A life’s work of mak­ing health­care avail­able to ev­ery­one

Modern Healthcare - - Q & A -

“Our pop­u­la­tion needs to learn how to use the health sys­tem more ra­tio­nally.”

Dr. Louis Sul­li­van has had a long, distin­guished ca­reer of pub­lic health ser­vice. He was named HHS sec­re­tary by Pres­i­dent Ge­orge H.W. Bush and served from 1989 to 1993—one of two African-Amer­i­cans to ever hold the po­si­tion. Be­fore that, Sul­li­van served as found­ing dean and di­rec­tor of More­house Col­lege’s med­i­cal ed­u­ca­tion pro­gram, which later be­came the School of Medicine at More­house Col­lege. Sul­li­van cur­rently serves as chair­man of the At­lanta-based Na­tional Health Mu­seum and heads the Sul­li­van Al­liance to Trans­form Amer­ica’s Health Pro­fes­sions in Wash­ing­ton. He just pub­lished an au­to­bi­og­ra­phy, Break­ing Ground: My Life in Medicine. Mod­ern Health­care re­porter Steven Ross John­son re­cently spoke with him about his views on the state of the coun­try’s health sys­tem and what he thinks about po­lit­i­cal op­po­si­tion to the health­care re­form law. The fol­low­ing is an edited ex­cerpt.

Mod­ern Health­care: What mo­ti­vated you to pur­sue a ca­reer in health­care?

Dr. Louis Sul­li­van: I grew up in Blakely, Ga., in the years of racial seg­re­ga­tion. Blacks go­ing to a white physi­cian had to en­ter a sep­a­rate wait­ing room or go around the back. My par­ents did ev­ery­thing they could to avoid that. So rather than go­ing to a white doc­tor in Blakely, we would go south to Bain­bridge to Dr. Joseph Grif­fin. Dr. Grif­fin im­pressed me as some­one who was mag­i­cal. He had pow­ers that other people didn’t have: he would make people well. He had built a 25-bed clinic and he was highly re­spected in the com­mu­nity. He was my true role model, and I said I wanted to be a doc­tor like Dr. Grif­fin. And that hap­pened at age 5.

MH: How should the U.S. pro­mote greater di­ver­sity within the health­care pro­fes­sions?

Sul­li­van: We need to strengthen our pub­lic school sys­tem, par­tic­u­larly in our in­ner cities, be­cause too many young­sters do not get a strong K-12 ed­u­ca­tion and can’t suc­cess­fully com­pete for col­lege en­try or per­form well in col­lege or in the sci­ences. Sec­ond, we need to have a bet­ter sys­tem of coun­sel­ing, be­cause many high school stu­dents have no idea what it takes to be­come a doc­tor, nurse or den­tist. Third, we have priced a health pro­fes­sions ed­u­ca­tion out of the reach of many mi­nor­ity young­sters. That is in part due to the fact that there used to be a num­ber of govern­ment schol­ar­ship pro­grams that were avail­able, as well as sup­port from foun­da­tions and oth­ers. In the mid-‘70s, many of these pro­grams were ei­ther elim­i­nated or greatly cut back.

It was thought it would make more sense to let health pro­fes­sion­als pay for their own ed­u­ca­tion by bor­row­ing money and then re­pay­ing it out of prac­tice earn­ings. This has been a dis­as­ter in prac­tice. The re­sult has been that low­er­in­come stu­dents are not go­ing to med­i­cal or den­tal school. Fi­nally, there re­mains the lin­ger­ing is­sue of bias in the health­care sys­tem. This is a com­plex prob­lem, there’s no one quick an­swer.

MH: What do you see as the great­est pub­lic health chal­lenges the coun­try cur­rently faces?

Sul­li­van: The first is the need to fin­ish im­ple­men­ta­tion of the Af­ford­able Care Act. That leg­is­la­tion was needed and I sup­port it. It has im­per­fec­tions that need to be ad­dressed by fu­ture ad­min­is­tra­tions and Congress, and it’s also been im­paired by a faulty roll­out. The sec­ond chal­lenge for the fu­ture is im­prov­ing the health be­hav­ior and health lit­er­acy of our pop­u­la­tion. By the year 2042, there will no longer be a ma­jor­ity (white) pop­u­la­tion, so we need to do a bet­ter job of see­ing that our na­tion’s mi­nori­ties not only have ac­cess to health­care, but also have a stronger ed­u­ca­tion. Health and level of ed­u­ca­tion go par­al­lel. That will help not only to im­prove health sta­tus, but also, in the long run, will bring health­care costs down. Our pop­u­la­tion needs to learn how to use the health sys­tem more ra­tio­nally. We need to con­tinue to work to make sure ev­ery­one has ac­cess to health­care and has health in­sur­ance. We have made progress in the ar­eas of tobacco and use of seat belts. When I be­came sec­re­tary in 1989, less than 50% of driv­ers in Amer­ica were us­ing seat belts. Now, that per­cent­age is closer to 90%.

MH: What are your thoughts on po­lit­i­cal op­po­si­tion to the Af­ford­able Health Act?

Sul­li­van: It’s un­for­tu­nate that there are pol­i­tics around health­care. There are two things that in my view should not be po­lit­i­cal—hav­ing a strong ed­u­ca­tion sys­tem for our young people and health. A health­ier pop­u­la­tion is a more pro­duc­tive pop­u­la­tion. So I re­ally wish that people would not view health in a po­lit­i­cal grid. We need to be able to make de­ci­sions based on what is needed from a sci­en­tific per­spec­tive and a med­i­cal per­spec­tive. I would ar­gue for low­er­ing the po­lit­i­cal rhetoric here. Ac­cess to health­care should not be some­thing that is sub­ject to po­lit­i­cal whims.

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