The experience tells us that affordability and private insurance is an illusive goal. Instead in both the aca and employer coverage it was extremely Narrow Networks of providers and more and more cost sharing for patients features that reduce both choice and affordability. They were so, they were very unified in opposition to universal programs up through medicare. And that was a last ditch attempt to oppose a national reform. So after the 70s, and costs increating, and private insurance increasing in the system, they use change. But by the time debates in the 90, positions, more divided. They fought their ability to Practice Medicine as they saw fit. But by the 90s, many, many many physicians were under the benefit of the companies. So they saw more value creating the system where everyone would be ensured. And that would remove the barrier between dr. And patient that the Insurance Companies had become. So some provider groups like in family medicine, pediatrics, they have come out more strongly since the 90s infavor of a universal plan. It is back to the old tricks when it comes to advertising. I just saw some of the new ads that are being put out against the medicare for all idea. So it seems to me that the ama is coming out against the proposals for single payer, but that should not lead us to make assumptions about what a physicians physician is. They are really more diverse than they used to be. I just want to under line the diversity as there is no one physician position on anything. And there was not on anything in the past as well. There was always doctors that were critical of that fee for Service System that i spriebed to you and it predicted the problems that would arise with us with it, and i would say today one of the major divides in position spn is around the primary care positions, they have eroded dramatically. So people who provide types of care are really at a disadvantage in the current marketplace. And they are more interested in solutions that might shift that you know i talked about the generalist to specialist that have shifted and the specialist going back to the generalist, and that is a big difference with european systems where the control over specialism is much tighter. You cant just go to a specialist any time you decide to. Yes. I mean, there is a long history that we cant get into for how the organized Labor Movement helped with the change. It left out women and people of color. It kind of shot itself in the foot. I talked about it being organized around Service Industry unions. And they have come back in terms of trying to change the insurance system. But certainly back in the day organized labor was seen as being the equivalent. They often could drive better rates from blue cross blue shield. Just the side and the membership. Yes, but that backfired with them being just communistic socialistic medicine. So reforms. Do you think the examples of European Countries are fully applicable despite much smaller your point taken, that the netherlands is the side of maryland. The kinds of problems they face are different. If you look at germany, that is a much bigger country with a larger population. I think the United States could learn a lot by looking at how our capitalist democratic peer nations managed the rise of bio medicine since World War Two. Its correct that not everything will be applicable. But trying to get a sense of why their cultural preconceptions are so different. In my work i came to see World War Two as the kind of fulcrum that because germany and france were destroyed they had a sense of solidarity that you dont see in the United States. It is devastation in our own land and we did not come out of it with the sameceps of having to rebuild from the bottom up. So i think there is a lot that in a lot of ways the examples are not comparable. The systems that nancy is talking about is also very diverse. We can look at different models, but there is something that applies everywhere regardless of population. Some have a role for private insurance, some are socialized medicine, but they all have in common that everyone is covered, every resident in the country is covered, and that these two, a pooling of risk, which helps bring down costs, and the other thing they have in common is that every every provider are in the same system. It leads to choice of provider. So those are lesson thats can be applied to any population i think. Certainly the fact that many wounded veterans got excellent medical care and they wanted that for themselves and their families. And that was a source of support for the truman type plans, it just didnt succeed. Briefly for maternity care, for soldiers wives, the Emergency Care act. It was only temporary. Having to inform and give decisions to inform and help with the Decision Making by policymakers. I think we have to look at history in order to have an honest conversation about what is happening now. A lot of and a lot of the health care debates today is not based on accurate descriptions of the u. S. Or Foreign Health care systems. So what do we mean when we say universal health care. How do Foreign Countries do what they do. I think history, if i can brag about our professor, we provide accuracy in debates. So if the key is reforming private insurance, how can we go about doing that . Well saving the sufficientest for last. Yes. The question of were in the private Insurance Industry. If we went to a single payer government run system, how many people would be out of a job. So one of the arguments for the system that i described was the high paying ploemt that emplt that it produced. Our costs are probably the highest in the universe. We like the economic benefit. Changing that is really going to require an enormous i would say brokering of economic interests so that the private Insurance Industry could accept the change. That is one reason they personally dont, i think a plan is more likely to work. It is really difficult for us to see a role for private insurances that it now exists. The systems that include a private role, most of them are actually nonprofit. Theyre price but theyre nonprofit. It is will a major i think im laning towards private insurance moving through this entity. They have too much say in our politics and and the main take holder with the people in this country, they should have less private insurance and have less of a say, they tolerate a higher level of government regulation of provider behavior, prices, and who gets what care. And until we can accept that april that government needs to regulate, and i mean hard regulation, these problems are impossible. How have states relationships with the Health Care System evolved overtime . That is a question about state initiative. Yaet question. Well the Health Insurance debated began at the state level. Nation n National Role for the states that was reserved in helping the state Health Care System, but i think the reality historically is that when health care can deinvold devolve to a state responsibility. And there is inequity in the system. There is so much differential between states. So the states have a role to play but they also have a role to play in preserving inequity in our system. I think because of our federal layer cape system there is potential for states to try out different funding schemes and possibly being a european model. If you can make it work in massachusetts, in washington state, and then that could possibly influence federal policy. What common themes have you observed what seems to be problematic and what creates progress. The problems are easy. That is mostly what we talked about. The theme that keeps coming up over and over again. The distortion, the debates, so that when they take place politically, theyre not they distort the reality of our Health Care System. So we are have not had an honest discussion and it was necessary in order to change it. I would say one of the les n lessons that i have learned is the dangers of hyper individualism. This sf a quoting of a recent commentator that america has lost its since that were all in this together. And that we do not have a sense of solidarity. What is wrong with people. And also to have competition. The worst thing you could do is to have people fear that their health care will be recovered. They start to worry they will be lazy unmotivated people. It is not going to be your family it is the family across the street. Perhaps one big that bares discussion. And on those lines, one example of success is not a top down process. So medicare is attributed to Lyndon Johnson and his negotiating prowless. He was pushed by organizations to take the kind of stand that he did on medicare. Again i think it goes back to the people organizing and they are the ones who pushed him. Thank you to all of our presenters today. A preview of what is available every weekend on cspan 3. Tuesday, smithsonian associates, the great great grandson of theodore roosevelt. A contrary view on how failures and reinventions have lead to our modern core values. American history tv every weekend this weekend on cspan 3. Every hasaturday night, lectures in history. Raise your hand if you heard of the gene harris murder trial before this class. The deepest cause will be in this transformation that took place in the minds of the american people. So were going to talk about both of these sides of this story here, right . The tools and tech nicks of techniques of slave owner power. Lectures in history on cspan 3 every saturday at 8 00 p. M. Eastern. It is also available as a pod cast. Investigation has changed in 40 years, but this year we brought you primary election coverage, the president ial impeachment process, and now the federal response to the coronavirus. You can watch all of the Public Affairs programming on television, online, or listen on our free radio app. Be part of the National Conversation through the daily washington journal program. Created by private industry, americas Cable Television companies, as a public service, and brought to you today by your television provider. Next, congressional members hear from a a expert on Irans Nuclear perhaps with the assistance of theizeen Hour Administration as part of an amends for peace initiative. Okay, good
comparemela.com © 2020. All Rights Reserved.