Speaker: Dr. Ezekiel Emmanuel, "Reinventing American Health Care"

By Puja Upadhyay

Note: This is an old post from April 2014 from WUHC's old website. Information from this post may not align with current events.

Dr. Ezekiel Emanuel, a chief architect of the Affordable Care Act (ACA), spoke on April 7 to WUHC and Penn Democrats about the American health care system and megatrends, or his predictions for the future of American health care. Emanuel is also the Vice Provost for Global Initiatives, Chair of the Department of Medical Ethics & Health Policy, and a Professor of Health Care Management at The Wharton School. His talk was largely based on his new book, Reinventing American Health Care: How the Affordable Care Act will Improve our Terribly Complex, Blatantly Unjust, Outrageously Expensive, Grossly Inefficient, Error Prone System.

He began by taking “a trip down memory lane” because one of the biggest problems that people have when discussing American health care with others is that people have “very, very short memories” and many people forget why and how such as massive piece of legislation (the ACA) was passed four years ago. “People don’t remember how bad [the situation] was [in the past],” so it’s very useful to review statistics to understand the reasons that the ACA was passed in the first place.

There were three big goals of the ACA. The first was to provide access to get people covered. Before the ACA, half of Americans had coverage through their employers, but 16% percent were uninsured. Of the uninsured group, 62% had one full time worker in the family, but then why no insurance? Unlike many people’s beliefs, the uninsured are not “welfare queens” – they are hardworking Americans. Usually, the uninsured just couldn’t get coverage from their employers because they worked low-wage jobs. The second goal was to achieve high quality care consistently, “for which the American health care system is not the most reliable,” Emanuel explained. The third goal was getting the cost of our health care system under control. In 2013, the United States spent nearly $3 trillion on health care. It’s hard to imagine what $3 trillion actually means – but as a reference, the entire French economy is approximately $2.5 trillion, and it is the fifth largest economy in the world. We spent 20% more on health care than the French do on everything in their economy. In a sense, the US health care system alone is the fifth largest economy in the world.

Looking at the present day, Emanuel explained, “At least for the first four years, the ACA is working.” Despite two years of problems with the website, 7+ million people signed up for private health insurance. What does that tell us? “People want health insurance!” Emanuel exclaimed. “There is a big hunger out there for affordable health insurance. It’s not that people are stupid and it’s not that people like going uninsured – people want health insurance, and these numbers tell you that.” Getting to this point was not the easiest feat, but people signed up regardless, demonstrating their desire to be insured. As evidence of the ACA’s impact, Emanuel also gave examples of increase in quality of care (i.e. lower percentage of return visits from patients) and a steady decrease in costs. Some of the megatrends, as featured in his book, that Emanuel discussed are:

  1. The end of insurance companies – health care companies will shift focus on analytics and risk management, transform into integrated delivery systems (i.e. Kaiser), or go out of business
  2. VIP care for the chronically and mentally ill – targeting these individuals and providing quality care for them is “the way to save money”
  3. The emergence of digital medicine – using technology as a way to monitor patients where they are through use of pictures, video, etc. will increase productivity and decrease costs
  4. The end of employer-sponsored insurance – a controversial megatrend. The president said that “if you like what you have, you can keep it,” but Emanuel believes employers will not continue providing insurance
  5. The end of health care inflation – “because we’re going to figure out how to deliver health care for cheaper.”