Professor’s Perspective: Interview with Dr. William Turner
April 29, 2011 No CommentsInterview conducted by Nathan Rothschild and Sid Sapru
Q: Can you give us a brief overview of your background and experience?
A: Well, I’ve been a university professor for about 20 years. Currently, I am the Betts Professor of Education and Human Development in the Department of Human and Organizational Development in Vanderbilt’s Peabody College. My academic interest is in family studies and marriage/family therapy, but I’ve done a lot of work in the healthcare area as well. After doing lots of different research studies over the years that had real implications for people in the real world, I became very interested in learning how to translate research into policy. It’s one thing to publish research in an academic journal and to have it read by other scientists and other academics who can take it and do something with it, but to apply it to the real world you need to take things in a different direction. I got really interested in working on policy when I was a professor at the University of Minnesota, where I became a part of the Hubert Humphrey Policy Center there. I started to work with policy writers and makers and decided I wanted to have a more thorough experience with it, so I applied for a Robert Wood Johnson faculty health policy fellowship back in 2007 on the outside chance I would be chosen. Generally speaking, they choose physicians and other people in the healthcare arena who are involved in much more direct ways than perhaps someone researching behavioral health, like me, but I got selected. I then went off to Washington and spent six months at the National Academies of Science, and after interviewing with different Senators and congressmen on Capitol Hill, I ended up interviewing with Senator Obama and was selected by him to come and work as his health policy fellow and adviser. I was a part of his health policy team, which was a really interesting group of people. His chief health policy adviser was a physician, who is actually a graduate of Vanderbilt Medical School as well as the Harvard School of Public Health. I think I was brought on board because they were really interested in looking at legislation that dealt with behavioral health, with families, and with health disparities — all areas in which I had a great interest.
Q: Given your experience working with then-Senator Obama on healthcare, do you feel that his views on the issue have changed substantially over the years?
A: I don’t know that they’ve changed, but I think he probably has a much more pragmatic approach to how he handles legislation. Back in 2008, even though he was a Senator, he was also a presidential candidate, and discussions about healthcare legislation were beginning both in his office as well as through the entire Senate. Toward the end of my time in Washington, after he had become nominee, the legislation Obama was proposing seemed much broader than what we actually ended up with. It was truly healthcare reform, not just health insurance reform. We were looking not only at how we pay for healthcare, but also at how healthcare was delivered, how we educated future physicians and healthcare providers, how information technology was altering healthcare. All of these were parts of his future plans to revise the healthcare in this country as we knew it. However, I think once he began President, the realities that he had to deal with — of a Congress who has to pay for these ideas, of a party that was very oppositional to what he was doing — made him compromise a lot, and realize that things have to be taken incrementally. I’m not sure his views on healthcare reform have changed as much as this views on the pragmatics of how you make it happen.
Q: What do you see as the strengths and weaknesses of the final healthcare legislation passed by Congress?
A: Well, I think it has a lot of strengths, even though you might not necessarily know that if you watch the news. I think nobody can deny the fact that it is important to cover as many uninsured as possible, and I think the healthcare bill goes a long way towards doing that. Although we don’t have the sort of public mandate that mandates insurance for everybody, we do cover a substantially larger portion of the population than has ever been covered before, and I think that’s a great thing. The fact that we know longer have to worry about pre-existing conditions to the extent that we once did is an extraordinarily important change, too. The fact that young people can now be covered on their parents’ insurance through age 26 is a really important thing. I have a daughter who just graduated from Vanderbilt this past May and though she will be starting graduate school soon, it’s been really nice knowing that she can still be covered under my insurance for another five years. These are very real changes that are happening today that make a huge difference. In terms of the weaknesses of the bill, I personally think that, in some ways, it didn’t go far enough in terms of covering the uninsured; there are still a lot of uninsured individuals in the country and I don’t know that we have a particularly great plan on how we are going to cover them. I think more needs to be done there. I think the fact that we did focus so much on how to pay for healthcare and didn’t look more broadly at the larger healthcare system was unfortunate. In fact, if we do a better job training physicians and recruiting physicians to the right areas of focus, we can actually lower the costs of healthcare overall. So many physicians these days are going into specialties that don’t necessarily reach the masses. We don’t have nearly enough primary care physicians, people who are on the front lines (even though we have an awful lot of specialists who make an awful lot of money). I understand why they go in that direction, but 4 VanderbiltPoliticalReview.com
I think that there needed to be some real change there. In short, I don’t think the bill went far enough. Some of that was for pragmatic reasons; the President was forced against the wall by those who also had a say in the matter. I also think they could have done a bit better job of communicating what they were doing; I think they let the opposition get a hold of the message in perhaps a way they shouldn’t have. I’m not sure exactly why that happened, but I think it may have had something to do with the fact that there were so many things going on in the nation at the time. With the economic meltdown, two wars, and so much unrest in other parts in the world, there were many different issues that were competing with healthcare reform. I’m always surprised that so many people don’t really understand the benefits of the bill, and that when people talk about it, their thoughts are usually couched in very negative terms that are based on what they’ve heard on talk-TV or from someone who’s charged with speaking about it in a negative way.
Q: What do you think is the best policy solution for reducing health disparities in America between the nation’s poor and rich, as well as among people of various ethnic groups?
A: That’s the million dollar question. It’s a huge problem, as your question suggests. I don’t know that there’s any one simple solution to how you go about doing it, but I think a lot of it has to do with our willingness to provide better preventative care for lower-income folks. They are disproportionately provided care through emergency rooms, when things are already out of control. If you could do something to provide early care, the problems would almost certainly be somewhat alleviated. I think we have to invest in terms of providing this kind of care, and I think this bill will touch on it in some ways just in that it brings more people coverage. Those who are on the very, very low end have always had some access through Medicaid, but its those families who don’t quite qualify for Medicaid but don’t have enough money to pay for private insurance that really are in a difficult situation. I also do think we need to provide better education about healthy living; I know there are a number of initiatives around the country that are starting to look at the social determinants of health — people’s lifestyles, the way they think about living in the world, and things like that. As long as we focus on health in isolation, I don’t think that we’re going to have a breakthrough solution.
Q: What do you see as the future direction of mental health policy in America, especially in light of calls to reduce entitlement spending and increase the age at which people are eligible for Medicare benefits?
A: That’s a really good question. I have had periods where I’m very optimistic; for example, when healthcare legislation first came on the table. I think in those early days, it seemed like mental health was going to be treated very similarly to physical health. Right now, though, I’m much more concerned, especially given the economic problems we’re facing, because it really seems like in the hierarchy of healthcare mental health is seen as being less important than physical health. Still, I think there is more acknowledgement than ever that mental health services are needed, especially since every now and then something dramatic will happen in our country that makes us aware of just how important it can be. For example, the shooting of Gabriel Giffords just a few months ago; the shooter clearly and certainly was a person who had severe mental illness. Incidents like that make us aware that we as a nation need to do something to address those issues, although once the spotlight isn’t on the incident anymore, mental health seems a lot more expendable to people who aren’t dealing with it on a day-to-day basis. I think in the earlier drafts of this healthcare legislation, mental health was very much a part of the thinking. In the final draft it’s still there, just not that well-funded or focused upon. Again, a lot of the really important and key overhauls of the healthcare system got lost because we got hung up on how we were going to pay for it, and that was unfortunate.
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