Speaking of Affordable Care: Big Ideas at the Town Hall

If you were hoping for a debate over Affordable Care on September 25 in Phoenix, you would have been disappointed. What was clear at the town hall conducted by Mayo Clinic and ASU Foundation was the panelists’ exasperation with the political debate about who pays for medical care. Contestants are so wrapped up in their squabbling that substantive issues never enter into it. In the meantime, people are dying.

How might people spend their time if they don’t feel compelled to debate the Affordable Care Act? They might address the problems that still exist regardless of whether the Act goes into effect.

The panelists at Wednesday’s meeting were ASU president, Michael M. Crow; Mayo Clinic Vice President and CEO, Dr. Wyatt Decker; and Dr. Richard Carmona, Surgeon General of the United States from 2002 to 2006. This town hall was part of a collaboration between Mayo Clinic and Arizona State University, but similar collaborations have been taking place with Mayo in Rochester and Mayo Clinic in Florida. Although Mayo Arizona has been working with ASU for about ten years, there was a new development in June of this year, a $1 million grant awarded to Mayo Clinic by the American Medical Association. Mayo Clinic is one of eleven applicants who received the grant, part of the AMA’s Accelerating Change in Medical Education program, aimed at the creation of a new model of undergraduate education, but its effects will go beyond these eleven schools. Selected schools will form a learning consortium to spread best practices to other schools.

The panelists were all justifiably proud of Mayo’s record. First, Mayo Clinic is the safest teaching hospital in the nation. Also, Mayo’s costs are lower. Lower costs were attributed to the fact that doctors are employed and not in private practice, so they don’t benefit from any procedures and tests they order. And Mayo charges a flat fee for procedures. This means that if there is a poor outcome, it is the clinic that loses money, not the patient and her insurance company. Great care is taken to make sure things are done right the first time around. For more on Mayo’s Model of Care see: Mayo Clinic Model of Care

However, in spite of Mayo’s good record, none of the panelists claimed to have the answer to the medical crisis. On the contrary, they made it clear that the system is unsustainable and that it can’t be saved as it is–not by money nor by increased efficiency.

Not only is the system unsustainable, it is self-perpetuating. In other words, it is difficult for those already in the system to think of a way to solve its problems. Therefore, their goal is nothing short of the creation of a new kind of person through educational reform; a new kind of doctor with a broad and comprehensive understanding, not only of the medical system, but of human behavior and the structure of society.

I appreciated the humility of the panelists in the face of the looming medical crisis, but I hope this town hall was merely the beginning of the discussion because I have a few concerns.

Dr. Crow shared a quote to the effect that industries fail because they don’t understand what people want. I would hope the panelists remember that the survival of the medical industrial complex is not the concern of medical consumers. If the industry is at fault in this crisis, maybe it should fail.

He also stated that the system used to work, but because times have changed it no longer does. Is this true? What is the definition of a working system? I’d like more discussion about that.

Finally, I would like to suggest that the proposed additions to the curriculum are part of the old way of thinking Mayo is trying so hard to escape: evolutionary theory, psychology, cultural anthropology. I’ve discussed some of the problematic ideas that stem from these disciplines, but my main objection is they’ve been used to justify the categorization and control of human beings. They shouldn’t be accepted without question.

I think the town hall was a positive start, so I say these things in the spirit of a conversation. The panelists’ initiation of this conversation certainly beat the competition in the House of Representatives.

Now about Affordable Care. Although nothing was said about it at the town hall, Mayo’s FaceBook page does provide a link to a video with the following information: The clinic estimates that doctors will see a decrease in payments for services of at least 10 to 20 percent. On the patient side, insurance premiums will go down but many policies will have high deductibles, ((cnbc video: Mayo Clinic and Affordable Care. Available: http://video.cnbc.com/gallery/?play=1&video=3000201514&6415814=1.))

Of course, insurance policies already have high deductibles. If the Republicans have plans to improve that situation, they aren’t saying.

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