Robert M. Heyssel has spent two decades at the helm of the Johns Hopkins Hospital.
He came from Vanderbilt in 1968 as associate dean of the medical school, worked on community health issues and was involved in the origin of the concept of the health maintenance organization in the then-new city of Columbia.
He became executive vice president and director of the hospital in 1972, then gained the title of hospital president in 1982.
Dr. Heyssel, who will be 64 this week, will retire July 1, to be succeeded by James A. Block, who comes to Hopkins from the University Hospitals in Cleveland.
Q: Looking back, are there any developments in health care that really took you by surprise over the last 20 years?
A: There was an interview in the Sunpapers at the time I took over, 1972, in which I predicted with great certainty that we would within two years have something akin to national health insurance. It was a wonderfully wrong prediction.
I don't think people foresaw what was going to happen to the insurance markets where, in effect, nobody insures anybody anymore. They don't underwrite health coverage -- they just pick off all the preferred risks and leave everyone else hanging out there.
But there were no particular surprises. Certainly technology changed. In 1981, I sat down with our radiology department and asked them what was going to happen in their field. I was told that magnetic resonance imaging -- MRI -- was at least a decade away. Three years later, there it was. So the pace of technological change is not really surprising, it's just that there's way to anticipate it.
Q: Now what's your prediction on national health insurance?
A: Logic would say that we would find ways to cover those people who don't have health insurance and also find ways to control costs. But if you look at the forces arrayed on various sides of this issue, it's not clear what it will take to do that.
Some people want to federalize everything, other people are opposed to the government doing anything. It's very tough to get from here to there, I don't care who's in office.
Q: What about the regulations on hospital costs we have in Maryland?
A: I was opposed to them originally, we took them to court, but I became a convert. It's been good, but it doesn't go far enough. There's no question it's been effective in lowering hospital costs, but if you squeeze things here, it pops out someplace else. So you tell a hospital it can't buy a CAT scanner, people find clever ways to get a CAT scanner next to a hospital.
So, even though we have less expensive hospitals in Maryland, the aggregate spending on health is about the same as the rest of the country.
I tell my colleagues who are absolutely anti-regulation, that it's not all that bad living in Maryland. We've done pretty well. And, to the extent that the U.S. News survey that ranks us [Hopkins] as the top hospital in the country means anything, after 20 years of regulation, we've managed to maintain some status.
I've come to the conclusion that this is not a business that can be treated like a market commodity. I think the public utility model is much more rational.
Q: Hasn't the rise in sophisticated technology driven up the costs of health care?
A: I would argue that most of this technology is not particularly expensive, it's the way we use it that's expensive. Take the two technologies that so revolutionized radiology and diagnostics -- magnetic resonance imaging and computerized axial tomography scanning. In both instances, those allowed diagnoses to be made without exploratory surgery with no risk to the patient in a short time span reducing the need for a hospital stay.
These technologies can save large amounts of money. The problem is the indiscriminate use and the proliferation of these expensive machines so that it's become almost a certainty that everybody will get everything when it's not at all clear that it's necessary.
Q: The debate on health care costs is much more a part of the public agenda than it was 20 years ago. Do you think this is healthy?
A: Absolutely it's a healthy thing. I think the amount of money going into health care in this country is probably unsustainable and is wrong. The fact is we're spending the money in the wrong ways.
For instance, I am confident that if we work with this community around us and have a better system of primary care that we could reduce the number of kids admitted to this hospital with asthma by 50 percent, and that's one of the biggest causes of admissions.
If we really focus on it, we could cut the number of low-birth-weight babies in this population and probably intervene effectively in teen-age pregnancy. That's not a doctoring effort, that's a public health and community effort that we help along.
A teen-ager's low-birth-weight baby that ends up in our neonatal intensive care unit is a $100,000 bill. You can do an awful lot of preventive care for $100,000. Or you can upgrade Dunbar High School which might be more important.