Opinion - Interviews   

“The issue is the cost of health care”

— Photo: S. R. Raghunathan

Michael O Leavitt: “There is a lot to be learnt from what has been in practice in India for many, many centuries — we are interested in that.”

As Secretary of State for Health in the United States, Michael O. Leavitt heads one of the largest civilian departments in the federal government with a budget that accounts for almost one out of every four federal dollars spent. In India recently, on the invitation of Union Health Minister Anbumani Ramadoss, Mr. Leavitt spent time interacting with senior officials, leaders of the health care and export industries in India, visiting sites that produce food and medicines for export to the U.S. and reviewing facilities that deliver polio vaccine and provide care and treatment for HIV/AIDS and tuberculosis. In Chennai, on the first leg of his tour, Mr. Leavitt spoke to The Hindu, making a strong case for collaborations to standardise the quality of food and drug products to ensure safe and effective treatments. Excerpts:

As you point out, the issue is the cost of health care. Access to health insurance is a closely related one, because the higher the cost the fewer the people who can afford health insurance. You also make a very important point — that is — just because people are provided a card, it does not necessarily mean they get care and if they do not have a card it does not necessarily mean that they do not get care. In the United States, there are roughly 47 million people who do not have insurance but there are mechanisms in place for them to get care. And they do. We need to solve the problem of those 47 million people — because they are not part of the insurance mechanism, it has the effect of distorting the costs to everyone else. And the best system is when everyone is included and every American is part of the insurance system.

In the United States the cost has become extraordinarily high, even unsustainably high. In the United States, health care is 16 per cent of the GDP and it is headed for 20 per cent. That is a great concern. So we are working to get at the root of that, which is learning to measure quality and value. In the United States there are very few people who know how much their health care costs because the insurance company pays for it. There are very few people who know the quality they get in comparison to others. So our objective is to create a system where people have access to information about the quality of care they are receiving in relationship to the cost. We have learnt over time in every other sector of our economy that if people have information about the cost and quality they will make choices that will drive the quality up and costs down. So that is the primary focus of our effort — giving consumers more information about cost and quality and creating a market based on value.

There are many countries in the world that have made health tourism/medical tourism a targeted industry. I had conversations with the Minister for Health Anbumani Ramadoss and am aware of India’s interests in that. I expect that there will be interest on the part of some private parties in the United States to participate. However, I don’t expect that we will see our government programmes necessarily turning [in] that direction.

I would generally like to continue the good, positive relationship we have with India on health. I will be spending time on how to avoid problems related to product safety in the future. In the past we have been co-operating on HIV, vaccine, biotechnology, malaria, and training of scientists. I want to add to that portfolio the area of product safety — food, feed, drugs and devices. Particularly in the area of product safety we have a mutual interest that is focussed on health. That is an important component of our economic relationship as well. It is in the interests of Indian producers of products to have them well-defined as high quality and safe because the world marketplace will punish, harshly and swiftly, anyone who is not perceived to have safe, effective products. As we see the world marketplace mature, a system will have to be put into place to do that and we want to co-operate with India to make certain that not only our citizens are protected, but that the brand “Made in India” is protected. We have seen in the United States incidents, relatively isolated, where the safety of imported products has created a lot of concern. We are working hard with the Chinese to make certain the systems are in place to give people confidence about the safety of imported products they are consuming. It would be well for us in our relationship with India to learn from that rather than wait for an incident that might somehow be overstated or somehow become a symbol.

One thing we have in common is a desire to have safe and effective treatments — whether it is drugs or devices. And we fully support the Indian government’s efforts to create a drug safety administration referred to as the Central Drug Authority. We have extended, and will continue to extend, technical assistance in its development. We think that is not only important for Indian interest but the United States has an inherent interest because many of the products our consumers use come from India.

I have no particular concern about drugs from India. However I want to be clear that as the global market matures, and more and more goods come from other countries, whether India or any other country, my responsibility is to ensure that they are safe and effective for citizens and consumers in the United States. I know my colleagues here have the same interest about their citizens. But we now need to begin to co-ordinate our systems so that as we have trade that involves medicines or drugs or foods, we have systems that will accommodate our respective needs for safety.

I recently spent a considerable amount of time in China looking at their traditional medicine. We have at our National Institutes of Health (NIH), one centre that focusses on alternative and complementary methods. We think there is a great deal of potential that can be learnt using traditional methods of healing as long as we are applying good science. So our effort is to take things, understand it better, apply good science to it and apply it or use it. I met in China Mr. Chim, who is world renowned for treating leukaemia. He told me that he had been trained in traditional Chinese medicine and had a hunch that if arsenic was introduced into the treatment it could have a potent effect, because he had seen that in traditional Chinese medicine. And it became the keystone to saving tens of thousands of lives all over the world. That is an example of how using traditional methods of healing will benefit us. There is a lot to be learnt from what has been in practice in India for many, many centuries — we are interested in that.

Yes.

I want to answer that in a more general way and then we can talk more specifically. One of my primary purposes in visiting [India] is import safety. We have a common interest in safe products for Indian citizens and citizens of the U.S. In order to accomplish that, we need to have high standards and methods of being able to certify that those standards have been met. It is impossible for those who are producing the goods to meet varying standards with any level of efficiency and therefore it is important that we begin to develop common standards for products. One could carry that to the point of recognising that there is value in having common standards with respect to the training of health professionals as well. There is a lot happening in that area already. I was told that we have nearly 350 Indian physicians and scientists who are currently working in the United States in partnership with the Centers for Disease Control and the NIH. I suppose we have some people in the FDA too. There are an extraordinary number of students who attend medical schools in the United States. I think as the global market begins to mature, there will be a natural need for us to find standards.

I am very proud of the partnership that exists between my department at the United States government and the Ministry of Health and other Ministries. [At Tambaram] I saw a very good example of the work India has done, not only in terms of progress, but also aspirations. I understand that the clinic we attended today [January 7] is a model and they want to expand it to other areas. I was impressed by many of the things I saw. Most of all, I think I was there to not just see what they are doing but also express the pleasure we have in being partners.

Printer friendly page  
Send this article to Friends by E-Mail

Stories in this Section

Containment is the key
Partnership with States
Democratic campaign: America at its best
Significance of blood and violence in present U.S. films
Bush drumming up support for Ahmadinejad
Corrections and clarifications
Surprising
Welcome decision
Race for Bharat Ratna
Rs.5000-computer
Sydney Test
Witness to change
“The issue is the cost of health care”

Copyright © 2008, The Hindu. Republication or redissemination of the contents of this screen are expressly prohibited without the written consent of The Hindu