Saying how difficult it is for the nation to take giant steps in social policy, Donna Shalala, PhD, a distinguished educator and former Cabinet member, delivered the Daniel Thursz Social Justice Lecture on Oct. 19 at the University of Maryland School of Social Work (SSW).
Speaking on the topic, "The Unfinished Business of Health Care Reform," Shalala told an audience drawn from the SSW, other schools at UM, and SSW alumni that the Affordable Care Act was structured to obtain coverage of the population and leaves unanswered the questions of cost containment.
Shalala, who is president of the University of Miami, became involved in health care policy more than a decade ago while serving under President Clinton during the period in which his wife, Hillary Rodham Clinton, led a failed attempt to overhaul the health system. "I still have marks on my back from the Clinton effort," Shalala quipped.
Shalala was secretary of the U.S. Department of Health and Human Services (HHS) from 1993 to 2001, making her the longest serving HHS secretary.
She described the legislation pushed by President Obama and passed by a Democratic Congress as "a dramatic change from where we've been." The Affordable Care Act was signed into law last March. "And yet the politics is devastating for the Democrats. They couldn't get the other side to play," she said.
Shalala predicted that Republican opponents will not be able to overturn the measure. "They may be able to tweak it a little bit as states design the delivery system," she said.
She recently chaired a committee of experts for the Institute of Medicine, which earlier in October released a report that calls for advanced practice nurses to play a much larger role in the nation's health system. In her lecture, Shalala said that is one way to meet the challenges of extending primary care to many more Americans under the Act.
Further, she said social workers, pharmacists, and other professionals also must be brought more fully into the system to coordinate care and perform other crucial functions. "We need to break down the silos between disciplines and get people to work together." She posited that the next great challenge will be to increase the quality of care.
She also called for elimination of regulatory barriers that prevent change. "We should get rid of scope-of-practice rules. We have got to allow people to work to the extent of their training," she said.
Shalala delivered the lecture at the invitation of Michael Reisch, PhD, MSW, MA, who is the Daniel Thursz Distinguished Professor of Social Justice. He pointed out that she "has played leadership roles at several major universities and in the public policy arena."
Dean Richard P. Barth, PhD, MSW, welcomed Shalala to the SSW, telling an audience of 150 in the auditorium of the School that her background makes her an ideal guide to our thinking about changes in health care. Jay A. Perman, MD, president of the University of Maryland campus in Baltimore, was among those who engaged her in discussions about the topic at the lecture's conclusion.
The lecture is one of a series in honor of Daniel Thursz, a former dean of the School whom Shalala noted she had worked with in Washington, D.C. Thursz and Shalala were both involved in the White House Conference on Aging.
She also drew attention to the life-changing experience of being a volunteer in the Peace Corps, having served in Iran in 1962.
She was assistant secretary for policy development and research, U.S. Department of Housing and Urban Development, during the Carter administration.
Her academic career includes the posts of chancellor, University of Wisconsin-Madison, and president, Hunter College of the City University of New York.
She became president in 2001 at Miami, where she is a professor of political science and a member of the secondary faculty in the Department of Epidemiology.