The Healthcare Informer

Healthcare is a controversial, multi-faceted topic that can be found on most everyone’s lips these days. Economical pressures, along with the upcoming 2008 presidential election, have helped to elevate the issue to be one of the most contested in today’s tense US economic and political climate.

While economic woes have heightened the challenge of dealing with rising healthcare costs, the highly anticipated presidential race has stirred up fundamentally different viewpoints between parties related to proposed solutions for the current state of healthcare, and the issue itself has become a cornerstone of each defined political stance.

Today the national conversation on healthcare reform has sparked debate from all sides – Democrats and Republicans, the insured and the uninsured, white-collar and blue-collar workers – and for various financial, political, economic and health-related reasons. Amid all the conflicting and biased viewpoints, there is one impartial source working to raise awareness of the sensitive, multi-layered issue without bias and based purely on facts.

The Henry J. Kaiser Family Foundation is a 60-year-old foundation that touts its ‘product’ as information itself, and serves as an exemplary model for sifting through all the hype around healthcare to represent a soundboard for truth. Built to play a direct, special role in the national healthcare scene, Kaiser has broken the mold for the traditional expectations of a not-for-profit foundation and is taking on a growing global influence as well.

“The role that Kaiser plays is the independent, non-aligned trusted source of information on these very hotly contested national healthcare issues,” says Drew Altman, the foundation’s President and CEO. “We don’t push any solution and we don’t ever take a position. We always call it straight. That’s enabled us to play a special role as a voice of the facts to the extent they can be known and a voice for the people in a giant $2 trillion healthcare system mostly dominated by money and politics.”

The creation of and the impetus behind the foundation can largely be attributed to Altman, who reengineered the organization from the ground up in 1991, and turned it from a family foundation to an independent national organization with a completely new interest and direction.

Altman, a confessed ‘do-gooder’ and true servant of the public who got hooked on public service during the Carter administration, has been in the public eye since that time through various roles, including three years as the Commissioner of Human Services in New Jersey, preceded by six years at the Robert Wood Johnson Foundation.

Turning Kaiser upside down and taking on the noble responsibility of building an institution to serve as a pulpit of unbiased information to traverse the delicate, controversial grounds of healthcare issues, has been his proudest achievement. Today Altman continues to forge the foundation ahead and is fully dedicated to the wide spectrum of duties the organization has undertaken as its responsibility.

Major healthcare issues

Today healthcare clearly lies at the forefront of national conversation – and while some say healthcare ranks right up there next to the economy in terms of issues of importance, most would argue that the two are one and the same, and that the affordability of healthcare is inextricably linked with the state of the economy.

Thanks to the spike in healthcare costs, the obvious overriding concern for Americans today is access to affordable care. “Increasingly healthcare is being defined in the public mind as a dimension of the people’s overall economic worries and concerns,” Altman says. “It’s being defined as a pocketbook issue. That’s really what has driven the worries that average working Americans have about the costs of healthcare and paying for their health insurance.”

While many attribute rising healthcare costs to the aging population, Altman calls out the real issue as healthcare costs simply rising in general. “The reason that Medicare faces the solvency crisis down the road isn’t actually the aging of the population. It’s rising healthcare costs generally in our healthcare system.”

Another big crux of the problem is the cost of advancing medical technology. As new developments emerge in the field, people have hopes for gaining access to the benefits of new drugs and new technologies. But quelling rising costs would require slowing the distribution of medical technologies and encouraging individuals to utilize less healthcare overall – a bold and difficult political move to carry out.

One avenue that Altman suggests to combat the trend of rising costs is coming up with better ways to conduct more thorough reviews of new technologies to discern the actual benefits. “We do need to develop better ways, as they have in some other countries, to get a handle on reviewing new technologies, to decide which ones actually bring new benefits, and which ones bring no new benefits but just new profits,” Altman says.

The reality is that there isn’t one simple solution, and over time costs will continue to climb. “Ultimately, healthcare costs are going to continue to go up faster than most anything else in our economy,” Altman acknowledges. “It’s proven to be the hardest challenge we face in healthcare and a problem without any obvious, immediate solution. There are lots of popular things that politicians can propose that sound good or might have some effect down the road – such as IT, prevention, pay for performance – but there’s no big, immediate magic wand type solution anywhere near the horizon.”

On the national agenda

Such high costs have helped to drive the issue of healthcare to the forefront of the national agenda, a place it hasn’t been since the Clinton Health Reform Plan debate of the early 1990s. As the 2008 presidential election heats up, Kaiser’s role will be to help ensure that there’s an honest debate regarding the fundamental differences between Republicans and Democrats about the healthcare issues at hand.

How the campaigns and the election unfold will have large ramifications for the direction of healthcare reform and the transformation of the healthcare system under the new leadership. Altman points out several critical determinants from the pending political activities – large questions remain as to whether there will be a big debate about healthcare in the presidential campaign, whether the new president will make healthcare a top priority early in his term, and whether there will be a willingness in the next congress to fashion a bi-partisan compromise on national health reform legislation.

One thing he doesn’t question, however, is whether the current healthcare system is in crisis. This commonly expressed opinion heard around the nation is one claim that Altman doesn’t agree with. “As long as I’ve been in the field, which is since the 1970s, everyone in the field has declared healthcare in crisis. So if it is in crisis, it is in permanent crisis, or the other way of looking at it is that word ceases to have any real meaning.”

With 45+ million uninsured Americans today, no doubt the problems in healthcare are very real, as healthcare costs are becoming a heavy burden for the average American. But with such a massive system in a fluctuating economy, challenges will always be inherent and there is no singular, magic solution. “Most countries view their healthcare system as facing profound and real challenges,” Altman admits. “Every developed country faces the challenge of having finite resources that can’t match up with ever growing needs and particularly the need to pay for expensive advancing technologies, which their people want.”

Altman likens this blanket view of healthcare system to similar views of other large systems, such as education and the environment. “If we pass national health reform legislation tomorrow, we would face ongoing challenges of healthcare costs, of affordability, of improving the quality of care. When something is a $2 trillion healthcare system, such a big part of our economy and such a giant system, we will always face challenges. The people who work on environmental issues believe that the environment is in crisis and the people who work on education believe that education is in crisis. Everything cannot be in crisis. These are our biggest issues and we always face challenges working on these big problems.”

Distributed focus

Aside from Kaiser’s focus on the larger impact of heath care challenges related to businesses and the economy, and specifically, healthcare costs for the average working person, the organization also focuses on bringing awareness to issues impacting vulnerable and disadvantaged populations and the public programs that serve them.

Kaiser views it as a special obligation to serve the less privileged and prides itself on being an expert on programs such as Medicaid, S Chip and Medicare, to focus on the problem of healthcare disparities. “To focus on those in greatest need is inherent in the values of our organization,” Altman says. “It is a challenge for us because our main role is to be there with analysis and information on whatever the big issues are that may be before the country, the Congress, the White House and the national media, and the issues that most affect the vulnerable and the poor aren’t always on the national agenda.”

Its commitment to bringing the lesser-known but equally important issues to the surface demonstrates the dual role Kaiser plays: to bring awareness both to the high-level issues surrounding healthcare as well as to bring attention to the disparities of the less privileged who otherwise may be forgotten. The latter resolve is part of its fundamental decision to focus less on providers and health professionals, and more on people and the impact of policies and programs on the people.

Altman acknowledges that the vast distance between its diverse focus areas makes it seem almost as if the organization wears two completely different hats for two completely different audiences. “Part of the world knows the work that we do on health policy issues, which is embodied in our policy research work and our communications efforts, where we try to be a broker or clearinghouse of information on health policy through kaisernetwork.org, our health news and information service,” Altman points out. “Then there is a part of the world that knows us for the work that we do that focuses on young people, public health issues and HIV. That work is led by our big media campaigns, which we do domestically and around the world in partnership with the world’s largest media companies.”

Its unique, award-winning public health information campaigns have been raising the level of awareness on sensitive health issues across the globe, with a current focus on AIDS/HIV and a special emphasis on the youth population. The innovative public service programming model of the campaigns was originally developed by Kaiser based on direct partnerships with the world’s largest media companies.

Through the special arrangements, the media companies dedicate all of their resources, including media time, while Kaiser provides its expertise on issues and develops various communication vehicles such as websites and consumer-friendly publications.

The campaigns have been extremely successful for Kaiser, having leveraged more than $1 billion and garnering multiple Emmy awards and TV awards through recognition for establishing a completely original campaign model and communication strategy. Evaluations of these programs, particularly the US commitments with partners such as Fox, Viacom, BET, MTV and Univision, have shown tangible, positive outcomes in terms of behavioral changes among young people.

Today Kaiser operates campaigns around the globe, including major broadcast initiatives in Russia and India, along with regional initiatives in Africa and the Caribbean involving more than 100 broadcasters working together in nearly 50 different countries.

One prime example of Kaiser’s unprecedented commitments through these various media campaigns is its African Broadcast Media Partnership, a coordinated effort across nearly 40 African countries, in which the broadcasters from those countries have committed five percent of all of their prime time programming to HIV, and Kaiser works with them to develop the programming.

The most notable campaign effort organized by Kaiser is the Global Media AIDS Initiative (GMAI), launched in 2004 at a United Nations summit convened by former United Nations Secretary-General Kofi Annan, which attracted all of the world’s media leaders, including executives from the Bill and Melinda Gates Foundation and the Ford Foundation. Today Kaiser serves as the secretariat for the GMAI, which has grown to include more than 300 media companies across the globe joined in the fight against AIDS.

Global campaigns under the GMAI include the Caribbean broadcast, the Caribbean Media AIDS Initiative, the African Broadcast Media AIDS Initiative, and the Russian Ukraine Initiative, and there is a new large effort already underway that will soon be launched in Asia.

“The GMAI has been very successful,” Altman says. “It’s chaired by the CEO of the South African Broadcasting Corporation at the moment and has a rotating chair. We’ve tried to mobilize the media literally across the world to do more on HIV and other public health issues and mobilize the leaders of the media themselves to be personally involved in making a commitment and that’s worked.”

Forward-looking aspirations

Looking to the future, Altman has high hopes for continuing to pursue new ventures with the foundation. Having watched the organization evolve over time into its own special niche, Kaiser is now recognized around the world as a credible arm of public health knowledge.

“It’s been tremendously satisfying to build an institution,” Altman says. “When we started what we did was very controversial. People didn’t know what to make of us or didn’t understand our agenda, but now we’re well-established and trusted and people understand the role that we play.”

Altman has found satisfaction in the fact that the foundation has created a noticeable impact on the sector and many organizations have since emulated its model over the years, and he is also proud of the working structure that has had measurable impact on young adults who’ve built their careers at Kaiser through the leading fellowship and internship programs for health journalists offered at its California headquarters.

Kaiser, who’s been close to the world of health journalism since the early 1990s, takes pride in sponsoring young people every year through various scholar, fellowship and internship programs, an aspect that is part of the formula for helping to prevent initiatives from becoming stale.

The next big thing on the horizon for Kaiser is one of its largest and most innovative undertakings in its history. “Early next year we will launch the country’s first completely not-for-profit national health news service called Kaiser Health Reporting, that will be dedicated entirely to in-depth reporting on health issues, both domestic and eventually global,” Altman reveals. “We hope to have some of the very best health journalists leading and working for Kaiser Health Reporting.”

The service will make available stories written for and produced by Kaiser Health Reporting to mainstream news organizations free of charge in the US and around the world. The formation of the news service is in response to the general decline and collapse of the news business, and represents Kaiser’s efforts to continue to provide opportunities for great health journalists and open the doors for the very best health journalism in the future.

At the end of the day, it all goes back to building an institution, and after 18 years, Altman assures the foundation is nowhere near being finished with the work at hand. Through reinventing the foundational model, to bringing newfound and impartial clarity to public healthcare issues, to heightening awareness of the health needs of the disadvantaged and less targeted populations – and now committing to augmenting health journalism across the globe – Kaiser has truly become an infinite source of credible and laudable knowledge driving informed, positive change in the arena of healthcare.