Although it has dominated much of the press coverage from the Democratic Presidential primary campaign trail, “Medicare for All” is a term whose actual definition, structure, cost and implications for patients, clinicians, health systems and insurers remains unclear. That was one of the takeaways from the one-day University of Pennsylvania “Medicare for All and Beyond” Conference that brought together a collection of the country’s top academic health care experts to discuss the issue that continues to rivet, and often confuse, the country at large.
In her welcome, LDI Executive Director Rachel Werner, MD, PhD, said, “We aim to engage all of you in productive conversations that go beyond rhetoric and partisanship. Our goal is to tackle the trade-offs of policy approaches head on, and to have an honest conversation about costs, affordability, choice and political feasibility.”
Penn Provost, Presidential Professor at Penn Law, and historian Wendell Pritchett, PhD, JD, began his remarks with a reference to a 1970 New York Times story in which Senator Jacob Javits said, “Although we spend more money than any other country in the world on health care, the quality of care remains uneven, and for many, particularly the poor — it is abysmally low, if not nonexistent.” The quote was Javits’ prelude to introducing a “Medicare for All” bill that would have extended the four-year-old program’s benefits to the entire population.
In his introduction for keynote speaker Paul Starr, LDI Director of Policy David Grande, MD, MPA, noted, “This is an important day as we convene in an effort to advance our understanding around some of the deeper issues that need to be examined beyond the overarching political debate.”
Starr, a nationally renowned health care historian, chronicled three quarters of a century of convoluted U.S. government efforts that failed to provide health care to all. Starr was critical of the Medicare for All push. In what became the event’s single most memorable quote, he predicted the cost of expanding Medicare into a universal health system would be so enormous, it would essentially turn the country into “a health plan with armed forces.”
Setting the stage for her Affordability Standards panel, moderator Sherry Glied, PhD, Dean of New York University’s Wagner Graduate School of Public Service and a former Assistant Secretary at the U.S. Department of Health and Human Services, noted that a fundamental problem is the lack of an established meaning or standard for “affordability” in health care. “We have a standard for poverty and a standard for affordability in housing but no comparable standard in health care,” she said. Her panelists were Tekisha Dwan Everette, PhD, Executive Director of Health Equity Solutions; Ezekiel Emanuel, MD, PhD, University of Pennsylvania Vice Provost, former White House health care consultant and LDI Senior Fellow; Frances Padilla, MPA, President of Universal Health Care Foundation of Connecticut; Mary Pauly, PhD, University of Pennsylvania Wharton School Professor of Health Care Management and LDI Senior Fellow; and Lynn Quincy, MA, Director of the Healthcare Value Hub at Altarum.
“When you think about the current state of the affordability question, you quickly get to the topic of prices,” said moderator Julian Harris, MD, MBA, as he opened the panel session on Pricing and Payment. Harris, who formerly served as the Associate Director for Health in the Office of Management and Budget overseeing federal spending for Medicare, noted that “one of the peculiarities of our system is we have this strange arrangement between Medicare, Medicaid and commercial payers who are in the interesting position of having conversations with some of the major stakeholders about what the rate will be for a particular service. The interplay among these three systems is really challenging and makes it difficult to have a rational conversation around prices.”
Harris’ panelists were Gerard Anderson, PhD, Director of the Johns Hopkins Center for Hospital Finance and Management; Miriam Laugesen, PhD, Associate Professor of Health Policy and Management at Columbia University; Kevin Mahoney, MBA, DBA, CEO of the University of Pennsylvania Health System and LDI Senior Fellow; and Kavita Patel, MD, MPH, a Fellow at the Brookings Institution and a member of the HHS Physician-Focused Payment Model Technical Advisory Committee.
In an interactive exercise about choice in health care, the Value of Choice panel began with a Mentimeter text-in poll about whether audience members would rather have employer health coverage that offered two different plans or one that offered 40 different plans. Fifty-three percent chose 40 plans. But is broad choice really the best way to fix the U.S. health care system? moderator Allison Hoffman, JD, Penn Law Professor and LDI Senior Fellow, asked her panel.
Hoffman’s panelists were Keith Ericson, PhD, Associate Professor of Markets, Public Policy and Law at Boston University; James Fishkin, PhD, Professor and Director of the Center for Deliberative Democracy at Stanford University; Richard Frank, PhD, Professor of Health Economics at Harvard University; J. Mario Molina, MD, Dean of the Keck Graduate Institute School of Medicine.
A special session hosted by Tradeoffs Podcast Executive Producer and LDI Adjunct Senior Fellow Dan Gorenstein was a live, on-stage production of a podcast exploring a recent NBER paper by Katherine Baicker, PhD, Dean of the University of Chicago School of Public Policy, proposing Medicare be replaced with a new, two-tier system.
The issues were discussed by Julia Lynch, PhD, Associate Professor of Political Science at Penn’s School of Arts and Sciences and LDI Senior Fellow, and Amitabh Chandra, PhD, Director of Health Policy Research at the Harvard Kennedy School.
The Political Feasibility panel was moderated by Rodney Whitlock, PhD, an executive at the Washington, D.C., health care lobbying firm McDermott+Consulting, and an Adjunct Professor of Legislative Process at George Washington University. Panelists were MollyAnn Brodie, PhD, Executive Director for Public Opinion and Survey Research; Daniel Hopkins, PhD, a Professor of Political Science at Penn’s School of Arts and Sciences and an LDI Senior Fellow; Diana Mutz, PhD, Professor of Political Science and Communications at Penn’s Annenberg School for Communication; and Carol Paris, MD, the immediate past President of Physicians for a National Health Program.
Panelist Hopkins cautioned, “Health care’s long-term cause is not advantaged by making it the signature issue it has now become” in current political campaigns. “I don’t think public opinion is the right audience for a lot of the nuanced questions that must be answered,” he said. “My advice is for policymakers to look for tweaks that can be made in the regulatory system that gradually begin to set us on a different path.”
Leading the audience polling and text-messaging of questions for panelists was LDI Co-Director of Health Policy Janet Weiner, PhD, MPH, with LDI Project Manager Megan McCarthy-Alfano providing technical assistance.
Posing a question to a panel was David Rubin, MD, MSCE, Director of the Children’s Hospital of Philadelphia PolicyLab and LDI Senior Fellow.
The conference audience was alive with feedback. Some of the most pointed questions were asked by audience member, media mogul and TV Shark Tank host Mark Cuban. [Photo by Will Burton]
Making a point from her perspective was audience member Lori Kearns, JD, the Legislative Director from Senator Bernie Sanders’ Capitol Hill office.
