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Delos M. Cosgrove occasionally visits his hometown, Watertown, to meet old friends and to carry a special message about health.

He has delivered the commencement address at Jefferson Community College and spoken before the Heart Association, the Watertown Noon Rotary Club and last weekend at the Clayton Opera House. Each time the message is clear: Success is a result of hard work to overcome obstacles.

Dr. Cosgrove, whose lawyer father was chairman of the board of the then-House of the Good Samaritan and the energy behind the expansion of the hospital in the 1970s, delivered a stark message at his lecture, which helped raise more than $10,000 to benefit the Opera House. He told the audience that the Affordable Care Act came as a result of the fact that “the current system is unsustainable from a cost standpoint.”

His disappointment in the new law was clear. He argued that the law’s medical reforms did not approach the challenge from a systemic perspective but instead dealt with thousands of individual issues challenging health care. Dr. Cosgrove would have preferred an overarching organizational approach to deliver care more efficiently and reform to encourage healthier lifestyles.

Continuing a medical delivery system that is fragmented will not reduce costs and improve care. Nor will health improve without lifestyle changes. He points at smoking and obesity, which drive 70 percent of chronic disease and 70 percent of health care costs.

Dr. Cosgrove does not preach healthier living; he enforces it. At the Cleveland Clinic where he is the president and chief executive officer of a $6.3 billion health care delivery system with a staff of 43,000, prospective employees are required to undertake drug testing that includes a test for nicotine.

Smokers are not hired. The clinic ended contracts with fast food franchises on the campus, removed candy bars from vending machines, posted calorie and nutrition counts for every menu item in its cafeterias, and began a weight-reduction program resulting in employees losing a total of 400,000 pounds.

His message on smoking frustrates New Yorkers where state and local governments struggle annually with the medical expenses of smokers but state law prohibits employers from banning smokers from their workforces.

The clinic is organized to ensure patients are treated by the highest level of competency required to correct the health challenge. A dozen cardiac surgeons are assisted by 80 physician assistants, which guarantees that highly trained doctors spend their time in surgery delivering care as they refine their skills while others tend to routine after care. Patients are shuttled by an elaborate transportation to a facility where the best care can be delivered.

Not every hospital in the clinic’s system has all services. Instead, each focuses on specific health issues.

The model was inspired by Dr. Cosgrove’s experiences in Vietnam where he marveled at the efficient methods used by the military to move battlefield victims to the optimum location for recovery.

Dr. Cosgrove has overcome the challenge of dyslexia. He has persevered to create 22 patented heart-valve devices and withstood the power of political forces who chafed at his successful attacks against smoking and unhealthy food.

At the core of his success is the devotion to hard work to convert his inspirations into a successful and efficient health care system. And he assured the crowd that with hard work the challenge of achieving quality health care will be in reach of those who accept and encourage change.

Dr. Cosgrove was here to meet old friends from the class of 1958 at Watertown High School, who were celebrating their 55th reunion. But he was also lucky enough to see former patients who came to Clayton to be inspired by the man who changed their lives and the lives of their family. They came to a lecture on a wonderful sunny Saturday afternoon to support a medical leader who has never forgotten his roots, has a special connection with the north country and who has never wavered from a mission to deliver health care to a healthier population at more reasonable costs.

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