I have been an academic physician my entire professional career, over thirty years now; but I would like to think that I have not been a captive of the ivory tower. I had the privilege and challenge of working in widely disparate areas of academia and health care. I have been a physician to the rich and the poor. I practiced and taught both primary care disciplines and medical specialties; both clinical and laboratory medicine. I pursued both basic and clinical research. I have been a physician executive for physician groups, insurance companies, and more. I chaired university, medical school, research, hospital, professional and community committees. I worked for both state and federal governments in areas relating to Medicaid, Medicare, and health care reform. For the last five years of my career, I was a full-time lobbyist for higher education, schools of medicine, and teaching hospitals. Details of some of these activities are available in my curriculum vitae (attached). I hope to bring this broad background to a fair and balanced discussion of health care issues on these pages.
I am at my roots, however, a physician. I was drawn into health policy issues because of the unconscionable things that were happening to my patients in the early 1990s. (It was happening earlier, but I was not smart enough to notice.) At that time I took care of many patients with arthritis and other chronic diseases and which caused them difficulty at their work. These were the archetypical "pre-existing diseases" that excluded my patients and their families from affordable systems of medical care. I will have many stories to tell, but the one I remember as a tipping point was when a minister's wife had her medical coverage canceled while she was sitting in her hospital bed waiting for medically appropriate surgery. "Too sick to insure" was the message I heard. Rather than insure her, the company dropped the coverage of the entire group of ministers. This was not a fly-by-night company, but one of the big reputable names. These discriminatory practices were then the industry standard. Additionally, what was passing for managed care at that time was driving doctors and their patients to distraction. I was told that my patients could not be authorized for medical admissions by telephone clerks who had to ask me to spell diseases they had never heard of. You have heard many stories like this, and I am the first to say that all of them have two sides if not more. (I actually spent a subsequent year as the guy who was in charge of saying no!) In any event it became clear to me I needed to learn more about the medical-industrial-educational-governmental complex that was shaping the way I practiced my profession and was affecting people I cared about. I wanted to try to fix the system from the inside. Through all of this I fancied that my orientation was as an advocate, if not a champion for the physician-patient relationship.
I learned a lot, but not enough to know how to fix it all at once. In fact, I learned as a lobbyist that the easiest thing to do is keep something from happening, and that the hardest thing to do is to take something away from someone who has it-- especially money. I am not happy with the state of our health care system. If anyone is, it is probably for the wrong reasons! Too many people are underserved through no fault of their own and an even greater number are over-served to their detriment. It all seems to suck up too much money and there is no end in sight. Making money seems more important than making health.
When I was working in Washington I had an occasion to try to organize my thoughts. I could not say I knew how to "fix the system," but I thought it would be useful to think about what a solution should look like. Without a destination I feared we would continue to wander at the mercy of precedent and vested interests. I place this vision of what a health care system should look like elsewhere on this site. As we approach the ten-year anniversary of that offering, it seems to me an appropriate time to evaluate whether we have made any progress as a nation, or indeed if the goals were more hallucination than vision!
The public and those who administer to them are going to have to work this out together. We have had enough of health care providers writing the legislation that regulates them. The process will be neither easy nor neat. There will be apprehension along the way. We need not fear that. The easiest way to block something from happening in the legislative and policy processes is to wave the yellow flag of "unintended consequences." There will always be unpredicted consequences of change in systems this complex. Indeed, there will be unpredictable consequences of doing nothing! Acknowledging these realities up front helps us to adapt continuously. (Of course, not all unintended consequences are bad!) Unless we have a catastrophic collapse of our health care system from which a clean rebuild can be performed, we will have to work with what we have already. It is as important now as ever that consumers, people subject to illness, participate meaningfully this process. That requires an honest and well-balanced exposition of all issues and choices. Perhaps more than anything else, it is my sense that such balanced discussion is not occurring has led me to my involvement in this Institute.
This Institute and its website are works in progress. We do not spring full-blown from the brow of Aesculapius. Just learning how to manage a website has been an interesting new challenge. Nonetheless, I am not willing to let the perfect be the enemy of the good. I want to start somewhere, and this is it. I intend to use these pages to offer opinion and information relating to current health care issues. Because I am an old scientist by nature, I hope also to present health policy research I conducted over the years. I am willing to consider written contributions by others if that seems like the right thing to do. I hope I can earn your attention and your participation. This is an adventure for me, and can be for you too.
Peter Hasselbacher, MD
Founder and President
Kentucky Health Policy Institute
January 30, 2007
About the Institute:
I founded the Kentucky Health Policy Institute, Inc. in 2005 as a vehicle for some of the writing and research I wanted to do. It is a nonprofit corporation registered in the Commonwealth of Kentucky. While KHPI is willing and able to accept contributions to defray its day-to-day expenses, we are not a federally exempt organization at this time and such contributions are not tax deductible.