Twentieth National Conference on Primary Health Care Access in Monterey

The Twentieth National Conference on Primary Health Care Access will be held at the Hyatt Regency Monterey from Monday, April 6 through Wednesday April 8, 2009. The Theme of the Twentieth National Conference will be “Primary Health Care Access, the American Medical System and Its Potential for Sudden Change”.

(To go directly to the Twentieth National Conference program, use the hyperlink: Twentieth National Conference on Primary Health Care Access: Program of Plenary Sessions.

The Twentieth National Conference theme

Although there is much to admire in the American health care system, there are obvious vulnerabilities as well. For several decades American policy-makers have assumed that health quality is enhanced if private employers “insure” that funds are available for the health care needs of their employees through contracts with insurance companies, that the federal government take responsibility for the health care of persons over 65, and that state and local governments provide the “safety net” for the health care of persons who are unemployed or indigent.

In the two decades since the First National Conference, increasing numbers of persons have begun to suspect that the status quo of the “American system” is based on the illusion that its elements were planned to be as they are, or that they are the products of an efficient marketplace.  In fact, Doctor Philip Lee, the chief health policymaker during President Johnson’s administration, when Medicare and Medicaid were established, proposed at the Tenth National Conference that every part of the current health care system should be regarded as the unintended consequence of a policy decision meant to accomplish some other objective.

During the past year, events have demonstrated that sudden change can overtake whole industries. The mortgage industry and investment banking are two of the economic activities that looked very different at the end of 2008 than they did at the beginning. In the 2008 presidential campaign, both major party candidates and their parties endorsed radical proposals to solve fundamental problems in the mortgage lending and banking industries.  One can begin to detect an emerging consensus that the United States should devise what one could characterize as a “commonwealth” approach to home ownership and housing.

Yet, at the beginning of 2008, neither the mortgage industry nor investment banking appeared to have been vulnerable to rapid change before their transformation. On the other hand, the health care industry has long appeared to have major vulnerabilities, and these vulnerabilities are likely exacerbated by the impact of financial sector problems on, say, the insurance industry and on government revenues.

For example, the number of persons “uninsured” or “underinsured” may be approaching half the population of a nation whose policies assume that insurance companies are the proper agents for handling the reimbursement of health care.

As a second example, the current revenue streams for health care are most advantageous for high cost, high technology, “end of life” care, and least so for the financing of primary health care, public health and preventive medicine. A significant factor used in the pricing of services for which these revenue streams are applied is what Medicare has agreed to pay. Yet Medicare appears to be approaching technical insolvency, and the national budget arguably has little room for the massive injection of new funds needed just to keep Medicare payments rates at the current levels for all services.

The transformation of banking occurred in the final days of an administration elected with no mandate nor any apparent interest in massive intervention in the financial sector, but circumstances forced it to become the agent of change.

On the other hand, the administration that succeeds it has expressed its determination to change health care policy in America. Whether or not raising the issue of health care reform was more of a campaign promise than a policy manifesto, circumstances could well require the administration’s attention to creating health care “commonwealth” policies also.

If, indeed, national policy moves towards treating the nation’s health care system as a “commonwealth” with a claim to public, as well as private resources, then the debate over whether health care is a “right” or a “privilege” is bypassed, because the major concern then becomes what governments and the private sector should do or be encouraged to do to promote the common good.

In our current environment is it safe to assume that just because a part of the system was financed at comfortable levels in the past, it will continue to be so in the future? Is the health care system really immune to sudden change?

The Lead-off Thought Provocateur

The first of the National Conference’s thought-provoking (thought provocateur) sessions will be a presentation by futurist physician Joseph E. Scherger, MD entitled “What is to be Done?: Designing American Health Care Policy to Promote the Common Good”.

The collapse of financial institutions, although certainly exacerbated by Securities and Exchange Commission (SEC) rule changes that permitted “bear raids” by short-sellers and general mischief by overleveraged hedge funds, made it clear that people remote from speculation on housing prices and sub-prime loans could be hurt badly – even if they did nothing wrong.

Some would argue that there should be have been more “laissez-faire” policies implemented, but the leadership of both political parties came to understand the need to consider housing in total as a “commonwealth” that impacts all of us. (This is stated more as a future historian might. Neither party used the term in its electioneering or its policy statements.)

Dr. Joseph E. Scherger will make the National Conferences lead-off presentation
Dr. Joseph E. Scherger will make the National Conference’s lead-off presentation

The same elements are there in health care, but it is even more precarious. If we could move back the clock to 2004, there are several things the nation could have done to prevent the collapse in housing and its devastating effect on financial institutions. However, the vulnerabilities in health care are omnipresent, and getting worse. There are fewer simple “fixes” in health care as there could have been in housing.

Doctor Scherger returns to Monterey, the site of his presentation of the Third G. Gayle Stephens Lecture at the Fourth National Conference on Primary Health Care Access, which might be perused on this website at The Third G. Gayle Stephens Lecture by Joseph E. Scherger, MD, MPH.

Sub-theme: Primary Health Care Access – Forty Years in the Wilderness: Unintended Consequences of the Health Care Reforms of the 1960s.

The year 1969 seemed like a year of promise for the health care system in the United States. Medicare and Medicaid had become law, and was in the process of implementation. The new Nixon administration (even though railing against the underlying concepts of the previous administration’s “Great Society”), within a year would bless such innovations as an expanded role for the United States Public Health Service, including establishing the National Health Service Corps and the “federally qualified” community health center and defining “primary health care shortage areas”. Both the public and private sectors had endorsed the idea of rejuvenating the “general practitioner” in the newly established specialty of family medicine.

Yet things happened that neither the supporters for nor detractors from an expanded government role in primary health care had expected nor intended to happen. For example, the structure for “charity care” that existed in most communities in the United States, was obliterated in many of them, without Medicaid replacing them.

The federal government intervened massively in the health care system through the Medicare program, yet – without consideration of what the consequences might be – delegated to private entities such important tasks as defining “relative value scales” on how much to reimburse physicians and health care providers.

As part of this sub-theme, a panel of plenary faculty will conduct a roundtable discussion identifying specific decisions and non-decisions that have created the current crisis of “the uninsured and underinsured”.

Doctor J. Jerry Rodos, Dean Emeritus of Midwestern University’s Chicago College of Osteopathic Medicine, who has been an esteemed member of the nineteen previous National Conference faculties, returns again in his role of historian of medical education policy development in the United States.

Dr Rodos’ major plenary presentation for the Twentieth National Conference is entitled: “The Majesty of History and its lessons for health care reform: an overview of the Glass-Seagall Act, The Social Security Act (FICA) and the role of Congress.”

Dr Rodos, who was the 1995 Charles E. Odegaard Lecturer also will take part in a roundtable discussion in which he joins a previous G. Gayle Stephens Lecturer, Doctor Alfred O. Berg (1994) and a Previous Charles E. Odegaard Lecturer, Doctor Mark E. Clasen (1996), on the continued relevance of the topics they discussed in the mid-1990s to today’s problems.

Additionally, Doctor Jack Colwill, an emeritus member of the Council on Graduate Medical Education, will analyze and comment upon national physician workforce projections.

Doctor Richard Clover, Dean of the University of Louisville School of Public Health and Information Sciences, will provide his perspective on the public health challenges facing the United States.

Sub-theme: Primary Health Care Access: The Promised Land – What Can Go Wrong: There is the Will, Now is there the Way to Make Things Better Without Making Things Worse?

Much of the National Conference will be spent seeking to understand the mistakes of the past, in an attempt to identify what must be done to obtain real health care reform.

In a later session, Doctor Mark E. Clasen of Wright State University Boonshoft School of Medicine will lead a panel entitled “Right or Risk Pool?: Issues Raised When the Insurance Industry is Expected to Manage Health Care Reimbursement”.

Recently, concerns have been raised about the adequacy of life insurance companies investments to meet their contractual life insurance obligations to their insured. Even so, their risk pools have been carefully selected, and actuarial information employed to assure an extremely high likelihood that all such obligations will be met.

Almost no one has articulated a “right” to life insurance that would impose external obligations to such risk pools. It is quite a different matter regarding health care.

If public policy were to be aimed at requiring insurance companies to add large numbers of presently “uninsured” to their risk pools, it could play havoc with any actuarial calculations they have made. But if insurance companies are to be the major managers of health care payments, how can all of the uninsured become insured without a major transformation of that industry, with unfathomable unintended consequences? But is our nation ready to agree that there is no right to health care, thus alleviating any “pressure” on health insurance companies to cover substantially greater numbers of persons, and these for substantially greater levels of service?

And, can we even be sure that the insurance industry, with its presently “pre-selected” risk pools, has a handle on the costs of managing the high costs of the present health care system as the nation’s population ages, any more than investment bankers had a handle on entering mortgage contracts at high interest rates with persons unable to afford them?

Also, as part of this sub-theme, Doctor Terry Zollinger of Indiana University will lead a panel entitled: “The Concept of a Medical Home: A Key Part of the Solution?” Other topics will announced soon.

Special Topics: Family Medicine and Community Need

Doctor Rick Flinders of the Sutter Santa Rosa Family Medicine Residency Program in Santa Rosa, California leads a panel entitled: “The Family Medicine Residency Program as a Community Change Agent”.

Doctors John Boltri and Judith Fifield will update the National Conferences on Mercer University’ Department of Family Medicine’s program to develop church-based community diabetes programs.

Doctor Margaret McCahill will update the National Conferences on the University of California San Diego/Saint Vincent de Paul Village joint family medicine-psychiatry residency program, located in Southern California’s largest facility for serving homeless populations.

Doctor Hector Flores of White Memorial Medical Center, Los Angeles joins Doctors Flinders, Boltri and McCahill in a panel discussion.

Stanford University’s Virginia Fowkes will make a presentation on community need issues in San Jose, relating to the transfer of a community-oriented residency program from one hospital to another. She will be joined by O’Connor Hospital’s family medicine residency director, Doctor Robert Norman.

The Importance of Geographic and Population-based Goals in Health Care Reform: Development of Policy Papers

In the 1960s a major goal of health care reform was addressing the needs of underserved or inadequately served geographic areas or populations. The institutional bases for addressing these needs included the evolution of community health centers, rural health initiatives, and activities of the United States Public Health Service and Indian Health Service. The principal medical education reform was the creation of family medicine education and residency programs with geographic goals.

The National Conferences, through the National Project on the Community Impact of Family Medicine Residency Programs, has conducted an ongoing study of the populations and communities served by family medicine residency programs. A task force has developed the framework for three policy papers, each of which will be addressed in activities of the morning breakout groups.

The current drafts of the policy papers can be accessed on this website. (See February, 2009 archives for the texts of the three papers or follow the hyperlinks for Care of Underserved Populations, for FMRP Impact on Medical Community, and for Public Health Impact of FMRPs.)

The Named Lectures and other Major Presentations

The distinguished permanent faculty of the National Conferences includes noted author Doctor John Geyman, Emeritus Professor of the University of Washington. For the seventh consecutive national conference, he will make a major presentation in the field of health care policy. For a feature on Doctor Geyman’s series of presentations, see: Noted Author John Geyman in Eighth Appearance at the National Conferences on Primary Health Care Access

Doctor David Sundwall, Director of Public Health for the State of Utah, has been designated the Nineteenth G. Gayle Stephens Lecturer.

[Left: Doctor David Sundwall, Director, Utah Department of Health will present the Nineteenth G. Gayle Stephens Lecture.]

Doctor Sim Galazka of the University of University of Virginia has been designated the Sixteenth Charles E. Odegaard Lecturer. The topic for his lecture is “The Role of Academic Medicine in Rural Health and Medical Care”.

[Below: Doctor Sim Galazka will present the Odegaard Lecture.]

Doctor Jonathan Weisbuch, MD, MPH, former medical director for the public health departments of the City of Phoenix and the County of Los Angeles will present the Fifteenth J. Jerry Rodos Lecture.

[Below: Doctor Jonathan Weisbuch, the Rodos Lecturer.]

Provoking Thoughts

One of the innovations of the 20th National Conference will be designation of key faculty members as thought provocateurs. Each presentation in the thought provocateur series of topics will have a responder panel.

Proposition: American health care should be considered a public utility, for whom the cost and provision of basic services should be regulated by federal and state governments.

(Provocateur: Doctor Marc E. Babitz)

Proposition: The federal government, in coordination with states and private health care entities should assure that networks of primary health care training programs exist, with strategic mechanisms including decentralized medical school admission and education models to ameliorate the geographic maldistribution of primary care physicians. Such networks would include specific obligations for care to underserved and safety net populations.

(Provocateur: Doctor Kevin Murray)

Proposition: The federal government should establish a clear policy on what should constitute basic health care rights for Americans and mechanisms for assuring that basic health care services are accessible to them.

(Provocateur: Doctor Joshua Freeman)


The following are confirmed faculty as of 3-18-09. 

Marc E Babitz, MD, Utah Department of Health, Salt Lake City

Alfred O. Berg, MD, University of Washington, Seattle

John Boltri, MD, Mercer University, Macon, Georgia

Mark E. Clasen, MD, Ph.D. Wright State University Boonshoft School of Medicine, Dayton, Ohio

Richard Clover, MD, University of Louisville (Kentucky)

Jack Colwill, MD, University of Missouri, Columbia

Ana Eastman, MD, Presbyterian Intercommunity Hospital, Whittier, California

Judith Fifield, PhD, University of Connecticut

Rick Flinders, MD, Santa Rosa Family Medicine Residency, Santa Rosa, California

Hector Flores, MD, White Memorial Medical Center, Los Angeles

Virginia Fowkes, Stanford University, Palo Alto California

Joshua Freeman, MD, Kansas University Medical Center, Kansas  City

Donald Frey, MD, Creighton University, Omaha, Nebraska

Sim Galazka, MD, University of Virginia, Charlottesville

John Geyman, MD, Friday Harbor, Washington

Kevin M. Haughton, MD, University of Washington Family Medicine, Olympia

James Herman, MD, Penn State University, Hershey, Pennsylvania

Margaret McCahill, MD, UCSD St Vincent’s Psychiatry/Family Medicine Residency, San Diego

David McClellan, MD, Texas A & M Family Medicine, Bryan

Kevin Murray, MD, University of Washington Family Medicine, Tacoma

Robert Norman, MD, O’Connor Hospital, San Jose, California

Charles Q. North, MD, MS, U. S. Indian Health Service, Retired, Albuquerque, New Mexico

J. Jerry Rodos, DO, Midwestern University, Western Springs, Illinois

Robert Ross, MD, Sky West Medical Center, Klamath Falls, Oregon

Joseph Scherger, MD, San Diego, California

David Sundwall, MD, Utah Department of Health, Salt Lake City

Jonathan Weisbuch, MD, Phoenix, Arizona

Allan Wilke, MD, University of Alabama, Huntsville

Terrell Zollinger, DrPH, Indiana University, Indianapolis

 

Concepts

Among the concepts integral to all of the National Conference activities are the propositions that (1) all Americans should have access to primary health care, (2) that health care resources should be geographically distributed to promote such access, with special attention to rural and inner city areas, (3) that the concepts of family medicine, and of accessible comprehensive and continuous health care services are critical elements for improving health care in the United States, (4) that family medicine residency programs and community health centers enhance primary health care access.

Registration fee INCLUDES hotel room

The Twentieth National Conference registration fee INCLUDES three nights of hotel accommodations (Sunday, April 5; Monday, April 6 and Tuesday April 7, checking out at noon on April 8, 2009.)

About the National Conference:

The Twentieth National Conference, like its predecessors, is an intense two and a half-day experience that begins in assigned breakfast breakout groups each date at 6:30 a.m. and continues through mid-day.

No events are scheduled on Monday or Tuesday afternoon or evening. As with all of the National Conferences, spouses/partners and families are welcome and encouraged to come. The dedicated free time permits conference registrants to assure their families that they will have time for them. Alternatively, it permits registrants to enjoy the surroundings in one of the world’s premiere destinations.

The Coastal Research Group requires that all registration fees be received in advance, including for extra room nights, and does not permit refunds. However, a full credit for all payments may be applied to registration for future National Conferences (provided that a cancellation of a registration is received in time to prevent the impostion of charges on the Coastal Research Group, which would be deducted from any credit). All persons holding credits are automatically invited to future National Conferences.

For further information, contact the Coastal Research Group at [email protected]

One Reply to “Twentieth National Conference on Primary Health Care Access in Monterey”

  1. There was a time when, if you wanted to become a physician, the bankrolling required more than the velleity of simply making the making the choice and the financing appears.
    Then in the 1950’s and 1960’s the (then) HEW came up with what seemed a simple solution to the health care conundrum: financial aid to medical schools. They planned to flood the market with new MD’s and so cause increased competition to lower the cost factor attributable to doctors’ incomes.
    In the mid 1970’s I was a dinner guest of a brilliant couple of Washington health apparatchiks. He was (among other things) guiding the nascent EPSDT program. And she (the sister of one of the Brookings Institution’s leading economists) was eventually to become the Director of the National Center for Health Statistics. In short, not only were they broadly wired into the beltway health establishment, they had their hands on the steering wheel.
    Another guest that evening was the wife of a health economist who had recently been jilted by her co-researcher husband. And she was getting back at him by blabbing about the results of their latest findings, before they had been published: financial support of medical education was having the opposite effect on health costs than they had anticipated!
    Although the money given to Medical Schools had worked to increase the supply of physicians, there hadn’t been the expected depressive influence on doc’s incomes. They had found that wherever there were new MD graduates, they would produce medical care and make a handsome income while doing it. The equation was more docs=more procedures and higher medical costs—not lower fees.
    By producing more Docs, Washington had increased the supply of costly medical care providers who continued to command a great return on the investment the government had made in their education.
    There was amused consternation around the dinner table. Medical Economics had not responded to the “Law” of supply and demand. “Well, maybe we’ll do better with this new entity, The HMO.”

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