If the American health care system is broken, who better to fix it than doctors?

“There is a crisis in health care, and is there an answer to it? Of course,” said Dr. Loren Walensky, a pediatric oncologist at Boston Children’s Hospital and a professor at Harvard Medical School, during an Aug. 27 Vail Symposium event. “When we say something is broken, go find a doctor in this room … we see broken and we run to it. We want to go fix that.”

Dr. Rochelle Walensky, the director of the Centers for Disease Control and Prevention from 2021-2023, joined her husband in offering solutions at the packed forum at the Vail Interfaith Chapel.

‘A national tragedy’

When it comes to American health care, “we have our feet in the fridge and our head in the oven and on average, we’re OK,” Rochelle Walensky said.

Residents of the American South and several Indian reservations have life expectancies 20 years lower than residents of states like Massachusetts and Hawaii.

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“The unevenness of this is a national tragedy,” said Clay Jenkinson, the discussion’s moderator.

People living in places with higher education and income levels are healthier, while rural regions face particularly daunting challenges when it comes to accessing health care.

“Alaska, if it were a country, would have one of the highest rates of colon cancer in the world,” Walensky said.

This is because most Alaskans have to take two flights to get to an anesthesiologist to receive a colonoscopy, and most of those flights are cancelled due to bad weather, she said.

“One of the challenges that we have is delivering equitable health care,” Rochelle said.

‘Innovate out of this problem’

Many of the solutions the United States needs to fix the problems in its health care industry already exist, Loren Walensky said.

“I don’t agree that you have to level the entire thing down to the foundation,” Loren Walensky said. “We have certain things in this country that will allow us to innovate out of this problem.”

The United States has the best medical and engineering drug discovery network in the world, the best academic medical centers and the best complicated care and emergency care systems, he said.

“We are starting with a workforce, and an innovation and a motivation that can be applied to fix the problem,” Loren Walensky said.

Reform to medical education “has to be on the docket for health care reform,” Rochelle Walensky said.

The form of post-graduate level medical education in the United States has not changed since 1990, when an act of Congress capped the number of general medical residency and internship spots, operating under the belief that there were too many physicians in the country. It will take an act of Congress to increase this cap.

Both Walenskys refuted the claim that doctors do not want to practice in rural areas.

“The most likely person to stay in a rural area to practice is one who trained there,” Rochelle Walensky said.

“A lot of those places don’t have medical schools. A lot of those places don’t have health professional schools. Folks then have to leave those places and they go to the big city and they don’t want to go back,” Loren Walensky said. “I actually think if you bring training to those locations and you incentivize people to go to those locations, they will go.”

Funding the solution

“Being part of this is to actually acknowledge that ‘broken’ means ‘fixable,’” Loren Walensky said. “In order to fix something, you have to invest in it.”

The U.S. spends nearly twice as much money per capita on health care compared to the average comparable country. But the funds are misallocated, the Walenskys said.

“We’re spending dollars in the wrong places,” Rochelle Walensky said. “We’re spending dollars on emergency rooms and not interventions.”

“We do not pay for keeping people healthy, because if we start paying for keeping people healthy, we would be paying for screening,” Rochelle Walensky said. “One of the challenges for that is insurance charging.”

On average, people switch private insurance plans every two years, so the way insurance companies see it, paying for prevention would benefit a different company, Rochelle Walensky said.

Preventative care is the easiest, most cost-effective way to keep people healthy, but many Americans either cannot afford or cannot access it.

“It’s very clear that if you have housing, if you have nutrition, if you go to your yearly visits, if you follow what the regimens are to keep yourself healthy, it is way cheaper to live a long, healthier life,” Loren Walensky said.

There is a deficit of 140,000 primary care doctors in the U.S. More than 80 million Americans are living in areas with a shortage of primary care physicians.

“A third of the country doesn’t even have enough health care professionals in order to, if they had insurance, to access (care),” Rochelle Walensky said.

On top of this, Americans pay more for prescription medications than most other countries.  

Annual HIV medication costs $50,000 a year in America, and $67 a year in Africa, Rochelle Walensky said. The difference includes “marketing, ability to use generics, industry markups,” she said.

When a patient goes into a pharmacy, one in 20 prescriptions gets abandoned, Rochelle Walensky said. “If the copay is over $100, 30 to 50% get abandoned.”

At the same time, Loren Walensky said that in his experience, Americans will never say it is too expensive to treat their loved one with a necessary drug.

“These are real, emotional problems, and when you anonymize the problem with a map or with statistics, you are losing the real issue, which is when you’re up against a creek with a medical problem … you want that care so that they can live, and you’re willing to do anything to get it. But if every single person in this country was in that same boat, what can you do?” he said.

Will the current political climate accommodate the necessary solutions?

“Having a healthy day-to-day existence is not a controversial political desire. Developing new drugs to cure cancer is not a political issue,” Loren Walensky said.

But the current political climate has introduced politics into health care to a larger extent than in the past.

Loren Walensky said he is concerned about the growing, unbased lack of trust in scientists.

“We’re in this very strange environment right now where something that makes a whole lot of sense is now being converted into something else that makes a truly different kind of sense,” he said. “How do you combat that? It’s very hard.”

Recent policies contained in the “big, beautiful bill” have limited the amount of federal loans graduate students (like future doctors) can take out for their education and increased barriers to accessing Medicaid. The federal government has also cut funding to institutions providing medical education and conducting medical research.

“It looks like about 10 million more people will lose health insurance on Medicaid. It looks like we will be closing rural hospitals,” Rochelle Walensky said.

Only about half of the 50,000 medical students who apply to medical school each year are accepted. Many take out loans far exceeding the $200,000 cap contained in the bill.

Loren Walensky’s solution to America’s health care crisis includes creating a bigger workforce by growing medical schools, increasing the number of training slots and encouraging students to move to areas where there are doctor shortages.

“The way not to do it is to say, ‘If you’re going to med school, we’re not going to allow you to borrow more than X number of dollars to do it,’” he said.

This fall, the federal government is looking at significantly cutting funding to federal health care centers like the Centers for Disease Control and Prevention and the National Institutes of Health.

“We are about to be facing in October the biggest threat to science, medicine and engineering in this country that we have ever seen,” Loren Walensky said. “When you talk about a proposal to cut the NIH by 40%, to cut the National Cancer Institute by 40%, you are essentially eliminating the chance to have any new science done, let alone continue the current science that is being done.”

“70% of your state-level health departments are funded by the CDC, so 50% cuts to the CDC, you will feel that in everything that you do every single day,” Rochelle Walensky said. 

Rochelle Walensky asked people to use their voices to speak out against the proposed funding cuts.

“We have to protect the future. That future is really being threatened now by cutting away all of (doctors’ and future doctors’) training and financial support,” Loren Walensky said.