BioxySource

Speeches - Workshops - Studies

Interactive seminar at Columbia University, New York City, February 2010

Water Security Initiatives for Risk Management and Application to other Infrastructure Programs

Moderator

Rao Kolluru, DrPH, MBA
President, Society for Risk Analysis, Metro New York
Introduction, Seminar Objectives

The purpose of the seminar is two-fold:

1. Present advances in environmental science and public health, and their application to our well-being -- while promoting interaction across disciplines.

2. Offer a glance for students of all ages into career and investment possibilities -- insights into opportunities that nest at the intersections of environment, public health, and economics.

The seminar is FREE, but advance registration is required by: February 5

Date and time: Feb 11, 2010, 5-7 pm
Reception/networking: 7:15-8 pm

Where: Columbia University Alumni Center
622 West 113 St. (between Broadway and Riverside Drive)

Interactive seminar at Columbia University, New York City, November 2007

Global Climate Change and Greenhouse Gases, Market Incentives, Risks and Lessons

Moderator

Rao Kolluru, DrPH, MBA
President, Society for Risk Analysis, Metro New York
Introduction, Seminar Objectives

Panel

Sashti Balasundaram
Columbia Students for Environmental Action
Aspirations, Actions
Geoffrey Heal, PhD
Professor, Columbia Business School
Corporate Responsibility/Initiatives and Climate Change
Thomas Prol, Esq.
Scarinci & Hollenbeck, LLC
Global Warming Legal Perspective: CA and NJ Models,
Strategies for Compliance, including Carbon Trade
Fiona Cousins, PE
Principal, Arup
Down to Zero – Case Study, Europe-US Lessons
Kim Knowlton, DrPH.
NRDC & Columbia
Health Effects, Mitigation
Rae Zimmerman, PhD.
New York University
Infrastructure Impacts
Doug Blazey Esq.
Air & Waste Mgt Assn (AWMA)
AWMA Initiatives
Walter Mugdan
U.S. EPA
Environmental Planning & Protection

Speeches given in 2007

Nanjing University of Science & Technology, May 2007, China

Introduction - a Bit of History
Risk Assessment and Management
China, India, USA - New World Dynamics
Student Career Guidelines

Andhra/GITAM University, May 2007, India

Introduction - a Bit of History
Entrepreneuring, Social Entrepreneuring
Risk Assessment and Management
China, India, USA - New World Dynamics
Student Career Guidelines

Rao Kolluru Workshops

Creative Performance

Reset Your Personal Odometer to Zero
Engage the Beginner's Mind, See the New in the Familiar
Adopt a "Peacock"
Playful Experiments for Creative Performance
Foster Triple Bottom Line: Profit, People, Planet
Build a Wholesome Workplace for Fun and Profit
Decode Your DNA
Identify Core Competencies and Markets
Practice Enlightened Self Interest
Attract and Retain the Right Employees and Customers
Recognize Pillars and Pitfalls of Professional Success
Achieve Quantum Leaps in Performance
Balance the Three Personae
Sattva Knowledge, Rajas Action, and Tamas Inaction
59-Minute Course in Creative Thinking -- for Adults and Children

Environment and Human Health & Safety

Assessing and Managing Risks to the Environment, and Human Health & Safety
Developing and Implementing Effective Environmental Strategies
Designing Closed-loop Birth to Rebirth Product Lifecycles

Dr. Rao and his colleagues have presented many lectures, courses, and workshops in North America, Japan, China, and India at companies, universities, and research institutitions. They have consulted on more than one hundred projects related to the assessment and management of environmental/site-related human health and ecological risks, including financial strategies.

Studies

Healthcare Myths and Cures

Let us seize the moment. Our so-called healthcare is at the root of much of what ails America: national angst, mounting debt, huge budget deficits, diminished competitiveness in the global marketplace.

President Obama and his team proposed a number of initiatives. However, they will not treat the basic disease – not as long as they don’t tackle the fundamental causes: misunderstanding the difference between Cost and Price, the Blank Check policy with perverse incentives, and fragmentation.

First, where do we stand?
We in America spend $2.4 trillion on healthcare, or twice the proportion of our GDP (17%) compared to other rich industrial nations. Yet in many public health measures, the US ranks at the bottom. It is a wonder we manage to do so little with so much!

Here are the prevailing myths and prescribed cures. But not much can be done to change if we continue to propagate the myths by design or default.

Myth # 1. We have the best healthcare system in the world.
Fact: What is euphemistically called healthcare can more aptly be described as “disease treatment and death postponement industry.” We rank at the bottom of most industrial countries at both ends of life – with high infant mortality and low life expectancy. Healthcare and related costs (of current and retired employees) add 5-10% to product costs, making our exports less competitive. Thousands go bankrupt or suffer from fear of going bankrupt. State and city budgets are strained.

The best healthcare systems identified below have a pyramid with primary health services at the base and procedures at the top. In the US, the pyramid stands upside-down due to lop-sided incentives. Only 3-4% of the total goes into preventive care, the bedrock of health.

Myth # 2. Costs are rising fast because of technology, litigation, aging population.
Fact: These are all factors but the so-called costs are not really costs but prices. For example, if the cost of aspirin is, say, 10 cents to a hospital and the hospital charges patients $20, then the latter is price (not cost). Imagine a scenario like this. You take a friend on her birthday for dinner at a restaurant, pay the bill and come home. Then over the next several weeks, you keep receiving bills from the cook, the waiter, the
birthday cake supplier, etc.

Ludicrous? That’s how our healthcare system is allowed to operate. After paying the hospital you come home and over the next several months receive bills from the physician/surgeon, anesthetist, lab, pathologist, on and on -- in the open-ended fee-for-service franchise of billing that is allowed only in America.

Myth # 3. The problem is that 45-50 million people lack insurance.
Fact: Insurance companies don’t pay for anything. As they operate in the US, they siphon off some 20% of the resources and interfere with doctor-patient relationship. People with conditions that are most in need of care are the ones selectively excluded by insurance companies. Moreover, they distort healthcare by their reimbursement schedules that favor procedures, causing the lop-sided pyramid.

So what is the prescription?
The effectiveness of a healthcare system is measured by three main criteria: cost-price, accessibility, quality . The best performing systems around the world share these three elements:

1. Universal single payer coverage (not a patchwork)
2. Negotiated prices for pharmaceuticals and medical services
3. Non-profit sector competing and playing a vibrant role alongside government and private industry

As it stands now, the patchwork of Medicare, Medicaid, State programs (including children’s SCHIP), price discounts, etc. are both diversionary and divisive. Besides being inequitable, these fractionated services add enormously to administrative complexity and costs.

Single payer systems work – not only in the countries cited below, but also here in America – Mayo Clinic, Blue Cross/Blue Shield and Kaiser Permanente, for example.

Why not the largest buyer of health services in the world? I believe the Veterans
Administration has flexibility in negotiating prices.

The solutions are staring us in the face from the north (Canada), south (Cuba, Brazil), east/west (Europe, Japan, Taiwan) – all free-market economies except Cuba. Vested interests raise the specter of socialized medicine and long lines. I have yet to meet anyone from those countries who would swap theirs’ for the American system.

Perhaps most important from the viewpoint of costs/prices is a budget. What the US has is more of an open pool than a real budget. For a lesson on bringing “open budgets” into control, let’s turn to that bastion of capitalism, Switzerland. They held a referendum and ended up adopting a system similar to the rest of Western Europe with negotiated prices for pharmaceuticals and medical services – including electronic medical records. There is a private nonprofit sector working alongside the government. The non-profits also compete, energized by their basic instinct of survival, to be in play. (To get an idea of the power of a nonprofit system working alongside for-profit enterprises, take a look at Aravind Eye Care in southern India, the largest and most productive eye care facility in the world : $1 for doctor’s appointment, a few $ for eye operation or free.)

Many in and out of government argue that this is too radical a change. It would not be politically feasible, we tried this before. But we could, as Switzerland did, reach a consensus through national referendum or ombudsmen. Let’s arrive at a consensus on what proportion of national income we should devote to true health care including consumer education and incentives for prevention.

Suppose this is 7-9% in line with major Western nations and Japan. Soon the whole structure will realign itself into a more responsive, more humane, more effective system, eliminating the indignities and threats of bankruptcy. It will prevent Medicare from undermining the whole Social Security network. And the savings of $1 trillion or more every year will fund much needed basic research and education.

As member of a family of medical practitioners, I learned the secret of health early: avoid hospitals and seeing too many doctors. If the attempts to reform are thwarted by vested interests, I’d prescribe a drastic remedy: Identify, say, 1000 insurance and hospital system executives and their lobbyists addicted to millions of bonuses. Award each of them $100 million bonus and send them away on vacation.

What do we get for our $100 billion?

The benefits of adapting the best healthcare systems from around the free-enterprise world will be:
1. Save more than $15 trillion over the next 10 years
2. Cover every citizen for every condition with direct doctor-patient relationships
3. Mitigate Federal, State and City budget deficits. – no threat of Medicare, Medicaid, pension funds going insolvent;
4. Prevent thousands of individual bankruptcies and fear of bankruptcies, engender peace of mind
5. Improve America’s competitive position in world trade– restore healthcare advantage

To sum up, it would be a shame to let this crisis go to waste! I recall something Churchill said: The extraordinary thing about America is it can be counted on to do the right thing after exhausting all other possible alternatives. Indeed, we can create a Healthcare Advantage for our citizens and our economy. Whatever system we opt to adopt, the remedy should be as drastic as the malady – no more band-aids.

Additional notes
Re economic incentives, while everyone supports better science and math in schools, the incentives for scientists and engineers don’t reflect such priorities. For example, in most of the rest of the world, doctors earn on average 20-30% more than engineers with comparable education– while in the US, doctors typically make 100-300% more, aided by government’s open-ended programs. Also, specialists earn twice as much as primary care physicians. In this regard, the burden of college tuition costs, especially for medical education, should be addressed as part of the overall reform.