by staff
Hugh Greene is president and CEO of Baptist Health, a locally owned, faith-based health system that includes five hospitals, a 45-office primary care network and other services. The health system employs about 8,300 people. Baptist also has a joint venture with Solantic to operate almost a dozen Northeast Florida urgent-care centers, which employ about 250 people. Greene is a frequent speaker about health care reform. He’s also a founder of the Jacksonville Civic Council and will chair the Jacksonville Regional Chamber of Commerce in 2011, leading the group on a fall trip to Indianapolis to study its economic and downtown development. Greene serves on the University of North Florida Board of Trustees and other boards. He and his wife, Susan, have three grown sons. Greene met Monday with the editorial staff of the Daily Record at his office at the flagship Baptist Medical Center Downtown.
You’ve given 45 presentations about health care reform. What are you saying?
You have to separate any discussion in terms of what are the implications for the populace and what are the implications for health care providers.
Let’s not underestimate the fact that this is momentous legislation. There’s been nothing equivalent to this act in health care since the passage of Medicare in 1965.
On the other hand, there’s a lot of hype and mischaracterization about this bill that disturbs me, whether it be the talk about ‘death panels’ or whatever form that hype takes.
I actually think that one of the most interesting things about it is people’s misunderstanding of this as sort of a government takeover of health care. In fact, those in the industry would suggest that rather than this representing some socialization of health care or government taking over, what this package more than anything else does is entrench the employer-based system as we know it.
The onus of health care has not been moved to the individual nor has it been moved to government; it has stayed squarely on the shoulders of business.
Reform of our health-care system is absolutely necessary, because the system as we know it is not sustainable. Nothing we’ve done over the last couple of decades has slowed down health care spending.
And a related but separate issue, obviously, is the rising number of uninsured, those who do not have coverage. For a sophisticated democracy to have 47 million people without coverage is really somewhat of an embarrassment compared to other nations in the world.
Does this bill solve the problem?
That’s the hard question. It does a lot of good things, and those who know it best will typically criticize it by saying that it does a better job of expanding coverage than it does curbing costs.
I think that what we’re talking about does do some pretty dramatic things that lead to somewhere in excess of 30 million more people having health care coverage, and so that’s a good thing. And some of that’s around the individual mandate, the employer mandate, the insurance reforms covering pre-existing conditions, all the things you’ve heard about.
How well and how quickly it’s going to reduce costs is still an open question. There are things about it that I don’t like, and there are things that simply weren’t addressed at all, not the least of which is the malpractice problem in the country, and defensive medicine. It really leaves that unaddressed. That’s a huge problem.
I think that what’s happened is better than having done nothing.
I think there are some good things in the bill, there are things that were left out of the bill. And I think we’re going to end up tweaking this thing as we go down the road, but I can’t help but believe something had to be done, and this is a step that is pretty important.
You know the subject very well.
People tend to get very worried about ‘what it’s going to mean to me.’ The average person is insured in this country through their employer, like most of us. I think probably you’ll see very little change as a result of this reform bill.
If you’re uninsured, you’re very likely going to benefit; if you’re poor and uninsured, you’ve probably got a better chance of being covered by Medicaid. If you have a pre-existing condition, you’re going to benefit. If you’re really wealthy, you’re going to pay more taxes.
So it depends who you are, in terms of how this really affects you.
I was on a plane talking with someone. He lit into me, a 20-minute tirade about (President) Obama and the socialization of medicine. And I said, you can believe what you want to, but it’s not true.
Was the flight over quickly?
The man can be concerned about health care reform, I have no problem with that. I can tell him the things he ought to be concerned about. But what he was talking about was nothing to be concerned about, and that’s where the hype and the misunderstanding is out there. Most of the people in the industry understand that what we’ve got going right now is not sustainable. And I think that most of us in the industry understand that the way we’re paid is not rational. We’re paid on the basis of volume. So the more we do, the more doctors do, the more we get paid, so there’s a perverse incentive just to keep doing more.
And at some point, you know it makes sense, that (reform) is a reward for effectiveness rather than volume. That’s the big message for providers that’s going to come out of health care reform.
You mention that you’d been out 45 times talking. Has anyone come up to you and said, ‘I had it all wrong.’?
People really do have the perception, particularly a certain segment of the population, that at the end of this, health insurance as we know it is going away, and that everybody’s going to be insured by the government. And they really do believe that. So you sort of debunk that myth.
It’s fascinating to watch the mindset of people and what they bring into it, and I think people are beginning to calm down a little bit. This thing’s phased in very slowly.
Most of this reform package actually does begin in 2014.
The city has been trying to market Jacksonville as a medical destination because of the many health care providers and jobs here. You’re also the incoming chair of the Jacksonville Regional Chamber of Commerce. What is the area’s future in the health care industry?
You have to start with your assets in your community and grow from there. Ours begin with the health care delivery system itself. After all, there are three cities in the nation that have a Mayo Clinic, where people come from all over the world. In this system we have the largest Catholic organization. We (Baptist) are the the largest health system, and we’re a private not-for-profit. You have the for-profit HCA, the Mayo Clinic, the University of Florida and Nemours Children’s Clinic.
I personally believe that we have some real opportunity. We’re pretty far ahead of the rest of the nation in terms of information technology in health care. I think that creates an opportunity for us to differentiate ourselves.
But I think we begin with our assets and we talk about becoming a destination. We have a very collaborative health care community. People do not understand how well we get along, compared to those in other cities.
The CEOs meet for two hours once a month and we have a very strong personal relationship, and so we need to leverage our strengths.
People say, why don’t we become a tech corridor? That’s all fine, but we really don’t have the assets to do that.
We have to define our possibilities, and then, with intentionality, claim that future. And you can’t do that unless you’re willing to invest in that future.
And you can’t do that, quite frankly, if all you’re concerned about is cutting-cutting-cutting-cutting. Good cities have invested in their future.
There has to be intentionality. I personally think this city has such incredible possibilities. I think we’re on the cusp of being the next level city. And I think the way we blow it is to say ‘let’s see how much we can strip away and cut back’ and that’s just not exactly investing in the future.
You have a lot of voters, though, who really cringe at the words ‘tax increase.’ And so how do you create a vision and sell it as an investment if it includes a tax increase?
I’m not advocating a tax increase, but my point being that when you look at Kansas City (the chamber destination last year) and Indianapolis, two comparable cities in size, and when you look at what they’ve accomplished, it has been a function of leadership, both private corporate leadership and elected leadership, with a common vision. And they’ve gotten it done. I’m encouraged by the fact that there was the Better Jacksonville Plan, with a mayor (John Delaney) who had a vision. He went out there and sold it. He got it done because he was a passionate leader with a vision. It was a function of leadership.
We’ve got to be very intentional about realizing our possibilities, and that means we’re going to have to focus on resources, and that’s going to involve the corporate community and it’s going to involve elected leadership. If I have a concern at this point, I think the next mayoral election is a critical election because it’s going to determine whether we’re willing to move forward, take the next step.
And that election is occurring in an era in which there is huge debate about the role and size of government. Let’s at least define the vision and begin to take steps toward it.
I really do feel that positive about the possibility of this city, because I see what others have done with far less natural beauty, far fewer natural assets.
Ultimately, over the next several years, coming out of the economic situation, with the right leadership, supported by private leadership - and that doesn’t just mean big corporate leaders, it means not-for-profit leaders - that we really can take the city to another level.
Is that private leadership the Jacksonville Civic Council, is that the chamber? Who is that private leadership?
That’s all of the above, including the not-for-profit leadership, because defining who we are certainly also involves situations to make sure there’s inclusiveness for the entire community.
What do you do for fun?
My fun tends to revolve around children and travel and I’m a fairly prolific reader of fiction. I tend to read award-winning fiction.
I work out routinely, by the way, at a wonderful Baptist fitness center on the River. And so I don’t consider there to be lack of balance in my life.
What’s a typical day for you?
In health care, there is never a boring moment. It is almost inevitably a 12-hour-plus day.