Hawaii needs national health reform like other states but “;remains a very efficient place”; for affordable, high-quality care, says Dr. Jack Lewin, former state health director.

Now chief executive officer of the American College of Cardiology, based in Washington, D.C., Lewin has worked closely with the White House and congressional committees on health reform issues.

Under his leadership the 35,000-member cardiology group has advocated for reforms in Medicare, Medicaid, the financing and delivery of high-quality health care, and for expanded access to care for the uninsured.

In an interview during a recent Hawaii visit, Lewin said he believes a health reform bill will be passed this year, saying President Barack Obama and the Democratic leadership “;have too much invested in it to fail. It will be called historic, even if it isn't, and it probably will take three or four years to fix.”;

Lewin practiced medicine on Maui and was medical director of Kula Hospital and Clinic before becoming director of the state Health Department from 1986 to 1994. He then served as executive vice president and CEO of the California Medical Association. He joined the College of Cardiology in November 2006.

Lewin said the House and Senate health reform bills expand access to care, “;but they haven't figured out how to bend the cost curve.”;

“;The irony is in this country the highest quality of care tends to be the most affordable,”; he said, citing Hawaii, Utah, Oregon and Northern California as examples.

Technology has allowed systematic improvements in quality of care, Lewin said. Using registries and clinical decision support systems, the performance of doctors can be measured to eliminate overuse of procedures and tests and guard against underuse, he said.

Cardiologists are the furthest along in developing those systems, he said.

The fear of malpractice lawsuits contributes to unnecessary practices and procedures—and the issue “;isn't even on the table,”; he said. “;Most people think $200 billion worth of testing and procedures are done each year because of fear of malpractice loss.”;

Even if it was only $50 billion, he said, it would total $500 billion in 10 years—“;half the cost of the whole health reform process. I think it's irresponsible that that isn't included (in the discussions) some way, that trial lawyers have so much power. We've got to get it on the table before the process is over this fall.”;

If health care payments were based on incentives to improve outcomes and quality instead of based on volume, Lewin said, “;we would transform American health care.”;

He predicts a far worse recession in 10 years if nothing is done to control soaring health care costs. Reducing unnecessary hospital admissions and readmissions is a big area of potential savings, he said.

“;Hawaii is fortunate—it has more access to care than in most states,”; he said. But it also has “;slipped back a bit,”; he added.