September 29, 2004

The Surprising Teresa Heinz Kerry Takes on Healthcare

Since seeing Teresa Heinz Kerry at a town hall "Conversation on Healthcare" last week (9/23) here in Las Cruces, NM, I’ve been surprised at how difficult it’s been to write about the event simply because it was the most unusual campaign event I have ever attended.

Although there were some of the trappings of a rally, the 300+ people in attendance actually participated in a challenging intellectual stretch for most of the hour and a half Teresa was on stage.

There were no surprises over the politics, of course. There were the "Women for Kerry" sitting on the stage of the small auditorium and a cheering section spelling out "T-E-R-E-S-A" and our Lt. Governor, Diane Denish delivering the grim statistics about the state of healthcare in New Mexico and Bush’s plan to deal it, namely "Don’t Get Sick." I was a bit surprised to learn from Denish’s introduction that Teresa holds 10 honorary degrees, but not at all surprised, after having seen Teresa’s convention speech when she said that Teresa "says what she thinks and knows what she’s talking about."

When Teresa came onto the stage I noticed how much she reminded me of a matronly suburban housewife in her jacket, slacks, and espadrilles. But I also noticed that she carried a slim, red loose-leaf notebook, which she placed on the table at center stage and which, when opened, revealed tabbed sections. The appearance of the red notebook was a signal that we were now going to get involved in some serious business.

Indeed, after greeting the crowd in English, Spanish, and even a little Portuguese, Teresa explained that she has been doing healthcare forums for the last seven weeks for nearly 80% of her time on the campaign trail. Of course, she touched on her involvement with healthcare during her convention speech. But in this intimate setting a much deeper understanding of Teresa Heinz Kerry took shape.

Her early interest in medicine is well known, of course, because she has spoken often of how she grew up with a father who was a physician and traveled with him to rural areas in South Africa delivering healthcare. But I was surprised to learn about other close relatives who have also worked in the field, notably a niece who is a "hospitalist" of whom Teresa seems especially proud. Teresa was quite effusive over the fact that this niece, named to list of the top 3,000 physicians in the country, has foregone lucrative private practice and has instead chosen to work in a hospital setting as a diagnostician, earning so much less money than she could earn elsewhere that at the age of 41 she still has medical school debts. She also bemoaned the long shifts without sleep that doctors in training, such as her stepdaughter, are forced to endure. So, it’s this lifelong, personal connection to the medical field that Teresa brings to her work on healthcare issues.

And, it is real work that Teresa is doing. Rather than simply writing checks, Teresa has spent decades working with private NGO’s, foundations, corporations, unions, and academic institutions in a non-partisan manner. But the extent of her involvement came as a surprise to me as she almost off-handedly described how directly she’s been involved with doctors at the University of Pittsburgh in designing pilot programs to study the effectiveness of early childhood initiatives, including one called Early Start. Then there was her discussion of PBMs (Pharmacy Benefit Management plans). Again, I was surprised at her hands-on experience in this area. Teresa has worked through her foundations to set up a state-administered prescription drug plan for the state of Massachusetts and one in Ohio for the uninsured and emphasized the need to offer different solutions for the needs of different states. She knows that unless they are set up with transparency and accountability, many of the private PBM plans set up through employers and pension plans to distribute drugs are just no-risk, cash cows that add an unnecessary layer of costs in our healthcare system.

So, the picture of Teresa that was emerging was not only that of a woman with long ties to medicine, but also that of a working CEO who personally directs the resources of her foundations into research and public policy that effect meaningful change and real benefits.

And, her approach to public policy has obviously been grafted to John Kerry’s approach to healthcare. Her belief is that impediments in our society prevent the U.S. from being "smart, well and happy." A plan must correct the obstacles, enable policies, and prevent problems from happening and that these are key goals of the Kerry plan. Central to his plan are "investments in our well-being." The jumping off point is that "from day one, every child will have access to healthcare."

As Teresa said, "It’s a way of thinking, a trajectory" which won’t happen in six months but by investing in children first, the rewards will be evident down the road.

Teresa went back to the red notebook as she detailed the elements of the plan that make it "holistic" -- allowing doctors and nurses to practice real medicine; cutting costs by being "smart," i.e., by choosing fewer administrators, having more nurses, and reducing litigation as a result of better, more attentive care; and a focus on prevention and wellness by, for example, monitoring diabetes rather than facing the huge costs of late intervention. These approaches are the core of the Kerry plan. Then she explored the economic value of enabling small business and individuals to buy health insurance with the help of tax credits...not via a handout, but through smart tax policy.

And then Teresa delivered the most important message of the day. John Kerry’s plan is a "plan of choices, an American plan, with no mandates." It’s American because it is free to use market forces, incentives, and Americans will be free to make choices. It won’t raise taxes. But most importantly, "IT CAN PASS" because it appeals to Republicans who prefer market forces, offers immediate care for children, which appeals to more liberal constituencies, and provides access to the Federal employee health plan, which will offer lower premiums as the coverage pool grows. And, until prescription drugs are included, Americans will be free to import their medicine from other countries.

Teresa then promised that healthcare would be the first piece of legislation that will be introduced if John Kerry is elected.

In the days since the event, I’ve been trying to put it all together. And, skeptic that I usually am, I find myself actually believing that there can be a healthcare plan if John Kerry is elected. Why? Because Teresa Heinz Kerry has been building coalitions for over thirty years across all the entities involved in the delivery of health care, from research to delivery. Her vision and experience has been codified into a workable structure that can cross party lines. She’s been a Republican, she’s now a Democrat, but above all, she is committed to wellness and care for all Americans. She is the driving force behind John Kerry’s promises and I believe she and the Kerry team know exactly how to get this program up and running from day one.

The realization about how far along we may actually be on the road to a workable healthcare system in this country if John Kerry is elected is still somewhat surprising to me. Actually, it’s more than surprising. It seems mind-boggling and I feel like Teresa has let me in on a big secret.

If John Kerry is elected, I know that Teresa will be in a pivotal role behind the scenes as she works in her quiet, yet powerful way to achieve their holistic vision. If she doesn’t become the next First Lady, however, I know she’ll still be involved in projects aimed at improving the future for Americans. But whether living in the White House or back in Boston or Pennsylvania, I’m sure the surprising Teresa Heinz Kerry will never let that red notebook out of her sight. Because, I believe, it’s all in there -- her life’s work and perhaps America’s future health.

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