If the proposed Medicare cuts take effect, will they change the process of implementing changes to the Medicare payment system proposed in the Patient Protection and Affordable Care Act?

Will anyone stop linking Medicare/Medicaid reimbursement payments to physicians to the SGR? I understand about saving money but killing the main providers isn't working.

[Note from Forum editor: SGR refers to Sustainable Growth Rate. See https://www.cms.gov/SustainableGRatesConFact/]

It is clear the country has trouble staying within budget. That is especially true in health care. Second, this is a huge country with fifty states and many health care subcultures. Dr. Charles and Warner Slack of Harvard have written in the Mayo Clinic Proceedings that we actually benefit or suffer from the United Countries of America when it comes to health care.

Our experts may introduce a top down approach to saving money on health care. But the reality is that the cost savings have to come at the bedside where the physicians, nurses, and others will have to figure out how to provide more for less. They know their patients. None of ou[r] top down ideas have worked.

Why not do crowd sourcing to get ideas on how to save money from all levels and tiers of the health care system?

Bohdan A Oryshkevich, MD, MPH (Kellogg Fellow HSPH 1981-83)
New York City

One of the main problems I see is the pharmaceutical industry, as well as the entire health system, absorbs lots of profits. Health care is at the foundation of human rights, and all people should benefit. How do you see the health care system should be regulated as to respect human rights?

FORUM WEB EDITOR

EMAIL RECEIVED FROM Susan Truitt, Towson University

Heres an issue I would love to have discussed: where do we draw the line between individual liberty and societys need to protect itself from overwhelming healthcare costs that are largely preventable. We require motorcycle helmets and seatbelts, and we prohibit smoking in public places. Why dont we prohibit the use of transfats, and heavily tax food choices that are sugar-laden and saturated fat-laden? Schools offer pizza, French fries and chocolate milk because they are cheap and tasty. We cant change the tasty part, but we can change the cheap part. We need to make healthy foods just as affordable as unhealthy ones.

How can society change or modify existing social structures to impact the paradigms th[at] frame our concepts of health and well being?

In the U.S., our cultural paradigms about health, well being and medical care are upside down and backwards. It seems that people are conditioned to expect medical intervention. Rather than exercise and eat "low on the food chain" most people would rather take a pill.

Back problems, one of the major causes of disability in the U.S., are a good example of this thinking. Most people do not do the exercises recommend by doctors and physical therapists. It seems people feel they will not be believed and their pain will be minimized or trivialized. This seems especially true if the need to prove injury becomes a legal matter: it is difficult to win a case if exercises prevent or delay the need for surgery or other intervention.

The maths do not ad up. This was the problem, and still remain[s] the real problem. And why the maths do not add up --we argue and disagree, but did we ever question the fundamental principles underlying national accounting system when we discuss health care. Could the panel say something how health care figure[s] into [the] national accounting system and how the fiscal and monetary shifts in the US economy could lead to dysfunctional national assets depository? Thanks. Mr. Muhammad Z. Khan, '92, HSPH, Harvard University

Community Health Centers have been shown to consistently save 15 - 30% of global health care cost while serving less healthy populations in medically underserved areas. Why not accelerate their expansion?

Why can't you have [an] NHS-like system, where Govt is the provider as well? If you have private providers, the costs are bound to rise.

Why not go to a health system like the vets have?

FORUM WEB EDITOR

EMAIL RECEIVED FROM ONLINE AUDIENCE MEMBER

As the fictional president in the film "Traffic" remarked, "Where are the treatment people?" (or something like that) referring to the substance abuse treatment professionals.

When are the Feds, insurance execs and health plan moguls going to appreciate the real damage that illicit drugs and more importantly problem alcohol use do to our society?

Alcohol abuse and its consequences in healthcare costs and deaths on the highways are an issue that we already have the tools to reduce their incidence. We just need more funding!

As for illicit drugs, either legalize them or give us the resources to treat the addicts.

--A Clinical Director of an outpatient First and Second-Offender Drunk Driving Program