28th National Conference Keynote Sessions to be Dedicated to ACA Issues of “Access”

The 28th National Conference on Primary Health Care Access is to be held April 10-12, 2016 at the Hyatt Regency New Orleans. Each of its three days will focus discussion of issues of access to primary health care, from national, regional and local perspectives.

Each of the last eight National Conferences has begun with plenary sessions that analyze an element of health care access.

John Geyman, MD

John Geyman, MDd critique the enactment and implementation of the Patient Protection and Affordable Care Act (referred to variously and ACA or Obamacare.)

On April 10, 2017, the discussion is resumed with two of the permanent members of the National Conference faculty, Doctor John Geyman, author and member of the University of Washington emertius faculty and Doctor David Sundwall of the University of Utah. [For their most recent discussion on the topic, see “What Should Happen Next”: Doctors John Geyman, David Sundwall discuss Obamacare

Doctor Geyman has been an eloquent critic of the corporate transformation of the medical profession and of the American system of health care.

He has argued that inherent in ACA are fundamental flaws that make the act ultimately unsustainable. A selection of Dr Geyman’s critical appraisals of the legislation may be found at “What Has NOT Changed” – A Critique of the Affordable Care Act: John P. Geyman, MD and Proceedings of the 22nd National Conference: Thought Provocateur Session #1 (John Geyman MD) – “What Will Not Work: The Fundamental Errors in PPACA”.

David N. Sundwall, MD; University of Utah

David N. Sundwall, MD; University of Utah

Doctor Sundwall has previously served as a staff member to the United States Committee on Labor and Human Resources, chaired by Utah Senator Orrin Hatch.

He also served as the Head of the United States Health and Human Services Health Resources and Services Administration under President Ronald Reagan, and more recently as the Director of the Utah Department Health under Governor Jon Huntsman and as a member of the presidentially-appointed Medicaid and CHIP Policy Advisory Commission.

After the keynote presentations by Doctors Geyman and Sundwall, presentations will be made by Doctor Norman Kahn, who is the Executive Officer of the Council of Medical Specialty Societies and Doctor Perry Pugno who is an emeritus Vice President of the American Academy of Family Physicians.

Doctors Geyman, Sundwall, Kahn and Pugno are all Senior Fellows of the National Conferences on Primary Health Care Access.

 

Confirmed Faculty: The 28th National Conference on Primary Health Care Access

The following members of the permanent faculty of the National Conferences on Primary Health Care Access have confirmed their participation in the 28th National Conference, to be held April 10-12, 2017 at the Hyatt Regency New Orleans. Other confirmations are expected soon. The list will be continuously updated.

The 28th National Conference Faculty (confirmed as of September 27, 2016):

A neighborhood in New Orleans' French Quarter

A neighborhood in New Orleans’ French Quarter

Suzanne M. Allen, MD, MPH, University of Washington WWAMI Program, Boise, Idaho

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

John Boltri, MD, Northeast Ohio Medical University, Rootstown, Ohio

J. C. Buller, MD, Touro University College of Osteopathic Medicine, Vallejo, California

Eileen Chiang, CMA, Family Health Center, Kalamazoo, Michigan

J. Scott Christman, MPDS, Office of Statewide Planning and Development, Sacramento, California

Mary T. Coleman, MD, Louisiana State University, New Orleans

Denise Crawford, MBA, Family Health Center, Kalamazoo, Michigan

Delight F. Erickson, RNC, FNP, MPH, Radius Medicine Group, Andover, Minnesota

Jeremy Fish, MD, Contra Costa County Regional Medical Center, Martinez, California

Rick Flinders, MD, Sutter Hospital, Santa Rosa, California

Donald Frey, MD, Creighton University, Omaha, Nebraska

John Geyman, MD, University of Washington Emeritus Faculty, Friday Harbor, Washington

Ivan Gomez MD, California Statewide Area Health Education Center, Fresno, California

Derrick Gruen, Adventist Heatlh Systems, Hanford, California

Jimmy H. Hara, MD, Charles R. Drew University, Los Angeles, California

Charles Henley, DO, Marian University, Indianapolis, Indiana

James M. Herman, MD, MSPH, University of Oklahoma School of Community Medicine, Tulsa

Norman B. Kahn, MD, Council of Medical Specialty Societies, Chicago, Illinois

Gary LeRoy, MD, Wright State University, Dayton, Ohio

Dennis E. Means, MD MMM, CPE, Family Health Center, Kalamazoo, Michigan

William A. Norcross, MD, University of California, San Diego

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

Keosha Partlow, Ph.D., MPH., Charles R. Drew University, Los Angeles, California

Perry A. Pugno, MD, MPH, American Academy of Family Physicians Emeritus, Lebanon, Ohio

Adalberto Renteria, MD, Adventist Health Systems, Hanford, California

Janice Spalding, MD Northeast Ohio Medical University, Rootstown, Ohio

David Sundwall, MD, University of Utah, Salt Lake City

Allan Wilke, MD, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan

The National Conferences on Primary Health Care Access: background

In 1990, a group of persons interested in family and community medicine, medical school reform, and advocacy for rural, inner city and other geographical areas of need, were invited to rural Wisconsin for the First National Conference on Primary Health Care Access. Since then, similar groups have been invited to assemble each Spring.

Periodically, landmark national legislation is enacted  (Medicare and Medicaid in the mid-20th century; the Affordable Care Act in the 21st), each of which has proven to have unintended consequences that exacerbate access to care.

Over the years, many of the pioneers, key strategists, researchers and policy makers who have promoted the idea of community-responsive medical education have participated in one or more of the National Conferences. (Many have participated in twenty or more of the 27 conferences held through 2016.)

The National Conferences have continuity in the conference faculty from year to year. The conferences are limited to approximately 55 participants. Persons who enroll in the conference series are invited to renew their space in each subsequent conference.

Public Policy and Access to Primary Healthcare

Lack of access to health care is a problem in most rural, inner-city, lower socioeconomic, and minority communities. That lack of access is in part due to the decline in the numbers of general practitioners and family physicians and the increase in medical subspecialists, who typically do not locate in inner city or rural areas.

The subspecialization of medicine increased in every decade of the 20th century and continues in the 21st. That specialization appears to be accelerating, and with it the decline in percentage of primary care providers when compared with subspecialists. (Many areas continue to experience an absolute decline in numbers of primary care providers.)

Trends suggest that current levels of funding for primary care activities are inadequate for turning the tide of subspecialization, and such new resources as might be commanded are marginal.

Hopeful approaches include the encouragement of strategies for increasing the cost-effectiveness of current levels of effort and the forging of strategic linkages between health care sectors such as primary care training programs, community-based health care delivery systems and primary health care professionals specifically trained to practice in communities of chronic physician shortage.

Such strategies and such linkages are the content of the National Conferences.

The National Conferences’ Named Lectures

G. Gayle Stephens, MD (right) with 12th Stephens Lecturer John Geyman, MD

The Coastal Research Group has sought to honor major intellectual leaders in the Family and Community Medicine movements.  Typically, each of the National Conferences on Primary Health Care Access has one of three named lectures associated with the conference.  One honors G. Gayle Stephens, MD, one honors the late Charles E. Odegaard, Ph.D. and the third honors J. Jerry Rodos, DO.  The lecturers in each series include many eminent figures in these movements.

The National Conferences have established named lecture series to honor three colleagues who have achieved prominence in their professional careers, and have additionally made significant contributions to the National Conferences. Continue reading

“Time Will Tell”: the Proceedings of the 26th National Conference – “Issues in the Training of Primary Care Physicians (Part One, Henderson)”, Monday April 13, 2015

We gratefully acknowledge the sponsorship of the Charles Q. North, MD of the University of New Mexico Department of Family and Community Medicine for his support of the transcription and editing of this section of the Proceedings of the Twenty-Sixth National Conference:

 

The following transcription is of the first plenary session of the 26th National Conference on Primary Health Care Access, held April 13, 2015 at the Hyatt Regency Orange County. This section follows: “Time Will Tell”: the Proceedings of the 26th National Conference – Introductory Comments, Monday April 13, 2015

Benjamin Fredrick, MD, Penn State University Hershey School of Medicine, Hershey, Pennsylvania [Doctor Fredrick is the 2013 Mark E. Clasen, MD, Ph.D. National Conference Scholar]:

Benjamin Fredrick, MD; Penn State University, Hershey

Benjamin Fredrick, MD;
Penn State University, Hershey Medical Center

Good morning! My role today is to be the moderator, which is largely a time keeper. For those of you who have not been here before, welcome! I think you’ll really enjoy this conference and these conversations over the next three days. They’re thought provoking and challenging, with lots of new and controversial ideas.

There’ll be a question and answer session following each of the presentations. After each presentation there will be an assigned lead questioner. That individual comes up to the microphone, and asks a question related to the session. Others are welcome to line up behind the lead questioner. When you do, please state your name and where you’re from for the record for the transcription.

For those who are new National Conference Scholars this year, I was a new scholar position as a National Conference Scholar three years ago, named after Dr Mark Clasen, who is with us at this conference. Each new Scholar is named after one of the National Conference’s Fellows or Senior Fellows.

Without any further ado, I’m going to ask the three individuals who constitute the National Conference’s first plenary panel, entitled “Issues in the Training of Primary Care Physicians”, with Tim Henderson from George Mason University, Stanley Kozakowski from the American Academy of Family Physicians and Thomas Hanson from Advocate Healthcare in Chicago.

Tim Henderson, MPH, George Mason University, Fairfax, Virginia [Mr Henderson is a Senior Fellow of the National Conferences.]

Tim Henderson, MPH; George Mason University

Tim Henderson, MPH;
George Mason University

Good morning! It’s good to be back. Let me ask you first of all, you can see I’m going to be talking a little bit about the Institute of Medicine (IOM) Report that came out in July, 2014.

I’m not going to be addressing issues about the clinical aspects of the report or the number of physicians that should be trained. I’m going to be looking at the report’s implications for public policy and the public good.

This was a very controversial report and I suspect we might have a number of different opinions in this room about the recommendations that IOM made on the report.

26PHCA HENDERSON (300) SLIDE1

I want to look first at the goals that IOM set out when they developed when they produced this report. There were six major goals that were issued here. The reason for the different colors there is this is what I’m going to be  paying particular attention to are the goals three, four, and five of the report.

26PHCA-HENDERSON (425) Slide2

I will not be talking about ways to address curriculum innovation, or practice incentives and so forth that a lot of the graduate medical education (GME) policy parts were related to, but instead to talk more about the controversy associated with how accountable GME is, particularly as a public good.

As IOM points out, it costs about $15 billion to support graduate medical education. GME is largely a government subsidy; largely Medicare, Medicaid and a few other sources of payment. I’m going to be talking about what the report addressed in regards to how effective it is as a public subsidy and to what extent GME is being accountable to the public

26PHCA-HENDERSON (425) Slide3

I love this quote from the report. “The critical missing piece in GME governance is the stewardship of the public’s investment. The public has the right to expect that its investment will be used to produce the types of physicians that today’s health care system requires. Under the status quo there are no mechanisms, or basic infrastructure to make this possible.”

26PHCA-HENDERSON (425) Slide5

In essence, they’re saying the financing and governance of GME are essentially disconnected. I’m going to provoke you to respond as to whether you agree or not agree with that statement. But I think this is one of the fairly bold statements that the report makes – that clearly there’s a missing link between what the programs do and what the taxpayers want from those dollars spent.

The IOM report goes on to say that clearly the stewardship of public funding is lacking. They gave a number of examples to support this statement: (1) the GME system does not yield useful data on program outcomes and performance, (2) there is no mechanism for time payments to the workforce needs of the healthcare delivery system, (3) there is no requirement that after graduation from a Medicare or Medicaid supported residency program that physicians accept or provide services to Medicare or Medicaid patients. The  only mechanism for insuring accountability is the requirement that residency programs be accredited.

26PHCA-HENDERSON (425) Slide4

These are pretty bold, critical statements made by the report to support its contention that stewardship is lacking.

The IOM went on to ask, who really is accountable for GME funding? I think they were quite concerned, as suggested by the quote “there is no overarching system to guide GME funding in the interest in the Nation’s local or health or regional health workforce needs. CMS, the Centers for Medicare, Medicaid Services simply acts as a passive conduit for GME funds, distribution to teaching hospitals. Medicare GME funding is formula driven and essentially guaranteed. How the funds are used is at the discretion of the hospitals. Program outcomes are neither measured nor reported. And to the extent that there is accountability, it’s accountability of the teaching institution and to its own priorities. And to accreditors and not to the public that provides the funds.”

The crux of the concern that IOM is speaking to here; is its question as to where is the link, where is the accountability to this $15 billion that comes from taxpayers for the use of these funds?

The public, the report goes on to say, in order to actually promote accountability effectively, and good governance requires transparency.  (Many of you know I am a governmental public policy- oriented person professionally interested in this issue.)

The public clearly needs to know what their dollars are being spent for and what those funds are used for. The problem is that the GME system currently is not transparent, and not answerable to taxpayers, as to what the funds are used for.

26PHCA-HENDERSON (425) Slide6

Here’s some examples of where they find a lot of transparency lacking, Do we have the outcomes and data associated with what those answers are. Do we even know much each teaching institution receives in GME funding each year? What proportion of these payments are used?

Those of you who work in training institutions inside the hospital, know we have a “black box” problem in terms of where the money goes.

26PHCA-HENDERSON (42) Slide7

Little is known about the overall cost. Of course, we know that of residency training. CMS is in part the culprit, because they only require that hospitals report a minimal amount of information back to them in order for them to continue to receive Medicare funding in particular.

The key here is the third point, that GME program staff have little knowledge of, or control over, how GME funds flow within their own institutions.

26PHCA-HENDERSON (425) Slide8

This is the black box phenomenon. We know that the monies flow into the coffers of the financial controller of the hospitals, but we clearly don’t have much information about where the money goes from there.

As I end here, these are some of the questions I’d like us to think about moving forward.  Who in the GME system has the most willpower to incentivize GME’s future? Who really does? Are they the advocates of reform, or are they advocates of the status quo.? If you’ve read the report and you’ve read the aftermath of the report, you know how certain major players among the system’s stakeholders came forward and immediately either promoted or denounced the recommendations. You can see where some people took sides. But how do you feel? Do you think the chances of this getting changed are going to lie in the status quo or in the reform movement?

26PHCA-HENDERSON (425) Slide9

Who has the most to gain or lose from GME reform? As far as the teaching hospitals, or is it the general public, residency programs, others? Who is really going to gain and lose the most?

To center on this issue of public accountability I’d like you to think about whether there really are advocates for the public good out there as far as GME is concerned? If there are not, should GME no longer be deemed a public good, worthy of this $15 billion investment? Should we, or those of us involved with GME, assume that the public is going to continue to want to invest this money through Medicare and other sources?

So, that’s some food for thought. Thank you very much!

28th National Conference – John Geyman MD on Health Care Reform 2017: What are our Options Now?

John Geyman, MD

John Geyman, MD

Doctor John Geyman’s insightful analyses of what he believes are the fundamental errors in the Patient Protection and Accountable Care Act [ACA] have been highlights of the National Conference on Primary Health Care Access over the past half decade, will be a featured speaker at the 28th National Conference on Primary Health Care Access, to be held April 10-12, 2017 at the Hyatt Regency New Orleans.

Dr Geyman’s presentation will be keynote on Monday morning April 10th.

Dr Geyman will be joined by a reactor panel enlisted from the permanent faculty of the National Conferences on Primary Health Care Access.

The National Conferences are invitational, and consist of approximately four to five dozen drawn from experts on health care policy, public health, community health centers and teaching health center projects, and academic health sciences center faculty. The National Conferences are conducted by the Coastal Research Group, a 501c-3 non-profit corporation devoted to healthcare workforce issues.

For information on the invitation process, contact William H. Burnett, Coordinator of the National Conferences at whburnett@coastalresearch.org.

The 28th National Conference on Primary Health Care Access to be held in New Orleans, April 10-12, 2017

For the first time, the Coastal Research Group will host the invitational National Conferences on Primary Health Care Access at the Hyatt Regency New Orleans. The National Conference will take place April 10 through 12, 2017. Invitations and registration forms will be mailed to invitees during the summer of 2016.

The Hyatt Regency New Orleans

The Hyatt Regency New Orleans

The theme of the 28th National Conference will be “Access”.

The founding of the Coastal Research Group 33 years ago and the establishment of the National Conferences on Primary Health Care Access in 1990 were both based on the premise that the American health care system was in need of substantive reform.

Although there are many admirable features of American medicine and comprehensive reform has been attempted through 2010’s Patient Protection and Affordable Care Act (PPACA), very serious deficiencies still exist in how American health care is organized and financed.

Over the past 27 National Conferences, much of the discussion has not only identified what should be changed in the health system, but has assessed the intended and unintended consequences of past federal legislation (i.e, Medicare, Medicaid and the prescription drug benefit).

PPACA, to which the media have assigned the nicknames “ACA” and “Obamacare” has had a transformative impact on some aspects of the health care system. Yet, although the ACA, at the time of the 28th National Conference will have been enacted for more than a half-decade, its ultimate efficacy and impact is still a source of intense debate.

Whatever its ultimate impact, the problems that brought forth the National Conferences – the geographic and specialty distribution of physicians, the lack of an appropriately functioning system of primary care, the lack of effective integration of medicine and public health – all remain concerns.

These concerns are at the center of discussion of each of the National Conferences.

The Political Climate in 2016

The Patient Protection and Affordable Care Act has yet to gain the widespread popularity predicted by the legislation’s proponents.

The strategic decisions of the two political parties to stake their political fortunes on support or opposition to the act as a whole has made, at least for the time being, the legislative process for modifying the Act in any significant way seemingly unlikely.

A principal concern for the plans’ proponents would be if participating health care plans, as many predict, were to increase rates substantially to cover their costs, and if such cost increases were to erode ACA’s political support among the electorate in such a way to complicate the implementation process.

A Brief History of the Concept of Primary Health Care Resources

Over a half century ago (1964), the treatise “Health Care is a Community Affair”, called the Folsom Report, was published. The next year (1965), the two principal federal programs for funding health care, Medicare and Medicaid passed, followed in the subsequent year, by the publication of the reports of the Millis and Willard Commissions.

The three reports and two financing mechanisms have had profound results, the former on development of public and private sector policies the latter on how the structure of American health care evolved.

The reports resulted in such familiar concepts as the idea of primary and tertiary health care, programs to address geographic and specialty maldistribution of physicians, especially in rural and “inner city” areas, and creation of new primary health care personnel.

In the meantime, multiple efforts to address poverty in America at the federal level led to the creation of the Office of Economic Opportunity, which promoted such ideas as Neighborhood Health Centers.

With the change in administrations at the federal level in 1968, many of the OEO ideas were institutionalized (made politically more “acceptable”) in federal legislation supporting the Community Health Centers and the National Health Service Corps. Legislation funding the new primary care discipline of Family Medicine passed at the same time as the other “safety net” programs, that had consequences for the evolution of training the family physician.

The effects of the two financing mechanisms were outsized, impacting the structure and organization of any entity that received funding from either. Neither Medicare and Medicaid were developed in concert with the policy recommendations of the Commissions, and thus a half-century of accumulated evidence suggests that the policy bases of health care financing do not synchronize with the policy bases would underlie a rational American health care system.

Some issues for consideration by the 28th National Conference 

The following questions, all of which were posed for and discussed at the previous National Conferences, are posed for the faculty and invited participants for the 28th National Conference as well.

  1. What were the changes in American Health Care intended by passage of the “ACA”? To what extent have such changes been effected, with the likelihood that the change is permanent?
  1. Are there unintended changes that have occurred through passage of the “ACA”? Are those changes good or bad?
  1. Because Medicaid historically has differed significantly from state to state, ACA attempted to impose a more consistent approach to the financing of Medicaid recipients between states. To what extent has this effort been successful, and where do problems still exist?
  1. Insurance companies, which evolved historically to assess and contain risk, have been assigned the task of advancing the “rights” of health care recipients to care (who are now obligated to enroll in a health plan) while charging them with the plan’s actuarial costs. Is this the best way to increase access to health care?
  1. Has the “ACA” enhanced or impeded primary health care access in rural communities, and to “underserved” and disadvantaged populations? What is the anticipated impact of the November 2016 election on the ACA’s progress in providing care access?
  1. What are the effects of changes being implemented in the accreditation of medical schools and postsecondary physician training programs?
  1. How are such innovations as primary care medical homes, teaching community health centers, rural training tracks, hospital-centered community health plans, and accountable care organizations faring? Are there examples of programmatic successes (or failures) that would be of general interest?

Invitations to the 28th National Conference will be sent out in Summer 2016. Those interested in the National Conference and the Invitation Conference should e-mail the conference coordinator, William H. Burnett, at whburnett@coastalresearch.org.

27th National Conference Fourth Day’s Breakout Session Topic (Thursday, April 7, 2016)

On Thursday morning, April 7, 2016, at Dondero’s Restaurant at the Grand Hyatt Kauai, the breakfast breakout groups will assemble. 

The assigned topic for discussion is the following quote of the Doctor Mark E. Clasen from the Third Charles E. Odegaard Lecture, “The Culturally Incompetent Physician” presented March 29, 1996 at the Seventh National Conference on Primary Health Care Access, held at the Williamsburg Inn and Lodge, Williamsburg, Virginia.

Dr Clasen will be memorialized at the 28th National Conference on Primary Health Care Access, on April 10, 2017 at the Hyatt Regency New Orleans.

Mark Clasen, MD, PhD

Mark Clasen, MD, PhD

“[Health belief systems] guide many of our personal decisions in matters of health and illness. These belief systems also guide our notions of adherence with medical authority, or with the teachings and beckonings of health providers.

“An entire hour could be devoted to issues of compliance or adherence; yet, we as healthcare professionals know that most compliance occurs in the milieu of a trusting relationship that is culturally competent. In this major thrust, that creating a real change in behavior, occurs best when the message is negotiated in one’s own language, articulated with the proper mixture of science, theology, and always love. There is little doubt that a culturally competent care giver is more valuable than the high priest of technology who possesses 100% knowledge to heal, but who lacks the human translation about how to heal.

“Does the title of this presentation suggest that our medical school graduates are inadequately prepared to deal with a diverse population? Does the title imply that interpersonal skills are not fully developed or as finely honed as they should be by graduation? Does it imply that 20th century physicians have been egocentric, dogmatic creature and practitioners of the art? Does it imply that 20th century physicians have not made tremendous strides in conquering disease and delaying premature death? The title was not selected to caste blame, shame, or dispersions on 20th century medical education, it was selected to look forward into the 21st century – pondering the questions about what knowledge, skills, and attitudes are needed to equip the 21st century physician. What types of educational activities will prepare the medical student of the future to enter this profession, and what are the threats and promises of such a career?

“To loosely paraphrase an old adage: ‘a physician is frequently in error, but never in doubt.’ For those in the audience who are not physicians, I want to assure you that ego strength is required to deal with pain and suffering, and demands a decisive, take charge approach, and is more egocentric than George Patton, especially when life and death matters hang in the balance.

“As a consumer of healthcare, we prefer to be clients or customers when the issues are superficial. However, when the issues are weakness, being sick unto death, being rendered helpless, we more likely want to be a patient of a loving, caring physician who will guide us through the storm to the shoreline of restoration, health, and well-being.”

The Assigned Discussion Groups

Group One (Freeman, Lead; Pugno, Scribe; Allen, Boltri, Chiang, Erickson)   

Group Two (Christman, Lead; Norris, Scribe; Babitz, Baird, Bejinez-Eastman, Clarke)

Group Three (Flinders, Lead; Partlow, Scribe; Buller, Crawford, Goodman, Smith)

Group Four (Burnett WH, Lead; Rush-Kolodzey, Scribe; McGaha, Means, Renteria, Sawyer)

Group Five (Wilke, Lead; Flores, Scribe; Burnett (Lee), Hansen, McKennett)

Group Six (Haughton, Lead; Carriedo, Scribe; Fowkes, Norcross, Osborn)

Group Seven (LeRoy, Lead; Woolsey, Scribe; Herman, Lee, Spalding

27th National Conference Third Day’s Breakout Session Topic (Wednesday, April 6, 2016)

On Wednesday morning, April 6, 2016, at Dondero’s Restaurant at the Grand Hyatt Kauai, the breakfast breakout groups will assemble. 

The assigned topic for discussion is the following quote of Doctor John Geyman, from his April 22, 2011 Thought Provocateur presentation at the Twenty-Second National Conference on Primary Health Care Access, held at the Hyatt Regency San Francisco (California).

John Geyman, MD

John Geyman, MD

“[T]here are a couple of alternatives for 2020. Consider a chart where the multi-payer system is on the left – that’s what we’ve have now – and a single-payer with universal coverage is on the right. On the left there will be a series of “noes”. There won’t be universal coverage. There won’t be cost containment, nor affordability, nor comprehensive benefits. On the right, yes we would have all of that.

“How about choice of physician and hospital? Not with the multi-payer systems. These ACO’s are going to get us more consolidation, so there will be less choice, in more restrictive networks. Quality of care will be highly variable. The bureaucracy will have greatly increased.

“Will there be health care equity?  No! disparities will increase even more. Is the system sustainable? No; there will be widespread system collapse!”

The Assigned Discussion Groups

Group One (Burnett (Lee), Lead; Frey, Scribe; Geyman, Goodman, Hansen, Wilke,)   

Group Two (Bejinez-Eastman, Lead; Baird, Scribe; Lee, LeRoy, Partlow, Woolsey)

Group Three (Flores, Lead;  Buller, Scribe; Crawford, McGaha, Osborn, Sawyer)

Group Four (McKennett, Lead; Herman, Scribe; Burnett (WH), Clarke, Flinders, Norris)

Group Five (Norcross, Lead; Babitz, Scribe; Allen, Boltri, Christman, Means)

Group Six (Pugno, Lead;  Carriedo, Scribe; Erickson,  Palafox, Renteria, Spalding)

Group Seven (Webster, Lead; Fowkes, Scribe; Chiang, Freeman, Rush-Kolodzey, Smith)

27th National Conference Second Day’s Breakout Session Topic (Tuesday, April 5, 2016)

On Tuesday morning, April 5, 2016, at Dondero’s Restaurant at the Grand Hyatt Kauai, the breakfast breakout groups will assemble. 

The assigned topic for discussion is the following quote of Doctor David Sundwall, from his presentation of April 20, 1990 at the First National Conference on Primary Health Care Access, held at the American Club in Kohler, Wisconsin.

David N. Sundwall

David N. Sundwall

“[O]ne observation I have made of ‘Washington policy’ is that part of the mess we’re in is because our policy makers for two decades have focused almost exclusively on financing of care and they’ve let so many other things essential in public health efforts slide. 

“The reasons for this focus is understandable, given that those who benefit from the financing are clearly the most vocal lobbyists.

“The providers, meaning doctors, hospitals, pharmaceuticals, medical devices, many more who are employed in our “medical-industrial complex,” are in a position to benefit from attention being paid to the financing.

“Unfortunately, the poor and the disadvantaged don’t have a very effective lobby.  The other observation I have made is that we have, in fact, “medicalized” or made part of the health care system things which really are not traditional health concerns.

“And I don’t mean to say they aren’t eventually a health problem, but if you look at the big-ticket items we’re dealing with, many are the result of social-behavioral problems.

“Alcohol abuse and dependence is far and away the biggest problem statistically and cost-wise for the country.  Perhaps second is tobacco use.  Other costly social problems are drug abuse, sexually transmitted diseases, (the cost of care for uninsured AIDS patients being the most pressing of these), injuries, premature births, and infant mortality.  All of those are theoretically preventable, saving the costs of medical treatment.  But we’ve medicalized them and put them on the shoulders of the health care system.”

The Assigned Discussion Groups

Group One (Fowkes, Lead; Hansen, Scribe; Allen, Bejinez-Eastman, Buller, Burnett (Lee))

Group Two (Burnett (WH) Lead; Crawford, Scribe; Carriedo, Clarke,  Goodman, Partlow) 

Group Three (Geyman, Lead; Flinders, Scribe;  Chiang, Christman, Hara, Sawyer)

Group Four (Herman, Lead; Haughton, Scribe;  McGaha,  Norcross, Renteria, Webster)

Group Five (Kahn, Lead; Spalding, Scribe; Baird, Flores, Osborn)

Group Six (LeRoy, Lead; McKennett, Scribe; Means, Schwartz, Sundwall)

Group Seven (Boltri, Lead; Pugno, Scribe; Babitz, Norris, Rush-Kolodzey)

Group Eight (Ross, Lead; Freeman, Scribe; Erickson, Frey, Smith, Woolsey)