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McDonough maps history of American health care

Health care advisor during Obama administration presents potential policy solutions

By
Staff Writer
Wednesday, November 1, 2017

John McDonough, who helped develop the Affordable Care Act during his tenure as a senior advisor on national health reform between 2008-2010, presented the history of health care since the 1940s in his talk.

“Health care is probably, more than anything, the exemplar of a dysfunctional market,” said John McDonough, professor of public health practice at Harvard’s T.H. Chan School of Public Health. As a speaker at the annual Healthcare in America Lecture Series, McDonough discussed the political history of health care since the 1940s and presented policy solutions at the Alpert Medical School Wednesday night.

More than seven years after the Affordable Care Act was passed, health care policy remains a contentious issue,  with several failed Republican attempts to repeal the ACA and some Democrats advocating for socialized medicine in a single-payer system. McDonough helped develop the ACA as a senior advisor on national health reform to the U.S. Senate Committee on Health, Education, Labor and Pensions from 2008 to 2010.

“We spent a lot of time before the process got underway learning the lessons from all of these prior health reform efforts,” particularly “the Clinton plan fiasco,” McDonough said. The Clinton health care plan of 1993 would have entitled every American citizen to preventative services and medical treatments, regardless of pre-existing conditions. But this plan did not offer a guarantee that people happy with their insurance plan could keep it, McDonough added.

Since 1994, three states have considered switching to single-payer systems through ballot initiatives, McDonough said. All three have failed, along with a legislative effort in Vermont. Even if Democrats gain control of the House, Senate and presidency by 2021, a single-payer initiative could still fail, he added.

“The nightmare for me is that (in 2021) Democrats put their money on single-payer, and … they run into a catastrophic wall of opposition, and by 2023 they’ve lost control of the House and the Senate,” McDonough said. “On the other hand, maybe they go for it and maybe they get it.”

Despite barriers such as the insurance and pharmaceutical industries’ vested interests in the current system, the health care system could eventually evolve into something dramatically different from what is outlined by current policy, McDonough said. In a comparative portion of the lecture, McDonough cited Germany’s health care structure as his personal favorite.

“There (are) some really good models out there that make sense if we have a different environment, and we will,” McDonough said. “It’s only a question of how long it will take.”

The series, which aims to improve attendees’ understanding of the U.S. health care system, is funded by the Office of Medical Education. Eli Y. Adashi, professor of medical science and former dean of the Med School and four medical students organized the annual series.

Student coordinator Caroline Burke MD’20 said they typically host between eight and 12 lecturers in the series each year.

“For us, the goal was to be able to touch upon a range of different topics that make up the landscape of health care in America as it currently stands,” Burke said.

Sophia Demuynck MD ’21 said she has attended all seven lectures in the series so far. “It exposes us to people who are close to policy decisions in health care but also extremely knowledgeable about the history of health reform,” Demuynck said.

The lecture series helps students understand the state of health care policy, and pre-clinical students are able to treat the series as a non-credit bearing elective course, Burke said.

“As medical students who are going to be practicing in an evolving landscape, it’s really important to be able to understand how different pieces of the puzzle fit together, especially as those pieces are changing over time,” Burke added.

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