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How Did We Get Here?

A quick guide to the health care debate

Though the RAM clinic has provided medical services to residents in southwestern Virginia for a decade, this year’s event was unique—it was held against the backdrop of a vigorous national debate about health care. Just as physicians, nurses and other UVA volunteers have assisted patients with hands-on care, faculty experts at the University have shared their research and insights to inform the broader dialogue.

Specific proposals are still being debated and health care reform remains a moving target. However, the information below—gathered from some of UVA’s experts—can be used as a “pocket guide” to why this debate is happening and what circumstances have propelled reform initiatives.

Q&A with Eric Patashnik

Eric Patashnik

Eric Patashnik is an expert on the politics of health care, a professor of politics and public policy, and an associate dean of the Frank Batten School of Leadership and Public Policy.

What are the most important aspects of health care reform?

There are two main health care problems: About 15 percent of Americans lack health insurance, and health care costs are rising. These problems compound one another. As medical care becomes more expensive, obtaining health insurance becomes less affordable for American families. The dilemma is that covering everybody will increase costs for taxpayers and people who already have coverage.

Debunk one of the worst health care reform myths.

Both conservatives and liberals fall prey to their own myths and misunderstandings. Conservatives say we have a private health care system. In fact, we have a mixed private/public system. Health care delivery is largely private, but government pays for a huge share of medical care through Medicare and Medicaid, and through tax preferences for employer-based insurance.

Liberals think that Americans overwhelmingly despise the current health care system. Actually, most Americans are satisfied with the quality of their personal medical care. While about three-quarters of Americans will agree, when asked, that the health care system is a mess and needs major reform, more than eight in 10 say they are satisfied with their current medical arrangements. This tension between collective unhappiness and individual satisfaction is at the core of the health reform debate.

What are the best features of the current U.S. health care system? Are there legitimate reasons to fear that a reform will diminish or destroy any of those features?

The best features of the American health care system are that it generates a lot of innovation, most people are satisfied with their own doctors and medical plans, and most senior citizens have reasonable coverage.

Health care costs are out of control because of the perverse incentives from the fee-for-service system. In most fields, technological innovation lowers consumer costs, but that’s not been the case in health care. The federal budget is on an unsustainable path because of Medicare costs. At the state level, rising Medicaid spending is straining state budgets, leaving less money available for other priorities.

Faculty Research

Faculty experts from around the University have researched health care issues from a range of perspectives. Here are excerpts from their books and other sources:

The health care inflation rate between [2007] and 2013 is estimated at 8 percent per year; the inflation rate in the general economy is expected to be 4 percent. Between [2007] and 2013, personal spending on health care is estimated to increase 7.4 percent while personal income will increase 4.6 percent per year.

Health Care Half Truths: Too Many Myths, Not Enough Reality (2007) by Dr. Arthur Garson Jr., executive vice president, provost and former dean of UVA’s School of Medicine; and Carolyn Engelhard, an assistant professor of medical education and a health policy analyst in the Medical School.

The estimated health care expenditures spent on administration are a staggering 25 percent of hospital spending and are estimated to be over 30 percent of all health care spending.

Redefining Health Care: Creating Value-Based Competition on Results (2006) co-authored by Elizabeth Olmsted Teisberg, an associate professor at the Darden School of Business.

Between 2011 and 2030, 76 million baby boomers will reach the statutory age of entitlement … [Even] if there were no impending increase in the number of Medicare beneficiaries, the program as currently designed poses a threat to not only the federal budget but also the U.S. economy as a whole.

The Long Baby Boom: An Optimistic Vision for a Graying Generation (2008) by Jeff Goldsmith, an associate professor in public health sciences at UVA and president of Health Futures Inc.

The current tort system’s “blame culture” is itself blamed by [the National Academy of Sciences, Institute of Medicine] for impeding improvements to patient safety because, among other reasons, the culture deters physicians from acknowledging their errors in the first place. Thus, according to the IOM, the law of medical malpractice is in irreconcilable tension with the realities of medicine.

A Recipe for Balanced Tort Reform: Early Offers with Swift Settlements (2008) co-authored by Jeffrey O’Connell, professor in the UVA Law School.

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This article appeared as part of our article on Bringing the Hospital to the People, a story about how 800 medical professionals and 1,800 volunteers brought free healthcare to 2,700 patients for one weekend.