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Learning from the Learners: Health Reform 101

By Dr. Kohar Jones

Once each month, I teach a one hour lecture in the family medicine clerkship, called “Health Reform.” This lecture developed in response to third year medical student concerns.  They wanted to know not only how to treat high blood pressure and diabetes, but also—what is the landscape that shapes
primary care reimbursements and determines the structure of a clinic day? And what is in that health reform bill their family and friends
keep asking them about anyway?

“Health Reform” provides a basic overview of the Affordable Care Act, relying heavily on materials provided by the Kaiser Family Foundation.  I begin with a pop quiz, using questions derived from Kaiser’s Health Reform Quiz.  Camara P. Jones’ allegory of the cliff provides a useful framework to understand our health care system. We discuss where the specific provisions in the bill are targeted to shift incentives (within the framework of our current system) from sick care to health care. Students then watch the Kaiser Family Foundation video “Health Reform Hits Main Street” to review the basics of what is in the bill, before reviewing their pop quiz and generally being amazed by how much they have learned in the course of an hour.

Today, I structured class a little differently, and asked the third year medical students to answer a different set of questions. How do you feel about health reform? What questions do you have about health care reform? What are your hopes for health care reform?

I learned a lot from the students.  The idea of health care reform makes medical students happy—and confused!  They have basic questions about what is in the bill, and the same big questions policy experts are grappling with about how to handle implementing the bill.  For these future physicians, health reform takes a personal bent, and they really want to know—what will health reform mean for their patients, their practices, and for their future lives?
They hope to provide high quality, cost effective care that is accessible to all, with an eye towards prevention. So much remains to be seen about how the health care law will unfold. I feel cautiously hopeful.  How much will change? Hopefully enough that we may replace our sick care system with a health care system that promotes health for all.

The raw data
Happy and concerned
Happy and overwhelmed by the complexity of the information
Good disbelief and cynical
Proud (from Massachusetts)
Confusion (“it’s so complex!”)
Confusion (“why is it so polarizing?”)

Why has it taken so long?
How will it affect how I care for patients? How will it affect my life?
How will spending be controlled? Who will pay for all medical services?
How will we have enough doctors, especially but not limited to primary
care physicians? What will be done to prevent brain drain from abroad?
When will effects be seen?  What is the timeline?
Will advances in medicine continue to grow at this level, slower or faster?
How will health reform close the gap/disparity among different
populations in the US?
Will everyone ACTUALLY have access to SUFFICIENT coverage?
How will the model be sustained economically?
How will this impact physicians and their practices?
Will outcomes be compromised to cut costs?

Better access and healthcare for all
Better distribution of doctors across US
That we do the same or better for cheaper
That everyone can have access to basic needs and that in trying to
figure out how to sustainably pay for that we find answers to a lot of
hard questions that have been neglected such as end-of-life care
decisions and costs, abortion access, who gets expensive procedures
like organ transplants, etc.
More preventive care and better coordinated care, not turning people
away or changing care because of insurance status.
Fewer emergency room visits.
Decrease cost, waste, needless expenditure.
Push more physicians towards primary care.
More focus on preventive medicine, integrative medicine, increased
education on healthy lifestyle.
Improve quality of and access to care.
Everyone can get high quality basic essential healthcare free.

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