we have got basketball.

Loren Bonner: Annual event featured music, sports, cooking stations and of
course, Easter Egg Rolling for the children, activities that encourage healthier

and more active living. The theme follows the First Lady’s Let’s Move Initiative –
a National Campaign to combat childhood obesity that she launched back in
February. President Obama gave his true sense after reading aloud to the
children the classic Green Eggs and Ham by Dr. Seuss. The event seemed to
appropriately follow the recent passage of Healthcare Reform Legislation that the
president just signed into law and President Obama continues to promote its
benefits. He spoke to a crowd in Portland, Maine last week and frame the
legislation as an essential part of the country’s economic recovery with particular
benefits for small business owners who have been hit hard by a weak economy.
President Obama says one key benefit of his healthcare overhaul is a tax-credit
for small companies that supply their workers with insurance.

President Barack Obama: This healthcare tax-credit is pro-jobs, is pro-business
and it starts this year.

Loren Bonner: The credit is based on the size of the company businesses with
fewer than 25 employees will get a tax-credit up to 35% of the company’s share
of their total healthcare premium. Businesses with 50 or more workers must offer
coverage or pay a penalty of $750 per worker. Companies with 26 to 49 workers
do not qualify. Some potential glitches to the system are still being worked out
however for companies with more than 50 employees the penalty fee per worker
is actually less than what the business would be spending on healthcare for that
worker not much of an incentive to offer coverage to everyone. The senate is
considering an increase in the $750 penalty to prevent that scenario. We spoke
last week about the potential nomination of Don Berwick to direct the Centers for
Medicare and Medicaid services. Although the appointment is not yet official the
healthcare community is healing the prospect of his leadership. Stuart Altman, a
leading Healthcare Economists and Professor at Brandeis University couldn’t be
happier.

Stuart Altman: I don’t know any other American that has had the impact on our
healthcare system that Don Berwick has had. I mean he created IHI the Institute
for Healthcare Improvement to focus primarily on increasing safety and the
quality of care. And according to many estimates as a result of the work that he
and his staff have done more than 100,000 Americans a year are alive as a result
of the delivery system becoming more concerned with the safety and with
improving the basic level of care so the quality improves.

Loren Bonner: Kerry Weems who spent 25 years in senior rolls at the Health and
Human Services Department and was acting Administrator of CMS from
September 2007 went further and said if Don Berwick is confirmed as
Administrator of the Centers for Medicare and Medicaid Services he and David
Blumenthal, the National Coordinator for Health IT would be a DreamTeam in
pursuing a coherent National Healthcare and Health IT strategy. Blumenthal is
already leading that campaign to direct the use of Health IT in ways that would
heal scientifically relevant data on healthcare treatment and practices.

Mark Masselli: This is Conversations on Healthcare. Today, we are speaking
with the American Medical Association President-Elect Dr. Cecil Wilson. Dr.
Wilson, welcome.

Dr. Cecil Wilson: Well, thank you.

Mark Masselli: Many books have been written about the history of efforts to
reform healthcare in America over the past century. I think it's fair to say that the
AMA has generally been portrayed as being an opposition to health reform that
wasn’t the case this year. The American Medical Association went on record is
being in support of President Obama’s Healthcare Reform Legislation. Was this
shift about the content of legislation or do you think it reflects the fundamental
change in the cultural beliefs and practices of the current generation of
physicians?

Dr. Cecil Wilson: This time, what we said at the AMA was that the need for health
system reform was an imperative that the current system was not serving our
country and the patients or the physicians who take care of them. And so I think
it's unfair to say we signed on to the President’s plan. What we did was to say
we want to support efforts and meaningful health system reform and we will work
with the administration and with Congress House and the Senate to make that
happen.

Margaret Flinter: Dr. Wilson, over the course of the many hours of televised
debate on the Health Reform Legislation, we’ve heard from several physician
members of Congress and when I think back on the debates I don’t recall any of
them really speaking in favor of the legislation that was passed in. Sir, we’ve
heard again the fears of government intrusion, socialization of healthcare,
potential for negative impact on physicians and patients, things that are more
consistent with more of the past. Tell us about your worker or the AMA’s work
with the physician members of Congress, did you have an opportunity to dialog
with them over the past year and what are the things that came out that you think
were the good outcomes of this legislation?

Dr. Cecil Wilson: So I think that the debate among physicians has reflected that
in the country and the answer to the question about reaching out to physicians is
that we have both in Congress and elsewhere to try to come to some agreement
about should happen and what is really good about the legislation is that the tens
of millions of Americans who currently do not have a health insurance and as a
result are at a greater risk of being sicker when they get care and a
11.13_______ center will have coverage. In the end the AMA did not expect to
get everything we thought was needed and we have looked at the package and
said on balance there is so much here that is good that we need to come on
board and accept and urge passage understanding that we really are at the start

of a process which is going to go on over the coming four or five years or more
as we implement what was passed and also make improvements on it.

Mark Masselli: Dr. Wilson, that’s a great summary of the benefits of the bill but
there are also some huge investments in medical education and training
particularly for primary care providers, the Patient-Centered Medical Home gets a
lot of attention as do investments in public health efforts to reduce obesity, stop
tobacco use and increase physical activity. How successful do you think these
elements of health reform will be in creating a more satisfied medical community
and healthier American public?

Dr. Cecil Wilson: Well, first of all I think physicians, even physicians who are now
uncomfortable or even angry about the legislation are going to find that their lives
are going to be, I think having patients who are insured and who have more
choice of plans and having the administrative simplifications and insurance
reform is going to make life lot better that the items that you listed which I would
say are extremely important. All we did to help system reform is to provide
coverage and do some insurance reforms. We actually may end up making the
system worse because we would not have addressed the issues related to work
force and you mentioned that related to primary care. We would not have
addressed issues related to care so the epidemic of health behavior that have
causing disease in this country that alcohol abuse, cigarette smoking, obesity so
all of those things are very important and then the other one which you also
mentioned having to do with workforce what we call workforce issues and that is
that not only do we have a shortage of physicians in the country but we also have
a shortage which is even more marred in primary care so there is a lot in this bill
in terms of bonuses for primary care, 10-year pilot projects for the so called
Patient-Centered Medical Home that I think into end are going to be very
important for the success of health system reform as well as the satisfaction of
physicians and patients.

Margaret Flinter: Let me ask you, your organization is perhaps the best known
physician organization in the Untied States but other groups have formed
including physician groups that absolutely champion a single payer or a single
national health program as the only way we will ever really control cost, improved
quality and gets universal coverage. How does the AMA view that platform and
what do you say to this group of physicians within the physician community about
the progress that we have made with passage of this bill?

Dr. Cecil Wilson: Well, I would remind them that one of the laments of the late
Senator Ted Kennedy was that when he and President Nixon were working on
the possibility of health reform that he did not meet him halfway that they did not
come to an agreement that he saw that made the perfect enemy of the good, I
think the position of the AMA is that for our country that is single payer or
government run system would not work with the size of this country and the

diversity of this country puts us in a different place from some other countries
around the world.

Mark Masselli: Today we are speaking with the American Medical Association
President–Elect Dr. Cecil Wilson. The health reform will increase the number of
people who are covered by Medicaid and one of the most striking elements of the
bill that only appeared in the reconciliation legislation was the provision moving
Medicaid payment rates up to 100% of the Medicare standard. That has the
potential to bring many more primary care doctors into carrying for the Medicaid
population and insurance that the majority of physicians for a long time shun
because of its historically low reimbursement rates. First of all how did that come
into play in the last minute and do you think it will have its desired effect?

Dr. Cecil Wilson: That the history of that is that that actually at some $50 billion
to $57 billion which issued indicated would require primary care payments under
Medicaid to be at least to equal to that of Medicare that was in the house
legislation. I think in the reconciliation bill was one of those things that house did
to put some things in legislation that the house in fact was very important you
know just taking example from the Medicaid payments varied among the states
depending as far as coverage and payments that has met nationwide that the
numbers of physicians who could afford to provide care for Medicaid patients has
been a challenge and we are certainly hopeful that this really significant amount
of money will help with that and also have to respond to the other observation
and that is that a part of the increased coverage for all this the uninsured is an
expansion of the level of coverage from Medicaid up to 133% of the federal level
I guess the other observation there and that is important and that is that Medicaid
for states is a big budget buster and states are challenged by that, and what this
legislation does is to anticipate that so that at least for the first two or three years
the federal government would pick-up all of the cost of this expanded coverage
and then subsequent to that there will be a gradual tapering down of that
coverage as you know now is a state federal match and I think that’s why you
have not seen a lot of the governors just really yelling and screaming about this
because they do recognize that at least early on there will actually be increased
funds coming to their states, from which they will benefit and then I am sure as
time goes on they will be looking to preserve that as modifications continue to
come down.

Mark Masselli: They will.

Margaret Flinter: They will. Dr. Wilson when we look at so much of how medical
care is organized and delivered and this moves away a little bit from the health
reform issue it just doesn’t seem to quite evolve the way other sectors in our
society and economy have, still most practices don’t have electronic health
records, virtual visits are a rarity and most practices are still in the small
independently owned business category and at the same time social networks in
the use of various health related apps are widespread use by the public our

patients for everything from support for living with the chronic illness to
monitoring diet and vital signs. Outside the US mobile phones are being used in
healthcare for everything from remote monitoring to ultrasound to tracking
infectious diseases. So it seems like medicine has made enormous strides in the
most complex technology for diagnostics in treatment but somehow that hasn’t
come down to the level of primary care or community practice. We would be
really interested in your thoughts on this technical divide within healthcare and is
it just the matter of time until the next generation of physicians coming up
changes all that?

Dr. Cecil Wilson: Well I think it is the a matter of time and I think I hope that as
people think about that and think that, that that’s going to be helpful and I think
we all do. I think better coordination, better interaction will be helpful but it is
going to take time because the demographics of practice in this country are that
it's build a case that at least something around 51% or 52% of the physicians in
this country are practicing in groups of three or less and they are practicing in a
variety of areas both urban and rural and so that demographic means that as we
look at ways that we can't take advantage of increased communication and
working together, you have got to get around that challenge.

Mark Masselli: Dr. Wison you have a great view of what’s happening in
healthcare around the world, what do you see that’s transformational that excites
you and who should our listeners be paying attention to?

Dr. Cecil Wilson: We recognize that, and you referred to it earlier that a lot of the
illness we have is illness we bring on ourselves. If you look the CTC that’s in
work where they looked at health and they contributed to determinants of health
behaviors and what they found was, the current population owned a 10% of the
department of health behavior had to do with access to care, so the treatment in
the hospital and doctor’s office. 20% had to do with urine genetic inheritance that
parents who chose or did not choose and 20% had to do with environment sort of
things like clean water, food things of that sort. 50% of determinants of the
health of our population has to deal with health behaviors and so cigarette
smoking, obesity, sedentary lifestyle, alcohol abuse those are all things that
people do that contribute mightily to the cost of healthcare and to illness in the
country and so just one example there, obesity and this type 2 adult, type 2
diabetes is up $114 billion a year that we spend on that. 10 or 15 years ago it
was not on the radar screen so I think one of the exciting things is how we are
going to engage society and certainly the First Lady Michelle Obama is in with
her initiative related to childhood obesity sort of raising that level. I think we have
to focus on that and that’s going to be a job for society in general not only, and
not just physicians in healthcare workers but everyone.

Margaret Flinter: Thanks Dr. Wison and let me get your thoughts on community
health centers for a moment if we can as you know the health reform legislation
has just unprecedented investment in funding the growth and expansion of

community health centers and developing some very exciting new models of the
teaching health center with residencies for all the various health professionals
and I am curious to hear thoughts on the role of the community health centers in
this changing landscape of primary care of the United States particularly with this
new investment, what is it really signaling to the country?

Dr. Cecil Wilson: Well I think it's part of the whole mosaic if you will of the things
we are going to have to do and that is we are going to have to provide care to
people where they are and under the circumstances they are in so that the
advantage of things like community of health centers is frequently responding to
a need and underserved areas, also providing a coordination of care,
coordination of health professionals. The public health kind of needs of the
community to service and the way it has attributed over the years, I think to our
disadvantage and so I would see this as a positive thing.

Mark Masselli: Today we have been speaking with Dr. Cecil Wilson President-
Elect of The American Medical Association. Thank you so much for joining us
today Dr. Wilson.

Dr. Cecil Wilson: Well, thank you so much.

Mark Masselli: Each week Conversations highlights a bright idea about how to
make wellness a part of our communities and everyday lives. This week’s bright
idea focuses on a new program that’s combating Alzheimer’s disease even
before it develops. A group of researchers at UC Santa Barbara recently
launched a new initiative called Cognitive Fitness and Innovative Therapies or
CFIT, which takes a comprehensive approach to cognitive health. CFIT
specifically aims at preventing Alzheimer’s disease. One of the most debilitating
and wide spread cognitive illnesses, Alzheimer’s is a progressive brain disorder
responsible for most dementia cases. Currently affects 5.3 million Americans
because the patients decline is often swift and unstoppable, one symptoms
appear. CFIT seeks to prevent Alzheimer’s before the first warning signs even
appear. CFIT guides participants typically aged 50 to 80 through a wide variety
of strategies for both treatment and preventions, participants are coached on how
to eat healthy. Mediterranean diets which help keep blood pressure and
cholesterol check are used. They are trained in how to improve their physical
fitness to strengthen their minds. They also play mental fitness computer games
and as part of the CFIT’s holistic approach to cognitive health and non-
denominational chaplin is available on site to participants for counseling and
guidance. Another key component of the program is a focus on building social
relationships between participants. Consistent social contact plays a vital role in
staying healthy, especially later in life. With that in mind CFIT organizes groups
of participants to use the facilities at the same time every week, so they can get
to know each other. CFIT is also in the process of creating a social networking
website for participants. This site will play a dual role, it will facilitate
communications between participants and by enabling people to log their diet

and exercise habits it will allow researchers to gain important data about the
program’s effectiveness. CFIT, well its membership is growing and participants
are already reporting maintained or improved mental and physical health, also
because the families and friends of Alzheimer’s patients are often suffering
physical and emotional stress, that benefits of this improved Alzheimer’s
prevention can be far reaching, making our communities healthier and happier
overall. Now, that’s a bright idea.

Margaret Flinter: This is Conversations on Healthcare. I am Margaret Flinter.

Mark Masselli: And I am Mark Masselli. Peace and Health.

Conversations on Healthcare broadcast from the campus of Wesleyan University
at WESU, streaming live at wesufm.org and brought to you by the Community
Health Centre.