"Debate Housekeeping" (05:51)
Moderator John Donvan frames the debate on the American healthcare system, instructs the audience to vote, and introduces panel members.
Opening Statement For: Shannon Brownlee (06:18)
Harvard T.H. Chan School of Public Health Visiting Scientist and Lown Institute Senior Vice President, Brownlee identifies two ideas on the healthcare premise: how broken is the system and can current reforms revive the system? She describes the system "as it is."
Opening Statement Against: Ezekiel Emanuel (06:42)
Bioethicist and Global Initiatives Vice Provost, Emanuel agrees that the U.S. healthcare system is under-performing but it is not beyond fixing. He cites many points of light throughout the country including Care More. Behavior change is important to repairing the healthcare system; we need to be careful about the timeline.
Opening Statement For: Robert Pearl (06:55)
Former Permanente Medical Group CEO and author, Pearl states that the current healthcare system is a political compromise and is too inadequate to overcome shortcomings. He shares the story of the death of his father. Drug costs are rising three times as fast as medical inflation.
Opening Statement Against: David Feinberg (06:17)
Geisinger President and CEO, Feinberg states that we can fix every problem with healthcare if we modified our behavior; acute care in the U.S. is excellent. He cites examples of healthcare reform outside of Washington D.C. and health in relation to zip codes. Healthcare reform begins with communities.
Debate Summary (01:43)
Donvan summarizes the panelists opening statements and their position on the motion, the U.S. health care system is terminally broken.
Can Islands of Excellence be Scaled? (06:30)
During previous ferments of healthcare, legacy players defeated the points of light. Emanuel and Feinberg cite an alignment of forces that can push for reform. Panelists debate the ability to reform on a large scale; Feinberg quotes Pearl's book.
Scaled and Mechanism Shifts (03:10)
Emanuel states the Affordable Care Act contains a mechanism to allow payment transformation; many large insurers are trying to move to capitation. Pearl compares closing hospitals to closing naval yards. Emanuel concedes there will be resistance, but change can occur.
Resistance to Change (05:56)
Proponents state 92% of legacy players are still fee for service and 78% do not want to change; Maryland globally budgeted all its hospitals. Feinberg counters that doctors coming out of training are not going into private practice; Emanuel cites examples of healthcare changes.
Generalized Examples? (02:08)
Pearl cites hospital price hikes in California to cover inefficiencies; Feinberg and Pearl argue about why people go to Kaiser Permanente. Emanuel cites an example of change.
Global Budgeting? (04:53)
Brownlee stresses that a shift in payment must be imposed and questions who will do it. Feinberg argues that change is a culture that will require years to develop; Emanuel cites examples of transformation and doctor response. Pearl states the totality of American healthcare is not significantly changing.
Q/A: Society and Healthcare (03:47)
Amsterdam is an example of a community decision to make changes. Emanuel states that healthcare costs are the reason many programs in schools are cut. Brownlee agrees and wonders what the mechanism for the transfer of money will be.
Q/A: Social Service Infrastructure (03:07)
Emanuel considers the necessary social determinants to change healthcare; nurse/family partnership in Medicaid should be a requirement. Pearl believes every system of coverage will deteriorate; pockets will change but the nation as a whole will not.
Q/A: Private Integrated Health Systems (04:19)
Feinberg cites ways systems are giving back to the community; Brownlee does not think it should be hospital responsibility. Panelists argue about major intervention. Emanuel states venture capitalists see opportunity in the healthcare system; hospitalizations are declining.
Q/A: National Identifier for Scaling Up Healthcare (01:23)
Brownlee does not think it is necessary but it is a good idea. Pearl cites the importance of access to electronic records.
Q/A: Will Reform Happen Soon Enough? (04:55)
Emanuel explains why he is confident change will occur by 2030; healthcare costs have been flat since the passage of the Affordable Care Act. Pearl believes there will be progressive erosion and describes what a crisis will look like.
Q/A: Quality Metrics (02:12)
Pearl explains why quality may not reduce overall cost. Brownlee states that many of the metrics have nothing to do with improving patient health. Emanuel argues that quality measures are expanding.
Q/A: Providers Become Risk-bearing Entities (02:50)
Pearl believes that if talked about changes work, they will have a good impact; underlying social determinants will not change. Feinberg discusses impacts of "doing the right thing." They debate the shortage of doctors.
Closing Statement For: Brownlee (04:03)
We can have a great healthcare system because of the examples cited be the motion opponents and because of those in healthcare who are dedicated to change. The problem is what it will take to move the system as a whole.
Closing Statement Against: Emanuel (03:28)
Yes, the U.S. healthcare system under-performs and has many problems, but there are many points of light. Smart money is developing many innovations in new areas.
Closing Statement For: Pearl (02:40)
The U.S. was first in cost for healthcare for the 10th consecutive year and last among 11 industrialized nations. We musts eliminate fee for service and move to capitation; primary care is becoming unsustainable.
Closing Statement Against: Feinberg (02:05)
Feinberg shares the story of talking to a father whose son experienced his first psychotic break. He wants to provide compassionate care and improve access for patients.
Results of Audience Vote (03:15)
Donvan instructs the audience to vote, thanks participants and supporter, and reveals voting results. Pre-Debate - For: 42% - Against: 34% - Undecided: 24%. Post-Debate - For: 45% - Against: 51% - Undecided: 4%
Credits: The U.S. Health Care System Is Terminally Broken (00:10)
Credits: The U.S. Health Care System Is Terminally Broken
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