STEVE JACOB is an award-winning veteran health care journalist. He has spent four decades as a daily newspaper and magazine editor and publisher and writes about health policy for Texas newspapers, magazines and health care organizations.
He recently retired after a 13-year career as publisher of the suburban editions of the Fort Worth Star-Telegram, where his health commentary was distributed nationally by the McClatchy Tribune News Service.
He has received many accolades for his coverage including a 2008 Public Health Award for Media Excellence from Texas Public Health Association for a commentary on obesity in Texas and an honorable mention in the 2008 Texas Medical Association’s contest for commentary on Texas’ poor record on immunization.
After five years of research and reporting on health policy, he became increasingly concerned that the health-reform debate was overshadowing larger problems that reform does not adequately address: runaway health-care costs; workforce shortages, and avoidable chronic disease.
Based on more than 1,000 references and a year of in-depth research, Jacob offers non-partisan a look at the future of America’s health care in Health Care in 2020: Where Uncertain Reform, Bad Habits, Too Few Doctors, and Skyrocketing Costs are Taking Us (January 2012, Dorsam Publishing). In it, he takes on the challenge of explaining what’s wrong with health care and presents solutions that rise above partisan politics.
Jacob is an adjunct professor at the School of Public Health at the University of North Texas. He holds master’s degrees in journalism and business administration from Indiana University and a master’s degree in health policy and management from the University of North Texas.
He is a sought-after speaker, focusing on health care issues on both the state and national levels. Health Care in 2020 is his first book.
Steve Jacob on Health Care in 2020
Q: Will health care reform still be with us in 2020? If not, what will health care look like?
Whether health reform survives a U.S. Supreme Court test and the next presidential administration is anyone’s guess. However, many of the biggest issues the health-care system is facing are not addressed significantly by the health-reform law: rapidly rising prices; health-care workforce shortages, and medical spending that is of no benefit. Health reform’s major thrust was to ensure everyone had affordable health insurance. How affordable that insurance will be in 2020 is a separate issue.
Q: What are the most significant ways we can cut health-care costs?
The only sure way to cut health-care costs is to use less health care. Most chronic disease – heart disease, high blood pressure, cancer, diabetes – can be avoided by four health habits: not smoking; maintaining a healthy weight; regular exercise, and not drinking excessively. These chronic conditions account for 75 percent of all health-care spending. Avoiding them, and controlling them, can have a huge impact on costs.
Q: How is the health-care system preparing for health care reform?
Regardless of whether health reform survives legal challenges and the aftermath of the 2012 election, health reform preparations are changing the system in profound ways. Health insurers are facing tougher scrutiny. Hospitals are paying closer attention to patient safety and satisfaction. Everyone is becoming more efficient because of the anticipated government payment cuts.
Q: Who is the bigger winner in health reform: consumers, or the health-care industry?
Certain segments of health-care consumers are clear winners. People with pre-existing conditions, women, older patients not yet eligible for Medicare will no longer be discriminated against when they seek insurance coverage. It remains to be seen how much the health-care industry will benefit. The major players made large financial concessions in anticipation of gaining more customers because of Medicaid expansion and the individual mandate.
Q: In your book, you address a major shortage of doctors and nurses in our country’s near future. Why is this occurring?
Health-care workforce experts erroneously predicted in the 1990s that there would be an oversupply of physicians. Once it became clear there would be shortages, medical schools and residency programs have not been able to recover quickly enough because it takes so long to train physicians. For nurses, there is an ample supply of qualified candidates. The problem is nursing school faculty shortages. Highly educated nurses can earn much more working in health systems than in education.
Q: What is the biggest misconception about health care reform?
The term “Obamacare” misbrands health reform. The law was shaped, nurtured and largely paid for by the health-care industry and AARP. These muscular lobbies are well-funded and represent nearly 20 percent of the economy. They collectively represent a far bigger barrier to repeal than President Obama’s re-election.
Q: Which companies are the most likely to opt-out of offering employees health insurance and send their employees to the health insurance exchanges?
Companies are weighing whether to continue offering health insurance or simply to pay the $2,000 penalty for each employee. The decision to discontinue health insurance might be prudent for industries with high turnover, such as hospitality, restaurants and retailers. Larger companies are more likely to conclude that offering insurance is too critical for employee recruitment and retention to abandon.
Q: How do you think health reform might be affected by the Supreme Court review in 2012?
The Supreme Court is unlikely to overturn the entire law. The individual mandate is the most vulnerable to being ruled unconstitutional. However, Congress did not say that the law would be invalid if any part was struck down by the court. It is unlikely the justices would fill that legislative void.
Q: What can we expect from the pharmaceutical industry in the coming years, especially in costs to consumers and research and development?
For decades, it lived off what it called “blockbuster” drugs: patented medications aimed at broad populations with chronic conditions. However, the patent-drug gravy train appears headed for the horizon. Worldwide sales of brand-name prescription drugs could be cut in half by 2015 as lucrative brands lose patent protection. Cheaper generics now account for more than 3 out of 4 U.S. prescriptions. Pharmaceutical companies likely will concentrate on specialty drugs aimed at smaller populations but can command a higher price tag, such as treats to treat cancer.
Q: Talk to us about the three types of preventive methods, and why is so little government fund of them.
Primary prevention focuses on community-wide efforts to reduce disease in everyone. This is usually called public health. Some examples are mass immunizations, air-pollution controls and public-service campaigns to reduce smoking and other risky behavior. So-called “sin taxes” on cigarettes and alcohol are a form of primary prevention. Secondary prevention is primarily screening to detect diseases such as cancer and heart disease in their early stages, in an effort to reduce severity. But screening does not prevent them. Tertiary prevention attempts to keep disease under control after it has developed. This is also known as chronic-disease management, and is the most expensive form of prevention. There is an entire chapter devoted to this in this book. Nearly everyone supports prevention, except when it costs taxpayers. Disease represents urgency. To some, spending money on prevention is wasteful because you may be shelling out taxpayer dollars for disease that might not occur. It is very shortsighted. Of the 30-year increase in U.S. average life expectancy in the last century, only five years can be credited to advances in medical care. The 25 other years are tied to public health.
Q: A large portion of your book is devoted to American health behavior and its consequences. How is medical spending tied to controllable factors?
In the United States, these four behaviors are responsible for 4 out of every 10 deaths. Nearly two-thirds of the annual growth in U.S. health spending comes from Americans’ worsening health habits, especially the rising tide of obesity. Exercising, eating right and maintaining a normal weight would cut the odds of heart disease, cancer and diabetes by about 80 percent. Treating chronic conditions accounts for at 75 percent of total U.S. health-care spending. It is the difference between life and death, and health and illness. In a study of nearly 80,000 U.S. women ages 34 to 59, it was calculated that more than half of the deaths from cancer and heart disease would not have occurred if the three practices had been adopted.
Q: What can be done on a national level to change destructive habits like smoking, failure to exercise, and eat right?
We could virtually wipe out cigarette smoking if we did four things: significantly increase tobacco taxes, expand public smoking bans, anti-smoking advertising campaigns, and ban cigarette marketing. The only barrier is political will to do so. Physical activity and nutrition are much more difficult to control. The best results on changing those habits are being done in workplace wellness programs. Employees are given financial incentives to change their health habits, and it is works. Unfortunately, duplicating that in the public arena would be virtually impossible politically.
Q: What is the most important point you hope readers will take away from your book?
The answers to health care’s most serious problems – workforce shortages, unabated cost increases, widespread and poorly controlled chronic disease – will not be addressed adequately by health reform or its repeal. Every American needs to become engaged in their personal health and personal health-care finances to avoid what appears to be a very perilous future.