Interview: American Medical Association's Edward Langston, MD

"One in seven uninsured is one too many."

Edward Langston, MD, is the board chairman for the American Medical Association. He is a practicing family doctor from Lafayette, Ind. Since 2005, he has also served as a commissioner on the Joint Commission on Accreditation of Healthcare Organizations. The commission evaluates and accredits nearly 15,000 health care organizations and programs in the U.S. In addition, he is a clinical assistant professor at the Purdue School of Pharmacy. Answers from Langston on the state of the nation's health care and how the election might affect it were provided to WebMD's Washington correspondent, Todd Zwillich.



How big an issue is health care for the nation now?

Polls show that health care now ranks as the top domestic issue, and this renewed national interest likely reflects the frustration many Americans feel when they have to deal with the bureaucracy of the health care system. Employers have to manage increasing health insurance costs against what they can offer their employees, those without insurance see that they are paying higher out-of-pocket costs than those with insurance, and even patients with government provided health insurance like Medicare and Medicaid have to endure long waits to get the care they need. Employer-provided health care remains the most prevalent form of health care coverage in our nation, yet 40% of employers do not offer health insurance. There's a growing realization even among those with health insurance that our system needs to be fixed.

Is the health care system really broken?

It's important to keep in mind that America is a health care leader the world over. Breakthroughs in how to treat diseases are made every day, and innovations in medicine and top-quality care are provided by health care professionals. There are some serious stressors on the system though, and they must be addressed by our lawmakers. Our health care system is uniquely American -- it's in essence a patchwork quilt with different solutions for different populations. We don't want to change what is working in our system, but we can make vast improvements, like insurance market reforms and providing health care coverage for all, to improve the overall system.

How -- or should -- we go about lowering the number of uninsured?

The AMA ardently believes that one in seven uninsured is one too many. Multiplied out nationwide, that's now 47 million uninsured. The bottom line is that for many Americans, regular access to health care is out of reach simply because they don't have health insurance. The AMA's new campaign, Voice for the Uninsured, is a three-year campaign with the ultimate goal of enacting legislation to cover the uninsured. Our plan rests on three key principles:

1. Provide all Americans with the means to purchase health care coverage.


2. Give individuals the choice to select the appropriate coverage for them and their families.


3. Promote market reforms that enable this approach.

In this, the first year of our campaign we are focusing our efforts in early primary states to educate voters about the problem of the uninsured and the AMA's solution, and urge voters to raise the issue with candidates for president. Next year the campaign will expand nationally and will focus on influencing Americans to vote with the issue of the uninsured in mind. The final year of Voice for the Uninsured campaign will focus on urging members of Congress to pass legislation to fix this national problem.

What is the best way to begin to lower health care costs?

Decisions related to health and health care should be framed in terms of value, with benefits being balanced with costs. After all, the ultimate goal is achieving better value for health care spending, rather than cost-reduction per se.

Health care spending is rising faster than wages and the overall economy, and rising health care costs drive more people into the ranks of the uninsured. Ultimately, health care spending cannot be reined in without reducing the burden of preventable disease. The biggest opportunities to halt the onset of illness and avert injury lie in changing personal behavior, for example, being physically active and eating nutritious foods. The lessons of the successful antismoking movement are starting to be applied to obesity control and other public health efforts. Additional spending may be required, such as paying for lifestyle counseling.

In addition to reducing the need for medical treatment in the first place, we must deliver health care more efficiently, for example, reducing unnecessary use of services, using lower-cost drugs as appropriate, and improving the coordination of care.

What should be done to cut prescription drug costs?

There are several factors driving the increase in drug costs, and a combination of methods will be needed to address the problem. Programs designed to contain the rising costs of prescription drugs must involve physicians and encourage optimum prescribing practices and quality of care. All patients must have access to all prescription drugs necessary to treat their illnesses.

Physicians must have the freedom to prescribe the most appropriate drugs for the patient and are encouraged to supplement medical judgments with cost considerations in making these choices. The pharmaceutical industry should be encouraged to exercise reasonable restraint in the pricing of prescription drugs, and to support programs whose purpose is to contain the rising costs of prescription drugs. Incentives should be maintained so that pharmaceutical manufacturers have the incentive for research and development of new and innovative prescription drugs.

The AMA has a long-standing policy in support of pluralism and free market competition, and it has concerns with setting prices because of their potential to stifle innovation and increase demand.

How important is prevention to any health care policy we pursue?

Prevention is a vital part of how we keep patients healthy. There's been a real shift in the last few decades as we've learned more about treating diseases early, and as technology has allowed us to screen for diseases before they reach crisis proportions. Female patients can be screened yearly for breast cancer with a mammogram, allowing physicians to catch the disease in an early stage and greatly increasing the chances for a positive outcome.

A low-tech example but equally important is providing patients with counseling to stop smoking. Every year, 440,000 Americans die from diseases caused by tobacco use, which kills more Americans than heroin, PCP, cocaine, alcohol and every other drug combined. Tobacco is responsible for more than $75 billion in health care costs and $92 billion in productivity losses each year. If we can get people to stop smoking, we're having a positive result on the patient, the family, the workplace, and society.