President Shalala Regales Students with Her Advice and Insights

To understand why so many Americans have no health insurance, UM President Donna E. Shalala encouraged first-year medical students to incorporate one of her habits into their lives: Ask every service-provider you meet what kind of insurance they have.

The answers, Shalala assured the students during one of her popular annual lectures at the Miller School last week, will illuminate why President Obama spent so much political capital extending coverage to most Americans in the new health care reform legislation that Republicans now vow to repeal.

As an example, President Shalala turned to a woman she often mentions – her manicurist, a mother of two girls who earns $30,000 a year. Even though the manicurist’s employer offers health insurance for just $60 a month, Shalala said she foregoes coverage for herself because she only has $50 a month to spend at the movies or on other discretionary pleasures she is unwilling to eliminate. So, she risks her own health so as not to upend her lifestyle.

“The new health insurance plan is aimed at precisely someone like her,’’ President Shalala said. “Most of the people who do not have insurance in this country are low-income workers and their families. Many of them work more than one job. Many of them work at minimum wage.’’

And all of them, the President said, should have access to affordable quality coverage so the rest of us aren’t forced to subsidize them by paying higher costs for our own health care. She noted that, as one of Miami-Dade County’s largest employers, UM heavily subsidizes small businesses in Miami whose employees have spouses who work at the University, and add their families to UM health plans.

“The underlying principle of health care reform is, unless we’re all covered, we can’t distribute the health care risk or the cost evenly,’’ she said. “Every time someone who is insured walks into UMH, in their bill is the cost of people who walked in there with lousy insurance, or without insurance. That’s why everybody has to have insurance.’’

Given the Democratic hold on the U.S. Senate, President Shalala expressed confidence that health care reforms will withstand a “symbolic” repeal by the U.S. House, which reverted to Republican control after the mid-term elections. Though she speculated an amendment to allow people to opt out of the plan may pass because President Obama “will agree to some things,’’ she said “they will not be the fundamentals.’’

Taking questions from her attentive audience, which included second-year students during a second lecture, President Shalala also offered her opinions and observations on a range of subjects, including tort reform (she’s for it), cost-containment (it can’t happen without getting rid of the fee-for-service system), advanced practice nurses (they should and will be vital members of the primary care teams of the future) and the biggest change physicians will see in the next five years (IT advances will provide seamless information on patients and feedback from specialists).

And with characteristic candor, she answered a student who expressed concerns about training at beleaguered Jackson Memorial Hospital by repeating her wishes in the event she is involved in a car accident elsewhere in the world:

“Please ship me to the Ryder Trauma Center. I don’t want to be treated somewhere else because it’s magnificent medicine at every level,” she said. “The systems may not be perfect, but the quality of medicine, because of UM’s leadership, is extraordinary…. I can’t think of a better place to go to medical school.’’

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