THE RICHARD AND HINDA ROSENTHAL LECTURE 2008

PROSPECTS FOR HEALTH REFORM IN 2009 AND BEYOND

20TH ANNIVERSARY LECTURE

INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS

Washington, D.C.
www.nap.edu



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THE RICHARD AND HINDA ROSENTHAL LECTURE 2008

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THE NATIONAL ACADEMIES PRESS 500 Fifth Street, N.W. Washington, DC 20001 NOTICE: The project that is the subject of this report was approved by the Govern- ing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineer- ing, and the Institute of Medicine. Support for this project was provided by the Richard and Hinda Rosenthal Foundation. International Standard Book Number-13: 978-0-309-13047-9 International Standard Book Number-10: 0-309-13047-6 Additional copies of this report are available from the National Academies Press, 500 Fifth Street, N.W., Lockbox 285, Washington, DC 20055; (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area); Internet, http://www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu. Copyright 2009 by the National Academy of Sciences. All rights reserved. Printed in the United States of America The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin. Suggested citation: IOM (Institute of Medicine). 2009. The Richard and Hinda Rosenthal Lecture 2008: Prospects for Health Reform in 2009 and Beyond, 20th Anniver- sary Lecture. Washington, DC: The National Academies Press.

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“Knowing is not enough; we must apply. Willing is not enough; we must do.” —Goethe Advising the Nation. Improving Health.

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The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal govern- ment on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding en- gineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engi- neering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Charles M. Vest is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sci- ences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal govern- ment. Functioning in accordance with general policies determined by the Acad- emy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering com- munities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of the National Research Council. www.national-academies.org

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Foreword The Institute of Medicine launched an innovative outreach program in 1988. Through the generosity of the Richard and Hinda Rosenthal Foun- dation, a lecture series was created to bring greater attention to some of the significant health policy issues facing our nation today. Each year a major health topic is addressed through a lecture presented by an expert in the field. The IOM later publishes this lecture for the benefit of a wider audience. The Rosenthal Lectures have attracted an enthusiastic following among health policy researchers and decision makers in Washington, DC, and across the country. The lectures produce a dynamic and fruitful dialogue. In this volume, we are proud to present the remarks of the 2008 Rosenthal Lecturer, Julie Rovner, who spoke about “Prospects for Health Reform in 2009 and Beyond.” I would like to thank Clyde Behney, Jody Evans, Abbey Meltzer, Autumn Rose, Marty Perreault, Sara Sairitupa, Judy Salerno, Vilija Teel, Lauren Tobias, Jackie Turner, and Ellen Urbanski for skillfully handling the many details associated with the lecture program and the publication. In their lifetimes, Richard and Hinda Rosenthal accomplished a great deal. The Rosenthal Lectures at the Institute of Medicine are among their enduring legacies, and we are privileged to be the steward of this impor- tant ongoing series. Harvey V. Fineberg, M.D., Ph.D. President Institute of Medicine v

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Contents WELCOME 1 Harvey V. Fineberg, M.D., Ph.D. KEYNOTE PRESENTATION 5 Julie Rovner National Public Radio Correspondent and Health Policy Expert DISCUSSION 9 BIOSKETCH 17 PREVIOUS ROSENTHAL LECTURES HELD AT THE INSTITUTE OF MEDICINE 19 vii

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