White House Forum on Health
Right place at the right time

By Jonathan Gramling

Part 2 of 2

      Siavash Sarlati, who was a participant in the White House Forum on Health last March, has witnessed
a lot for a second-year medical student at UW-Madison School of Medicine and Public Health. His family
immigrated to the United States from Iran when he was young and settled on the fringe of Milwaukee’s
inner-city. He knows what it is like to be a struggling immigrant. And he saw a lot of people struggle to
survive in the inner-city. He worked in rural Ecuador the summer before he entered medical school and
worked in a HIV/AIDS clinic in Nairobi, Kenya. He has seen what the consequences are when people don’
t have access to the proper medical care.
      But Sarlati also saw a lot of privilege when he attended the exclusive University School during his
high school career. He spent four years in school with people who had access to the best medical
resources. Sarlati has seen the inequities from both sides.
      “We spend 17 percent of our GDP, about $2.4 trillion, on healthcare in this country and our health
indices don’t reflect that kind of expenditure,” Sarlati said during an interview at a coffeehouse on State
Street. “People of color, people of lower incomes and people in certain areas of the country in rural areas
Siavash Sarlati participated in the White House
Forum on Health in Washington D.C. March 5
don’t receive the quality and quantity of healthcare that they need and it is seen in the differences in their outcomes relative to people who have better access
and more resources.”
      Sarlati feels that the current healthcare system is inefficient on a number of different levels. In its present state, many of the “real life” incentives are for
people to end up in costly, intensive care. In essence, there is no true incentive built in to promote preventative care.
“If anything, we need to make sure that every American has access to primary care,” Sarlati emphasized during an interview with The Capital City Hues. “That
includes increasing the primary care workforce, increasing coverage and then prevention, preventing the catastrophic consequences of chronic illnesses through
consistent management, prevention through creating a healthy, conscientious, active population that is addressing tobacco use, alcohol use, weight and diet. I
think these are critical to decreasing cost and decreasing pressure on the system. I think universal coverage would be ideal for every single American to help
facilitate those two things as well as provide the resources that people need to get care. Primary care means family medicine, internal medicine, OB/GYN and
pediatrics. Often this is the first line in any kind of healthcare service that is critical to managing your everyday health. And the reason these are important is to
prevent some of the things that happen when people don’t manage their health, which often becomes the priciest things to deal with such as going to the
emergency room, getting an amputation when you don’t manage your diabetes, hypertension, all of these things which can be prevented and managed.
Preventing and managing chronic illnesses will decrease costs.”
      Sarlati is also concerned about the negative impact that the current treatment of preexisting conditions by insurance companies is having on the healthcare
system. “People don’t want to tell their employers and physicians and others about something they are suffering from because they might lose coverage for their
children,” Sarlati said. “They might have to start paying more. They might have to get a new job. It’s ridiculous in my opinion. No one should have to choose
what they do for a career based on their health care coverage. No one should have to worry about whether their children are going to be covered if they go
ahead and start to deal with a chronic condition that they may have. No one should have to worry about whether they can afford the medications they need and
the day-to-day healthcare they need because they have a condition that requires long-term care. It’s absurd in my opinion.”
      The Obama Administration inserted money into the economic stimulus package for making medical records digital across the healthcare system. Sarlati
does believe that will help drive down costs. Another initiative that would create efficiency, in Sarlati’s view, is making the healthcare system more transparent.
“Some physicians have no idea what they are doing costs,” Sarlati said. “They order tests and who knows if they are absolutely necessary. If patients could know
how much what they need costs between different clinics and hospitals and managed care groups, it puts pressure on the industry to both increase their own
efficiency and cost effectiveness, which I think will ultimately increase access. Sometimes there aren’t market forces at play promoting efficiency in healthcare.
Creating some of those market forces I think is important.”
      The reduction of the cost in prescription drugs is also something that Sarlati believes will drive down healthcare costs. Again, he relies on a market model.
“Countries like India and Brazil produce a lot of the expensive drugs that people need very cheaply,” Sarlati said. “Right now, I think there are certain bans that
prevent people from buying drugs in those markets. You relieve those bans and I think you create access to some of those cheaper drugs. I think that is important.
And I think looking at what kind of medications old people are needing the most access to and ensuring those are produced either cheaply or subsidized would
be critical.”
      The need for healthcare reform, in Sarlati’s view, doesn’t begin with the healthcare system, it begins in the country’s medical schools. “I think medical
education needs some paradigm shift also,” Sarlati said. “I think the level of conscientiousness amongst people who are entering the medical field needs to be
addressed. I think anyone who is becoming a physician needs to be familiar with some of the basic premises of public health and public health education no
matter what discipline they are going into.”
And with the public health emphasis that the UW School of Medicine and Public Health has, Sarlati and his fellow students will be in the forefront of carrying out
the healthcare reform that is only now just starting.