Ethical Considerations for Repealing or Reforming the Affordable Care Act.
Date: Wednesday, February 1, 2017, Time: 3-4:30 PM.
Hilton Head Public Library Conference Room Presenters:
Charlie Miner and Bill Manning. Moderator: Neil Funnell
Two highly qualified speakers introduced ethical issues surrounding the current “hot topic” of repealing or reforming the Affordable Care Act (ACA).
Charlie’s career began as an engineer in construction and manufacturing. He managed several large conglomerates before switching to healthcare in 1992 as president of a large Cleveland hospital. Later, he became CEO of the Meridia Health System, which later merged with Cleveland Clinic, where he remained as President and CEO of the community hospitals, now a part of the Clinic. Charlie retired in 2006, then returned for three years to start Cleveland Clinic Abu Dhabi located in the UAE.
Bill graduated from Brooklyn College and began his career in the insurance industry. He was employed in the insurance industry from 1959-1999, as a licensed insurance broker in New York State, working in varied capacities. Most of his career was Underwriting and Underwriting Management, in the Casualty and Property side of the business. While employed by Cigna (32 years), he worked with others employed in the Medical side of the business. Bill retired in 1999 as a Senior VP of Liberty Mutual Insurance Company. Since then he has testified and been deposed over 50 times on behalf of Insurance Companies.
Neil Funnell introduced our two speakers and asked the following questions: What is the scope of the ACA problem and how do we fund it?
Bill spoke first and noted that there is a cost problem since we are spending twice the amount of our GDP on health care when compared to other major countries. He noted that there are pros and cons of the ACA. USA has 325 million people and 295+ million are insured with some 25+ million uninsured. More have been covered since the ACA. Medicaid involves some 70 million people (twice the population of Canada. This is jointly funded by the Fed and each state, using a basis of 138% greater than the poverty level or approximately $18-20,000 for a family of 4 or more. Some are using Medicare advantage and some are disabled, with this latter number growing. In France all workers pay 8% of salary and employers pay 13-15%. They have the longest life expectancy of any major country. They get “annual” exams every 2 years and carry a health care card.
Our Consumer Price Index has gone up 4.6%/year and healthcare costs have gone up 14-15%. It costs $10,000 per individual for the cost of medical care (17% of our GDP, rising to 25% by 2025). This is twice the cost of other major countries for health care. 94% of large companies are self insured, using insurance companies as middle men. 60 plus %of all employers are self insured.
Main reasons for our higher medical costs are:
To fund all this, the healthy must all pay for insurance. Rewards for Good health management has not been working. Electronic Medical Records (EMRs) are very helpful. It took 50 plus years to get us to stop smoking, so changing health styles is not going to be instantaneous. Price transparencies should be out there for all to see.
How do we generate more income: Germany charges 7% from workers and employers. Health Savings Accounts maintained while working. Tobacco and Liquor taxes to be specifically designated for medical care. Canada uses Health care lotteries. Bureaucracy is protective of the hospitals. Bill suggests read the article ACA Aftermath by John H Cochrane.
Charlie Miner presented and listed the types of health care available to us in the U.S.:
Is this concept reasonable? We do not have a health care system in the US, but rather a sick care system. So solve the cost problem first in order to solve the price problem. Changing the ACA is a very complex problem. I am an engineer, coming out of industry and got involved with mergers and acquisitions. This brought industry discipline.
18% of our GDP is spent on health Care—to reform such one must deal first with the COST. How do we deal with price costs that are twice as large as they need to be? Administrative costs have to be reduced to 7-8% of total cost. People are living longer, and are more prone to chronic disease. Some unnecessary costs are due to:
Japan costs are lower probably due to differing lifestyle.
Mediterranean diet works to keep Italian people healthier longer.
1/2 of our total health care costs are during the last year of our lives.
How do we fix this:
Bill adds that the maximum fees charged by insurance companies is 20%, usually around 12%. Should we have a single payer system. He states that the Fed can’t control any costs, e.g., VA, et al.
*ACA has been a disaster from the start: 50 million were uninsured; 25 million still uninsured and 25 million still unable to get insurance. Young people have to pay to pick up the slack. Insurance companies pay 10% of the bill. Hospitals are part of the problem. Young kids are getting hit with huge tax bill. $785 per adult should go into Health Savings Accounts (HSAs). All will be covered under this sensible system
Charlie answered that there is always a problem with for profit for service. HSAs are a bad idea.
*For profit medicine is an oxymoron to the rest of the world.
Bill says that Medicare dictates to providers and leads to concierge medicine.
Charlie adds re hospitals and providers: In Non Profits, the extra money stays in the system and in For Profits, some goes to taxes and some to shareholders.
*How much money should a doctor make?
Charlie answered that it is not the doctor’s salary that is the problem, but Evidence Based Medicine (EBM) is the answer. Inner city and rural care is neglected. The ethical problem is how to deliver the health care.
Bill asked : Do we all have the right to expect health care?
*David Kelly, our retired Ethics Professor Emeritus from Duquesne answered: From the Christian and ethical perspective, Yes, we do have that right.
*Isn’t Life, Liberty and the Pursuit of Happiness guaranteed by our Constitution?
Charlie and Bill: Each state differs in specific health care rendered.
Europe cares for all.
*A physician in the audience noted that Medicaid is lousy coverage and many doctors refuse to see these patients.—Is that Ethical?
*We are already socialized in medical care:
VA, Military and Indian Health Services. Medicare Advantage gives some additional features and pays for such by decreasing their payment to the provider. This limits their providers and their choice of such.
Charlie finished by adding that Kaiser Permanente has been an ongoing success and is the right idea. They give care to the populace in a given area, and pay on the dollar amount, per person treated. They practice preventing hospital readmission and caring for the chronic care patient properly as an outpatient
Thanks to Bill and Charlie for providing us with an informative, educational and ethical presentation on this very controversial and timely issue. Thanks also to Neil Funnell for moderating and to our Sgt. at Arms, Isam Sakati.