President Bill Clinton touched on topics ranging from social inequality and skyrocketing health care costs to safe drinking water, school lunches, global warming and living wills during his keynote speech today at the annual meeting of the American Society of Health System Pharmacists.
   He began by recalling the role that pharmacists played during his administration’s ill-fated attempt at health care reform. “When Hillary and I were working on health care 20 years ago, the pharmacists were the single most helpful group in helping us write the law in a way that made sense for what had to be done for the welfare of the American people and the integrity of the health care system,” he said.
   He went on to discuss the terrible impact of runaway health care costs, noting that 20% of those costs cover the administrative activities of providers, insurers and employers, and have created a “massive increase in paperwork costs, which doubtless a lot of you deal with,” and which annually burdens the health system $250 billion dollars annually. Even greater costs are incurred by the U.S. system for delivering care and determining prices.
   Particularly troubling, he continued, is that overall life expectancy in the United States has risen steadily for all groups except non-Hispanic whites with poor high-school graduation rates. For them, there has been a “stunning drop in life-expectancy over the past two decades,” Clinton said, much of it attributable to increased cigarette smoking, obesity and prescription drug overdoses.
   “But you could say these people are dying of a broken heart,” Clinton said, “because they’re the people who were raised to believe that the American dream would be theirs if they worked hard, and their children would have a chance to do better than them, and their dreams were dashed disproportionately to the population as a whole.” The plight of this segment of the population, he added, exemplifies the “intersection of health, economics and politics” that he encounters regularly in his work with the Clinton Foundation.
   President Clinton also outlined three of the greatest challenges facing the world:
   An excess of economic and social inequality that threatens social cohesion. “You want to have some inequality in a society if you believe, as I do, that a market economy is the most efficient way to create wealth, employment and give people opportunities,” he said. “But if there’s too much inequality, it not only crushes people who are on the short end of the stick, it also operates as a severe restraint on economic growth.”
   Excessive social instability. Some instability benefits dynamic societies, because it promotes innovation, he explained. Too much, though, leads to rigidity, such as witnessed during the recent financial crisis when banks refused to loan money and corporations continue to sit on huge amounts of cash. “Things just shut down because people are scared to take risks,” he said. “If we feel too threatened by it or it draws us into a shell, it robs us of a lot of the potential of the 21st century world,” he said.
   Unsustainable and irresponsible energy use and resulting climate change. While this threatens the entire global economy, Clinton asserted, the United States remains the only country in the world where “any major political party actually still questions whether it’s real. Everywhere else, conservatives and liberals are debating what to do about it,” he said.
   The former president circled back to health care, reminding the audience that Americans, by and large, don’t have to worry about getting sick from their drinking water or walking for days to reach medical care—problems that often plague many of the countries that participate in his Foundation’s outreach efforts. In United States and all advanced societies, in contrast, the essential systems are already in place. The trick is to keep them from becoming too rigid to adapt to change. “How do we advance the purpose for which all of you got into this [profession]?” Clinton asked. “How do you provide affordable health care to all Americans at a price [that] leaves enough money in the economy for it to continue to grow and invest in education and enable people to raise their kids?”
   One answer he offered is for pharmacists to “do whatever you can to make sure that we implement the Affordable Care Act properly.” If the health care law has flaws, he noted, the profession should move quickly and aggressively to correct them. “Pharmacists,” he added, “are trusted by both parties in Washington as people who are interested in making the system work.”
   He also implored pharmacists to ensure that the “magnificent advances in pharmaceuticals actually work to make people healthier.” President Clinton told of two close family friends, both of whom suffered the death of a child after the children had taken oxycodone, a prescription painkiller, recreationally along with a few drinks.
   “We simply cannot afford to continue to do things which cause human loss with medications that are supposed to alleviate human suffering,” said Clinton. “These are all things we have to own. We can’t blame the politicians, we can’t blame the health insurance companies, we can’t blame anybody when something is in our control…. The job in a rich country is to reform its systems…. we’re in the reform business, and the better we do it, the stronger America will be in the future. On the health care front, we need your help.”