In this, the second episode of the Surviving Healthcare podcast, I had a chance to talk to Adam C. Powell, Ph.D. about the history of our healthcare system. In this freewheeling interview, we cover how we paid for care in the past and how we pay for it now. Dr. Powell has a Ph.D. from the Wharton School in Health Care Management and Economics, and he is currently a managing partner and president of Payer+Provider, a consulting firm that deals primarily with managed care and health care delivery issues, as well as health care economics.
The podcast opens with a discussion about how we paid for health care before World War II, when patients largely paid for healthcare out of pocket. He explains how and why economic conditions during the war led to our current system, which is now dominated by employer-provided group health insurance.
As initially conceived, insurance premiums began low, largely because medical care was cheaper, but Dr. Powell explains why costs and premiums began to rise and the impact of major changes in the healthcare industry that happened in the 1960s and changed the way we pay for some health care forever.
There is also a discussion of historically important events from the 1970s on, including the creation of programs like Medicare Advantage, the Children’s Health Insurance Program (CHIP) and Medicare Part D, which allowed plans to include prescription drugs for the first time. Dr. Powell explains their impact on our healthcare system as well as the impact of rapidly advancing technologies on its overall cost.
Dr. Powell also predicts the overall impact the Affordable Care Act will have on the system, and discusses a variety of impactful issues such as the tendency for health care delivery companies and insurance companies to negotiate and determine payment amounts and the effect of contract pricing on charity health concerns.
Our discussion of the history of healthcare payment concludes with Dr. Powell’s vision of the future of health insurance and how it could impact the overall quality of health care. This includes the potential impact of electronic health records on patient care.