A Second Opinion: Rescuing America

1
A Second Opinion Rescuing Americas Health Care

• Arnold Relman, author
• Critique by Stephanie Nobles

2
About the Author

• Renowned published physician
• Professor Emeritus at Harvard Med School
• Has served on several boards and committees
• He is a former editor of the New England Journal
  of Medicine

3
The Premise

• Universal health care
• Single payer system
• Multi-specialty physician groups

4
A system out of control

• 46 million uninsured
• Health care expenses are rising at gt 7 per year
• Costs rising from 5 of GDP in 1950 to approx 17
  of GDP today
• Fraud and abuse

5
Commercialized Medicine

• Post WWII
• Increase in employment based coverage and
  Medicare/Medicaid
• Appealing to investors
• Business interest reshaped
• Fee-for-service
• Quality of our health care
• IOM-Institute of Medicine

6
The Revolt of The Payers

• Nixon administration calls the system a crisis
• Managed care organizations
• HMOs
• PPOs

7
Consumer Driven Health Care (CDHC)

• Consumer chooses/pays
• Providers compete based on price, quality,
  convenience
• Purchase high deductible catastrophic insurance
  plans
• Health Savings Account
• Information on health care decisions

8
CDHC-adverse affects

• Affects the poor and uneducated
• Low and modest income families seek care less
  often
• Preventative care measures would decline
• Uneducated making decisions about complicated
  health care issues

9
CDHC- what it leaves out

• Overuse of new technology
• Increase in specialists and decline of primary
  care physicians
• Fee-for-service reimbursement plans
• Increase in market competioin
• High fees paid for technological procedures

10
The Second Opinion

• Single-payer insurance plan
• Prepaid Group Practice
• Reform for physician practice groups and the way
  they are paid

11
Single-Payer Plan

• A central agency would be responsible for paying
  for services
• Who funds the agency?
• All health care benefits are guaranteed with few
  exclusions
• Services that are not a approved
• Payments made on capitated basis-no more
  fee-for-service

12
Prepaid Group Practice (PGP)

• Teams of multi-specialty physician groups
• Includes primary care physicians-paid by salary
  w/ supplementary bonuses
• Includes specialists paid variously
• Small community based groups of 50-100 doctors
• Nationally certified
• Physicians could only practice in the plan

13
PGP

• Private physicians would still exist
• Patients would pay out of pocket or with private
  insurance for private doctors
• Plan physicians could join any group that would
  hire them
• Patients could choose the group they want to be in

14
My Opinion

• Good points
• Commercialization
• Technology
• Single-payer system
• Group physician practice
• Change way of thinking of medicine

15
My Opinion

• Need more development
• Physician way of thinking???
• Consumer responsibility