Behind Health Care Reform: An Insider's View: Stan Hupfeld at TEDxOU

Behind Health Care Reform: An Insider's View: Stan Hupfeld at TEDxOU



the night that the Affordable Care Act was passed some of you might refer to it as Obamacare which its opponents do derisively I got up in the middle of the night I was so upset with both political parties in the disservice that I think they had done to the American public because of the opportunity that was missed to do something right I began to write and I found that only by writing could I exorcise the demon within me three months later I'd finished a book and I tried to make several points in the book number one we've asked the very worst people in the world our politicians to solve the most complex domestic issue of our time people for the most part that had never cared for a patient had never started a medical service and many of whom had never even met a payroll secondly I've determined and I'm going to try to demonstrate this today that there is sufficient money already in the medical care system to do what we started out to do and that was care for the uninsured without creating a new entitlement and thirdly to attempt to explain why the health care system is so very hard to change in order to understand this we have to go back just a moment and review how we think about the medical care system in this country it is true at any United States we represent the very best and the worst of medicine in this world – Valentine's ago Baptist Medical Center in Oklahoma City participated with Johns Hopkins University in Baltimore and barnes-jewish in st. Louis to do a three state 3 Hospital nine surgeon 12 patient dominoe kidney transplant the first time that had ever been attempted in the United States as kidneys flew back and forth across the country on the same day this is example of our technology that occurs everywhere in this country certainly occurs in this community on a regular basis but here's the interesting part at the very same time that that miracle was happening now two miles away from the campus of Baptist Medical some of the most desperate people in the world were lined up to receive free care from volunteer doctors and volunteer nurses hoping beyond hope that the resources of those of those meager clinics could meet their medical needs because if they could not then we'd start this dance of trying to find a surgeon and a hospital and an anesthesiologist that might take care of their needs a process it could take weeks even months and by then the patients were worse off and often wound up in hospital emergency rooms the very worst place the most expensive place to treat these kind of conditions so the question is how do we how do we answer this very simple question how do we provide the most care to the most people a sufficient quality and constrained cost now that seems like a very easy question to answer but in fact the answer seems to elude us and let me give you a sort of a real-world example so we can compare how our healthcare system works compared to what all of us are familiar with if I give my daughter my credit card and I say dear you go to the mall and you pick out anything you think you want when you're in the mall I as if cardholder will pay the bill my daughter goes to the mall she goes to the dress store she hands my credit card to the salesperson and tells the salesperson you pick out for me what you think I need what's the result of my card bill has a card holder well my costs go up exponentially that's what happens there's a complete disconnect between the three parties at interest the card holder me in this case perhaps the employer or the government the person benefiting from delivering the service a sales clerk in this case the doctor and the person receiving the service my daughter in this case the patient it is this that is this total disconnect that leads us to our out control healthcare cost health care costs that have exceeded inflation for the last thirty years health care costs and receipt exceed any rise in the cost of wages you know the problem is we think about in health insurance as if it were insurance it's not insurance I'm not an insurance a person but here's what I think insurance is is taking up a little bit of money from the many to cover the extraordinary losses of few when we have homeowners insurance we don't expect a homeowner's insurance to pay when someone throws a ball through our window we have auto insurance we don't expect the auto insurance company to pay when we have a flat tire but yet every time we have a contact with a medical provider we accept we expect someone else to pay the bill in whole or in part that by definition is not insurance it's a transfer a payment system so let me go over a couple of things that I think and there's about 15 of them that I think make American medicine and health care so hard to change number one is tort reform now we all sort of know that the idea in the rest of the world of people suing doctors and hospitals for acts of negligence is not unknown but we've taken it to the extreme every doctor in this country views every patient as a potential litigant that adds extraordinarily to the cost of medicine but here's that here's the interesting part that most people really don't realize in our fee-for-service medicine where the more we do the more we get paid we actually benefit because to do more because we think we have to do more benefits us so the thing we fear the most works to our economic benefit secondly there's a lot of conversation about whether healthcare at its core should be market driven if we just let the wonders of the free-market work will solve all our problems in 40 years in health care I've never seen anything convinces me the healthcare can be market driven can it be market driven at the fringes at the margins absolutely can we train people to say doctor do I really need that MRI or court could I go get it over here because I've read on the Internet is cheaper sure but that's at the fringes when it comes down to something serious heart disease cancer stroke you and I our knowledge of medicine is so insufficient compared to our doctor we in effect are uninformed Zoomers and an informed consumer is the essence of a free market at the end of the day when it's something serious we see doctor for your mother your father your brother what would you do and that's what we do we're uninformed consumers we have extremely high overhead 1/4 that bears repeating 25% of every health care dollar goes to collecting a bill that's unknown in the rest of the world every doctor has two or three patients do nothing but collect bills Integris health as hundreds and hundreds of people that do nothing but collect bills let me go back to my daughter analogy my goat when my daughter goes to the mall she takes with her two or three different lines of credit she takes a MasterCard she takes a Visa maybe a discovery card what if in fact the retailer had to meet 150 different lines of credit all with different regulations all absolutely bent on paying you as slow as possible what does that do to the cost of that retailer that gets passed along ultimately to the buyer you and I are part of the problem I talked to a lot of doctors in writing this book and what I found is that to a person they feel tremendous pressure to do something when doing nothing would be better if a patient leaves their offices without a lab test without an x-ray and particularly without a pharmaceutical they feel cheated and the doctor Fields is why in fact the insurance to pharmaceuticals advertise to patients at night over the television over the head of the doctor who has to write the script because they know that 80% of time when you ask for a medication by name your doctor will write the prescription and the reason is simple doctors work on the basis of time so if they take 15 minutes out of your schedule for every patient to explain why they didn't need that purple pill they saw on television that's one or two patients less they can see and finally words get in our way I invented a disease called the Pelosi Palin syndrome these two women could not be more different politically but to me they're the flip side of the same coin they give absolutely no intellectual depth to any comp Lexx problem everything is everything is decided on the basis of sound bytes let me give you a couple examples of the sound bytes we have the very best health care system in the world that's a sound byte you hear it all the time why would we say that why would we say that we don't rank near the top and World Health Organization statistics on any category except cost per capita if we started out 50 years ago and said to ourselves let's build the most expensive healthcare system in the world we've been marvelously successful secondly death panels we all heard this story about death panels and both parties have used this recall during the presidential election the number of times you saw a commercial depicting congressman Ryan running for vice president pushing his mother over a cliff because of the things he wanted to do to Medicare and the other Republicans is just as bad the New York Times reported that the Obama administration was going to begin to pay doctors to end a life discussions with their employees and the Republicans went crazy see we told you what they want to do to the old people you know it's it's crazy because every state in this union has a law and a requirement and an encouragement that each of us have an end-of-life discussion with our lawyer and we produce a living will so that someone can act on our behalf and we cannot but yet we don't want to pay our doctor to have the same discussion I don't understand now here's here's what I'm thinking here is part of the problem and maybe part of the solution if insurance takes up 25% of every health care dollar why don't we see if we can recapture that cost the reason the insurance companies delay payment and I will tell you right now you're talking about a process that ought to take a week you're taking a bill from a provider you're comparing it to a benefit plan on your issue in a check it in fact takes three to four months at best because the insurance companies are working on the time value of money they do not want to pay you and if they pay you they want to pay you as slow as possible so let's take that incentive away let's figure out a clever way using our tax system to make them not-for-profits and then pay them on what it is they do and that's adjudicate claims and pay them on how quickly they can adjudicate those claims secondly the president said during this debate something I really agree with we ought to pay for only what works fact is we pay for a lot of things that don't work some estimate as much as 30 or 40 percent of everything that's done to us is unnecessary or duplicated let's use evidence-based medicine they're very they're very good systems in this country to follow the protocols every medical school most specialty societies have protocols on how to deal with disease and if you follow the protocols you reduce variation most people don't realize a variation that's president medicine there may be a 30% variation between here and Tulsa ninety miles away on certain surgical rates and you engineers out there know that variation is a sign of poor quality we've got to follow the evidence and recapture that 25-30 percent and thirdly we need information available on us real time if you go to South Dakota on vacation today and you have a heart attack in the middle of the night you're going to be taken to a South Dakota hospital and the doctor is going to ask you some questions what medications are you on have you had a coronary arteriogram what were the results and in the absence of your memory being good and your memory is not a very good medical tool that will all be again there's huge redundancy in the system simply because there is a lack of information available real-time we need a system with an identifiers that identifies each of us like a so like our social security number does and then we use identifiers to locate our records and know specifically what's happened to us you know we have another issue too and that is it is medically related but it affects all society we've got to begin to have discussion about what we're going to do as we age because we are aging at a very historic rate you know if the 80 years old of today are like the 60 year old of yesterday and the hundred year old of tomorrow is like the 80 year old today the kind of systems both medically and social that we have to have for that population we haven't begun to address and let me mention one other thing before I close you know those of you out there who are old enough and have to begin to think about a living will the only thing I would encourage you do is very very careful in my own instance I changed my insurance policy leaving a lot more money to my wife the same week that I executed a living will giving her full power of attorney to make decisions for me and the instant I was signing the document for the living will I had a vision and I was in an ICU hooked up to lots of machines and my wife was standing at the foot of my bed along with my doctor and in this vision I hear my wife saying will he looks dead to me you know what we've done we have violated one of the specific principles of Steven Covey and that principle is to begin with the end of mine and when we started this whole process what we were talking about is how do we cover the uninsured that forth of the population that through no fault of their own son insured and we've gone away from that I think we need to get back to that and let me close with a story that I use in the book this story revolves around a patient named Lucy now Lucy's a composite patient but nevertheless she actually exists Lucy is a single mother with three children none of those jobs that she has he's domestic and two jobs and she works for a fast food restaurant in the third none of those jobs through no fault of her own provide her no health insurance now Lucy's doing everything we could ask of a citizen to do she's working three jobs to take care of her family Lucy makes twelve thousand dollars a year that makes her too rich to qualify for the Medicaid program so Lucy has to depend on free clinics for the care of her children and herself I believe we've got to get back to the leases of this world I believe we we have to figure out a way that in this very rich society we don't ignore Lucy Lucy is not an heir do well living in a box under a bridge he's an American citizen paying payroll taxes and paying property taxes through her rent this is where we need to focus this is what we've got to solve and I think if we get back to the Lucy's and really focus and then do some really straightforward things like I mentioned I think we can again begin to get a handle around health care reform thank you you

14 thoughts on “Behind Health Care Reform: An Insider's View: Stan Hupfeld at TEDxOU”

  1. An informed consumer chooses between price, convenience and quality. It is the responsibility of potential patients to learn where to purchase medical services as much as they learn about which car or dress to buy. Insurance should be for an $X limited fund in exchange fora $Y premium, regardless of pre-existing conditions. The value of one's own life has to be decided by each premium payer. The price of services has to be decided between customer/patient and supplier for market forces to apply.

  2. What I Want

    Since the elected and well paid politicians of both parties, seem incapable of the intelligence to come up with a plan that addresses health care, infrastructure, jobs, taxes, or education, I thought, as a normal and thoughtful Citizen of the USA, I would present my own plan for consideration and modification by interested citizens.

    I want a newly built health clinic in each county in the whole USA (including all territories), offering conventional and helpful medicines and treatments, experimental and alternative modes of healing and public health which is responsible for the testing of individual persons (regardless of legal status), testing of food and water and the health of the environment.

    All labor and most of materials are to come from local sources. Expertise can come from anywhere.

    Finance will come from local sources and backed by the federal government, as it’s #1 priority, above all other spending.

    The opening would be attended by the Congressional Representative from that district, the Constitution of the USA shall be read (in full) and “Washington Post March” by John Philip Sousa, shall be played by a local band.

    .There is more, but, this is good for a start.

    Sincerely,
    Georgemarc Schevene

  3. 1)TO COVER EVERYONE USE SINGLE PAYER. THIS ALLOWS PEOPLE TO TAKE RISK TO BECOME AN ENTREPRENEUR. ALSO ALLOWS THE GOVERNMENT TO PURCHASE DRUGS AT A LOWER RATE LIKE THEY DO IN CANADA, MEXICO, AND THE MILITARY.

    2)CREATE AN INDIVIDUAL HEALTH ACCOUNT WHERE PEOPLE CAN STASH UP TO 25,000 A YEAR. THEY CAN USE THAT MONEY TO INVEST AND GROW THEMSELVES.

    3)CREATE TAX CUTS UP TO 5,000 FOR PEOPLE TO DO HEALTHY THINGS. LIKE EAT AT A HEALTHY RESTAURANT, PURCHASE FRUITS AND VEGETABLES RATHER THAN PROCESSED FOODS, JOIN A GYM, JOIN YOGA CLASS, DO ACUPUNCTURE ETC. THIS KEEPS PEOPLE HEALTHY AND PEOPLE WITH PREVENTABLE OR CHRONIC DISEASES HEALTHIER.

    JUST SAYING

  4. As an attorney I took an oath to be ethical and to take unpopular cases.  I took a woman's botched hysterectomy case because of that obligation.  The tort reformers came after me with a vengeance.  It is such a politically entangled situation that the police refused to show up when I called to report an assault on me.  Later in my own medical  emergency the hospital castrated me.  There is no one to tell. I've been politically ruined and cannot even get a job as a tax preparer.   All the judges are "conservative" tort reformers.  The lecturer here touches on the benefits of tort prosecution but leaves out the most important :  It teaches other doctors how not to be negligent and to practice better medicine.

  5. Dr. Julia Tortolani MS, DAOM

    Would be great if only he could edit out his sexist remarks (about his daughter, female politicians, etc. Their are plenty of men using politicians sound bites out there). Given his generation, he is probably just totally unaware, but the remarks are really not necessary, insensitive, and detracts from his message.

  6. Affordable Care Act- great for some, but why are we ALL forced to pay for it? There is nothing at all wrong with socialism, but it is most certainly un-American.

  7. The shutdown is a typical tool of those idiots. It really had nothing to do with healthcare. Demand they accept the 28th amendment prior to any other matters.

  8. Glad I watched. Media does a disservice in attempting to divide us. I was just beginning to read the ACA for myself due to the hysteria. In fact the reason I found this was because I am debating reading the entire act out loud and posting it on YT. Obviously in segments as the length of any law is just to complicate matters. KISS principle should be used in laws too. Thanks again. Btw to those who give this speech a negative mark, why?

  9. we should not let the fed control our money. New money should be added through the infrastructure repair, social services which amounts to their spending the money on businesses stimulating the economy. food stamps is a good thing as we are blessed in helping people as food does,'t rot or stay on the shelves. It is fear which keeps the economy on the brink. We need to print enough money for circulation, if done in the spirit of God, in faith, the value will increase old debt purchased forgiven

  10. It is causing a stir because its being implemented to fast; That the businesses and middle people will be hurt because of the fast tracking in it being passed. Where they could of worked together with booth sides, instead of fearing as to force it through causing fear and division in the country now in the possible shutdown. In claiming equal rights half are being left out, effectively dividing the nation causing economic fear increased business loss due to their policies. fixing is breaking it

  11. YOU are soooooooooooo right !! But as of Sept 2013 – we are winning the fight to defund obamacare ……( please pass around my info I wrote to you below )

  12. It's a shame that the American model is beginning to spread out in Europe. It's really scary. In Spain we had the best Health Care system, we still do, but powerful health insurance companies are brainwashing profit-hungry politicians to change our Health care system following the American model. The spanish system is fair and affordable for everyone since it all comes from our taxes, and believe me, the quality of the medical attention is excellent. ¡¡Sanidad pública de todos y para todos!!

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