Daschle Calls for Greater Primary Care, Prevention Efforts

During a Senate hearing here on Jan. 8, HHS Secretary-designate Tom Daschle called on Congress to shift the nation's health care paradigm from an illness-based model to a wellness and prevention-based model by providing more resources and support for primary care health professionals and services.

Daschle, who testified before the Senate Committee on Health, Education, Labor and Pensions as part of his confirmation process, said he views health care as a pyramid and primary care as the "base of that pyramid."

"As you work your way up … you get more and more sophisticated until at the very top you have heart transplants, MRIs," said Daschle, a former senator from South Dakota and the former Senate majority leader.

"Every country starts at the base of the pyramid with primary care and works their way up until the money runs out," said Daschle. But the United States starts at the top of the pyramid and works its way down until the money runs out, resulting in a lack of primary care and wellness.

"So we have to change the paradigm," he told the committee. "We have to start at the base."

The current system works through incentives, said Daschle. "Right now, there is a great deal of incentive to become a subspecialist." But he would like to see the same kinds of incentives applied to primary care health professionals.

Daschle described payment reform and academic tuition assistance as "tools" for turning the health care system around, saying they both are ways of encouraging medical students to pursue careers in the primary care field. "We should put more emphasis on scholarships for primary care providers and more emphasis on forgiveness of college costs for primary care providers," he told the committee members.

Sen. Tom Coburn, M.D., R-Okla., agreed with Daschle's assessment, saying prevention "does not happen in this country because we don't pay for it." The only way to truly reduce Medicare costs in the long term is through the prevention of chronic diseases, not just the treatment of those diseases, Coburn said.

Sen. Patty Murray, D-Wash., asked Daschle about the sustainable growth rate, or SGR, formula, which is used to determine Medicare physician payment rates. Murray described the SGR as an outdated system that relies on utilization of services rather than on health outcomes to determine payments.

"I couldn't feel more strongly that the SGR system is not working right," agreed Daschle, emphasizing that physician payment under Medicare should not be based on procedures but on health care outcomes. "I am not one who supports the so-called performance-based approach," said Daschle. "But I believe there are episodic ways of looking at reimbursement to give us a lot more latitude to incentivize better outcomes at a lower cost."

Daschle said cost, access and quality represent the three major problems with the nation's current health care system, leading to obvious questions about how to improve access and quality while reducing costs.

"There has to be a framework," said Daschle. "Unless we have a framework, we can talk about policy, but ultimately, the implementation of that policy will never come to fruition."

Daschle also noted that the country does not yet have an interoperable health information technology system.

"It just seems to me that it ought to be an embarrassment to this country in this day and age that we still do not have an interoperable system when it comes to health information technology," he said. "We need to find a way to make that happen."