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REMARKS BY: DONNA E. SHALALA, SECRETARY OF HEALTH AND HUMAN SERVICES PLACE: New York University Medical School Commencement,New York City, New York DATE: May 11, 2000
Dean Glickman, President Oliva, distinguished members of the faculty, parents, alumni, guests -and most of all - to the wonderful NYU Medical School Class of 2000: Congratulations. I'm delighted to share your joy, your achievement - and your relief.
This is the second time I've addressed an NYU Medical School graduating class.
The first time was in May 1993. I had only been HHS Secretary for about four months. Now, seven years later, I'm once again back at NYU - and once again measuring my time as Secretary in months. In about eight months - I, too, will be commencing a new life.
Of course I'm not alone.
Perhaps you saw the recent video of the President washing his car, doing his own laundry, and making the First Lady's lunch. I have to admit, I thought it was hilarious, and I do feel a bond with the President - and with each of you. We are all brothers and sisters on that spiritual road that begins - when life begins again.
In my 1993 commencement speech, I tried to keep everyone amused - while making some serious points about America's health care problems. Along the way, I told a story or two. Here's one I did not tell. A bright young man from New York - who used to be my dentist - graduated from high school and was trying to decide what to do next. His mother gave him a one-word answer: College.
Advice like that explains why we will be celebrating Mother's Day three days from now.
Anyway, the young man told his mother he did not want to go to his neighborhood college - which happened to be Brooklyn College. His mother replied, "Your cousin loved the college he went to. I can't remember where it was, but it had three letters." "NYU?" he asked. "Yes! That's it!" So off he went to NYU. A few years later, he ran into his cousin and said, "My mother told me about the college you loved, so I followed in your footsteps and went to NYU." His cousin answered, "NYU? I went to MIT."
All of this goes to prove that even life's biggest and best decisions sometimes come dressed in luck, coincidence and serendipity. Still, I believe, what we decide is less important than what we do after we decide. That is the message of the great book: Don Quixote. I'm a big fan of the Man from La Mancha. Not because I look like Don Quixote.
Frankly, I look a lot more like his short sidekick - Sancho Panza.
No, I admire Don Quixote because he - like you - went on a journey. Because he - like you - maintained his humanity through a difficult ordeal. And because he - like you - learned a thing or two along the way. For example, you learned how to cope with Rubin Hall's tropical temperatures. You learned to swallow gourmet meals in the Tisch cafeteria - and survive early morning shuttles to the North Shore. And lest we forget: The prison lock-up at Bellevue. Retelling those harrowing tales will keep your grandchildren hanging on to your every word.
They would also keep the producers of ER hanging on your every word.
I learned this back in January when I gave a tour of the White House to the actors and writers of ER. They were looking for story ideas. I could have said: "You want story ideas? Don't talk to me. Go talk to the experts - the Class of 2000 at NYU medical school." But since I have to go out and find a new career - I decided to try my hand at being a script consultant.
As I was showing my new friends from ER around the White House, we got into a conversation about how elderly people sometimes share prescription drugs because they can't afford to buy their own. Two Thursdays ago, ER ran an episode about a couple who inappropriately shared a beta blocker medication.
Since then, I've been invited to consult with the writers on more episodes. Personally, I think I'm more cut out for The West Wing. But I'm happy to contribute wherever I can. That's why instead of writing one more commencement speech I chose to write a memo to the producers of ER - and use it as a commencement speech.
To: The Writers of ER
Fr: Donna E. Shalala, Secretary of Health and Human Services
Re: Which Way is Up? Health Care in the 21st Century
Da: May 11, 2000
One year into a new century, we are living longer, healthier and better lives. We know more and we're doing more. But more is never enough. Our nation still faces serious public health challenges. Some are old. Some are new. None is easy. And all will confront - but I know not confound - the next generation of doctors.
So here ER writers are 10 story ideas for your consideration.
Episode 1: What's Up Doc?
A realistic show about the practice of medicine in the 21st century will answer the W'ascally Wabbit's famous question: What's up Doc? Or more precisely - what's up for docs? This episode is not about monitors and wires and intubating - all captured with a hand held camera. It's about maintaining morale, autonomy, and the sacred doctor-patient relationship at a time when our health care system is undergoing profound change. Today, hospital stays are the exception - not the norm. Treatment plans are often supervised - or sometimes even dictated - by non-doctors. Doctors are told - directly or indirectly - that managing costs not caring for patients is the bottom line.
Yes, the revolutions in managed care have helped keep costs down - and opened up new employment opportunities for young doctors who want to go into primary care. But efficiency must never be a substitute for quality. That is certain to drive our hardest working and most committed young doctors - like the graduates of NYU Medical School - away from the profession that they worked so hard to join.
How can the medical profession continue to attract the most talented students?
By making sure that patient care - not the marketplace - guides what they do. By keeping as much decision-making as possible in the hands of doctors. By offering bonuses for the highest quality treatment - not the lowest possible costs. In short, by making sure that being a doctor is a great job - one that the best of the new generation takes on with enthusiasm!
Episode 2: The Greening of American is Now the Graying of America.
Somebody once said that middle age is when a man is warned to slow down by a doctor - instead of a policeman. If you ask me, doctors should tell middle-aged women and men to be more active - not less. The real public health challenge we face is with older Americans.
There is a demographic time bomb - and it's ticking away. The number of Americans over 65 will double in the next thirty years. The time has come to modernize Medicare so that it neither bankrupts our children - nor is unavailable to our grandchildren.
We've already strengthened Medicare by fighting waste, fraud and abuse - and by investing in prevention services. This bought us valuable time. The hospital trust fund is now solvent until 2025. Now we must finish the job by setting aside a portion of the surplus for Medicare - and by modernizing Medicare with a prescription drug benefit.
Fixing Medicare is not the end of our preparations for the graying of America. We must also promote "active aging." That means encouraging older Americans to keep working if they want to - and participate in social activities as long as they can. It also means coming up with more choices and better quality for both institutional and home based care. Unfortunately, our nation still has no long term care policy. That must change. We must support seniors who wish to stay in their own homes, or live with a loved one. Or, when necessary, a retirement community.
The point is: We need a serious long term care strategy.
Episode 3: The Uninsured are Waiting
Long before there was ER, there was the play, Waiting for Godot? As you may recall, Godot never shows up. That's how many Americans feel about their health insurance.
Today, over 44 million Americans have no health insurance - including over 11 million children. We learned the hard way that the best way to achieve universal coverage is one clear, explainable step at a time. We began by making health insurance portable. Now changing jobs, or having a pre-existing condition, doesn't mean losing coverage.
We made it possible for millions of Americans with disabilities to join the workforce without fear of losing their Medicaid or Medicare. We extended Medicaid to young adults transitioning from foster care to living on their own. And in 1997, we passed the bipartisan State Children's Health Insurance Program. Today, almost 2 and a half million children from working families have access to insurance through this program. This year we've recommended to Congress that the program be expanded to cover the parents of eligible children. Equally important, we've learned to "think outside the box" on this issue. We know that more insurance doesn't automatically guarantee quality health care. That's why we must continue to help low income workers by strengthening the safety net of local clinics and teaching hospitals - like NYU/Bellevue - that traditionally serve their communities without regard to ability to pay.
Episode 4: Quality, Quality, Quality
In 1997 President Clinton created the Advisory Commission on Consumer Protection and Quality in the Health Care Industry - co-chaired by the Secretary of Labor and me. The Commission issued a landmark report calling for a Patient's Bill of Rights. A Patient's Bill of Rights must not be an empty promise. There must be strong protections for all Americans - including access to specialists - and a meaningful way to enforce those protections.
Quality is also about outcomes. As every young doctor knows - and every true-to-life medical drama would show - what counts most is getting the right result for the patient in the right way. Usually that happens. But not always. As many as 98,000 deaths occur each year because of preventable medical errors. We set a goal of cutting these errors by 50 percent in 5 years. We're going to do this through a nationwide system of reporting that will be state-based and phased in over time - and by sponsoring research on the causes of errors - and how physicians and hospitals can eliminate them. Today's medical school grads, and the nurses and technicians they work with, are the best in the world. By reporting errors - and learning from them - they will become even better.
Episode 5: HIV/AIDS: We Can Beat This Disease
HIV/AIDS was with us eight years ago - and it is still with us. Nevertheless, death rates are down - and funding to fight HIV/AIDS is up. I have no doubt that we saved or extended many lives through our focus on research, treatment and prevention. But as good as this record is - we must do even better. There must be no let up in the fight against this terrible disease - or in the use of the media to teach young people how to prevent it.
HIV/AIDS is a bigger problem for most of the rest of the world than it is for us.
Which brings me to Episode 6: Global Public Health Brings Global Prosperity
There's an old Jewish saying: Nine rabbis cannot make a quorum, but ten shoemakers can. This is not a saying about the power of shoemakers - or rabbis. It's about how the power of numbers. There is strength in numbers. That's why it is in our nation's best interest to set up a worldwide public health infrastructure - that includes research, surveillance and treatment. We also need a vigorous international effort to develop vaccines. Infectious diseases such as TB, Malaria and West Nile know no borders.
In addition to the humanitarian need for a global campaign against infectious diseases - we have a strong economic incentive to wage this battle. Today, 40 percent of our exports go to developing countries. We need those markets to expand - not shrink. But shrink they will if millions of people in the developing world are cut down in the prime of life by infectious diseases like AIDS.
Episode 7: Bioterrorism: It's Not Just a Dustin Hoffman Movie Anymore
We don't know the likelihood of a deadly biological attack. But this much seems certain: As terrorists become more sophisticated, the threat will grow. Imagine if the World Trade Center bombing had been a biological attack. We would have heard no explosion, but within hours or days, the circle of exposure would have mushroomed. We wouldn't even know we'd been hit until waves of sick people began overwhelming our emergency rooms. Hospitals and medical providers - not police and firefighters - are the first line of defense against bioterroism. That's why we've requested a major increase in funding to prevent and respond to biological attack. And that's why I sit on the National Security Council. In the busy world of immediate health care needs, it is easy to overlook preparations for a "what if" problem like bioterrorism. That's a very big - and potentially deadly - mistake.
Episode 8: Focusing Like a Laser on Prevention
The majority of preventable deaths in our country are rooted in just three behaviors: Tobacco, poor diet and lack of physical activity. Doctors on television - and in real life - can save countless lives by promoting changes in behavior and early screening for disease. That means making sure we don't raise another generation of couch potatoes. That means making sue we meet the goals of Healthy People 2010 - a prevention agenda for our communities and our nation for the next 10 years. And that means getting the message out to young people that tobacco kills. One place to start is to stop showing doctors smoking on ER. Another is to persuade Congress to give the FDA authority to regulate tobacco. Teaming up with the doctors, nurses, public health leaders, and yes, the television industry - will keep the pressure on. Eventually, Congress will do what's right.
Episode 9: Keep Our Science Strong - and Our Ethics Stronger
America has the most talented scientists - and the greatest biomedical infrastructure - ever assembled. From the human genome to vaccine research to food safety - this century's blockbuster discoveries will come from America's medical and scientific genius. Over the last eight years, funding for every science agency rose steadily. But that's not enough.
We must protect the treasure of academic health centers like NYU/Bellevue - which will train the next great generation of doctors. I'm not talking about walling off academic health centers from revolutions in health care management. But I am talking about preserving the irreplaceable role these institutions play in training, indigent care and clinical research.
Woody Allen once joked: "I was thrown out of college for cheating on a metaphysics exam - I looked into the soul of the boy next to me."
Metaphysics is fine. But what we really need is some soul searching about medicine, because - as was written for this year's Days of Remembrance ceremony in the Capitol Rotunda - "Science and technology are not inherently moral; the responsibility to ensure that they are put to a moral purpose belongs to society."
That means we must never create a health care system where our genetic map is used to deny jobs or health insurance, where breakthroughs widen the gap between the haves and the have-nots, where we fail to protect human subjects involved in genetic research, and above all, where our science gets ahead of our ethics. Which brings me to my concluding Episode 10: The Moral Challenge of Health Disparities
A famous African American once said, "Why should I pay taxes? I won't get the money until I'm 65. Meanwhile the average black man in America dies at 54."
Behind that joke is a moral challenge. Yes, overall life expectancy for Americans is up. And yes, some gaps in health outcomes between minorities and the majority population are closing. But they're not closed yet. So we haven't finished our work yet.
In 1998, President Clinton set a goal of ending health disparities in six major areas - including infant mortality, cardiovascular disease and diabetes. We've made important progress. Still, when it comes to closing gaps in health outcomes, we are like Moses standing on the edge of the Promised Land. We are not there yet. But we will get to the Promised Land.
I hope this memo generates a few ideas for upcoming shows. But much more important I hope it inspires the graduates of NYU Medical School to seize the magnificent and challenging opportunities that await them in their own Promised Land.
That is the end of my memo - but not quite the end of my remarks. Let me leave you with these parting words.
As graduates of NYU Medical School, you are the most skilled new doctors our nation can produce. So if you want to relax - watch television or go to the movies. Listen to music. Go to a concert or the theater. Take in a baseball game - or better yet - play one.
My point is this: The drama of your own lives will always far exceed the imagination of any writer, musician or artist. So stay optimistic. Hold on to your compassion. And never stop serving your communities.
Love your work. Love all the people who made this day possible - which includes the taxpayers of New York. And, of course, love what blessed fortune has given you.
Remember, every moment counts. Every laugh is healthy. And every life saved is a gift to that person, that person's family - and to God.
The doctor's work is like no other.
Filled with joy. Occasionally touched by sorrow. And, I'm certain, in your skilled hands - forever noble.
Thank you.
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