discussion 8

Required Textbook:

Henderson, James W. 2015. Health Economics and Policy, 6th edition. Southwestern Cengage.

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The Future of US Healthcare” by Barry Bittman, MD.

Speaker 1: The future of US healthcare. It is not surprising that every hospital and health institution in America is facing a substantial degree of uncertainty concerning the future of our nation’s healthcare. While the writing on the wall certainly includes accountable care organizations, bundled payments, insurance exchanges, core measures, hcaps, meaningful use and value based purchasing. The precise nature of that which will ultimately shape and enable our healthcare system to survive is at best uncertain. The real question is how can we improve and sustain our healthcare for future generations. Highly politicized the affordable care act is poorly understood and widely debated. Yet what appears to be universally agreed upon is a series of remarkably straightforward goals referred to as the triple aim: improving the health of populations, improving the experience of care and reducing per capita healthcare costs. The pressure is building. Undoubtedly something has to give. According to the centers for Medicare and Medicaid national health expenditures grew to 2.5 trillion dollars in 2009, actually more than 8,000 dollars per person or 17.6 percent of our Gross Domestic Product. CMS suggests National healthcare expenditures will balloon to 4.48 trillion in 2019 or 19.3 of GDP. As a reference point contrast this with our total actual Federal Spending in 2009 equal to 3.5 trillion dollars, yielding a resultant budget deficit of 1.5 trillion. Bottom line, we’re no longer running on vapors. The tank is empty, we’re out of funds. Beyond any reasonable doubt our deficit situation cannot persist despite all political bantering of our healthcare reform or debt ceilings. While some have challenged the W.H.O.’s ranking of the US in 37th place among the world’s health systems just behind Dominica and Costa Rica, it’s a fact that healthcare spending as a percentage of GDP distinguishes the US as the world leader. SO does our ranking as number one in the world for cheese production, and not surprisingly obesity compared with the shamefully incomprehensible ranking of 47th of infant survival. Compound our challenge with more than fifty million uninsured Americans and an additional twenty five percent underinsured and the nature of the ugly beast that is rearing its head comes apparent. And if you believe that our present challenges are great just consider that there are more than forty million American’s age sixty five and over in the US and a projected 80 million seniors in 2040. While these staggering numbers could keep a building full of actuaries arguing for a year it is not surprising that most hospitals fear Medicare, Medicaid and Commercial Insurance cuts. Neither political party is prepared to openly duel over the matter, yet somehow most of the healthcare executives believe that the axe is about to fall and funding cuts are going to decapitate the highly vulnerable organism we commonly refer to as our ill-fated American healthcare system. While that fear is not unjustifiable the real question is whether or not our present challenges can be solved with the purely economic solution. Frankly I do not think so. I also don’t have a crystal ball to foretell the future, yet I am convinced that each hospital and healthcare system in America can better prepare itself for weathering the storm regardless of the wind’s direction. And we must not rely on a Federal mandate to do so, rather than fretting about future cuts or policy changes, waiting for the sky to fall or contemplating early retirement we must now work together diligently toward the triple aim. You might be surprised to learn how we can effectively reshape what we already have, a broken system supported by the largest per capita health spending in the world. The real question is where do we begin. The answer is a new vision. Our rapidly expanding fee for service system must give way to focusing on prevention, eliminating wasted services and procedures, and reducing costly admissions. There has never been a better time to break down the healthcare silos and barriers that impede communication and coordination across disciplines. These predictable results in devastating care gaps. A new standard must be set to insure that doctors, hospitals and third party payers work together cohesively for the wellbeing of our communities. We must voluntarily and proactively develop and adopt an unprecedented level of coordination between physicians and caregivers, hospital departments, community providers and healthcare institutions across town and across the nation. Sharing of medical records, information and evidence based solutions and best practices must take precedence over competing at practically any cost. Fragmentation must give way to a reliable continuum of care within a comprehensive patient centered community care network without walls that replaces the building once affectionately referred to as the hospital. Patients and families within this network must be encouraged to take an active and meaningful role in healthcare decision making and end of life care. When we finally focus on the fact that a mere five percent of our population utilizes forty nine percent of our healthcare resources the prospect for a developing an exemplary high quality sustainable US healthcare system becomes clearer, an interdisciplinary healthcare approach orchestrated in a caring coordinated manner is doable and achievable within our grasp and ultimately within our budget. Through evidence based interdisciplinary prevention strategies and true care coordination with an emphasis on improving outcomes along with the overall patient experience, as a nation we will not only survive we will thrive as the best healthcare system in the world.

After reading transcript on The Future of US Healthcare” by Barry Bittman, MD. Select one of the following critical analysis and discussion questions and post your answer. Please write out the question at the top of your answer.

•View the video entitled, “The Future of US Healthcare” by Barry Bittman, MD. (The link may be found in the Content.) Among other things, the video talks about “Triple AIM.” What is “Triple AIM” under the Affordable Care Act? The video also cites the Center for Medicare and Medicaid Services (CMS) projections that our national health care expenditures will rise to $4.48 trillion by 2019, a number equivalent to 19.3 percent of our GDP. There is no doubt that the system must be reformed in order to sustain a viable and affordable health care system for everyone. What is Dr. Bittman’s recommendation for health care reform? Do you agree with his recommendations?

Please support your argument.

•The Affordable Care Act is expected to help increase access to health care. Health insurance exchanges will be an important part of that. Most people get health insurance through their employers. But people without this option will now be able to shop for health insurance on exchanges, as an alternative to buying coverage directly from individual health insurers. Exchanges are new and easy to use. And they’ll be open for business in October 2013, allowing consumers to shop for health plans that will begin on January 1st. Experts predict that by 2016, more than 25 million people will use exchanges to buy health insurance. Doing an online search discuss the following:

What are these exchanges? How