Data analytics firm SAS, last week, played host to a bevy of pharma executives at the company’s Health Care & Life Sciences Executive Conference. The highlight, however, was a duel keynote speech from former Arkansas Governor Mike Huckabee and his sparring partner, former Massachusetts director of health and human services Philip Johnston.

The topic of conversation: Healthcare reform. What else?

Huckabee was in pure TV personality mode, revving up the packed room with his take on the state of healthcare.

“Today, if we were going to redo Wizard of Oz, Dorothy would be going to Washington with people with no heart, no guts, and no courage,” he said to the crowd.

Diagnosed in 2002 with Type 2 Diabetes, Huckabee (who by his own account once weighed as much as 300 pounds) was told by doctors that he would only have a decade left to live if he didn’t change his lifestyle—and that the decade would not be fun. He said that he decided to start being concerned about his health and exercise more.

“While weight is important, it’s not the only thing we must be concerned with,” he said. “The goal of a person shouldn’t be weight control, but health control. There isn’t a healthcare crisis in America, there’s a health crisis. As far as pharma innovation, physicians, and tools, there are a whole lot of ways where our healthcare system is doing well.”

His main point was that until Congress addresses the fundamental problem of health reform—not healthcare reform—nothing will change.

“Why do southerners eat fried food?” Huckabee asked. “Many of us are from generations of abject poverty and if you take food and fry it, you can take the cheapest meat and bread it and fry it and serve it, you can feed the same amount of food and feed more people. Anything that came out of Southern kitchen was fried.

“For me it was also religion. I’m Baptist, and one day when I was in school we had to bring in a religious symbol for show and tell, and I brought in a casserole.”

He said that he felt that it was wrong that healthcare companies are made out to be criminals. “If companies don’t bring in more money than they pay out, they will not be able to stay in business,” Huckabee explained. “The health insurance companies did a poor job supporting themselves. People in the medicare program are twice as likely to be denied benefits than a private insurance company.”

Finally, Huckabee predicted that the US will eventually have two levels of service in this country: a concierge service for patients with wealth, while others will be in plan that will be paid through reimbursement by government. This will create a system of polarization.

Philip Johnston took the stage with a presentation showing how Massachusetts’ universal healthcare plan works, and why it is a good model for the federal healthcare plan.

“It took us 70 years to get to this point. FDR was going to introduce a health coverage plan, but dropped it because he didn’t think it could get passed. Truman was the first to introduce comprehensive health insurance,” Johnston said. “This period now is the most exciting and hopefully the most innovative since Medicare.”

Johnston led his speech with a simple graphic: Transformation = Reform + Technology. He explained how Ted Kennedy worked with then-Massachusetts Governor Mitt Romney and the members of his administration to bring about health reform in Massachusetts. The reform law, which provides nearly universal coverage to state residents, was enacted as Chapter 58 of the Acts of 2006 of the Mass General Court.

“Everyone has to get in the game, and it isn’t free, and what you pay is higher than the penalty,” Johnston said. “What happened was that the vast majority of people took the insurance to have peace of mind.”

Comparisons of key provisions:

• Similar Exchanges: state-based marketplaces for insurance plans to compete (subsidized and unsubsidized)
• No public option in either Massachusetts or national plan
• Coverage expansion – US law provides subsidies up to 400 percent of poverty ($43,320/individual, $88,200 family)

“There’s no way federal legislation would be repealed,” Johnston said. “They need a two-thirds majority vote to repeal. Let’s try to make it work, not only in Mass, but in all 50 states. Let’s show the world that while we are well behind them, we are ready to step up to the plate and hit the ball out of the park.”

The global economic crisis and its impact on the healthcare industry clearly became the central theme beginning with the opening remarks Monday morning when Doug Braunstein, Head of Investment Banking at JP Morgan, claimed there has never been a time when “credit, liquidity, and capital” were so central to every healthcare company’s strategy. This focus permeated presentations of companies and keynote luncheon speakers. Company presentations I attended included some mention or clarification about the company’s cash balance, cash flow, cash management, operational efficiencies, etc. up front and center—across big pharma, big biotech, specialty, and generic companies.

Art Levinson, GENE CEO, had a slightly different message slant—assuring listeners that innovation wasn’t dead at his company by listing their 26 NMEs in clinical development. He amused all when he took several minutes at the beginning of his talk to demonstrate how JP Morgan’s conference logo incorrectly represented the right-handed DNA helix as left-handed, a fact he thought a bank with involvement in such a highly capitalized sector should correct. He commented that if he talked about pursuing biogenerics as a strategy he would expect his board to fire him. Was this remark directed at Merck, Roche or both? Both companies have recently mentioned their prowess to pursue that business opportunity with Merck CEO Richard T. Clark making a strong point on Tuesday that they would be pursuing new revenue growth opportunities in “follow on biologics.”

A day earlier, Roche CFO Erich Hunziker spoke about its management of cash which he noted was critical to managing the business. He also wanted to make it clear that Roche wasn’t making short-sighted cost cuts and, thereby, sacrificing long-term perspective. He spoke of enhancing innovation and “operational efficiency” in the planned merger of Roche and Genentech operations. Hunziker answered an unspoken question—that Roche did not intend to kill innovation at Genentech with their planned buyout of the remaining 44 percent that they don’t already own. His tone of voice suggested he really meant it but many just don’t believe Roche can control their management style from destroying the GENE culture that nurtures their innovation. Many believe the “biomarker” for implementation of that intent or not will be whether Art Levinson and his team leaves or stays.

It was clear that there will be major changes in the healthcare system in the US with reinforcement of how that might take form by the keynote speakers Uwe Reinhardt, professor of health economics at Princeton University on Tuesday and Ted Kennedy, Jr., Marwood Group, on Wednesday. Reinhardt thought that a universal healthcare plan could be sold on its stimulus potential alone, and Kennedy assured the audience that “out the gate” the new administration would deliver the expansion of SCHIP, a Medicaid bailout for the states and a major investment in Health IT. Kennedy declared there was a “planetary alignment” on a health plan as result of the appointment of former Sen. Tom Daschle (D-SD) to head Health and Human Services and the new White House Office of Health Reform and the state of the economy. This coming together might finally result in a single comprehensive universal coverage bill in the US.

Kennedy further delineated the industry sectors most likely to feel pricing pressure and included all branded pharma and biotech drugs. He predicted new policy initiatives would drive growth for generic pharma and pathway for biogenerics as well.

There were 337 healthcare companies presenting starting Monday and running through Thursday, Jan. 12–15. These include 276 public and 61 private companies making their “pitches” to 1,427 public and 1,124 private equity and venture capital investors, respectively. Registration of attendees was sharply constrained by JP Morgan to a total of about 3,500 altogether versus 6,000 in the past. Many who couldn’t gain admittance to the upper floors where the formal presentations and breakout sessions occur filled the St. Francis hotel lobby below. They made appointments with attendees for meetings in the lobby and other venues around Union Square or waited near the elevators and stairs to introduce themselves to attendees exiting the meeting.