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Moderator:
Larree Renda, Executive Vice President and Chief Strategist and Administrative Officer, Safeway Inc.

Since the dawn of the Industrial Age, the labor-management relationship has most often been combative. However, with the dramatic rise in the incidence of chronic diseases over the past two decades, driven in part by increasing obesity, corporate executives and union leaders are forming closer working ties with a goal of improving the health of Americans. For corporations, skyrocketing health-care costs have reduced their ability to invest in their core businesses. For labor, quality of life and longevity issues are a serious concern. This roundtable discussed efforts to create a national initiative, spearheaded by business and union leaders, aimed at improving the health of Americans through greater access to preventive care, better nutrition and physical fitness.

Moderator:
Greg Simon, President, FasterCures / The Center for Accelerating Medical Solutions

What does the future hold for health care in the United States and around the world? Moderator Greg Simon of FasterCures / The Center for Accelerating Medical Solutions opened the discussion by noting that the increase in longevity and expected life span that the United States has been enjoying since 1900 is starting to decline, especially among women and children. Recent studies are showing lower life expectancy rates for women, mostly attributable to an epidemic of obesity.

Considering the dynamic balance between humans and microbes, it is inevitable that new infectious disease will continue to emerge worldwide, said Anthony Fauci of National Institute of Allergy and Infectious Disease. "While humans will not be wiped out by microbes," he said, "we will never kill all of them, either." The health-care system will face dual challenges of combating relatively recent threats, such as HIV, and established diseases like West Nile virus, which probably emerged about a thousand years ago and undergoes cycles of outbreaks. The known diseases, he said, are relatively predictable and preventable, even though they may kill thousands of people a day. But unknown diseases can create sudden and dangerous pandemics. Even though Fauci said he was optimistic about the progress of an HIV vaccine, he cautioned that recent failures in therapy experiments underscore the difficult task ahead.

How we gather, manage and disseminate information to develop effective treatments and cures will be a major challenge for health care in the 21st century, said Peter Neupert of Microsoft Corp. On the down side, he said, $50 billion to $60 billion is spent by the National Institutes of Health and pharmaceutical companies in R&D, while only $1 billion is spent for developing health-care IT solutions.

As a positive example of the possibilities that exist, he said, Microsoft has acquired a company that provides health-care IT solutions for a hospital in Bangkok that sees 1.3 million patients a year — patients who speak 19 different languages. In this hospital, he said, 60 percent of the patients are local Thaïs, and 40 percent are international, including 75,000 U.S. citizens. In addition, 40 percent of the patients are walk-ins. Yet their average wait time is just 17 minutes, and they have a guaranteed one-hour wait time for basic blood tests and radiological exams. The same hospital fills 12,000 outpatient prescriptions a day and bills are generated in just 10 minutes. These kinds of advances in information technology, said Neupert, will ultimately influence health care in the rest of the world.

Eva Vertes from Weill Medical College of Cornell University addressed the need for "rationally designed therapies," especially for cancer. Health care today offers cures that are limited to chemotherapy and/or radiation. "But there's a fine line between killing the patient and killing the tumor," she said. According to Vertes, cancer is the body's uncontrolled response to an injury — for example, to excessive ultraviolet light, radiation or smoke inhalation. Current therapies focus on eliminating the cancer cells but do not address underlying cause for the cancer itself, she said. Future research in this area will need to understand the difference between a controlled vs. uncontrolled response to injuries.

On a global scale, said Neupert, "health delivery systems work well for the rich, but it is unlikely that we can scale the 'wealthy world' health delivery systems to people to the developing countries." Software could improve how information delivery systems are integrated into software solutions, and this will be the key to deliver health care on a large scale. Most of the challenges are economic, he added, and this creates barriers.

Moderator:
Richard H. Carmona, 17th Surgeon General of the United States (2002-2006); President, Canyon Ranch Institute

Members of this panel addressed the prevalence of obesity in the United States, factors that have contributed to its proliferation and actions the private and public sectors can take to help reduce its prevalence in the population. Moderator Richard Carmona, the former surgeon general who is now with Canyon Ranch Institute, framed the discussion by acknowledging that "as surgeon general, few issues that I faced had the pervasive ... effects of obesity."

Obesity has increased significantly in the United States over the past few decades. In 1991, explained Ross DeVol of the Milken Institute, none of the 50 states had average obesity levels greater than 20 percent. By 2006, only three states had an average obesity level less than 20 percent. The highest levels tend to be concentrated in states with the lowest socioeconomic levels, supporting other research that has confirmed the relationship between obesity and socioeconomic status.

Panelists discussed several reasons for the increase in obesity. Tomas Philipson of the University of Chicago explained that increases in agricultural productivity have resulted in a declining price per calorie of food, and that full-time employment requires less physical activity now than in the past; many people are now sedentary in their jobs. Rather than exercising as part of the workday, they now pay to exercise, at health clubs and gyms, or as part of their leisure and family time.

Francine Kaufman of the University of Southern California Keck School of Medicine discussed her research, which is demonstrating links between obesity and diabetes, and the biological and genetic factors that contribute to a person's propensity for obesity. While diet and exercise are the most significant determinants of obesity, genetic characteristics for different U.S. populations also affect the likelihood of becoming obese.

Public policy can have unintended effects on health and obesity, and former Surgeon General Carmona noted that there is a need to consider the consequences of a government health policy before implementing it. Steven Burd of Safeway Inc. offered an example: Many public schools have eliminated physical education as a means to reduce costs and to improve academics. But the result of this policy has been a decrease in academic performance, in addition to the expected general decrease in physical activity among young people. Commenting on the increased prevalence of chronic diseases among children, Carmona said, "We're taking middle-age diseases and ratcheting them down to children."

The government, private sector and individuals can all take actions to reduce obesity. Panelists suggested various government incentives, such as compensating physicians for time spent helping patients prevent obesity rather than only treating its effects.

Representing the private sector, Burd said that "information is important, but insufficient." He outlined several steps Safeway is taking to reduce obesity among its customer base and work force. Specifically, Safeway allows loyal customers to download nutritional information for purchases made over the previous six months and compare it to established standards. Businesses can also encourage their employees to take part in nutritional and exercise programs.

Mark Mastrov of 24 Hour Fitness explained that individuals can combat obesity by introducing more movement into their lives during the day, such as walking, taking the stairs or spending time outdoors. He also discussed the importance of being accountable to others for weight-loss goals. 24 Hour Fitness emphasizes the role of trainers, using workout buddies and group classes to remain committed to exercise regimens.

Panelists agreed that obesity is a significant problem in the United States, and that it will take the cooperation of individuals and organizations to prevent further deleterious effects on individual health and the economy.

Speaker:
Jeff Hawkins, Founder, Numenta Inc.; Inventor of the PalmPilot and the Treo Smartphone

Interviewer:
Michael Merzenich, Co-Director, Coleman Memorial Laboratory, Department of Otolaryngology - Head and Neck Surgery, University of California, San Francisco

"Everything we do as humans is a matter of brains interacting with brains."

With this bold declaration, Jeff Hawkins began to explain his visionary conception of how the brain operates. In a dialogue with Michael Merzenich, whose research at the University of California, San Francisco, focuses on brain plasticity, Hawkins addressed where we are in our understanding the brain. To those people who say the brain is so complex it could take another hundred years to understand it, Hawkins responded that "the claim of complexity is simply a symptom of not understanding."

Hawkins demystified the workings of the neocortex, the outer layer of the cerebral hemispheres, and described it as the locus of all high-level cognition, as well as a memory system comprising 30 billion cells. In effect, he said, the neocortex is an organ of memory that builds a model of the world with continuous inputs of knowledge. Whipping out a large blue dinner napkin, Hawkins explained that this was the area the neocortex would occupy if you "ironed it flat." Using the napkin to bring science home, Hawkins said he wasn't lecturing — his napkin was merely talking, and the crowd's napkins were processing the actions of his napkin.

Hawkins has a gift for pattern recognition and, early in his career, developed an interest in pattern-recognition puzzles and problems. At the same time, he realized that the patterns of the brain could be overlain with the brain-like algorithms he was writing for software. Thus, intuitively, he saw both how the brain "operates" like a machine and, conversely, how it could be the model for "smart machine."

The brain processes and stores knowledge in a methodical way, he says, in a hierarchical and temporal memory system — by sorting and storing sequences of patterns. Everything the brain takes in is stored as sequences, and then sequences of sequences, and we are constantly coalescing and storing these time-based sequences throughout our life. This is known as brain plasticity, referring to the brain's ability to reorganize neural pathways based on new experiences.

Merzenich addressed brain plasticity in a discussion of how well we continue to acquire, sort and store information as we age. Older brains can keep growing stores of knowledge, he said, but after age 60, the majority of what we see and hear is lost. He is developing software that exercises the brain and reverses mental decline due to aging. Through repeated computer activities similar to video games, the brain undergoes fundamental plasticity processes; and through repeated exercising, the neural connections are strengthened and the brain actively evolves.

Hawkins and Merzenich offered slightly different views on brain plasticity, with the former citing the importance of early pattern exposure in childhood that leads to learning proficiencies later in life (learning to play music, for example, or learning multiple languages). Mezenich, on the other hand, claims that brain plasticity allows for lifelong learning and minimizes the role of early learning in establishing brain patterns that affect learning later in life.

The applications are numerous for each of these new fields of brain research. Plasticity exercises are expected to quickly become part of remaining competitive in the second half of life. In some seniors, improvements of about a decade in cognitive processing have been realized in controlled tests. The exercises have also shown therapeutic value in studies with schizophrenia at Yale. Measures of impulsivity linked to addictions have also been studied and show promise in withholding response.

Hawkins's vision will be applied in the development of brains for "machines" that will be a million times faster than the human brain and capable of taking in sensory information directly without filtering it through the domain of thought. In the near future, these machines will be as important as computers are today, he said. When he designed the PalmPilot, Hawkins explained, it was "really nothing new." He just combined existing information differently. Creativity, he added, is the process of building slightly different patterns over existing patterns that the brain already recognizes. Ultimately, the new smart brain machines will owe their design to the human brain and also be able to perform inferences, predictions, self-training and a host of other processes.

The sense of positive potential was palpable in the room as the session ended. Who can doubt the power of Jeff Hawkins′s visionary creativity? All we have to do is look at Palm Pilots and Blackberries, smart tools we can no longer live without.

Moderator:
Frank Douglas, Senior Fellow, Ewing Marion Kauffman Foundation

Pharmaceutical firms have produced a string of blockbuster drugs that can save lives and alleviate suffering. But lately their discovery model appears to be drilling dry holes. Despite rising research and development budgets, fewer therapies are receiving FDA approval. With many high-profile drugs about to come off-patent, the industry's current business model appears to need an overhaul. Researchers are trying to tackle more complex diseases, but why haven't new drug-discovery tools (such as high-throughput screening) improved productivity? This panel of experts tackled this question, along with other key issues. How can new technologies pull risk forward, allowing failure to occur in the earlier clinical stages, when costs are lower? How might the FDA approval timeline be condensed to reduce costs? How will the research and development model be structured and financed among the major players? Will multinational pharmaceutical firms work more collaboratively with biotech firms, universities, private research labs and government research facilities? What can be done to foster innovation that saves lives?

Moderator:
Greg Simon, President, FasterCures / The Center for Accelerating Medical Solutions

Global health is no longer about "health over there" or "issues of the poor." In a world where increased travel and trade have erased the barriers that once kept localized diseases from spreading, care and prevention are concerns that hit home for everyone. Led by moderator Greg Simon of FasterCures/The Center for Accelerating Medical Solutions, the panelists agreed that health problems affecting certain segments of the world's population are no longer solely that specific group's burden to bear.

Anthony Fauci of the National Institute of Allergy and Infectious Diseases became involved in global health issues via his work with HIV/AIDS. Its prevalence brought to his attention the interconnected nature of all infectious disease. Christopher Elias of the Program for Appropriate Technology in Health has also played a role in the evolution of global health programs and has "watched the worlds come together," representing a real shift in perceptions. Seth Berkley of the International AIDS Vaccine Initiative remarked that the global nature of the HIV/AIDS crisis helped to bring about innovations in program management.

Changing treatment and prevention priorities have led the global health community to grapple with the political and economic burdens created by disease. Kari Stoever of the Sabin Institute commented, "The economics of disease and diseases of poverty have tremendous effect on the development of emerging markets and productive work forces." She noted that there is a larger return on investments in public health programs in the form of productivity and overall economic growth.

Elias commented that while the global health community is motivated by a desire to alleviate suffering, hard economics point to the fact that the developing world would be acting to protect its own self-interest by investing in improved global health systems.

Fauci stated, "If you get a president who understands the need, they will make it happen." Citing the president's Emergency Plan for AIDS Relief (PEPFAR) as a recent success story, he explained that the program stemmed from the belief that the United States has an obligation to assist. Berkley noted that effective global health programs must be sustained politically in order to be successful.

The necessity for action and the importance of involving developed nations in the effort to reduce global disease incidence led Simon to pose the question: "Whose idea was it to call these diseases neglected and how are we going to get them un-neglected?" Stoever stated that resources have not been directed at these "diseases of the poor" because they affect neglected populations. She went on to add that 1 billion people, or 1/6 of the world's population, are infected with one or more "neglected" diseases, a fact that affects their political and human rights and highlights the disparities in access to care.

Berkley pointed out the frustrating fact that we have the ability to make urgently needed drugs but lack the incentives to do so. Elias pointed out that he is working with developing nations that have tremendous potential and rapidly maturing systems for pharmaceutical production. He explained that different opportunity costs for these nations serve as incentives for developing pharmaceuticals to combat the diseases that plague their own populations.

While global health problems affect populations worldwide, there is much work to be done within the United States. The panel agreed that rejuvenating the public health system is imperative to deal with current and future health threats. A critical component will be promoting behavior change, especially in at-risk communities. As Fauci pointed out, "Education and behavior modification are not the same."

Moderator:
Carol Lin, Founder and CEO, Cancer Social Network

Panelists discussed the provision of health care to the very poor in developing countries, particularly Bangladesh and India. All agreed with moderator Carol Lin of the Cancer Social Network, who said in her opening remarks, "It takes money to get health care."

Nobel Peace Prize laureate Muhammad Yunus discussed the state of health care in Bangladesh, where he founded Grameen Bank, making small loans to poor people — 97% of whom are women — to start their own micro-enterprises. "Income is the best medicine," Yunus stated.

He described prevalent health problems in Bangladesh and the tactics that the Grameen Bank has used to address them. For instance, night blindness among children was a major problem caused by vitamin A deficiency, a problem that has typically been addressed by providing supplements. Grameen Bank decided to sell seeds to families so that they could grow their own vitamin-rich vegetables, eliminating the risk of deficiencies and allowing the families to sell the surplus. Night blindness vanished (and Grameen became the number one seed-seller in Bangladesh).

Grameen Bank has also been involved in working to address water shortages, the need for sustainable housing, sanitation and malnutrition, all of which are major sources of health problems in Bangladesh as well as in other developing countries. Through joint "social business ventures" with private companies such as Dannon and Veolia Water, Grameen has been able to tackle childhood malnutrition and arsenic in well water, respectively. As Yunus put it, "Health is not just medicine coming from a doctor; health is something that you build."

That is exactly what Grameen Bank has been doing through such social business projects with private partners and its new health-insurance program, which allows members of Grameen communities to pay premiums of $1.50 for primary-care services and telemedicine (telephone consultations with doctors, made possible by the expansion of technology). Yunus hopes to see other private and public enterprises venture out of the profit-maximization model and into the world of social businesses to alleviate global poverty.

Eugene Williams of Translational Medicine India addressed the issue of sustainability of programs and services for the poor. These cannot be provided solely as charity, since that model is not self-sustainable. He believes that the poor must participate in health services by paying for it, even in small amount. When asked what he sees as a tangible outcome in 25 years, Williams stated that he would like to see "a health-care system in the developing world that we wish we had in the United States, with continuous improvement and sustainability."

Tomas Philipson of the University of Chicago directed attention to the problems of delivery, which he said are more important than the availability of technology. The costs of delivery must be considered in any viable solution to providing health care in developing countries. He remarked that profit motives are very important to the development of health care and research in the developing world, and financial rewards should be present for those that seek opportunities to contribute to this work.

Anne Wojcicki of 23andMe is interested in collaboration with organizations such as Grameen Bank to improve the quality of health care globally. Through such collaborations, a global community can be created to direct the revolution in health care in the developing world.

The question of whether for-profit companies can effectively participate in developing world programs came up in the discussion. For the panelists, the answer seemed to be a matter of the design and intent of the for-profit's participation. For instance, Wojcicki stated that if 23andMe were to take on a project in India or Bangladesh, it would not have a for-profit purpose. It would be separate from the profit centers of the company, but take advantage of those entities' capabilities and knowledge. Yunus stressed the importance of maintaining profits within the "social business" and eliminating shareholders that could influence the work of such a venture.

When asked what she sees as a tangible outcome for the future, Wojcicki replied with a plan for her own company. She stated that 23andMe wants to work with global development organizations such as Grameen Bank to identify the most pressing health issue in the developing world and begin tackling it.

Moderator:
John Tedstrom, Executive Director, Global Business Coalition on HIV/AIDS, Tuberculosis and Malaria

Moderator John Tedstrom of the Global Business Coalition on HIV/AIDS, Tuberculosis and Malaria opened the panel with two sobering facts. "One million people die every year from malaria," he related. "And every 30 seconds a child in sub-Saharan Africa loses his life to the disease." On top of that devastating toll, malaria harms productivity, creating annual losses of around $12 billion for Africa. But even though the disease poses immense challenges, Tedstrom declared that this moment "also holds some hope for success."

There was an uncontested agreement among all panelists that the costs of the disease can be seriously minimized in about 5 to 10 years. Tedstrom cautioned that there is "one dark cloud" that threats prospects for eradication of malaria: inefficient access to therapies and preventive measures.

Sir Richard Feachem of the University of California, Berkeley, called for an aggressive global initiative that will shrink the "malaria map." He recommended implementing four key strategies that have been proven to dramatically improve child mortality rates. The first is a system of rapid diagnosis and treatment, using effective drugs that cost only 37 cents per child. The second principle is that every women and child in a malaria-prone area should sleep under a bed net, protected from the mosquitoes that carry the disease; that simple preventive measure costs approximately $2 per person per year. The third goal is to have indoor residual spraying, while the fourth strategy is offering anti-malaria therapy to pregnant women. Feachem also noted a fifth method of prevention, which involves draining the breeding sites of mosquitoes adjacent to residential areas.

Feachem described the global challenges of fighting malaria. Over time, humans develop resistance to anti-malarial drugs, so new drugs must be introduced. Moreover, mosquitoes similarly become resistant to insecticides. Another obstacle he mentioned was the sustainability of the overall effort. "Success is our enemy," he noted, fearing that a significant alleviation of the disease will divert public interest to some other cause. But the battle against malaria will have to be a sustained multi-decade effort. Feachem also noted that the need to create incentives for the research and development of drugs and technologies.

Blaise Karibushi of the Access Project in Rwanda explained the success of recent anti-malaria efforts, noting that the initiative was led by community organizations. Their strong political commitment and coordination increased the percentage of households using bed nets from 15 percent to 74 percent in just one year. Rwanda's mortality rate from malaria has decreased by 66 percent, and malaria-related visits to health centers are down dramatically. This translates to a tremendous "freeing up of health facilities" that can now focus on treating other illnesses. Karibushi noted that it is vital to enlist the local community, concluding that health services should be managed as self-sustaining businesses to insure long-term viability.

Belinda Stronach, a member of Canada′s Parliament, commented that "it is important to inspire and educate the pubic about the issues of malaria because it will create political will." She recounted her experiences in founding Spread the Net, an organization that partners with UNICEF Canada to subsidize the purchase of bed nets for poor households in developing countries affected by malaria. She recalled the positive public response to the organization's projects, including 35,000 unique visits to its web site and $200,000 raised from youth initiatives and high school programs. Yet Stronach noted pointedly that "there are still 120 million nets that we need to buy." She calculated that "$1 billion of preventive spending translates to a $12 billion return in productivity."

Peter Chernin of News Corporation agreed that political will is a crucial element. As chairman of Malaria No More, he felt that increased coordination is needed among the many initiatives working to tackle this challenge. Chernin referred to malaria as today's "most compelling global health crisis" and called for greater involvement by business leaders. He believes there should be a concerted effort to rally public attention, donations and political commitment. Malaria No More has already begun to shine a spotlight on the issue through high-profile media partnerships that have reached a wide U.S. audience.

The panel concluded with some remarks about the economics of the disease. Chernin noted that there is not enough commitment from industrialized countries such as Germany, Italy and Japan to eradicate the disease. Feachmen added that Africa's economy can benefit from local production of bed nets, which would create jobs and reduce the price of transportation.

Moderator:
Margaret Anderson, Chief Operating Officer, FasterCures / The Center for Accelerating Medical Solutions

Acclaimed scientist Craig Venter began the panel by describing the latest genomic discoveries, including the breakthrough of successfully sequencing his own DNA. "We are far more individualistic" than Venter expected, even though he noted that "we are only 5-6 percent different from chimps," our closest ancestors. Venter emphasized the need to understand genetic variations among individuals as a key to improving health and wellness.

Moderator Margaret Anderson of FasterCures asked Venter about his reaction to seeing his own genome decoded. "Everything surprised me," he responded. Venter emphasized that it is a naïve to look at single genes to predict diseases; it is essential to look at the whole genome along with how the environment affects genetic predispositions.

Joan Scott of the Genetics and Public Policy Center echoed Venter's sentiments: "It is not just about genes. It is also about gene-environment interaction." She then introduced the topic of the current economics behind genetic testing, noting that it is still expensive to adopt these tests on a large scale. Scott also mentioned the need to improve how we use and apply notions resulting from genetic information: "Transitional research [needs] to connect all the dots generated by genetic testing." Finally, she commented that for genomics live up to its potential for improving our health, it will be necessary to change the health-care infrastructure to account for the costs and benefits of genomics.

Ryan Dow of Stark Investments predicted a strong future for the genomics industry. "People want to know," he commented. Dow believes that the market for genetic testing is on the verge of explosive growth, and even pharmaceutical companies will increase their focus on genetic testing. He also cautioned against the potential for consumer deception. Dow noted that the health-care infrastructure needs to change, including increased training for health-care professionals in this exciting new field.

Mari Baker of Navigenics, a company that recently started to perform whole genome scanning to look at thousands of DNA sequence variations (SNPs), commented on the trends of the industry, noting that "the number of SNPs per dollar is doubling every month." Navigenics provides genetic testing for consumers that screens for disease risk, and Baker noted that the company is working with the Personalized Medicine Coalition to define standards for this industry. Patients can utilize this service as an early screening tool for diseases that might otherwise go undetected in regular medical exams. Additionally, having access to genetic information allows individuals to modify their behaviors to improve their health and wellness. "People have to engage and take responsibility for their health," Baker commented.

Venter noted that understanding our own genomes will allow "the democratization of medicine." The challenge will be to educate the health-care work force to understand the value of genomic tools. "The information needs to be more complete and currently that's not in place," said Venter.

The panel closed by addressing the need for private funding to enable the sequencing for thousands of genomes. Such efforts will provide enough data to allow scientists to associate genomic information with traits of diseases. Baker predicted that soon genetic information "will become integrated in what we do in our daily lives."

Moderator:
Margaret Anderson, Chief Operating Officer, FasterCures / The Center for Accelerating Medical Solutions

The future of health care in the United States has taken on new urgency, impacting the nation's ability to compete in the global marketplace. A panel moderated by Margaret Anderson of FasterCures examined the current state of affairs, which has produced more than 47 million uninsured patients, spiraling costs and a questionable quality of service.

Jennie Chin Hansen of AARP described the organization's current "We failed" campaign, which demands a focus on health and economic security while promoting a wide range of partnerships across political parties and multiple organizations. As Jonathan White of Pfizer observed, "The current situation is unsustainable. It is about time to prove the value of products in the real world and better understand how drugs fit into the patient's lifestyle."

Peter Orszag of the Congressional Budget Office made a clear statement: "Health care is not the problem of future generations." It is a current problem that affects all of us today. In his opinion, there is a fundamental misunderstanding of what we all really get from Medicare.

An overview of the cost of health care across the United States was presented, outlining wide disparities between states. The fact that we do very little to understand what actually works in medical care is alarming, especially when costs keep skyrocketing without improving the system. The notion of "more care" equating to "better care" must change. John Lumpkin of the Robert Wood Johnson Foundation emphasized the importance of public reporting and the need to build infrastructure to support improvements in quality service. According to Lumpkin, "if you don't do quality work — you simply don't stay in business."

Orszag suggested that the current financial incentives system hinders innovative physicians. He also urged medical professionals to accept econometric statistical methods to learn which interventions are most effective. Chin Hansen pointed out that inefficiency and administrative burdens are disheartening to professionals who care about treating individuals. Lumpkin brought up the vast body of information that is available for providers and asked how to make sense of it all; he suggested that the flow of information must be improved and better decision-making tools must be designed for health-care professionals. Applying sophisticated IT tools can help to improve efficiency. White suggested that health data is already being shared by consumers, but in his opinion, IT by itself will not be enough. It is only one part of the solution.

Uninsured people have a reduced quality of life and die earlier. Under our current system of "doing nothing" about this population, uninsured patients still impact the bills of the insured. Lumpkin stressed that "doing nothing" can't continue. He announced that health-care reform is on the agenda of his bipartisan policy center, which hopes to prepare a draft proposal by 2009, with all participating parties figuring out what compromises they can live with. The outlook of "winners and losers" is not applicable anymore; everyone will need to make some concessions in order to improve the situation.

The panel concluded by agreeing that the role of patients is evolving. Chin Hansen supported the empowerment of patients, enabling individuals to make better decisions about their own treatment. White suggested learning what other countries are doing and learning from past mistakes. Orszag emphasized the urgency of realizing how much we really pay for health care and demanding more transparency. "We are running out of alternatives," stated Lumpkin, issuing a strong call to action. He urged business leaders and policy-makers to "strike while the iron is hot."

In the United States, the buzz of a mosquito is a trifling annoyance that can put a damper on a backyard barbeque. In Sub-Saharan Africa, that same buzzing insect is synonymous with something much more ominous than an overdone burger: death by malaria.

It is a death measured in millimeters. One million people die each year of a disease that can be prevented with gossamer-thin bed nets treated with insecticide that can protect two people's lives for just $10. A mere $2 supplies lifesaving medication to a child, and 20 cents can buy preventative treatment for a pregnant woman.

This was the central "malaria challenge" discussed during the session led by five luminaries in the field and others who participated in the roundtable discussion.

The experts in the room agreed on one central premise: While the strides in malaria prevention had been great, thanks to life-saving organizations like Malaria No More and the Access Project in Rwanda, the disparity in the distribution of resources was wide, partly due to the potential for "sharp elbows" and "tunnel vision" between aid groups when facing health and economic challenges omnipresent in Africa. The question is: how do we fix this divisive problem?

In describing the crux of the issue, Sir Richard Feachem, a professor at the University of California, San Francisco and Berkeley campuses, pinpointed three fundamental gaps preventing the eradication of this deadly disease in the Third World: funding, management and scalability of aid distribution.

In particular, the theme of management — and finding the right talent to manage — resurrected itself many times throughout the hour. While Feachum applauded the presence of M.D.s in Sub-Saharan countries, for example, he lamented the lack of financially and operationally capable M.B.A.s to ensure that important programs are well constructed, accurately forecast and appropriately funded, and that supplies are adequately delivered.

Taking it a step further, Karibushi of the Access Fund Rwanda called for local economic renewal, encouraging the manufacture of nets domestically to help improve Africa's economic position. Today, 93 cents on the dollar go to purchasing aid materials from the United States. Redirecting lobbying efforts in the United States could help shift the way aid is provided, with African companies, such as AtoZ Textiles, potentially switching from clothing to mosquito nets manufacture.

Still, the group was hopeful, citing awareness programs that were making a difference, such as the popular "American Idol" campaign, "Idol Gives Back," that this year raised $250 million to fight malaria. And corporations like DHL and Accenture have found ways to get involved that may be more indirectly related to their core competency. Other organizations are finding ways to piggyback malaria prevention on top of a measles initiative, giving away free bed nets during measles immunization. With smart management and a steady flow of resources, collaboration is critical in bringing an end to a disease that kills 3,000 children a day.

Moderator:
Martha Amram, CEO, GreenNow USA; Senior Fellow, Milken Institute

Funding for biomedical research and development has fallen off in recent years. Large pharmaceutical companies have watched their stock values drop and their business models crumble, and they're shying away from risky early-stage drug discovery and development. Research and development output, as measured by FDA applications for approval to initiate clinical trials and market new drugs, has plummeted. The shortage of investment capital remains acute; it's being felt from drug and device discovery all the way through clinical trials. Can financial technology help? How can we bridge the gap in medical innovation funding? Which partnerships can be crafted quickly to weave together incentives, ideas and financing to drive the next generation of health-care breakthroughs?

Moderator:
Peter Passell, Editor, The Milken Institute Review

After decades of denial and delay, the combination of an aging population and rapidly escalating health-care costs will soon force Washington to confront the issue of cutting the pension and medical benefits promised to retirees or finding new sources of revenue to pay for them. Moderator Peter Passell of the Milken Institute opened the discussion with a discussion of the growing burdens of social security, Medicare and Medicaid. What would it take today to make it right, he asked? The fiscal imbalance for the federal government is almost $74 trillion dollars and the United States is already paying 8 percent of its GDP for entitlement programs. Does a crisis loom?

Robert Litan of the Ewing Marion Kauffman Foundation warned that much of the public is not even aware of the entitlement crunch problem. It′s a political hot potato, which explains why both parties are silent on the issue. "Democrats don't want to talk about it because they don't want to concede that there will have to be cuts in their favorite programs and that they'll have to raise taxes," he explained, adding that Washington knows the Medicare trust fund is going to run out of money. Litan predicted a crisis in Washington and urged for entrepreneurs to look for market solutions. With two-thirds of expected cost increases driven by inflation, and health-care costs rising 4 percent faster than the Consumer Price Index, why aren't there the equivalents of big-box retailers or airlines in the health-cares sector?

The reason? Insurance. As long as people are paying the low co-pays or deductibles, there is no incentive to cut costs, he said. The solution may be a progressive deductible. Incentives matter, said Litan, and there won′t be entrepreneurial responses if there are no incentives. Harness the power of the free market, he urged.

Peter Orszag of the Congressional Budget Office discussed how the American political system doesn′t deal well with creeping long-term problems. He offered four possible options: One is to "beat the drum louder." Second would be to change the political system. Third, try to create a false sense of crisis with social security reform. And, finally, try to approach the problem in different ways that are salient today. "Since the bulk of our problem is health care, let's try to grab that," he said. He also noted that the growing gap in life expectancy between higher-income, better-educated people and those of lower income. When looking at the problem as a whole, means and averages are fine for study, but it's important, he said, to look deeper within those statistics. Essentially, Orszag concluded, there are only two solutions: more revenues or fewer benefits. It should also be easier to help people lead healthier lives — little things like moving fruit displays to the front of the cafeteria line. "There needs to be more psychology in public policy," he said.

One-third of the American population is currently in retirement and enjoying the productivity of the rest, said Sylvester Schieber of the Social Security Advisory Board. The problem today is to ensure that the entitlement programs won't disappear for the younger generations who are contributing and paying for the benefits — a "grossly unfair" situation, he added.

Eugene Steuerle of the Urban Institute compared the current entitlement problem and the tax reform of the 1980s. Tax reform occurred was because there was a "vacuum" of need and major efforts coming in to fill that vacuum, he said, adding that "each incoming president gets one big package he wants," and with the right president, this could happen. Overall, the panel agreed that there will be continued debate as to what health care will look like in the future, but that some means exist now to help constrain the costs.