LOWN 2018: Clinicians, advocates, and policy experts envision radical change for America’s next health care system

April 10th, 2018

Lown Conference tackles market-based system that drives high cost and low value


Washington, DC– “We need universal coverage, but that’s not enough,” said George C. Halvorson, former CEO of Kaiser Permanente, as part of his keynote at the 6th Annual Lown Conference. “We need to follow the money, and align clinicians’ and hospitals’ financial incentives with patient care.”   

The conference, titled “Breaking the Cycle of High Cost and Low Value: America’s Next Health System,” brought together hundreds of clinicians, researchers, policy experts, and patient advocates determined to bring real change to the American health care system.  

Participants explored some of the most vexing issues facing U.S. health care, including the crisis of affordability, the prevalence of harmful unnecessary care, and the downstream effects of social inequities – as well as the policies and interventions necessary to solve them.

Universal Coverage: A Good Start

Halvorson’s keynote address built on the comments of experts from Canada and Australia, who discussed the challenges their health systems continue to face despite government financing. “As long as funds are wasted on low-value care, the potential for gain elsewhere in the system will be restricted,” said Dr. Adam Elshaug, co-director of the Menzies Centre for Health Policy in Sydney, Australia. “The U.S. can learn from this information or dismiss it at its peril.”

“Moving to universal coverage is important, but the system that incentivizes profit over quality, access, and affordability also needs to change,” said Dr. Vikas Saini, president of the Lown Institute. “An affordable single-payer system isn’t possible unless we tackle the many drivers of excessive costs, such as profiteering and unnecessary care.” 

The Cost of Unnecessary Care

Among the most vivid examples of unnecessary care was a panel examining the implications of a recent trial on stents. The ORBITA trialrevealed that cardiac stents are no better than placebo for patients with stable angina. However, we still spend more than $1 billion each year[1] on unnecessary stents, while exposing patients to risk of harm.

The implications of ORBITA for medical device approvals are hugely important. In our current approval system, “Most high-risk devices on the market have undergone no clinical testing at all,” said Jeanne Lenzer, journalist and author of The Danger Within Us: America’s Untested, Unregulated Medical Device Industry and One Man’s Battle to Survive It. “Without higher standards for evidence, patients will continue to be harmed by untested devices,” she said.

Social Inequities: Key Barriers to Health

Even with universal health coverage, lower health costs, and the best evidence informing health service delivery, our redesign of the health system would be incomplete without addressing the social inequities that create poor health.

“Health disparities are driven by social inequities and the trauma of structural violence,” said trauma surgeon Dr. Rishi Rattan during a panel on gun violence, organized by the surgical council of the Right Care Alliance. “Gun wounds can be healed,” said Dr. Rattan who works in emergency medicine at Jackson Memorial Hospital in Miami. “It is much harder to heal patients of the chronic conditions brought on by the constant stress of insufficient income, poor education, and substandard housing.”

In a featured panel, health policy experts and researchers discussed how we can move from a hospital-centric system to a community-centric one. Reversing the pattern of hospital consolidation and controlling costs are crucial, panelists said. “We want better coordination of care, but the primary outcome when hospitals consolidate is that they raise prices,” said Mark E. Miller, vice president of health care at the Laura and John Arnold Foundation.

At the same time, reforms targeting health care delivery in hospitals are not enough, said former Denver Health CEO Patricia Gabow. “We need to be asking how we can use innovation to re-purpose the trillion dollars in waste from the health care system to address social determinants that have a greater influence on health,” she said.

Other keynote speakers at this year’s conference included:

Steven Brill: Longtime journalist, founder of Court TV, and author of the 2015 bestseller, America’s Bitter Pill: Money, Politics, Backroom Deals, and the Fight to Fix Our Broken Healthcare System, Brill engaged in a dialogue with Lown Institute Vice President Shannon Brownlee on the damaging convergence of money and politics in medicine.

Danielle Martin: A family physician and associate professor in the Department of Family and Community Medicine, the Institute of Health Policy, Management and Evaluation and School of Public Policy & Governance at the University of Toronto, Dr. Martin shared her insights into the barriers to universal high-quality care across Canada and how values affect health policy.

Victor Montori: Endocrinologist and researcher at the Mayo Clinic and one of the most respected clinical researchers in the world, Dr. Montori found The Patient Revolution, a nonprofit organization dedicated to advancing careful and kind patient care for all. His moving keynote condemned the “industrial health care” model that has undermined the healing doctor-patient relationship.

“The incentives driving today’s health care system raise costs while undermining patient health,” said Vice President Shannon Brownlee. “This year’s conference brought together thought leaders who recognize the need for transformational change that puts patients first.”


About the Lown Institute: Founded by world-renowned cardiologist and humanitarian Bernard Lown, the Lown Institute is exposing the failures of the U.S. health care system and advancing a vision that supports universal access to cost-effective, patient-centered care. The institute is led by cardiologist Dr. Vikas Saini and Shannon Brownlee, an award-winning science journalist and author of Overtreated: Why Too Much Medicine is Making Us Sicker and Poorer.

Support for this conference is provided by the Robert Wood Johnson Foundation, a platinum level sponsor, and the Gordon and Betty Moore Foundation. Views expressed at the conference do not necessarily reflect the views of the funders.

For further information, contact:

Karen Kahn,Karenkahn33@outlook.com


[1] 2017 MEDPAC Data Book, p. 53: http://medpac.gov/docs/default-source/data-book/jun17_databookentirereport_sec.pdf?sfvrsn=0