Landon Lecture

By:  Kathleen Sebelius
Date: Nov. 29, 2010
Location: Manhattan, KS

Thank you, President Schulz, for that kind introduction. And thank you for your leadership of this great university that is one of our state's crown jewels.

I'm pleased to be joined today by so many members of the Wildcat family: Administration, faculty, supporters and advisors, and students.

And I'm especially pleased to be in the company of two of the nation's best coaches, Bill Snyder and Frank Martin. Coach Snyder and I have known each other for a long time and worked together on many projects, including recruiting more adults to mentor Kansas kids.

I don't personally know Coach Martin, but I am among his legion of fans. And after watching the game with Duke last Tuesday, I know that with a few more free throws and Pullen finding his mojo, the K State team CAN beat any team in the country! Best of all, these coaches understand that they are coaching kids for life skills, not just sport skills.

So it's great to be here with all of you. In my new position in Washington, I'm guided every day by the work we did every day to build a stronger, healthier, and more prosperous Kansas.

And it's also great to be back in Manhattan. I have always had a soft spot in my heart for K State; marrying a Wildcat is what first brought me to Kansas. And even though I'm now on the East Coast, Manhattan for me still means Kansas, not New York.

I also know that this is not just a terrific place to get a college education. It's also an important engine for our state's economy and a steady source of innovations in so many areas from aviation to engineering to agriculture.

I'm especially proud that K State was selected to be the site of a new state-of-the-art lab -- one of only three in the world -- that will put our state at the forefront of animal health research. Our department operates similar labs for human diseases through the CDC and NIH, and they are absolutely critical to the health and security of our nation. So I'm glad to see plans for this facility moving forward here in the Heartland.

So, thank you for inviting me; it's a great honor to be giving the Landon lecture. It's humbling to be standing here where so many great leaders have stood before.

Of course, that list starts with the first speaker, Governor Alf Landon himself. Governor Landon lived a remarkable life, becoming a great success in the oil business, fighting in the First World War, serving as Governor of Kansas, running for President, and eventually becoming one of our nation's greatest statesmen.

Governor Landon was also fortunate enough to witness some extraordinary history: the invention of the automobile, the defeat of fascism, the Civil Rights and Women's Rights movements, technological leaps that put a man on the moon and gave us the personal computer.

But I would argue that there is no area in which our country made greater leaps during the last century than health.

When Governor Landon was born in 1887, the average lifespan for an American was the mid-40s, about a dozen years higher than the average lifespan of a hunter gatherer thousands of years ago.

By 1987 when he passed away just after his 100th birthday, the average lifespan in the US had risen to 75 years.

Diseases like small pox and polio, which used to be every parent's greatest fear, were wiped out in this country. Conditions that had once been death sentences became manageable. The death rate for coronary heart disease has dropped more than 60 percent from World War II. The death rate for stroke has dropped 70 percent.

There are many reasons for these gains in health. Scientific breakthroughs like the discovery of penicillin played a role. So did public health breakthroughs like improved sanitation and clean water. And so did policy breakthroughs like Medicare, which provided unprecedented security for the half of seniors who, prior to 1965, had no health insurance at all.

These gains in health transformed our country. Health is freedom. When we live longer, healthier lives, we have more time to do our jobs, volunteer in our neighborhoods, play with our children, and watch our grandchildren grow up.

Health is also the foundation of our prosperity. Healthy adults are more productive workers. Healthy children are better students. Healthy families can make bigger contributions to their communities.

When the health of our nation improves, we see the benefits in every area of our lives.

Today, I want to talk about some of the steps I believe we can take to continue this progress, so that we too can leave a healthier country for our children and grand-children.

The most significant health legislation passed in the last 45 years is the Affordable Care Act, signed into law this March. And it lays the framework for reorganizing health care as well as reforming our health insurance system.

For years, we have had a health insurance market that was crumbling.

Employers were dropping coverage. Premiums were skyrocketing. Consumers were getting more and more frustrated. And more Americans were shut out, priced out, or dropped out of the market altogether.

Without health insurance or with insufficient health insurance, too many Americans went without critical care. Or saw their life savings disappear with one accident or illness.

And without legislation, the market would have kept deteriorating.

So over the last eight months, our department has been working closely with Governors like Mark Parkinson, and Insurance Commissioners like my friend Sandy Praeger, as well as the health care community and consumer and employer groups, to implement the first parts of the new law.

And while we've got a long way to go, you can already see signs of progress right here in Kansas.

In the last eight months, we've begun addressing one of the unacceptable gaps in our health insurance system -- the so-called donut hole gap in insurance coverage for prescription drugs for seniors -- by mailing $250 checks to almost 19,000 Medicare beneficiaries in Kansas. In 2011, seniors will get a 50 percent discount on brand-name drugs. And eventually, we'll close that donut hole completely.

We've also established an Early Retiree Reinsurance Program that helps employers maintain health coverage for their early retirees. Right now, a lot of retired folks aren't yet eligible for Medicare, and rely on their former employers for health insurance.

But as health costs have risen, more and more employers are ending this coverage, which leaves folks in their early 60's with nowhere to go. And individual coverage for a 60-something can be very expensive. So far, 34 major Kansas employers and unions from Spirit AeroSystems to SprintNextel have applied to be part of this program to keep their retiree coverage in place.

With support from our department, Kansas has also set up a Pre-Existing Condition Insurance Plan where Kansans who had been shut out of the health insurance market because of their medical conditions can get affordable coverage.

I remember one Kansan who wrote to me last year. He and his wife ran a small business in Salina for 28 years. They bought health insurance for their employees because they thought it was the right thing to do. They played by the rules and did everything they were supposed to.

Then when they retired, they applied for individual coverage from their same insurer. But they were rejected because of minor medical issues like taking blood pressure medicine. When they wrote to me they were worried that they wouldn't be able to get any health insurance at all. Now, thanks to the law, there will be new options for people like this couple.

We've also created a new Patient's Bill of Rights that establishes some long overdue consumer protections in our health insurance market.

For example, insurance companies are no longer allowed to take away someone's insurance when they get sick just because of an unintentional mistake in their paperwork. And last week, we announced new rules that will make sure that at least 80 cents of every premium dollar will be spent on health care, not CEO salaries, marketing, and administrative costs.

Finally, there's one reform that's especially important for the students here today. We know that young adults, in their 20s, have had very low rates of health insurance, being twice as likely to be uninsured as older Americans.

That's because it's not always easy to get a job that offers health insurance right out of high school or college. I know this because when my sons graduated from college, neither had a job with insurance benefits. But as part of the new law, young Americans who don't get insurance from their jobs can stay on their parents' plan until their 26th birthday.

So whether you're still looking for a job after graduation, or going off to graduate school, or working for a small business or non-profit that doesn't offer health insurance, you won't have to worry about losing your health coverage.

Now, these reforms are not going to fix every problem in our health insurance system overnight. In fact, because we didn't want to disrupt the coverage people already have, many of the most important changes won't take effect until 2014.

But we're starting to fill in some of the biggest gaps, end some of the worst abuses, and give some more control to all the people who felt like there was nothing they could do when their premiums went up 30 percent or their claims were denied.

And as we go forward, I can tell you that we're going to keep working with all of our state partners to implement this law effectively and improve it where we can.

But contrary to the impression you might get from watching cable news, there's a lot more to health than health insurance. And there's more progress happening today than just the new law.

So this morning, I'd like to share with you six additional reforms, investments, and technologies that I believe are essential to creating a healthier country. This list isn't comprehensive.

But they provide some useful examples of the kinds of work we can do together to keep America on track towards a healthier future. And along the way, they might answer another question that some of you might have, which is: what exactly does the Department of Health and Human Services do?

Here in Kansas, we have a proud military tradition. And there's no doubt that a strong military is still the foundation of our national defense. But increasingly, the range of dangers we face is widening to also include biological, chemical, nuclear, and radiological hazards.

We don't know where the next public health crisis is going to come from. It could be a dirty bomb set off in a university lecture hall. It could be a naturally-occurring superbug that can resist all treatments. It could be a biological weapon we've never seen before, assembled from the building blocks of life by a terrorist in a lab.

In order to respond effectively when this crisis comes, we'll need to have what are called countermeasures, the vaccines, antivirals, diagnostics and other drugs and equipment that are often our first and best defense against these threats. (The same kind of response that the new animal health lab will help to identify for an animal crisis, we are responsible for when it comes to human health).

The problem right now is that there's little incentive for private companies to produce medical countermeasures for rare conditions like the Ebola virus or exposure to non-medical radiation -- even though in the event of an Ebola outbreak or a nuclear explosion, these countermeasures would be critical.

After September 11th, the US government came up with a plan to make up for this shortfall. But we still aren't as nimble and flexible as we need to be.

So over the last two years, our department has conducted the first-ever review of how we develop and produce these medical countermeasures. And we've identified a couple key areas where we can strengthen our countermeasure pipeline.

For example, one approach we're exploring is launching a non-profit venture capital firm, that can provide strategic support to small companies with big ideas that have huge potential to improve our public health preparedness.

Another is providing additional resources to the FDA and NIH, so that they can make it easier for the companies that produce countermeasures to navigate our regulatory system by creating clear regulatory pathways, analyzing promising new discoveries faster, and helping identify and solve scientific problems as they occur. The goal is getting great ideas from microscope to marketplace in a more timely and efficient manner.

As all the athletes here know, how well you perform in the spotlight depends on how well you practice when no one is watching. The same is true of our response to public health crises.

How well we prepare now will determine how successfully we can respond when the next crisis comes -- and we know it will.

Our review has given us a roadmap for improving our preparedness. Now we need to follow it.

A second area we need to focus on is cancer. One of the changes that has come with living longer is that we have to worry about new health threats.

For example, many cancers don't become deadly on average until after your 60th birthday. When Governor Landon was born, and the average lifespan was less than 50 years, folks often died before a tumor become fatal.

But today, about half of men and a third of women will develop cancer in their lifetime.

The good news is that as cancer is becoming a bigger part of our lives, breakthroughs in science are giving us better weapons for fighting it.

For years, the main approach for treating cancer was similar to "carpet bombing." Using either radiation or chemotherapy, you'd try to kill as many of the cancerous cells as possible while hoping there was as little damage to healthy cells as possible.

But thanks to the progress scientists have made cracking our genetic code, we now have the possibility of developing more effective, targeted therapies.

For example, we have a drug called herceptin that can cut the risk of early breast cancer recurrence in half for patients whose tumors have a certain genetic marker.

To speed the development of these new treatments, we have created what we call the Cancer Genome Atlas at the NIH. Using funds from the Recovery Act, we're expanding a comprehensive database of the DNA changes associated with 20 major tumor types.

This could unleash a new generation of cancer treatments that are targeted specifically at your tumor. But we have just begun to travel down these research avenues, and we need to need to keep pushing forward.

Since I started talking this morning, twenty more Americans have died of cancer. If we can speed up the development of the next generation of targeted therapies, we could strike a huge blow against a disease that now kills more Americans than any other besides heart disease.

To be a healthier country, we'll need new cures and treatments. But we will also need to improve the way we deliver care.

For example, every year, tens of thousands of Americans die from what are called healthcare-associated infections: more than die from homicides and car accidents combined.

These are not the infections that bring you to the hospital. They are the infections that kill or injure you once you are in the hospital. And they're one of the top ten killers of Americans today.

Doctors at Johns Hopkins have developed an incredibly effective tool for saving these lives. It's not a fancy new treatment or instrument. It's a checklist that reminds health care providers to take basic safety steps like washing their hands with soap and wearing a sterile mask, each and every time.

It's hard to imagine that such a simple protocol could make a big difference. But when it was tested it in Michigan in a group of hospitals and used by doctors who insert catheters into a major vein, the results were incredible. In just 18 months, infections went down by 66%, 1,500 lives were saved, and costs went down by $200 million.

If you heard these numbers, you might guess that every operating room in America now uses one of these checklists. Unfortunately, that's not the case.

The truth is, innovations travel way too slowly in our health care system. Our department's research shows that it takes 17 years -- 17 years! -- from the discovery of an effective treatment for it to be incorporated into routine patient care.

By comparison, it takes seconds for your friends in California to learn on Facebook that you are in a new relationship. (Or, for some of you, that "it's complicated.") But it can take years for a hospital in California to learn about how a hospital in Kansas is improving care.

So one of the best ways we can become a healthier country is to speed up the rate at which life-saving innovations we already have like the checklist are adopted. That starts with creating incentives that reward better care.

If you study the new health care bill, you'll find that there is provision after provision that create new incentives for doctors and hospitals to deliver high-quality care.

To understand the potential of these changes added together, think of Michigan. They adopted one quality measure for one kind of procedure and saved 1,500 lives in 18 months. Multiply that by 50 states and all the different kinds of care that hospitals provide these days, and you can start to see the difference that these changes could make.

Another step that will help us improve the quality of health care is adopting electronic health records for all doctors and all hospitals.

In industry after industry, we've seen the power of information technology to bring down costs and improve the customer experience.

Imagine going back to the days when you had to wait at the grocery store while a cashier added up all the hand-written price tags. Or wait for the bank to open every time you wanted to get cash.

We'd never accept that. Health care shouldn't be any different.

In fact, we've already seen the power of electronic health records across the country to cut health care costs, reduce paperwork, improve outcomes, and give patients more control over their health care.

Four months ago, I visited the neonatal ward at Cincinnati's Children's Hospital. They had gone 1,000 days without a serious safety incident -- a record they credited to their use of electronic health records.

And even though a big part of my job is talking to doctors and nurses, I still haven't met a single health care provider who uses a high-quality electronic health record and says: "I really want to go back to those paper files. That was really the best way to practice."

And yet, we know that just two in ten doctors and one in ten hospitals use even a basic electronic record system today. (How many of you have gone to the school clinic and spent 15 minutes filling out the forms you've already filled out for your doctor at home?)

There's a reason for this. It's not easy to learn a new technology, especially if you're a doctor in a small practice that doesn't have an IT department. Sometimes as a doctor in a small practice, which we have many of in Kansas, you are the IT department.

There's also the challenge of being able to share information with other providers securely even if they have a different system. If you can't get information from your patients' other doctors, electronic records lose a lot of their value.

And then there's the fact that these systems can be expensive, even if they pay off in the long run.

So what we've done over the last two years is undertake an unprecedented effort to remove some of these barriers. We created Health IT Regional Extension Centers across the country that are modeled on the agricultural extension service. Through that program, which you're very familiar with here at Kansas State, we send experts out to your plot of land to look at the seeds you're using, look at the quality of your soil, and figure out why the corn or wheat weren't growing the way they should.

These Health IT centers will provide the exact same kind of hands-on technical support, and one of them will be right down the road in Topeka.

We're also providing grants to help states create a framework for doctors and hospitals to exchange information with full protections on patient privacy. And most important, we are providing bonus payments for hospitals and doctors that adopt electronic health records -- and using them to improve patient care.

Together, these investments are going to knock down many of the obstacles standing in the way of building a 21st century health care system that uses technology to improve results and lower costs just like every other enterprise.

The result is that people are going to be healthier. Doctors are going to have more tools and more time to do their jobs of patient care. And America has an opportunity to be a world leader in one of the key industries of the future: the technology of health information.

But if we want a healthier country, we can't just focus on what happens in hospitals and doctors' offices. We also need to pay attention to the air we breathe, the food we eat, and the lifestyles we lead.

Right now, America has an obesity epidemic. Two in three adults in American are obese or overweight; as are one in 3 of our children. This isn't a fashion crisis; it's a health crisis. Obesity brings a far higher risk of heart disease, stroke, and certain cancers. It's the single biggest predictor of diabetes.

That's why this Administration has launched a broad agenda to help Americans make healthier choices from the First Lady's Let's Move campaign to the investments we're making in some of the most promising community approaches for reducing obesity, like bringing supermarkets to food deserts. And for a farm economy like Kansas, linking local growers to purchasers improve health and help the local growers.

But one of the biggest obstacles to eating healthy today is knowing which foods are healthiest.

We all know that fresh fruits and vegetables are better for you than a cheeseburger and French fries. But it's hard to guess that the tuna melt at a fast food chain has more fat than a stick of butter. Or to pick out the healthy cereal from fifty choices at the grocery store.

While you could go to the fast food chain's website to look up how much fat the sandwich has or spend 15 minutes studying the nutrition facts on every box of cereal, who has the time?

That's why this Administration is putting a new focus on helping consumers get better information about the foods you're eating.

As part of the Affordable Care Act, certain chain restaurants will have to display the calories for each of their offerings on their menus.

And we're also working food manufacturers to develop more helpful front of package health and nutrition labels, so that when you go to the grocery store after a long day of studying or work, it's easier to figure out the healthy option.

The truth is most Americans want to eat healthy. (Well, maybe not when they're in Aggieville at three in the morning, but usually!) The key is to make the healthy choice the most convenient and affordable.

And that's what we're trying to do.

At the same time, we're also putting a new focus on keeping our food safe. Every year, millions of people in the United States suffer from foodborne illness. Hundreds of thousands are hospitalized. And thousands die.

Here's how our food safety system works today. First, local health officials around the country begin to see report of people getting sick and they suspect a foodborne illness. The local folks notify the CDC whose investigators try to pinpoint the outbreak and notifies the Food and Drug Administration. Then the FDA investigates to find the source and warns the whole country to avoid the food of concern.

In other words, we work backwards, chasing outbreaks after they occur.

This creates anxiety and confusion for consumers shopping in grocery stores. And it creates major disruptions and economic losses for farmers. Every time one farmer or processor produces tainted food, people get sick and the entire industry suffers.

In farm states like Kansas, we understand the importance of a safe and secure food supply better than anyone. And we've seen firsthand how the producers can take a huge economic loss if folks are scared away from buying a product.

The problem is that we've been monitoring a 21st-century food system with 20th century tools, rules, and resources. Today, nearly half our fruit and over three quarters of our seafood come from overseas whether it's tropical fruit from Mexico or Chilean Sea Bass. But many of these importers don't have the same strict safety standards that we have here in the US.

In other words, our food system has evolved, but our methods for monitoring it haven't. The last significant food safety-related changes to the Food, Drug, and Cosmetic Act took place in the late 1930s, before your parents and many of your grand-parents were born.

So one of my biggest goals as Secretary has been working with our Agriculture Secretary Tom Vilsack, another former farm state governor, to build a 21st century food safety system.

We want to move to a system where we can prevent these outbreaks or catch them early, close to their source.

There's legislation being considered right now in the Senate that would be the biggest update to our food safety efforts in decades. And we hope it will pass soon so that we can start reducing these preventable deaths.

I've just shared six transformative steps we could take to become a healthier country -- strengthening our medical countermeasures pipeline, pursuing targeted therapies against cancer, reducing healthcare-associated infections, switching to electronic health records, putting better nutritional information in people's hands, and building a 21st century food safety system.

They are all top priorities for this Administration and areas in which we are currently either making significant progress or poised to make significant progress.

They are also all goals that almost all Americans can support. Making sure we have an adequate supply of vaccines and antivirals for the next public health crisis is not a Democratic or Republican issue. The new food safety bill has strong support from both parties. We can all get behind saving lives and lowering costs by reducing hospital errors

And yet, you rarely hear about these stories in the newspaper. That's not surprising. There will always be more coverage of political battles than areas where we agree. A plane crash that kills 200 people will always be more dramatic than a hospital checklist that saves 2,000.

But it's important that we don't lose sight of these opportunities because it's these steps and steps like these that will determine whether we continue to make the same kind of gains in health that we made in the last century.

And we should never fall into the trap of believing that progress is guaranteed. Recently, some experts have said that this may be the first generation of Americans in 200 years to have shorter life spans than their parents.

After the enormous gains in health we made last century, our momentum is in danger of slowing to a halt -- and even reversing.

But it doesn't have to. If we can work together in the areas we agree on, compromise in the areas we don't, and make health a top national priority, I'm confident that the students here today will be able to look back at the end of their lifetimes as Governor Landon did at the end of his, and know that you are leaving your children a stronger, healthier, more prosperous America.

Thank you.