Page 6 - Volume 69 Number 3
P. 6

President’s Message
By Andrew R. Barnosky, DO, MPH
With Liberty and Justice for Some?
It is June 22nd and I am on a flight home from London to Detroit. I was fortunate to have spent the past four weeks in Oxford teaching at the University of Oxford Medical School, and leave with fond memories of the experience and the privilege of having been invited to serve on their faculty for a brief time.
While my work at Oxford was
concentrated in medical student
teaching, I was also fortunate to talk
with several physicians about
practicing medicine in England under
the National Health Service (NHS).
There’s no question that spending time in a different country and culture with clinicians, professors, and students is an enriching experience in countless ways, and looking at a country’s health system from the inside can be both interesting and informative.
Just before I left for the UK, the US House of Representatives narrowly approved legislation to repeal and replace major parts of the Affordable Care Act (ACA); Republicans moved a step closer to delivering on their promise to reshape American health care without mandated insurance coverage. While embraced by many, enthusiasm for the legislation was diminished in some corners when the Congressional Budget Office estimated that over a ten-year period 23 million individuals would lose their health insurance.
I lost track of US health care politics after arriving in Oxford, as the British media heavily covered two significant events, one political and the other tragic. Prime Minister Theresa May had stood for election and ended up losing 13 seats, and with them her party’s majority. And the tragedy of the Grenfell Tower fire happened days later. This was a horrific fire at a 24-story high tower block of public housing flats in west London, resulting in the death of eighty people and many more still hospitalized in critical care as I write. The indescribable sadness of Grenfell, and to a lesser extent the Prime Minister’s change of fate, consumed the television and print media. The ever-present drumbeat of political news from America was temporarily silenced, and with it news of evolving health care policy in the United States.
And now coming home, the major news item captivating my attention is the Senate’s continued efforts in restructuring health care, in essence modifying the American Health Care Act (AHCA) which passed the
House in May. The Senate measure appears to borrow from the House bill in eliminating the ACA’s employer and individual insurance mandates with a majority of the tax increases it imposed in order to pay for new programs. Both proposals call for a restructuring of Medicaid funding that would allow states to institute work requirements and discontinue the program’s status as an open-ended entitlement. The Senate bill would go further than the House’s $800 billion in cuts by reducing its growth rate beginning in 2025, but unlike the House version, it would
begin a three-year phase-out of the program’s expansion in 2020. The AHCA would cut off the expansion entirely that year. The ramifications of this are not known at present; the Congressional Budget Office has yet to
offer an economic opinion and an assessment of the number of individuals who could be affected by loss of insurance coverage.
My reflection on this Senate health care bill brought
to mind discussions I had recently with physicians at Oxford about the NHS, and earlier conversations ten years ago with both patients and physicians during a summer sabbatical at Oxford. As most know, the NHS was born in 1948 out of a long-held ideal that justice should guide the development of health care, and that quality services should be available to all, regardless of wealth. From the beginning, the three core principles guiding its development were: that it meets the needs of everyone; that it be free (to patients) at the point of delivery; and that it be based on clinical need, not ability to pay. While other principles have been added over the years to enhance the quality and integrity of the NHS, these three inaugural core principles remain to this date.
My conversations with physicians and patients in Oxford often brought out criticisms of the NHS. Complaints were voiced in many areas (access issues, waiting lists, absence of new interventions or medicines due to cost-effectiveness concerns, various scandals, the GP referral process to specialty care, cost containment, the regulatory burden to physicians, and the list goes on). And yet in spite of this dark side of the NHS expressed by both providers and consumers of health care, there seemed to be an overwhelming sense that the health system in the UK always seeks justice in the allocation and delivery of health care to its people. I was impressed by a
6 Washtenaw County Medical Society BULLETIN JULY / AUGUST / SEPTEMBER 2017

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