“What to Expect” McCanne, Q and A

We gratefully acknowledge the sponsorship of the Penn State University Hershey Medical Center Department of Family Medicine for funding the transcription and editing of this section of the Proceedings of the Twenty-Fifth National Conference:

This section follows: Proceedings of the 25th National Conference – Thought Provocateur #1(McCanne) “What to Expect: the PPACA’s Promises Unkept”.

The designated lead questioner for the morning’s Thought Provocateur Session is Doctor David Sundwall, of the University of Utah [Dr Sundwall is a Senior Fellow of the National Conferences]: 

 David N. Sundwall, MD University of Utah
David N. Sundwall, MD
University of Utah

Hi, I’m David Sundwall and I’m now a Professor of Public Health at the University of Utah.

First of all, thank you for a really scholarly overview of what’s wrong with the ACA. It’s just great, because as a Republican you can imagine the ammunition I have now to say what’s wrong with the ACA. (I’m saying that to be kidding.)

Dr McCanne: But you’re welcome to use it.

Dr Sundwall: I put in the partisan dig here because I once mentioned in a meeting that in Washington, D.C., I was described “every Democrat’s favorite Republican”. To which Doctor Alfred Berg  raised his hand and said he thought I was his only Republican acquaintance. But, aside from politics (and this is clearly politics), you’ve done a great job of laying out a lot of the reasons why the Affordable Care Act falls short.

Don McCanne, MD Physicians for a National Health Program
Don McCanne, MD
Physicians for a National Health Program

I do also want to tell Doctor John Geyman I’ve come around on “single payer”.  You know that I was teasing him at one of these meetings a few years ago. I said “Oh for heaven’s sakes. You might as well move to Canada, You sound like a Canadian Aocialist or something. Well now, I clearly agree that a single payer is the only thing we’re ever going have that will work, f we can ever achieve that. Tomorrow, I’ll be talking about some steps we might take in the direction of “single payer.

Dr McCanne: Thank you.

Dr Sundwall:  Remember, that Republicans have a heart, Some of us! We’re all so smart about how to manage money but ACA is not the way to do it.

But in addition the flaws you’ve mentioned, there’s another one that you should include in your list. It’s a huge problem that I call “the family glitch”. In fact, in Utah it’s about a third of all eligible people that would qualify for some new benefit but they can’t because in the law it says people making,

if they’re employed and if its, if the premium for that insurance that their employer offers is only 9 point something percent then they must use employer based insurance. That’s for a single person plan, it’s not for a family plan which could be two, three, four times more than that price at which essentially means they can’t have public assistance and they can’t afford private insurance. There are many, many flaws in this system and I just appreciate you pointing them out.

I guess my only question for you would be if, and we’ll talk about this I’m sure through the course of our meeting but if you and your energy and your leadership and your intelligence about all of these things; how do we get from here to there? Do you have some suggestions on what we might do as a, you know there’s a lot of brain power in here and some influence too. Where do we go now?

The role of the people in this room is education. Educating others, it’s educations, coalitions, grass roots efforts, but our role should be education so people understand, politicians understand, the public at large understand, the tea party people understand that when they say keep the government out of my Medicare, that you explain to them what that means. Education.

I just got to tell you that was famous, a women in Chicago actually hit Rostenkowski with her purse and as she was slapping him said “get the federal government out of my Medicare”.

Charles Q. North, MD, MS; University of New Meixco, Albuquerque: [Dr North is a Senior Fellow of the National Conferences: Hello, my name’s Chuck and I’m a recovering Republican. Probably like John Geyman.

Charles Q. North, MD, MS University of New Mexico
Charles Q. North, MD, MS
University of New Mexico

I grew up a Republican in Washington State, just too close to Canada to continue. And I think the point you make should be taken up by the Chamber of Commerce as they fight the tea party for selecting candidates in the Republican Party and I think the contest ought to be between who can have the best single payer system proposal from a political party. I read your daily comments and I appreciated the one in British Columbia having been there a couple weeks ago.

It’s this morning’s comment.

And I’d like to point out that I talked to a family doctor in Prince George, British Columbia,  who said that a family doctor in British Columbia can make as much money as an orthopedic surgeon $400,000-500,000 by serving isolated communities. So there is some justice in the pay gap there also.

But I think the most important point you made was in inequality in this country and the social stress that that causes for all of us, not just the poor, but for the middle class and the wealthy too. And I wondered if you could comment on the book that you quoted from and I read your book review in your daily comment so I thought it was really worth mentioning again.

Thomas Piketty is a French economist and Emmanuel Saez who’s here at the University fo California Berkeley is also a French economist but he’s over here permanently. And they’ve worked together to analyze what’s happening with income and wealth. And the last three decades it’s been a nightmare as far as where we’re headed. We are very close to social disruption.

Last time I tried. I got a copy, I tried to get another one and they were sold out. But so, it’s people are reading it and it’s very, very important economic treatise, so.

Perry A. Pugno, MD, MPHA, American Academy of Family Physicians, Leawood, Kansas [Dr Pugno is a Senior Fellow of the National Conferences]: Perry Pugno. Sundwall Republican. In the spirit of Doctor G Gayle Stephens I think we’re at the point where the big red bull needs to become big red hamburger for all.

Very good.

I just want to say one little comment I didn’t mention. It’s at the bottom of my notes and I forgot to mention; I don’t know if any of you saw the article in the British Medical Journal it was just a week or two weeks ago. And it being across the pond and Nonpartisan, it’s not Republican, Democrat, but they essentially declared the ACA a failure.

They said because of the incredibly complicated roll out and the, and they were kind of chiding saying they seem to be celebrating they have seven million enrolled in the exchange and the last count was about 50 million uninsured. And then they furthermore, the most damning statistic I heard was that there are apparently more uninsured now than when Obama ran for office.

Well right now that’s not quite true because so many enrolled, but, yeah.

Well this was taking that into account and I don’t know their data, but regardless it was kind of a dispassionate apolitical view that I thought was damning. And then, I, my friends in Washington that are working so hard to get this too work say gosh it’s too early to say that, it’s too early to call it a failure because Medicare took a role, a year or two to get up and running. So maybe we need to give it a little bit of time but I don’t think the flaws are going to go away.

Well the end point in healthcare reform is not how many people we can get insured with crappy insurance. It’s how many people can we get healthcare that they need without having to face financial hardship.

Thanks Don.

Well I think you all would agree it’s been quite a morning. We’ll reconvene tomorrow morning at 6:30 in our breakfast group; and look at that day out there.