Ex-surgeon general says change needed

Health care 'revolving door' breaking system, group told

COLUMBIA — Dr. Richard Carmona rose from the streets of Harlem, where he roamed as a high-school dropout, to become the nation's 17th surgeon general.

Carmona spoke Thursday to a roomful of hospital leaders during the S.C. Hospital Association's 87th annual meeting on behalf of the nonprofit Partnership to Fight Chronic Disease.

His points of attack were threefold: smoking, obesity and health disparities among minorities.

In July 2007, a year after leaving the White House, Carmona testified before a U.S. House committee that the Bush administration stifled him from talking about issues such as embryonic stem-cell research.

Carmona now serves as president of the Arizona-based nonprofit Canyon Ranch Institute, which promotes health and wellness.

"Many of the lessons I learned growing up as a child in the inner city, being poor, being homeless at 6 years old, not having access to health care ... really set the stage for my true understanding of the struggles that the average everyday person goes through in this country," Carmona said.

Born to a large, loving Hispanic family, he learned about community. But it was the Army that taught Carmona accountability, he said.

Self-described as "not the smartest" student, he was disciplined, rising early and staying up late to master his studies. During the Vietnam War, he served in the special forces as a weapons specialist and medic.

He became a nurse, a doctor, then a surgeon. In addition to his interest in public health, Carmona also served in police and fire departments and has expertise in disaster preparedness.

The former surgeon general challenged the state's health-care leaders to change the paradigm of care. Hospitals make money treating sick people, he said, but their goal should be the eradication of preventable illness.

The health-care system needs to find a way to make money by keeping people healthy, he said. Chronic disease accounts for 75 cents of every health-care dollar spent. The "revolving door of health care" is breaking the system, he said.

During Carmona's time as a trauma surgeon, he put people back together who suffered gunshot and stab wounds. As a vascular surgeon, he saw the effects of diet and smoking on the circulation system.

But once treated, patients were released with little or no intervention of their lifestyles, he said.

"The system is breaking. Emergency rooms are crowded. Primary care is shutting down," he said.

Until those problems are addressed and people take accountability for their health, he said no proposed solution — vouchers or universal health care — will sustain the system.

Reach Jill Coley at 937-5719 or jcoley@postandcourier.com.