Verhoef 4

Verhoef: Healthcare reform in 2017, What does it mean for the intensivist?

Today we welcome another brilliant individual, Philip Verhoef, MD, PhD, FAAP, FACP. Dr. Verhoef demonstrates a significant level of dedication to medicine. Not only did he do a Med-Peds residency at University of California-Los Angeles, but he then went and completed a Fellowship in both Adult and Pediatric Critical Care Medicine at the University of Chicago (10 years of training!!). Since that time he has stayed on at the University of Chicago with an appointment in both Pulmonary/Critical Care Medicine and Pediatric Critical Care Medicine, recently rising to the level of Assistant Professor. He has also made a name for himself as a clinical expert on the REAL ramifications of the boom that is Healthcare Reform. Today he was kind enough to stop by for lunch and share a very concentrated view on the ACA, AHCA, and on the idea of Single Payer system. This talk is vital not only to the intensivist, but to everyone in the United States. I assure you, this is one lecture you will want to watch with the ENTIRE family!!

** Please also note the addition of the special extended lecture presented to the Baltimore Chapter of SCCM. This is a unique and rare opportunity to delve deeper into this topic. I assure you, it is worth the extra time!! **

Clinical Pearls

Realities:

  • Even in 2016, under the ACA, 29 million Americans still lack health insurance
    • Leading to 15-30k deaths a year!
  • We continue to be the only developed nation that does not guarantee health insurance to its citizens
  • Options:
    • Continue to support ACA
    • Repeal ACA
    • Replace with…….
      • The only way to install “Trump Care” is to support a “single payer” system

Single Payer, ala HR 676 (verbatim from slide as it is IMPORTANT)

  • Insurance is public, delivery is private
  • Every citizen is covered
  • Minimal or no deductibles and co-pays
  • Access to care based on need and not means
  • Insurance risk is managed by risk pooling alone, pooled across the entire population
    • Not shifted onto doctors, hospitals, and patients 
  • Vastly simplified administration
  • Minimizing centraled management of care and bureaucracy 

Verhoef 1

http://www.oecd.org/els/health-systems/health-data.htm

Current health state of the US

  • 50% of healthcare costs are from the private sector, a vast difference compared to nearly any other country (Chile and Russia being the exception)
    • Even with this, we are 11th in the world in overall health care rankings (due to access issues and lack of efficiency)
  • Why is the US so inefficient?
    • We pay the most out of pocket on a “per person” basis
    • We do not go to the doctor more than any other country (US: 4 visits per year, Japan: 12.9 visits per year!)
    • Biggest issue: EXPLOSION of health care managers and administrators
      • Increased need to pay new salaries without an increase in healthcare
    • Private insurance costs are 5-6x that of public insurance 
      • Insurance overhead is RIDICULOUSLY higher than other developed countries (advertising, marketing, etc.)
      • Medical-loss ratios are dropping (i.e.: insurance companies are retaining more money without releasing it for healthcare costs)
  • Prescription drug costs are exceedingly higher than other countries and continuing to increase!
  • Oddly, malpractice and defensive medicine is NOT causing this inefficiency
    • Inappropriate care MAY be the issue:

Verhoef 2

ACA: Main features

  • Expanded Medicaid to people at 138% of the poverty level (instead of 50-100%)
    • If you were at 139% – 400%, than you were subsidized to buy state-based health insurance
  • Mandated citizens purchase health insurance
  • Mandated medical/loss ratios to be <85%/<80% (for large/small insurers)
  • Bans pre-existing condition exclusions 
  • Also:
    • Children <26 yo were covered under parents plans
    • No cost sharing for preventative care
    • Defined 10 essential benefits that must be covered
  • ICU specific: bans lifetime dollar limits on benefits or rescinding coverage

Suggested Reading

  1. Bauchner H1. Health Care in the United States: A Right or a Privilege. JAMA. 2017 Jan 3;317(1):29. [Pubmed Link]
  2. Brice T, Unruh LY, Rosenau P, Barnes AJ, Saltman RB, van Ginneken E. Challenges facing the United States of America in implementing universal coverage. Bull World Health Organ. 2014;92(12):894–902. [Pubmed Link]
  3. Gaffney AW, Verhoef PA, Hall JB. Rebuttal From Drs Gaffney, Verhoef, and Hall. Chest. 2016 Jul;150(1):14-5. [Pubmed Link]
  4. Gaffney AW, Verhoef PA, Hall JB. POINT: Should Pulmonary/ICU Physicians Support Single-payer Health-care Reform? Yes. Chest. 2016 Jul;150(1):9-11. [Pubmed Link]
  5. Berdine GG. Rebuttal From Dr Berdine. Chest. 2016 Jul;150(1):15-6. [Pubmed Link]
About the Author

Jim Lantry

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Just your average critical care doc: Wandering the ED and ICUs for the USAF down in the San Antonio Military Medical Center, traveling the globe to cannulate for ECLS wherever the need arises, and trying to keep up with great minds of today. E: JlantryMD@gmail.com

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