led to information about the many challenges Kentucky faces when it comes to improving the health of its people, and a few solutions.
, said little will be done to improve health care and health-care costs as long as people don't demand change from their lawmakers in Frankfort and Washington.
"Apparently, it's OK with you guys," Chandler told the Lexington business-and-civic group. "That's all I can say, is that apparently it's OK with you guys because you are not demanding that it change. We can change it through public policy if the citizens of this country wants to do it - and apparently, we don't."
Chandler, 64 and a Democrat, was state auditor and attorney general before losing the 2003 governor's race and representing the 6th District in Congress from 2004 through 2012.
'Kentucky uglies'Asked about what then-
University of Kentucky President Lee Todd called "the Kentucky uglies," referencing the state's most troubling and chronic health issues, Chandler said we don't pay enough attention to them.
"Kentucky's numbers are abysmal," he said. "We have some of the worst health numbers in the United States in almost any health indicator that you can think of, starting with cancer. We lead the nation in cancer . . . and in cancer mortality."
Kentucky
ranked No. 41 in the
America's Health Rankings 2023 report. Kentucky has found itself among the bottom 10 states in health status since the rankings began in 1990, except in 2008, when it ranked 39th.
Chandler said many Kentuckians work on this problem from a health-care standpoint every day, but "a long, long way to go" remains toward improvement.
"I think there are some solutions," he said. "But we as a society, at least right now, are not prepared to deal with" them.
Christopher Roty, president of Baptist Health Lexington, agreed that health-care providers are working on these Kentucky uglies, like obesity, diabetes and lung cancer.
One way, he said, is by employing new technology, pointing to new protocols for lung-cancer screening that include low-dose CT scans and remote monitoring tools that reduce hospital readmissions. But when it comes to prevention, which involves things like education and poverty, he said, "We've got a ways to go."
Opioid epidemic
Asked about the opioid epidemic in Kentucky, Roty noted that the hospital has instituted new pain-medication protocols that send people home with just enough medicine for a few days, with instructions to call their doctor if they need more. Also, an addiction nurse at the hospital is available to patients.
"Lots and lots of progress, but then, we've got a ways to go with that," he said.
Chandler said the prescription-monitoring system that was created out of a task force he created while serving as state attorney general worked to stop the "proliferation of the pills on the street," heroin quickly followed and "it has been a significant problem ever since."
Further, he said that despite all of the "really good work" being done to deal with opioid addiction, we haven't figured out how to effectively treat it.
"We have yet as a society, not gotten the tools to deal with this dreadful addiction," he said. "It's just dreadful. My own brother died of a fentanyl overdose a couple of years ago. . . . There are very few people who have not been affected by this." Chandler was speaking of his brother, Matthew Chandler.
He added, "We're pouring a whole lot of money into well-intentioned efforts to try to fix people who are already addicted. And we're not doing enough on the preventive side to stop the addiction in the first place. And that's where the money. We need to see what we can do to go upstream to try to deal with some of these things."
That would include, he said, addressing what are often called the social determinants of health, or the social drivers of health status. These include things like education, housing, transportation, food insecurity, education, access to health care, employment and poverty.
'As important as health care is, and it's very, very important, it's only a piece of the problem," he said. "If we want people in our society to be well and to live healthy lives, we've got to work on these social determinants," the biggest of which is poverty.
"People who don't have resources are less healthy and they live less long," he said, adding later, "It's a problem of equity in our society and quite frankly, I think we ought to be deeply concerned about it."
The state's latest annual Overdose Fatality Report shows that 2,135 Kentuckians died from overdoses in 2022, with opioids involved in 90% of those deaths, led by fentanyl, which was involved in 72.5% of the deaths.
Health worker shortage
Roty said a shortage of health-care workers continues to be a problem, saying about 5% of his nurses are "agency" workers for outside firms. Another challenge is that they see a lot of first-year turnover among the nurses, who he said leave for various reasons, including a dislike of shift work.
Asked how they are addressing this issue, Roty said they are doing what many hospitals are doing, offering all kinds of bonuses and loan forgiveness programs.
He said some of the schools that produce health-care workers aren't graduating enough students to take care of the shortages: "We've got a new class of nurses coming in this spring, but it's not going to . . . get rid of all the agency workers," who are generally paid more.
Roty noted that Baptist Health is opening a second Lexington hospital, on Interstate 75, in phases. He said the outpatient facility, with a freestanding emergency department, cancer center, surgery center and medical office building will open first, followed by a hospital bed tower.
The hospital's site was selected party to serve rural areas south and east of Lexington. Chandler noted, "The people in rural areas don't have the same services. . . . It's just an urban/rural problem."
This led to him talking about the "institutional problems" in health care, including the fact that the U.S. spends about twice as much per capita on health care as any other industrialized country in the world, while ranking near the bottom for health outcomes.
"Now, something is wrong institutionally with a system that spends twice as much per capita on a problem and ends up with the 60th best result," he said, adding that any other business with such results would surmise that "something has got to give."
"People in this country are dying because we can't fix this issue," he said. "They are dying and their quality of life is much poorer than it ought to be. And again, I go back to the social determinants of health. One of the reasons that other societies are doing better than we are . . . is that they do a better job on the social determinants."
Health-care costs
Roty said they do their best to work with people challenged by the costs of health care, whether that is getting them signed up for Medicaid or a financial assistance program. "It's a broken system when it comes right down to it," he said.
Chandler added, "There are a lot of citizens who are going bankrupt because they can't pay for their health care."
Further, he said, the health-care system is hard to navigate, while agreeing with Roty that the system is "incredibly complex" for patients and providers.
"And for a country as strong and capable as we are, it's just amazing to me that we can't come together and find the answers to these problems," he said. " We actually have an idea about what the answers are, we're just unwilling to implement them. And it's because, as you can imagine, there are interests that are not interested in seeing that implemented. "
Legislative priorities
Chandler opened this segment of the conversation by saying, "The legislature is not easy to work with, we have found, particularly on these kinds of issues."
This year, he said the foundation's priority was creation of an "all-payers claims database," which would track all health-care insurance claims (including Medicaid and Medicare) in Kentucky to improve the transparaency of health-care costs in the state. He said 22 states already have this in place.
"We were unsuccessful in that effort, " he said. "And that's not surprising because it's a complicated thing and it's not really sexy." He added, "At some point, we're going to need to get to the bottom of where all the money is going."
Other priorities, he said, revolved around the social determinants of health and adverse childhood experiences, which he called "childhood trauma." He added, "We're trying to address those things, but we can't seem to get the legislature to invest in the solutions."
The foundation funds Kentucky Health News but does not control its content.
Drugs for weight loss
Asked about the use of the new weight-loss drugs, like Ozempic and Wegovy, in which Kentucky leads the nation, Roty said Baptist Health would no longer cover them for weight loss because they are too expensive, effective May 1. He said they would only cover it for the treatment of diabetes. Roty said the company, Kentucky's largest hospital chain, has spent $24 million on this drug this year in its employee health plan.
"We are not going to reimburse for that anymore . . . for weight loss purposes, obesity," Roty said. He acknowledged that "A lot of people are seeing results," but "The expense to us, so to speak, is incredible."
"Baptist Health’s employee health plan has seen significant growth in usage of both these medications since they were introduced, with Wegovy alone seeing a 600% increase in users over the past 13 months," according to a statement provided by Baptist Health.
Chandler suggested that tackling obesity would ultimately result in overall health-care savings, since so many health conditions are caused by or worsened by obesity.
"If they are working and they are healthy and they are not hurting people, then ultimately in the long run, while the short-term expense may be very high, in the long term the expenses ought to go down for the society in general in savings on health care."
The 20th annual State of Obesity report from Trust for America’s Health says 37.7% of Kentucky adults are obese and nearly 72% of the state’s adults are either obese or overweight, tied for sixth place with Delaware. Among the state’s high-school students, 19.6% are obese and 16.2% are overweight.
