Dr MacLean Explains #3 - Reforms & Status Now

2 months ago
This video is #3 in the series Dr MacLean Explains… about the U.S. healthcare problem and how to fix it. This segment reviews previous attempts at reform and ...

English subtitle

welcome back to dr. maclean explains my
goal is to break down the US healthcare
system into understandable parts to
clarify what is the problem with the
system and to talk about how to fix it
in segment two we looked at the history
of medical care in the u.s. until 1965
the Year Congress enacted Medicare and
Medicaid in segment three we will look
at reform movements starting with
Medicare and Medicaid we will look at
why later reforms failed and where that
leaves us now by the early 1960s nearly
all employees were covered by Blue Cross
Blue Shield but problems emerged first
low-wage workers were often not covered
by their small businesses and older
retirees were not covered costs were
going up because prepaid insurance
increased patient demand for services
Harry Truman had proposed national
health insurance after he surprisingly
was re-elected in 1948 but the AMA
launched a multi-million dollar
publicity campaign to deride the plan as
communism and socialized medicine
Truman's public insurance plan failed
the next attempt to reform was
successful
the 1965 passage of Medicare and
Medicaid Lyndon Johnson succeeded because
coverage targeted the uninsured poor and
elderly leaving the rest of the private
for-profit health system unaffected
senator Teddy Kennedy tried in 1971 to
extend Johnson's success to build a
single-payer system and one support from
President Nixon but this plan was
derailed by the Watergate scandal the
next attempt came from Bill and Hillary
Clinton after Clinton took office in
1992 Hillary and expert panels devised a
plan for universal coverage that
included defined essential benefits and
pre-existing conditions with mandated
employer insurance and expanded Medicaid
this plan failed because the insurance
industry launched a stinging publicity
campaign featuring a down-home couple
named Harry and Louise Americans also
balked at the tax increases needed to
fund it the Clintons failure made it
necessary to find another solution to
rising costs managed care which had
first appeared in 1973 became that
solution and it did work slowing growth
to under 6% but around the year 2000
came a backlash over mammograms and the
so-called
drive-by deliveries which undermined the
ability of managed care to control costs
what do we make of this history here are
the main takeaways that help us
understand our present system first
there has always been a tension between
the profit motive in the free
marketplace and health promotion motive
second Americans have given special
treatment to the health industry in
return for medical advances and third
powerful vested interests doctors
hospitals insurance drug companies have
often used polemics and ideological
arguments to defend their favorite
status not necessarily actual health
outcome arguments so this leaves the US
with the largest most expensive health
care system in the world in 2011 shown
here it took in payments of 2.7 trillion
dollars mostly private insurance
Medicare Medicaid and out of pocket the
figure for 2015 was 3.2
trillion dollars representing one-sixth
of the entire economy government share
of payments was almost 50% in 2015 this
graph shows the dollar spent in 2011
mostly on hospitals doctors drugs
long-term care remember that 25 percent
of this pie graph actually goes to
administrative costs not medical
services
in defense of US healthcare in 2012 then
House Speaker John Boehner and then
Senate Minority Leader Mitch McConnell
famously said the US has the finest
health care system in the world and
further that wealthy foreigners flock to
the US because of its cutting edge
facilities however the World Health
Organization rates the u.s. 15th in
performance life expectancy and delays
in care and only 37th in overall
attainment including financial and
service fairness in 2015 the Kaiser
Foundation compared the u.s. with 10
other developed countries here are their
results showing areas in which the u.s.
is better equal or lacking here are the
Commonwealth funds in 2011 rankings the
u.s. is in the middle of the pack in
most areas but dead last on several
others and on overall rank what about
those foreigners flocking for care
well this pertains to highly specialized
treatments available only in certain
centers such as Mayo Cleveland Clinic or
Hopkins some centers in Florida and
Texas do market to wealthy
foreigners who pay the full charge in
cash not discounted insurance rates like
the rest of us Boehner and McConnell
pointed to Canadians coming to Michigan
hospitals but the Commonwealth study
found that Canada is worst in timeliness
so not surprising even though Canada did
rank ahead of the US in other measures
the further truth is that according to
Centers for Disease Control 3/4 million
Americans go abroad each year for
medical treatments such as for holistic
care or dental care but mostly seeking
lower cost in the next segment we will
talk about cost namely how the rising
cost of healthcare is affecting our
economy our politics our society and
some say our very existence I'll see you
then