 Welcome all of you to this evening's discussion about health care. This evening we come together in recognition of a great medical leader and an outstanding humanitarian, the late Dr. Frank Bryant. He was a dynamic force in the San Antonio community and especially in the African American community and we're proud to honor his legacy with this lecture every year. Dr. Bryant believed in giving back to his community and that such giving was really the purpose and the privilege of the education he received. He graduated from the University of Texas Medical Branch in Galveston in 1956 and he was only the third African American to receive a medical degree in Texas. He was the first African American intern and physician at the Robert B. Green Memorial Hospital and after a few years in the Army he opened up a family practice on the east side of San Antonio. He was known in those parts and in many parts of San Antonio as the father of medicine in San Antonio. And tonight we're especially honored to have with us his wife, Ms. Gloria Bryant. She's here with a number of members of her family and Gloria, on behalf of all of us, we would very much like to thank you for the privilege you've allowed us to have in honoring Dr. Bryant's legacy. Would you stand so we can recognize you please? Gloria Bryant. Now events like this happen because of a lot of people contributing to them and we are most grateful to the law firm of Fulbright and Jaworski for their generous sponsorship of the event. I'm pleased to welcome George Schofield who's the managing partner of the firm who is here tonight with many of his colleagues and many guests from the firm. For so many years the firm has contributed in an extraordinary way to this community and we're thankful. George would you and your colleagues please stand so we could honor you. Thank you very much for doing this. You know when this event was planned in April, Dr. Bergen and I talked about this. We had thought that the health care bill would have been voted out by the committee and voted on by the entire congress signed by the president into law and so this debate was planned as more or less a post mortem on the health care bill. Well as they say timing is everything and it turns out we're in the epicenter of this debate as we convene in mid-October to discuss this. We're privileged to have with us Dr. Kanshine, the executive vice chancellor for health affairs at the UT system and all of our experts on the panel. Stuart Altman professor of national health policy at Brandeis and economists focused on federal and state health policy from Massachusetts. David Hunt the chief medical officer in the office of health IT adoption for the office of the national coordinator of health information technology from Washington. Dr. Jeremy Lazarus, speaker of the American Medical Association House of Delegates from Denver and Anna Malano, associate professor of pediatrics from Baylor College of Medicine in Houston and she will be giving her perspective. So thanks to each of you for traveling to San Antonio tonight to be part of this great event. So my last official duty is to welcome to the podium Dr. Ruth Bergram, our director of center for the medical humanities and ethics. Ruth with the support of Dr. Glenn Hough, the interim dean of the School of Medicine and the advisory board and her staff has shaped the center into a first class organization and this event I know will meet that standard. Please welcome Dr. Ruth Bergram. Thank you Dr. Henrich. Quick housekeeping details. I have a question and answer period at the end of the presentation. We've handed out note cards like this with your program. Please print your questions legibly and hand them along to the end of your row during the final presentation and these will be collected by our student ushers and they'll bring them forward to me. Now your feedback is very important to us so please complete this pink evaluation form and return it before you leave today. And finally, a requirement of continuing medical education with our strict guidelines are that I must make a verbal disclosure. Our moderator today, Dr. Ken Shine, has disclosed that he is a board member of United Health Group and now I'd like to recognize the community partners that have made tonight's event possible. This series was actually, although it's the Frank Bryant lecture, it's the second in a series called Conversations about Ethics and it was created in partnership with our friends at the Ecumenical Center for Religion and Health and Methodist Healthcare Ministries. On behalf of my colleagues there, let me say that we are all delighted to be on the planning team for this unique event through which we hope to further the dialogue about health reform in our community and our country. How we train doctors and shape their professional and personal codes of ethics is one of the most important considerations for health reform, one that is largely unaddressed by the congressional bills being considered. Over half of Americans are confused about what Congress is considering and yet this legislation has been described as the most consequential social policy debate since the creation of Medicare 44 years ago. Health reform embodies the intersection between economics, politics, philosophy and ethics. As such it becomes critical for the medical profession to educate and nurture its students to be empathic and ethical health professionals as well as knowledgeable ones. And that is the role of the Center for Medical Humanities and Ethics and tonight's an example of our many enrichment programs intended to fill this need. So I thank you very much for participating in this conversation about ethics. And now it's my great pleasure to introduce Dr. Kenneth Schein. Dr. Schein is the Executive Vice Chancellor for Health Affairs at the University of Texas System. He was in the Institute of Medicine from 1992 to 2002. Under his leadership that institute played an important and visible role in addressing key issues in medicine and healthcare. Its reports on quality and patient safety heightened national awareness of these issues. Dr. Schein is a Professor of Medicine Emeritus at UCLA School of Medicine, a cardiologist and physiologist. He received his MD from Harvard Medical School in 1961. Dr. Schein is the moderator for today's scholarship, credibility and expertise of the group of panelists and their moderator is worthy of national attention at a time when confusion and discord reign across the nation whenever the topic of healthcare or health reform is addressed. Tonight we hope to listen, to educate and to shine a light of clarity on health reform that will resonate across the country. Please welcome Dr. Schein. Thank you Dr. Bergen. It's entirely appropriate that this conversation about health reform be conducted by a center concerned about ethics. Over 35 years ago at Alma Anna, the nations of the developed world and many developing nations concluded that healthcare was a right. The United States has never subscribed to that notion and we still as a country have not accepted the notion that healthcare is a right for every one of its citizens. Therein lies a substantial conundrum with regard to what and how we behave. The title of this panel is healthcare is broken, how do we fix it? In your brochure I call your attention to the bios of our speakers and point out that Jim Rohack is in Washington working on health care reform and we're very pleased that Jeremy Lazarus has replaced him but I will not provide a lot of detail about the bios of each of our speakers in the interest of time and refer you to the material. I also refer you to the other issues with regard to disclosures related to myself and Dr. Altman as well as the importance of getting your CME credit. Is healthcare broken? The United States has the most expensive non-system of healthcare in the world. That non-system is associated not only with costs which are almost twice the amount spent in other developing countries but also with quality which ranks us regularly in the high teens, parameters that might be mentioned whether it's life expectancy, infant mortality, a variety of other parameters. As a country we don't do well and as a matter of fact even for our insured citizens the work of Beth Maglenn and others has shown that only 55% of meetings between physician and patient result in optimal treatment for the patient. That is extraordinary in terms of the value of what we pay for. In Texas 25% of our population is uninsured and we rank 51st in the country in terms of that parameter. We recently made a lot of progress but children Arizona has more uninsured children than we do. It used to be we compared ourselves to Mississippi and Louisiana. And if you look at quality in Texas only Louisiana and Mississippi in fact show lower quality parameters in spite of the fact that we have the number one cancer hospital in the country, the Texas Medical Center, great centers such as this. We also know that we have among the highest cost per capita of any state in the nation and that we are a state of small businesses only 37% of whom offer insurance to their employees. If that isn't broken I don't know what is. You pay a lot and on average you're not getting very much. You either access or quality. And so tonight's discussion is how do we fix it and hope that rather than repetitions of the doom and gloom that in fact we can look at some positive proposals.