1996 All Over Again

One day shortly after the Sun began publishing, the phone rang in my office. At the other end of the line was the president of the Manhattan Institute, Lawrence Mone. He wanted to bounce a name off me as part of his search, he said, for a person to write a book that would do for the debate about health care what Charles Murray's 1984 landmark "Losing Ground" had done for the debate about welfare reform.

There's been plenty of good work done since then on health-care issues, some by the Manhattan Institute, but three years later, we are all still waiting for the book that changes the debate. "A Call to Action: Taking Back Healthcare for Future Generations" (McGraw-Hill, 265 pages, $27.95) is not that book, but if widely read, it could be a pretty good substitute.

The book is written not by some academic, journalist, or think-tank denizen, but by Hank McKinnell, the chairman and chief executive of Pfizer, the global pharmaceutical company headquartered on East 42nd Street in Manhattan, along with John Kador, a corporate speechwriter credited on the book's title page and in the acknowledgements. It is short, readable, lucidly and accessibly written, and full of fascinating facts and anecdotes. Its policy proposals make sense. And, in a political season in which health-care reformers Hillary Clinton and Dr. William Frist are spoken of as presidential contenders, this book serves as a useful preparation for the coming debate.

Mr. McKinnell has unconventional thoughts to offer on many fronts. Concerned about the cost of health care? What about the cost of disease, he counters. And anyway, why the alarm - "Spending on information and communications technology has similarly soared over the past decade, yet no one speaks of a 'computer crisis' or a 'mobile phone crisis.'"

Think advertising is driving up the cost of medicine? He cites a study showing "the average price of drugs that are advertised is lower than those that aren't."

Think Canada-style price controls are the answer? Mr. McKinnell notes that, in the last 50 years, the entire Canadian drug industry has brought a grand total of exactly two new medicines to market.

How to improve health-care quality? Make doctors and clinics compete for the business of individual patients based on cost and results. Also, let globalization work. Mr. McKinnell gives the example of the Escorts Heart Institute & Research Centre in New Delhi, India.

"The total bill at Escorts for a heart valve replacement is about $10,000, including a round-trip airfare from the United States and a side trip to the Taj Mahal. A similar procedure in the United States would run in the neighborhood of $200,000," he writes. He adds that "the death rate for coronary-bypass patients at Escorts is 0.8 percent. By contrast, the 1999 death rate for the same procedure at New York-Presbyterian Hospital, where former President Bill Clinton underwent heart bypass surgery, was 2.35 percent."

Want an example of how litigation risk drives business decision-making? Pfizer "concluded that the company could not make a go of it in the human vaccine sector." Yet Pfizer "leads the world in animal health vaccine research and development." One key difference, Mr. McKinnell writes, is that "Animals don't file lawsuits."

Mr. McKinnell doesn't flinch from speaking of the flaws in American medicine. He says 100,000 Americans die each year as a result of preventable medical errors, and that between 5% and 10% of all hospital patients - 2 million Americans a year - contract a hospital-acquired infection. He calls for transparency as a cure: "If we required every hospital to publish the number of dropped babies, surgeries on wrong body parts, wrong drugs or dosages, deaths from hospital-borne infections, etc., I guarantee you that hospitals would shape up overnight." He says insurers should tell doctors and hospitals they simply won't pay when, for example, the wrong drug or the wrong dose is given a patient.

Mr. McKinnell calls for electronic medical records - supported recently, after this book's publication, by legislation introduced jointly by Senators Frist and Clinton. And he calls for an increased emphasis on disease prevention via diet, exercise, and smoking cessation. Pfizer is implementing this approach in Florida together with another 2008 presidential possibility, Governor Jeb Bush, in a program called "Florida: A Healthy State."

In his conclusion, Mr. McKinnell makes the same link Mr. Mone did in his phone call to me. "Advocates of healthcare transformation can take heart from the experience of welfare reform," he writes. "Eventually the moral and financial bankruptcy of the existing system could not be ignored. ... Though opponents trotted out a frightening scenario of starving children, the transformation is achieving the desired benefits. The promised calamities have yet to materialize."

He predicts: "So it will be for healthcare transformation. The forces of obstructionism will put up a fight, but they will lose."

It is something for the chief executive of one of America's leading drug companies to imply that the American healthcare system is morally and financially bankrupt. After all, it saves lives in nearly miraculous ways every day. It attracts doctors from around the world seeking training and patients from around the world seeking treatment. But you need not sign on to such a dire assessment of the problem to agree with Mr. McKinnell that there is much room for improvement and innovation.

As for whether those forces will eventually triumph in the sphere of politics and policy, that is one of the things our next series of elections will be about. The more people read Mr. McKinnell's book, the more likely it will be the transformation will happen.