Our hearts go out to the patients and families of the horrific incident at the ConAgra plant in Garner.

Several hospitals in our area received patients from this tragedy, including our own Rex Healthcare. But those with the most critical injuries came to UNC, where the N.C. Jaycee Burn Center is the largest in the region. Some of these patients will surely require months spent in our burn center, and possibly years of follow-up care.

The families of our patients, like those from other tragedies and traumas, will have a difficult fight, also. Even in the best of times these injuries would be life-altering; in the financial straits in which the country and our state finds itself, they are sure to be doubly so.

UNC has experienced these tragedies numerous times – the Kinston explosion in 2003, the crash at Pope Air Force Base in 1994 and the Hamlet chicken processing plant fire in 1991. It is in crises like this one that people are made aware of the burn center, but it is important to know that, according to national data, the average survivor with burns on 50 percent of his body stays in a burn unit almost 58 days, with a mean cost of around $447,000.

The center has 21 ICU beds, making it one of the largest in the country, and there is never a lack of patients to fill each bed.

Dr. Bruce Cairns, director of the burn center and associate professor in the Department of Surgery, very aptly says there is no such thing as a minor burn. Even relatively small burns require special acute care, and lengthy follow up.

Dr. Cairns, the resident physicians, nurses, social workers, therapists and myriad other staff members of our burn center continually perform with at the highest level of professionalism, and I thank them for it. They take very seriously the NC Jaycee Burn Center’s mission to support the entire state, and the region, and they show that time and again – not only with the excellent inpatient and clinical care they provide, but also with educational outreach programs throughout the state, and they make all of us at UNC proud to work here.

We wish our patients and their families well, and we pledge, as we do for everyone we care for, our commitment to providing them the best care possible.

You can receive updates by following the UNC Health Care News Twitter feed, and this video is an update of the patients and an explanation of burn care by Dr. Cairns and nurse manager Grace Schmits.

The decibel level of the Washington health reform debate is going up rapidly.

President Obama has put health reform at the top of his domestic agenda, right next to saving and strengthening the economy.

The challenge is – how to deal with the main problem faced by most Americans – the staggering cost of health care, while at the same time dealing with covering the uninsured and our quality / safety concern.

Two ideas that have often been raised — but just as often said to be out of bounds – are front and center in the debate now.

They are (1) setting a limit on the amount of health care benefits that can be received tax-free, and (2) mandating that everyone have health insurance (and subsidizing the cost of health insurance for those who cannot afford it).

The tax cap (or taxing excessive health benefits, if you want to call it that) will force people toward more cost-effective health insurance plans, and will raise tax revenue that can pay for the subsidies for those who need them.

Mandating that everyone have health insurance (with subsidies for those who cannot pay themselves) is the surest way to make certain that everyone (or almost everyone) has coverage.

I have long been in favor of both of these ideas – and they seem to be supported by growing numbers in Congress.

The next few weeks / months will be filled with rhetoric and passion. Let’s get on with it.

The Charlotte Chamber of Commerce holds a summit each year at which they focus on pressing matters affecting their area. This year’s focus is health care in North Carolina.

The folks who have planned this year’s meeting could not have chosen a more timely topic about which they can assist and educate the business community.

I will have the pleasure of speaking at tomorrow morning’s meeting at the Hilton Charlotte University Place, and sharing with the audience UNC Health Care’s unique perspective on what I believe to be a health care crisis in North Carolina.

I use the word “crisis” because persisting problems – in our state and around the country, such as physician shortages and rising rates of chronic diseases – have combined with current economic challenges to create just that.

Members of local and state Chambers of Commerce surely play a crucial role in how we we will respond. Small business owners and heads of multi-national corporations are all struggling to keep employees on the payrolls, and many have made difficult choices about increasing health care premiums.

UNC is both upstream of this crisis, because our researchers and clinicians are continually looking for ways to abate these issues, and downstream, because we feel the economic impact of unemployment and rising health care costs.

Last week, for a story in advance of tomorrow’s meeting, I spoke with Charlotte Business Journal reporter, Jennifer Thomas, and shared with her the message I have delivered in other parts of the state, which is that we must act now to turn our crisis around. I made one slight adjustment to my earlier picture of health care in North Carolina: we now expect our uncompensated care for fiscal 2010 at UNC Health Care to reach $300 million, or more.

Jennifer asked about funds from the “stimulus package,” the American Recovery and Reinvestment Act that promises to provide funding to expand health care IT, extend COBRA benefits and add to our Medicaid coffers.

In a recent interview for HealthLeaders magazine about hospital IT, I pointed out that the stimulus money, because of its relatively short deadline, carries with a great risk. As I was quoted in the article,

“Unless we are careful, we may end up spending this money and not accomplishing nearly what ought to be accomplished. This notion seems to be driven by a too-simplistic idea that all we need to do is go out and buy a bunch of computers and wires and plug them all together and, bingo, great things will happen. We all know it’s more complicated than that.”

In the short term, these surely are welcome and necessary funds.

However, what we need most is substantive, national reform. Such changes, broad in scope, should have a very local impact to assist North Carolina businesses and all of our citizens.

Yesterday at the White House a group of representatives from various sectors of the health care industry met with President Obama to offer their long-term support for health care reform. Hospitals and physicians were there, as well as the health insurance, pharmaceutical industries and organized labor.

The meeting was noteworthy in that it keeps this very important discussion atop the national agenda and includes major stakeholders in health care. As the President himself said that some of the groups present yesterday had opposed previous attempts at reform. They now support it. That demonstrates that reform efforts this year are worth paying attention to – organizations and special interests are now willing to put aside their differences to help find a solution.

While it is doubtful that a voluntary approach will result in dramatic cost reductions, the gathering of this group at the White House does signify the importance of inclusion and stake holder involvement. Our complicated, complex and costly health care system will, however, require much more. We still need a massive overhaul to keep costs in check, expand access and ensure quality and safety.

President Obama told the American public that reforming health care is crucial to stabilizing and growing our economy. I couldn’t agree more. As I said most recently at the White House regional health reform forum in Greensboro, N.C., on March 31, we do not need to throw more money at the problem. The Obama Administration and the Office of Health Reform are on the right track. Our country needs to provide universal coverage, so that everyone has full access to the health care system. We need to invest in better IT systems that work more efficiently and effectively. We need to continue funding research to combat disease (and control costs). And, we can do all of this while improving quality.

We, as a nation, need to have the courage and fortitude to make reform a reality.

As a new strain of swine flu appears in the United States, the U.S. Centers for Disease Control and Prevention once again takes the lead.

The CDC, based in Atlanta, is uniquely qualified to deal with potential public health crises – whether infectious diseases or other challenges. Its epidemiologists and laboratory scientists work in close partnership with colleagues around the world, as they are now, in Mexico, where this H1N1 flu strain first emerged.

Fortunately, we have not had any reported cases of swine flu in North Carolina. But at UNC we are taking the matter very seriously. We are taking extensive precautionary measures to ensure we are prepared to care for patients who might arrive at our doors, and to protect our staff who care for our patients.

The White House and the CDC reported today in a news briefing that each of the 20 people in the United States who contracted the flu has recovered without medical treatment. Basic hygiene practices, such as hand washing, covering your mouth when you sneeze and staying home when you are not feeling well go a long way to controlling the spread of even the most worrisome flu.

I applaud my former colleagues at the CDC, which I directed in the early 1990s, and I wish them the best of luck. They are consummate professionals who work tirelessly to keep the American public safe from threats to their health.

U. S. News & Word Report announced its list of best graduate schools today, and I am once again proud to say that the UNC School of Medicine has ranked among the very best in the country.

Among primary care schools we are 2nd in the nation, and among research schools we are tied for 20th.

Three of our specialties ranked in the top 10:

Family medicine: 2nd
Rural medicine: 6th
AIDS: 9th

These rankings are one measure of our excellence, and they reflect what we at UNC already know, that we strive every day to deliver the best medical education in the country. Our faculty and staff, as well as our students and alumni, bring great credit to us all, and I would like to say thank you to all of you who make this possible. Thank you for making UNC among the best

You can read more about the rankings here.

If there were any doubts that reforming health care is integral to solving the economic crisis, this wonderful article in the Washington Post today by Ceci Connolly will help eliminate them.

I met with Ms. Connolly in Greensboro, N.C., in March immediately following the White House regional health reform forum. She quotes me in today’s story: “Our paying customers are slowing down, and our nonpaying customers are surging to unprecedented numbers. … We’re getting hit in both directions.”

Ceci also spoke with some of our colleagues, including Brian Toomey, CEO of Piedmont Health Services and Tim Rice, CEO of Moses Cone Health System.

Some of David Talbot’s patients paint the picture most poignantly. Talbot, medical director of HealthServe Community Clinic in Greensboro, tracks the economic crisis by the number of patients waiting to make an appointment — now almost 200, according to the article. Many patients recently lost their health insurance when they lost their job, or their work hours have been cut back and they are having trouble making ends meet.

Ceci’s article puts North Carolina’s crisis into a national perspective:

In North Carolina, more than any other state, the recession has triggered a burgeoning medical crisis. A steep rise in unemployment has fueled a commensurate increase in the number of people who do not have health insurance, including many middle-income families.

As I’ve said before, I am more optimistic now than I have ever been that our country can make meaningful changes in our health care system. If we seize this as an opportunity, and work together, we will make a difference.

I had an engaging conversation about health reform yesterday with Frank Stasio, host of the program “The State of Things” on our local NPR station WUNC. You can hear the interview, “Prescription for Health Care,” on the Web.

Mr. Stasio was well informed, and asked important questions ranging from how the wheels of reform move within the Washington Beltway to how unemployment is affecting the UNC Health Care System and the health care of the people in North Carolina.

I was grateful to share with Mr. Stasio and his listeners my belief that our country will come together soon to create a uniquely American form of health care. Providers, policy makers and representatives of the private sector, including those who once opposed universal health coverage, are willing to compromise. This is something we have to do if we truly value the health of the American public.

As N.C. Gov. Beverly Purdue said recently, we have a history in North Carolina of coming together to solve problems. We are doing so now with health care in a program called Community Care of North Carolina. Institutions across the state are working with community health care centers and private physicians to make sure our citizens get the most appropriate care. The UNC Health Care System has partnered with Piedmont Health Services Inc. We provide funds to Piedmont so patients can get care close to home without having to come to the emergency room in Chapel Hill. Dr. Warren Newton, who serves many roles for us at UNC, has led this program for us.

View my interview with News14 from the White House Health Forum on March 31 here. In the interview, I discuss challenges facing our health care system today – uninsured patients, limited access, high costs and improving quality of care – and how we can address them moving forward.

I have just returned from a large town hall meeting today in Greensboro, on the campus of NC A&T State University.

It was hosted by Governor Bev Perdue and my friend, Nancy-Ann DeParle, the head of the White House Office for Health Reform, and counselor to President Barack Obama. This regional health reform forum was attended by several hundred people, and was well covered by the news media.

I think it served a very useful purpose – to tell in compelling fashion what the problems are with our too flawed health care system in America.

A number of real citizens told their stories – of the challenges they have had to find and keep health insurance, and their difficulties in navigating our much too complex system.

Nancy-Ann called on me, and I was able to tell the other side of this story – what it looks like to try to run a large safety net institution when unemployment is surging and uninsurance is causing a tidal wave of indigent patients to come our way. I cited the figures from a recent NC-IOM study that showed that with each one percent rise in NC’s unemployment rate, we lose $14.4 million dollars. Since the rate has gone from the 4+ range to the 10+ range – the impact on us is nearly $100 million!

I also said that it is my belief that we have plenty of money in America’s health care system – we just are not spending it very wisely. And I went on to say that we each will have to be willing to make changes and make sacrifices for the common good.

Finally, I said that I am more hopeful than I have been in many years that we are about to do major health reform – and I urged us all to work together to make that happen.

Afterward several of us were able to have a small group meeting with Nancy-Ann DeParle – and to talk in more detail with her. I urged her to be bold – and to press ahead with this most important effort. I told her that unless each of us are a bit uncomfortable – they are not pushing us hard enough.

All in all – a very encouraging day. Read more about the event from WRAL-TV, Raleigh here and WUNC radio, Chapel Hill here.

View more of my comments here.