The jokes were sparse as a somber former President Bill Clinton took on the ills of the health care system during his HIMSS13 keynote speech, and urged his information technology audience to accelerate their work to support improvements.

The politics and social impact of the health reform law have yet to be fully determined, Clinton noted, because that depends on how fully the law is implemented and many contentious issues have not yet been resolved. The politics of reform continue to resonate deep, he reminded. Health care reform politically killed supporting congressional candidates in 2010, then the politics changed and reform politically killed candidates opposed to the law in 2012.

Clinton warned of budget fixes that would further transfer health care costs to consumers, which would be a real burden. In this political and budgetary maelstrom, health information technology will be vitally important to learn how to keep costs down and give consumers information that can give them huge collective clout to get more value at lower cost, he emphasized. And he reminded his audience that all of them will be in the middle of the maelstrom.

Fundamental reform and changes in how health care is operated and financed must come, he asserted. “Eventually, almost every system gets long in the tooth. There are huge transactional costs that don’t get taken care of. You can’t keep defending the status quo, that’s just the way it is.”

The former president also spoke of other forces affecting the health care industry. The world, he said, is still highly unequal and unstable, and not sustainable because of the effects of climate change, “which will have a huge impact on health care.” To those who doubt climate change, he reminded that the Pentagon in 2000 declared the changing climate a national security priority and began supporting green initiatives.

The spiraling cost of care imperils economic growth and consumer’s pocketbooks in many ways, Clinton said. He noted that many U.S. workers have not had significant raises in a decade or more, and that employers want to give the raises but are spending all their extra money on paying health care premiums.

The United States spends 17.8 percent of gross domestic product on health care and no other advanced nation spends more than 12 percent--with better outcomes, he noted, and that’s about a trillion dollars a year being unnecessarily spent. “So, what lies before us is the necessity to reform.”

The absence of financial transparency and information technology means health care consumers have no idea what the cost of their care will be, and Clinton praised health information exchange applications that can educate and empower consumers. “We need much more transparency in pricing.” He also called for more I.T. to help consumers take a bigger role in their treatments, take better of themselves, and to know what is going on. For instance, too many people are dying because they don’t know that Oxycontin can’t be mixed with alcohol.

He proudly spoke of the seminal work down on human genome sequencing during his presidency and the knowledge that has come from it. “I spent $3 billion of your taxpayer dollars to do that thing.” Now, the information technology that supported genomic research also can support fundamental, structural changes in health care, he added. “We cannot continue to spend money the same way or perpetuate inequality the same way, or we will be devastated.”

Clinton also talked of the work of his foundation to improve global health, working with pharmaceutical firms to get huge price cuts for AIDS, tuberculosis and malaria drugs in underserved nations, and partnering with other organizations to build clinics and reduce overhead costs in foreign aid to get more funds in the field. The foundation also has worked to combat child obesity in the United States, getting school food manufacturers to reduce calories and increase nutritional value, and getting soda makers to substitute healthier drinks in schools.

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