This morning’s meeting was informative and enjoyable. Michael Dowling is the President of Northwell Health and is is a very capable communicator. The format that we used was a dialogue between Joe Campolo of the law firm Campolo Middleton & McCormick and Mr. Dowling

We covered many aspects of concern about the cost and quality of healthcare. According to Dowling the impact of superior health facilities, medicine and doctors comprise about 20% of the impact on health outcomes. Poverty, smoking, diet, living conditions and other factors that effect health are out of the control of the health resource providers. Therefore health providers are always going to have better outcomes in high income areas than in poverty areas.

Independent hospitals which were the norm on Long Island in the past are being absorbed by enterprises such as Northwell. They simple cannot exist as stand-alones in this costly environment.

When asked about mal-practice insurance Mike was not as concerned as we thought he may have been. Northwell covers all of the doctors that are in his system as well as the facilities and the premium is about $180 million. It is a lot of money but his overall budget is approaching $15 billion.

Michael spoke about the urgent care centers that are sprouting up all over the covered region. These units are less expensive to maintain than the emergency rooms but we still have fairly heavy use of ER.

Another lament is the overuse of corrective surgery. Hip replacement for example is a 45 minute operation, and a relatively short recovery but it is expensive. We now have processes that add enormously to the overall cost with only marginal additional quality of life.

Dowling is no fan of government provided healthcare even as I pointed out the medical outcomes in the Canadian and European systems are often better. He told us that among other things, they are inefficient, and often result in long waits for attention.

Pharmaceuticals are another craw in the throat of our speaker, but because of the size of the healthcare enterprise that he oversees he has some clout. Small independent hospitals are becoming a thing of the past and that is among the reasons why.