Unit 8 Town Hall Seminar

1. The future of health care in the United States. Unit 8Town HallSeminar

2. Agenda • The Unit 10 discussion board is for debate purposes. • There is no Seminar or Discussion Board in Unit 9. • The Final Project will be your last grading obligation beginning this week for Unit 9. However, the papers are due only one week before the end of class. Late papers cannot be accepted in the final week of class. 

3. Great Britain’s Healthcare Delivery System Britain's National Health Service (NHS)

4. National Health Service (NHS) • The NHS is a rare example of truly socialized medicine. • Health care is provided by a single payer — the British government — and is funded by the taxpayer. All appointments and treatments are free to the patient (though paid for through taxes), as are almost all prescription drugs. The maximum cost of receiving any drug prescribed by the NHS is $12.

5. National Health Service (NHS) • The NHS officially came into being in July 1948, in the wake of World War II, to replace an inadequate system of volunteer hospitals that had, during the war, come to rely on government funding.

6. National Health Service (NHS) • In a statement on Aug. 14, BMA chairman Dr. Hamish Meldrum said, "The NHS is not perfect. But the market-style philosophy of the U.S. is a lesson we could do well without."

7. How does NHS health care compare with U.S. health care? • Britain ranks above the U.S. in most health measurements. Its citizens have a longer life expectancy and lower infant mortality, and the country has more acute-care hospital beds per capita and fewer deaths related to surgical or medical mishaps. Britain achieves these results while spending proportionally less on health care than the U.S. — about $2,500 per person in Britain, compared with $6,000 in the U.S.

8. World Health Organization (WHO) • The World Health Organization (WHO) ranked Britain 18th in a global league table of health-care systems (the U.S. was ranked 37th). However, there are measures by which the U.S. outperforms Britain: for instance, the U.S. has lower cancer mortality rates.

9. Does private health insurance exist in Britain? Yes, and it works in a similar way to health insurance in the U.S. Many employers offer private health-insurance plans as a perk to workers — a minority of patients opt out of the NHS system to receive their medical treatments privately. Private patients can choose their specialists and avoid waiting lists for non-emergency procedures; NHS patients wait an average of about eight weeks for treatments that require admission to a hospital, four weeks for out-patient treatments and two weeks for diagnostic tests. While NHS patients have a choice of hospitals, they cannot always choose their specialist.

10. Arguments for Great Britain's Healthcare System A plurality of physicians, particularly primary-care doctors, supports national health insurance. And there is now strong evidence that, even in developed countries with addiction problems like ours, universal coverage correlates with improved quality of health across the socioeconomic spectrum.

11. Arguments for Great Britain's Healthcare System • No major organizations or national political figures have advocated creating a system like Great Britain’s, where the government owns all the facilities and employs all the doctors and nurses.

12. Arguments against Great Britain’s System Compared to the private sector, government programs are inefficient and the higher costs have to be paid for with higher taxes or spending cuts in other areas such as defense, education, or even medical research and development.

13. Arguments against Great Britain’s System • The fundamental flaw in universal health-care systems is a misplacement of incentives. The decisions that drive health-care costs and quality of care are made by individual patients and their health-care providers. These decisions should not be influenced by universal government mandates, administered pricing systems or expenditure targets, but should instead be based on an adequately informed assessment by individual patients and their providers about the value of services in a particular clinical situation.

14. Nationalized Healthcare in the United States • The 10-year, $900 billion bill would remake one-sixth of the U.S. economy, clearing a path to health insurance for millions who don't have it now. It would be financed by slashing Medicare and Medicaid payments to health care providers, and by ordering new taxes and fees that are already meeting fierce resistance. Insurers would no longer be able to turn away those in poor health.

15. MyFamilyDoctorMag.com • Could Great Britian’s NHS work or not work in the United States? • Are there differences related to culture, diversity, geography, or problems of economic and government structure which make universal health care unworkable in the US? • If the United States had Nationalized Healthcare but had to cut some federal programs to pay for it, what programs would you cut?

16. The Clinton health care plan • A 1993 healthcare reform package proposed by the administration of President Bill Clinton and closely associated with the chair of the task force devising the plan, First Lady of the United States Hillary Rodham Clinton.

17. Hillary Clinton • The core element of the proposed plan was an enforced mandate for employers to provide health insurance coverage to all of their employees through competitive but closely-regulated health maintenance organizations. • The Clinton plan would have required every business in America to provide health care coverage to its employees. • Clinton's plan would also have provided all U.S. citizens with health insurance in return for a government-designed standard benefit package.

18. Hillary Clinton • The Clinton health plan required each US citizen and permanent resident alien to become enrolled in a qualified health plan and forbade their disenrollment until covered by another plan. • It listed minimum coverages and maximum annual out-of-pocket expenses for each plan. It proposed the establishment of corporate "regional alliances" of health providers to be subject to a fee-for-service schedule. • People below a certain set income level were to pay nothing. The act listed funding to be sent to the states for the administration of this plan, beginning at $13.5 billion in 1993 and reaching $38.3 billion in 2003.

19. President Obama’s Health Care Plan • In order to control rising health care costs, guarantee choice of doctor, and assure high-quality, affordable health care for all Americans.

20. President Obama’s Health Care Plan The Administration believes that comprehensive health reform should: • Reduce long-term growth of health care costs for businesses and government • Protect families from bankruptcy or debt because of health care costs • Guarantee choice of doctors and health plans • Invest in prevention and wellness • Improve patient safety and quality of care • Assure affordable, quality health coverage for all Americans • Maintain coverage when you change or lose your job • End barriers to coverage for people with pre-existing medical conditions

21. Department of Health and Human Services (DHHS) • We support health reform that follows these principles: • Protect families’ financial health • Assure affordable, quality health coverage for all Americans • Provide portability of coverage • Guarantee choice of doctors • Invest in prevention and wellness • Improve patient safety and quality of care • End barriers to coverage for people with pre-existing medical conditions • Reduce long-term growth of health costs for businesses and government

22. Questions