Kansas Health Institute | Information For Policy Makers. Health for Kansans.

WICHITA — Former Surgeon General Richard Carmona lived up to his reputation for outspokenness during an appearance here Wednesday to mark the 25th anniversary of the Kansas Health Foundation.

The once homeless child of immigrant parents whose Army Special Forces service in Vietnam gave him the confidence to go to medical school talked about his unlikely selection by President Bush to serve as the nation’s 17th surgeon general and the political difficulties that led to his exit after only one term.

In Washington, Carmona said, politics too often trumps science in the formulation of health policy. He cited as an example attempts by the Bush administration in 2006 to delay the release of a seminal report on the dangers of second-hand smoke. He also noted political controversies generated by former surgeons general C. Everett Koop and Jocelyn Elders publicly discussing AIDS and sex education against the wishes of the administrations they served.

Beyond issue politics, Carmona, who today teaches at the University of Arizona and runs a resort and residential development company, said heightened partisanship has made the nomination and confirmation process a nightmare for too many prospective federal officials.

“You start to see not only how intrusive, but how malicious these processes are,” Carmona said. “And you all as citizens should be concerned because we’re losing fine young men and women who would like to serve but who refuse to put their families and themselves through this circus to get one of these politically vetted jobs because it becomes so partisan.”

President Obama’s nomination of Dr. Donald Berwick to head the Centers for Medicare and Medicaid Services is perhaps the most recent example. Anticipating intense opposition from Republican senators, Obama bypassed the confirmation process by installing Berwick in the job while Congress was on vacation, a move technically known as a recess appointment.

U.S. Sen. Pat Roberts, R-Kan., criticized the maneuver when he delivered the weekly Republican radio address on July 17. Roberts, like other GOP senators, is concerned that Berwick favors more explicit rationing of health care services to control costs.

“Dr. Berwick has spoken very favorably about the British National Health Service, calling it ‘not just a national treasure, [but] a global treasure as well,” Roberts said in the radio address. “Unfortunately, the British system rations care to contain costs.”

An ounce of prevention

Carmona didn’t discuss rationing, but he said that much of the $2.5 trillion that the U.S. spends annually on health care is not doing much to improve the health of Americans because the money is going to treat the symptoms of chronic conditions such as diabetes and heart disease rather than preventing them.

“We have a perversely incentivized health system,” Carmona said. “Our providers are paid to make you better when you get sick. It is very difficult to make a living keeping you healthy. It’s unfortunate, but that’s the way the business plan is.”

More resources should be directed to help people quit smoking and to slow rising obesity rates, Carmona said, noting that nine million children and two out of three adults in America are either overweight or obese.

“Obesity is the greatest accelerator of chronic disease in the history of mankind,” he said, explaining that obesity is either a contributor or the cause of many of the diseases that cause Americans to die prematurely.

Marking a milestone

Steve Coen, KHF president, said Carmona was invited to the anniversary event to highlight public health issues that have been a focus of the foundation’s grant making since its creation in 1985.

“We thought he was a perfect match for us,” Coen said.

The foundation was started with approximately $200 million generated by the sale of Wesley Medical Center to the Hospital Corporation of America. Since then, it has awarded nearly 6,000 in grants totaling more than $440 million but because of investment earnings still has assets of approximately $400 million.

Coen said the grants given by the foundation have helped to strengthen the state’s public health system, create new sources of health data, support nurse practitioners, physicians and doctors in rural areas and to educate Kansans about the dangers of second-hand smoke and the benefits of physical activity.

“As a result of these grants, a lot has changed in our state,” Coen said.

The Kansas Health Institute was created by and receives a substantial portion of its funding from the foundation.