National Health Care System

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We’ll talk about a possible National Health Care system with Sir Malcolm Grant, the chairman of National Health System in England, and Dr. Denis A. Cortese, emeritus president and CEO of the Mayo Clinic.

Ted Simons: Most nations around the world have some kind of government run national health care system but the idea has yet to catch on here in the U.S. Joining us to discuss whether or not health care systems should be nationalized is Sir Malcolm Grant, chairman of NHS-England, and Dr. Denis Cortese, president and CEO of the Mayo Clinic clinic. Thanks for joining us.

Sir Malcolm Grant: Great pleasure.

Dr. Denis Cortese: You're welcome.

Ted Simons: Should health care systems be nationalized?

Sir Malcolm Grant: I'm not sure about nationalized but they certainly should be national. I think every nation that takes an interest in the health and welfare of its population is doing something that all politicians aspire to do. I think that a system that invests in the health of its population also invests in its economy. To do that and to have equity across a nation it's critically important to have an over all strategy for health care.

Ted Simons: Taking an interest, investing, still is it the best way to provide coverage?

Dr. Denis Cortese: Yeah, that's a very interesting point. The nationalness of a delivery system and of the health system of the United States could very well have two or three components. One is the strategic level. What are we trying to accomplish. We have spoken to presidents and other leaders nationally. They ask for that we should be getting what we pay for. We should be getting high value care. Better out comes, better safety, best service, lower cost. You've heard me say this many times. When you take the next level down and you begin to look at the strategy for that we should be looking at our outcomes, how we're delivering care and changing it, supporting that with these other two issues, which is very much what Malcolm was getting at. One, should we have a national approach to insurance. Which is what your question was. The other is should we have a national approach to the way care is delivered. I personally feel a national approach to insurance makes sense. It should be viewed that way, a model that I would prefer to see would be one like the federal employees health care plan. That is one with the government requiring people to have insurance, premium support for those who need it and private insurance options so they have a choice.

Ted Simons: How does that compare to what's happening in England?

Sir Malcolm Grant: What's happening in England since 1948 has been a model in which insurance is quite marginalized. We pool risk across the whole of the population by running the healthcare service on the basis of taxation. The consequence is we end up spending about 8% of the nation's GDP on health care. That is almost exactly the equivalent of the tax base contribution in the U.S. to towards the nation's healthcare. The other half of that, which brings the U.S. up to about 17.4% of GDP, comes from private contributions. Our model is by no means perfect. Having a tax base gets mixed up with politics all the time but at the same time it does two things I would say. It cuts out a lot of the complexity and overhead cost of running an insurance model. Secondly, it enables you to spread equity across the whole system. The fundamental promise is that everybody, every citizen, rich or poor, gets free health care at the point of clinical need.

Ted Simons: When you see what's happening in England and what's happening in America, where do the Twain meet?

Dr. Denis Cortese: First they are totally different countries in this sense. The cultures are quite different. It would probably be the meet would be somewhere closer to what some other European countries are doing for their national health scheme. Health care scheme. Particularly their health insurance scheme. Which it would be the examples would be the Netherlands, Germany perhaps, Switzerland, where they have much more involvement with the government overseeing, but the insurance is provided through private insurers. That's very much what we have in the federal employees plan. The alternative is single payer like Medicare for all. But I'll stop and pass the ball back. Medicare for all is not a single payer. We have to understand that Medicare covers with federal dollars, through taxes, the primary payer. However, 90% of all people on Medicare by the AARP numbers also have private insurance for their supplemental coverage, for co-pays and deductibles, and another set of private insurance for their drug coverage. Even Medicare, two of the three coverages are private.

Ted Simons: When you see what's happening in the U.S. and how health care -- the debate, the changes, what do you think?

Sir Malcolm Grant: Well, I think the systems are very different, but actually the fundamental problems we face are exactly the same. An aging population. We've got I think two or three very serious health issues running through the population. Certainly an aging population one is dementia, which costs an increasing amount of investment to look after. Which requires us to bring health care and social care into the same basket, particularly for funding which we're doing I hope increasingly in the U.K. The second issue is obesity and type 2 diabetes flowing from that. Now, these are issues over which actually the former health care system is relatively marginally important, much more important on prevention in the case of obesity, particularly with cheerlead hood obesity. The complexities of health care systems I think still require a lot of ironing out in both countries. I have to say Denis is a magnificent advocate in the U.S. for some of it. I have to say I just so soundly believe in a uniform system. Tax based pooling risk across the whole population, and founded on the premise since 1948 in place of fear that the population should always have access to health care irrespective of insurance.

Ted Simons: The idea of governments getting involved, especially in the tons, with political polarization as a possibility, and right now reality, the impact, the balance. How do you work that dynamic?

Dr. Denis Cortese: It's extremely difficult. And it's compounded by an additional problem that both countries deal with. That is that the payment models are based on fee for service and volumes we do for people. If we're going to deal with long term chronic illnesses just the U.S. and the U.K., both countries are moving to new payment models. I'm very tuned in to what they are doing, where you begin to bundle the amount of dollars that are available and you have to come up with new models of care. So we need to have the politicians get out of micromanaging the way we practice but manage the outcomes we're doing and change the way they are paying for care. That's happening in the U.S. It's starting to change now.

Ted Simons: It's starting to change, but will the big changes happen by way of a lurch or a ramp-up?

Dr. Denis Cortese: we had a lurch, unfortunately without bipartisan support. That was a major mistake that we did the ACA, in my opinion. The ACA was put through without -- this is major social legislation without bipartisan support. To me that's politics 101. You don't do something like that.

Ted Simons: That goes back to my previous question. Things are so polarized, how do you get bipartisan support?

Dr. Denis Cortese: We had a little closer opportunity in 2008 but you're exactly right, we need to start having a very good, thought basis around the overarching national strategy for health care. This is how you started the question and I agree completely with Malcolm on that point. We need a national strategy.

Ted Simons: As far as what's happening in England will things gradually change at all? Will they develop? Are you you pretty solid where you are?

Sir Malcolm Grant: I would say they are going to change in several respects. The first is the fact medicine worldwide will be transformed by new technologies. I think secondly, in the U.K. we will see changes along the line that you're talking about, which is no longer paying for activity but outcomes for patients. Thirdly we're going to move from being a national service to more regional. Last week we launched a whole new program from Manchester. 3 million citizens bringing together local governments to give that integrated model that includes social care alongside health care.

Ted Simons: Wow, very interesting discussion, great to have you both here.

Dr. Denis Cortese: Thank you.

Sir Malcolm Grant: A great pleasure, thank you for the invitation.
Ted Simons: You're welcome.

Ted Simons: That is it for now. I'm Ted Simons. Thank you for joining us. You have a great evening.

Video: "Arizona Horizon" is made possible by contributions from the friends of Arizona PBS. Members of your PBS station. Thank you.

Sir Malcolm Grant: Chairman of National Health System in England, Dr. Denis A. Cortese:Eemeritus President and CEO of the Mayo Clinic

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