Michael O. Leavitt, Secretary of Health and Human Services


New Orleans


July 17, 2006

Remarks As Delivered at the New Louisiana Health Care Redesign Signing Ceremony

Thank you, Governor Blanco for that introduction.

It's a privilege to be here, and I would like to thank you for allowing me to be part of this ceremony.

I'd also like to recognize the incredible work of the partners and friends in this effort including

  • Governor Blanco,
  • The members of Congress, and also the state legislature,
  • Mayor Nagin,
  • Fred Cerise, (Louisiana Department of Health and Hospitals Secretary), and
  • The members of the Louisiana Healthcare Redesign Collaborative.

On the 24th of August last year, Dr. Kevin Stephens, the Director of Public Health for New Orleans, boarded the Medicare bus with me at the Hyatt Hotel, next to the Superdome.

We were there to build a team of partners to undertake enrolling Louisiana's seniors in the prescription drug program.

We rolled through the streets of New Orleans, past Charity Hospital to the Pontchartrain Senior Center, where we met with community leaders and senior citizens to talk about Medicare.

As we traveled, Kevin and I talked about his experiences in Zimbabwe working with HIV/AIDs patients.

He also did his best to answer questions I had about a book I had recently read, called Bayou Farewell. It had an entire chapter about the effects of the erosion of the Gulf Coast region and the fact that New Orleans was below sea level and what would happen if the levees broke. It's almost eerie to think about it now.

We also talked about health care in New Orleans. Kevin didn't mince words as he quoted statistic after statistic illustrating an area with serious health problems. The statement I remember most clearly was this one: "Mr. Secretary," he said, "if you need treatment for a medical emergency at any hospital in New Orleans, you have a 24-hour wait."

Fewer than 100 hours later, the storm described in Bayou Farewell struck and levees broke. The Pontchartrain Senior Center, Charity Hospital, and every other street I traveled that day were under water; my friend, Kevin Stephens, and hundreds of thousands of other New Orleans people were trapped in the most hellish disaster in United States history.

Like so many others, Kevin's heroic actions deserve acknowledgement, but because there were so many people doing the similar things, they seemed commonplace.

In fact, he and 35 members of his health department staff struggled to give treatment and aid in unthinkably difficult conditions. Service that has continued to take a toll among his staff-the death of two, can be linked to these traumatic days.

Finally, on Friday of the week following, Kevin loaded an exhausted team onto a bus headed for Dallas but he stayed behind, becoming a one-person outpost, using his cell phone with a limited battery to become the eyes and ears of HHS as we struggled to provide help.

There were so many others with stories just like Kevin's. Fred Cerise was there. He spent days ministering to the sick and injured.

Dr. Norman E. McSwain, Jr., the chief of trauma surgery at Charity Hospital in New Orleans, was there. He helped carry some of the hospital's sickest patients to reach waiting boats and helicopters. He stayed at his post until the last helicopter for staff left, and he later declared, "Medical people don't evacuate . . . They stay and take care of people."

Dr. Manish Jain, a third-year neurosurgery resident at Tulane, was there. He spent the days after Katrina at the Veterans Affairs Hospital in New Orleans. He took care of the intensive care unit patients on intravenous hookups. Since the monitors didn't work, Jain counted the drips of medication one by one until the dose was right.

During the days that followed, I traveled to 17 cities in eight states and saw, first hand, Americans opening their homes, their churches, their wallets, and their hearts to fellow citizens in need.

The small part I played changed me forever, and it changed Louisiana forever. In time, it will have made us better. Hardship enables opportunity.

Our nation was born in hardship. A bloody revolution supplied the hardship; courageous patriots saw the opportunity.

John Adams, who became our nation's second President, was there as the signers pledged their lives and sacred honor in declaring independence. Adams wrote a friend describing the "hardship enabled opportunity" he saw. In essence his letter said this: …we have been sent into life at a time when the greatest lawgivers of history would have wished to live; how many people in the history of man will ever have the opportunity to form a government for themselves and future generations?

He then said that it is our obligation to "form and establish the wisest and happiest government that human wisdom can contrive." And, they did.

Our government, born of the courageous acts by patriots, laid a foundation for this nation, and many others.

Today, we meet to pledge our commitment to another noble task. This is not a celebration because we mourn the fact that Katrina struck, taking the lives of thousands and changing the fortunes of millions more; but, circumstances have contrived to produce a circumstance unlike any in modern history.

Our hardship is that we must rebuild the health care system in Louisiana; and to borrow the words of John Adams, our opportunity is to build "the wisest and happiest system of health care that human wisdom can contrive."

What we do here can not only save lives and relieve suffering, but it can light the way for a nation and world struggling to find a better way to deliver health care.

There may never be a green field moment quite like this again.

Being part of it is our opportunity. Doing it right is our moral duty.

So, what will the right system look like when our work is finished? Time will tell. One thing we know is that it shouldn't look like the current two-tiered system.

There is wide agreement that the old system may have served well in a former day, but that day has passed.

It is filled with good intention but fraught with inefficiency and even dysfunction. The recent report prepared for the Louisiana Recovery Authority by PriceWaterhouseCoopers declared, "The entire healthcare system suffers from high cost and lower than expected quality."

Frankly, that's exactly what Kevin Stephens told me 100 hours before Katrina hit. The report noted that the current two-tiered system has led to:

  • An excess of beds in the private sector that produce more care than is needed, and
  • A shortfall of beds in the public sector that produce less care than is required.

Any system that depends on emergency rooms for routine medical services will provide neither well.

Care delayed, becomes care denied. Chronic conditions can become exacerbated. Those who could gain the most from preventive care and proactive involvement-the poorest and most vulnerable-rarely receive it.

We must not simply rebuild hospitals. Victory is quality care and a sustainable cost.

Already, we have agreed upon principals of what the new system must look like. I think those principles produce a system where:

  • Community health centers dot the landscape, and every citizen has a medical home where the goal is to keep people healthy, not just treat them after they get sick.
  • Where every citizen has access to basic health insurance at an affordable rate, even if we have to use Medicaid dollars to help some people buy into the private market.
  • Where government-funded health dollars follow a person to the most efficient, most convenient and highest quality provider available rather than propping up institutions that are slow, have poor quality, and indefensible costs.
  • Where doctors and hospitals get paid extra for doing a better job, rather than doing more procedures.
  • Where every consumer knows what a provider charges, how good it is, and has a financial incentive for it to make a difference.
  • Where our senior citizens and persons with disabilities can be treated at home or in the community, and not just in institutions.
  • Where people can obtain medical records electronically with continuous updates from every interaction, whether it's at a community health center, a pharmacy, a hospital, or at home.

I'd like to see a health care system better prepared to respond in the case of an emergency-for one will surely come.

I want to say just a word about collaborations. Collaboration is hard; it's messy; and it's absolutely indispensable in solving a problem this big.

The collaboration we formalize today will be required to sort through conflicting philosophies, competing economic interests, and regional rivalries. There will be disagreement, the need to sacrifice, change, and think differently.

But we have to succeed. Our success here weighs heavily on the capacity of this region and state to prosper in the 21st century. Without adequate health care, Katrina wins, Louisiana loses.

And we should be clear-collaborations often fail. When they do, it's almost always because people allow personal interest to overshadow public interest.

Critics and cynics should always be at the table, but never selfish saboteurs. Collaboration takes our best statesmanship.

When collaborations succeed, they are powerful beachheads of progress. People are required to change and adapt but they live to prosper another day, often in a different way.

We need to have a clear picture of what victory is. The first step toward victory will be the adoption of a formal blueprint. That plan will be embodied in a large-scale Medicare and Medicaid demonstration waiver.

As most of you know, nearly 70 percent of the dollars in the Louisiana health care system are paid by the Department of Health and Human Services. As Secretary of HHS, Congress has provided me with authority to amend some of the normal rules when I believe doing so will produce innovation and improvement.

I am prepared to use that authority liberally, but this collaborative must provide the design and the courage to carry it out.

I want to reiterate my willingness to sign a waiver that matches the principals we have agreed upon. Well deployed, they will produce true innovation and a better system.

Likewise, you should know, I will not sign one that doesn't. In a moment of rare opportunity like this, we need to push ourselves to attain our highest aspirations.

You have identified an aggressive target of October 20, 2006 to have the waiver done. Ninety-five days is an aggressive schedule, but it can be done, and lives depend on it. The longer this region goes without sufficient health care, the more the region it will suffer.

During the next few months, I won't simply be standing off and waiting for the blueprints to arrive in Washington.

Rather, we will do everything in our power to support you. We've identified funds that the Collaborative will be able to access, which should assist it in obtaining the expert help it needs to accomplish its goals.

I have appointed Sonia Madison as my personal representative in this effort. During our last visit together, I said that several members of Sonia's staff would soon be moving here to better provide full-time support for the effort. They are here, ready and eager to help.

I'll continue to devote substantial amounts of my time to this effort. As long as we are moving forward, I will be here personally when needed.

I would like to comment on the scope of your work.

The charter we sign today highlights the importance of initially addressing the needs of the greater New Orleans area-a focus in which I concur. There are apparent needs and special opportunities here.

The charter also reflects that solutions have to be sensitive to local needs, and those can vary. They may be different in New Orleans, Baton Rouge, and Lake Charles.

Some of your proposals will have statewide impact. And it may make sense to propose statewide solutions when they are needed.

Here's an example. The plan will undoubtedly deal with primary and ambulatory care facilities in New Orleans. That task is too big to be tackled statewide all at once.

However, it might make sense to make changes in the way Medicaid is administered statewide in order to move from the two-tiered system to a better way-where money follows the person.

The initial focus is on greater New Orleans, but everything we do should be done with a statewide vision in mind.

The first time I viewed the destruction of Katrina, I was struck by how similar its destructive path looked to the moonscape left by a raging forest fire inferno in Yellowstone National Park several years ago.

Water and fire seem like such opposites and yet both produce unthinkable devastation.

A couple of years later, I returned to Yellowstone. There I witnessed a new growth of young green and healthy trees. The forest was rebounding; in many ways, time would make it a stronger and healthier forest.

Hardship had enabled opportunity.

As we sign our names to this collaborative pledge, let it mean that this hardship has now enabled opportunity and let us produce "the wisest and happiest system of health care that human wisdom can contrive."

Last revised: July 18, 2006