American Academy Convenes Online Dialogue on the Health-Care Crisis9/8/2009
As policy-makers debate measures to reform the U.S. health-care system, the American Academy of Arts and Sciences has convened an online forum of Fellows, who are medical experts and leaders in health care, to explore ways to control costs and improve the quality of services.
Available at www.amacad.org
, the online forum examines issues such as capitation payments, universal coverage, Medicare policies, access to care, insurance, and preventative medicine.
Within the lead essay (by Drs. Mitchell T. Rabkin and John S. Cook) and the commentaries that follow, the authors offer diverse opinions on aspects of the health care crisis.
- Mitchell T. Rabkin, M.D., Professor of Medicine at Harvard Medical School; former CEO of Beth Israel Hospital, Boston, with John S. Cook, D.Phil., consultant in health care payment
Focusing on cost, quality of care, and the emerging shortage of primary care physicians, Rabkin and Cook offer a new Medicare initiative, “Balanced Incentives for Health,” that would give doctors the means to provide comprehensive, cost-effective care under a fixed budget.
- Eve Juliet Higginbotham, S.M., M.D., Dean and Senior Vice President for Academic Affairs and Professor of Surgery, Morehouse School of Medicine; Professor of Ophthalmology, Emory School of Medicine
Higginbotham sees the need for an even deeper “systems approach” to the challenges of health care, a series of practical policies rooted in community awareness and state politics.
- Arthur H. Rubenstein, MBBCh, Executive Vice President of the University of Pennsylvania for the Health System and Dean of the University of Pennsylvania School of Medicine, with Richard A. Cooper, M.D., Professor of Medicine and Senior Fellow, Leonard Davis Institute for Health Economics, University of Pennsylvania
Rubenstein and Cooper take on the three “Ps” of health care reform, arguing that pay-for-value is a “dangerous game” in medicine, that the drive for more primary care physicians will not solve systemic issues or produce a higher quality of care, and that the effects of poverty on the health care system must be addressed to decrease cost.
- Claire M. Fagin, Ph.D., R.N., Dean Emerita and Leadership Professor Emerita, University of Pennsylvania School of Nursing
Fagin argues that health care reform should be grounded on the principles and philosophy of care rather than of profit, with regionally based, not-for-profit health care groups as the basis for organizing a new system.
- Steven A. Schroeder, M.D., Distinguished Professor of Health and Health Care, Department of Medicine, University of California, San Francisco
Schroeder questions some of the basic assumptions underlying Rabkin and Cook’s “Balanced Incentives for Health (BIH),” particularly whether the field of primary care is sufficiently robust to absorb all patients interested in the initiative and the choice provisions of BIH as the means to avoid managed care backlash.
- Jeremiah A. Barondess, M.D., President Emeritus, New York Academy of Medicine; Professor Emeritus of Medicine, Weill Cornell Medical College
Barondess points out that the current primary care paradigm increases cost by encouraging referrals and the high-technology practice patterns associated with subspecialist care.
- Arnold S. Relman, M.D., Professor Emeritus of Medicine and of Social Medicine, Harvard Medical School; Former Editor-in-Chief, New England Journal of Medicine
Relman envisions an efficient and cost-effective system of integrated, salaried groups of primary care and specialty physicians, as opposed to the current, profit-driven, fee-for-service, overly specialized system.
- Jerome P. Kassirer, M.D., Distinguished Professor, Tufts University School of Medicine; Editor-in-Chief Emeritus, New England Journal of Medicine
Kassirer believes that there will be no meaningful reform until society confronts the health care giants: insurance and pharmaceutical companies, physicians and nurses organizations, and a population that voraciously consumes tests, procedures, and treatments.
The Academy dialogue on the health-care crisis is the first of a series of online forums on pressing issues facing the nation. Opinions expressed in the forum are those of the individual authors and do not represent the American Academy of Arts and Sciences.
Founded in 1780, the American Academy of Arts and Sciences is an independent policy research center in Cambridge, Massachusetts, that conducts multidisciplinary studies of complex and emerging problems. Current Academy research focuses on science and global security; social policy; the humanities and culture; and education. The Academy’s work is advanced by its 4,600 elected members, who are leaders in the academic disciplines, the arts, business, and public affairs from around the world.