Transcript A Second Opinion - University of Texas at Arlington

A Second Opinion:
Rescuing America’s Health
Care
Arnold Relman, author
Critique by Stephanie Nobles
About the Author
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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
The Premise
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Universal health care
Single payer system
Multi-specialty physician groups
A system out of control
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46 million uninsured
Health care expenses are rising at > 7%
per year
Costs rising from 5% of GDP in 1950 to
approx 17% of GDP today
Fraud and abuse
Commercialized Medicine
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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
The Revolt of The Payers
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Nixon administration calls the system a
crisis
Managed care organizations
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HMOs
PPOs
Consumer Driven Health Care
(CDHC)
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Consumer chooses/pays
Providers compete based on price, quality,
convenience
Purchase high deductible catastrophic
insurance plans
Health Savings Account
Information on health care decisions
CDHC-adverse affects
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Affects the poor and uneducated
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Low and modest income families seek care
less often
Preventative care measures would decline
Uneducated making decisions about
complicated health care issues
CDHC- what it leaves out
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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
The Second Opinion
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Single-payer insurance plan
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Prepaid Group Practice
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Reform for physician practice groups and the
way they are paid
Single-Payer Plan
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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
Prepaid Group Practice (PGP)
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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
PGP
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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
My Opinion
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Good points
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Commercialization
Technology
Single-payer system
Group physician practice
Change way of thinking of medicine
My Opinion
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Need more development
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Physician way of thinking???
Consumer responsibility