Health care costs are rising, and patients across the country are struggling to find doctors and nurses — even when they have insurance.
Elias Zerhouni, the former director of the National Institutes of Health under President George W. Bush and a presidential envoy for science and technology under President Barack Obama, said those pressures are fueling widespread frustration with what he calls a confusing and dysfunctional U.S. health system.
Zerhouni, pointed to a growing shortage of primary care doctors and nurses, long wait times to see specialists and complex insurance rules that make it difficult for patients to understand what care will be covered.
Even insured patients, he said, are often left navigating pre-authorizations and denials that add delays and uncertainty to their care.
Zerhouni said the challenges are not just medical, but political — a theme he expands on in his book Disease Knows No Politics, where he calls for health care policy to rise above partisanship.
WHRO Health reporter Yiqing Wang sat down with Zerhouni to talk about what he sees as the most pressing health issues facing Americans — and what he believes health officials should do next.
This conversation has been edited for length and clarity.
WHRO: Dr. Zerhouni, thank you for sitting down with us. Tell us, what do you see as the most concerning health issues Americans are currently facing?
ELIAS ZERHOUNI: Right now the issue is the cost of insurance is too high and is going to get higher because the subsidies are expiring. So I would say that's number one in a lot of people's minds – the cost of the Affordable Care Act insurance premiums.
Two, is what you would call accessibility and affordability issues in healthcare, meaning that you have trouble right now to get a primary care doctor to follow you and take care of you over the long run, and that takes months, sometimes, to get a doctor to be helpful to you. So that's the primary care crisis, if you will, where there are fewer and fewer doctors available to take care, which means that healthcare is less and less accessible. So we have a shortage of doctors and shortage of nurses, which impacts both the availability and the quality of care and access to specialists is the same way.
And then the third issue is this issue of denial and pre-authorization, so you never really know what's going to be reimbursed or not being reimbursed by the insurance companies. So it becomes a very confusing and disorienting system. It has become. People are overall frustrated, even when they're insured.
WHRO: In your book Disease Knows No Politics, you said health should transcend partisanship. How do you see the current climate impacting healthcare?
ZERHOUNI: When a system gets to this level of dysfunction, it becomes a political issue. Politicians don't like to tackle it because there are lots of vested interests and lobbyists that are there to protect their revenue from the healthcare system and our healthcare system has become captive to special interests. So, that's the reason why you have trouble fixing it.
Disease knows no politics. I mean, disease is going to affect you whether you're Democrat or Republican, and in fact, it should be made as apolitical as possible, because that's how you make progress, right? Because if you politicize it, then you lock in your gridlock. That's what's happening right now. There's a tremendous amount of politicization.
There's a big dispute between what the current administration believes, and what the majority of public health experts believe, and it seems like they're not even communicating with each other. We have more cases of measles this year than we've had in many, many years. And then you hear about other conditions that people don't want to get vaccinated, because they've been scared by officials about vaccines hurting you.
That's another one that I think is dangerous, is that when you politicize something that touches people's lives, you can come up with any kinds of stories and fear mongering and then say, well, not follow the science, just follow the political instincts and the political discourse that some people have.
WHRO: Based on your experience leading the NIH, what do you believe health officials need to do?
ZERHOUNI: I think what they need to do is step back, and if they really have the courage to address it, which I don't see right now, then profound reform needs to occur, which means, depoliticize the issue, disintermediate the system by having reducing the number of non value added extraction of money that's done in the system. I mean, we waste a ton of money on administrative issues, denial of pre authorization, and over pricing and all kinds of things that are dysfunctional, but you have to depoliticize to be able to fix that.
WHRO: Dr. Zerhouni, thank you for speaking with us.
ZERHOUNI: Thank you for having me and asking me to participate in your Q &A.
Zerhouni will be in Norfolk on Jan. 27 to speak at the Norfolk Forum about the future of U.S. health care and the need to depoliticize public health.
