"What to Expect" 25th National Conference Monday Breakout Group Scribe Notes, Groups 1 and 2

The topic for seven assigned breakout groups at the 25th National Conference on Primary Health Care Access was the following:

What do you see as the endurable successes of the ACA? Are there elements of the legislation that you believe will not be in existence at the end of this decade?

The introduction to the topic is found at:  “What to Expect”: 25th National Conference Monday Morning Assigned Breakout Groups.

The participants in Group 1 were Doctors Marc Babitz (Senior Fellow, Coastal Research Group, Lead); Suzanne Allen (the 2014 Norman B. Kahn National Conference Scholar), Donald Frey (Fellow, Coastal Research Group); Norman Kahn (Senior Fellow, Coastal Research Group), William Norcross (Fellow Coastal Research Group) and Elisabeth Schlegel (the 2013 Marc E. Babitz National Conference Scholar).

A sailboat navigates the waters of San Francisco Bay
A schooner navigates the waters of San Francisco Bay

Discussion Group One (William Norcross, University of California, San Diego, scribe)

Endurable Successes?

PPACA: Some states might keep some elements.

Gone at End of Decade?

PPACA: Too few healthy people enrolled (although it might have worked with a “public option”

If PPACA is repealed, uncertain what each state would keep, if anything.

The guarantee that patients with pre-existing conditions will not be refused admission to plan. (Insurance industry will argue as unfair.)

Comments:

We need to take the step of instituting national health insurance, which is not funded through business, and, therefore is not a “job killer”.

Because PPACA has become identified with one political party (Democrat), its ultimate success will depend on how that party fares in the 2014 and 2016 elections, and whether such constituencies as the Latinos and the poor vote.

The primary care physician gap is not being filled by family medicine. Walmart clinics utilizing nurse practitioners have become popular. “Disruptive innovation” may prevail.

Could the physician specialty societies work gtogether to design an optimal United State  physician-centered workforce plan?

A view of Stow Lake in San Francisco's Golden Gate Park
A view of Stow Lake in San Francisco’s Golden Gate Park

The participants in Group 2 were Ana Bejinez-Eastman, MD (Senior Fellow, Coastal Research Group), William H. Burnett, MA (Senior Fellow, Coastal Research Group), Walter Mills, MD (2014 Perry A. Pugno National Conference Scholar), Caryn Slack, MD (2014 Michael D. Prislin National Conference Scholar) and Daniel Webster, MD.

Discussion Group Two (Elizabeth Kimball, Accreditation Council for Graduate Medical Education, Chicago, scribe)

Endurable Successes?

PPACA brings into focus some of the costs previously undisclosed. By creating new kinds of insurance company “risk pools” in which persons with existing conditions cannot be excluded, will result in both health care’s always visible and its previously  hidden costs being quantified.

Increased transparency will lead to increased accountability.

The financing of high cost interventions (such as pharmaceuticals) for certain chronic diseases such as HIV.

Gone at End of Decade?

The financial intermediary role that insurance companies play in the administering of health care delivery in the United States, replaced by single payer mechanisms.

The “names” chosen to describe those in need of better health care systems: “Medically Uninsured”, “Medically Underserved”, as well as “Patient Protection”, “Affordable Care Act” and “Obamacare”.

Comments:

A key question is where one should go to receive care. There will be a big impact for all exisitng delivery systems, some of whose futures are uncertain.

The continued fragility of the primary care network needs to be addressed. Perhpas “primary care” should be renamed, recognized the specialized skills to manage complexity.

There could (and arguably should be) a movement to federalize (through a Medicare like financial system) care for those either 18 years and younger, or 26 years and younger.

The division of the country into two political parties of approximately equal political power, prevents a “knockout” punch by either party that would result in a settled national health care policy.