Article Image America**Q**s Health Care System: How We Got Into This Mess and How We Can Get Out


America's Health Care System: How We Got Into This Mess & How We Can Get Out - Course

Written by Subject: Events: Arizona

This course describes the evolution of the American health care delivery system from the early 20th century to the dawn of the 21st century. It identifies both the positive and the negative aspects of the present day health care system and their causes, and defines critical areas in need of reform. The Affordable Care Act of 2010 is critically examined with respect to its ability to achieve needed reforms. Alternative reform proposals are explored.

Unlimited slots available


Meeting Time:

7:00 p.m. - 9:00 p.m.

The course will meet on Wednesday evenings for five weeks.

January 7: The Rise of the Medical Cartel / Birth of the Blues – the music begins

-The Rise of the Medical Cartel

Creation of medical hegemony

The Flexner Report – 1910

The American Medical Association (AMA)

The American Board of Medical Specialties (ABMS)

Physician licensing issues through the 20th century – basis, need, licensing role, regulatory aspects, etc.

-Birth of the Blues – the music begins

1930s – health insurance for the individual

WW II – the role of wage and price controls in health care insurance

Rise of employer provided health insurance

The McCarran-Ferguson Act of 1945

The Hill-Burton Act of 1946

Kerr-Mills program of medical care for indigent seniors signed by President Eisenhower

January 14: The Medical Mushroom Cloud – how Medicare changed everything / Initial Efforts to Rein in U.S. Health Care Costs

-The Medical Mushroom Cloud – how Medicare changed everything

Medicare and Medicaid signed into law on July 30, 1965 – legislation the old-fashioned way

Life span versus Medicare eligibility in 1965

Medicare reimbursement – doctors trade up from a Buick to a Mercedes

Medicare as a cost driver and the problem of 'mission creep'

Medicaid – the states take control;  variations in incentives lead to variations in care

A tale of unfunded liabilities

Medicare (taxpayer) support of physician training – supply and demand be damned

-Initial Efforts to Rein in U.S. Health Care Costs

HMO Act of 1973 – the rise and fall of HMOs

Employee Retirement Income Security Act of 1974 (ERISA)

Birth of Medicare price controls under President Reagan

Diagnosis Related Groups (DRGs), Resource-Based Relative Value Scale (RBRVS) and unintended consequences

January 21: Unindicted Co-Conspirators – other cost drivers of U.S. health care

-Unindicted Co-Conspirators – other cost drivers of U.S. health care

Indigent care before Medicaid – the Arizona example

EMTALA – the emergency room 'magnet'; no going back

Cost shifting – it ain't just dollars

State based Certificate of Need (CON) laws

Medical malpractice, tort law and the rise of defensive medicine

-Unindicted Co-Conspirators – continued

The FDA – safety versus efficacy; how 'mission creep' raises costs in money and lives

Proposals for FDA reform

'Big Pharm' – the good, the bad and an ugly cost driver

Evidence based medicine – it cuts both ways

Preventive care – real health care or another cost driver?

January 28: The Patient Protection and Affordable Care Act (a.k.a. Obamacare) – a law of unintended consequences

-The Patient Protection and Affordable Care Act (a.k.a. Obamacare) – a law of unintended consequences

The legislative landscape of 2009

'Doing' healthcare versus 'reforming' healthcare in 2009-2010

Transformation of the United State health insurance model (and system) into something else – what is it?

Increased demand with rationed care (decreased supply) – Medicaid expansion and the IPAB

-The Patient Protection and Affordable Care Act (a.k.a. Obamacare) – a law of unintended consequences – continued

What is an Accountable Care Organization (ACO) and what are they for under Obamacare?

Electronic Health Records (EHRs), practice 'guidelines' and protocols

The doctor – patient relationship – Obamacare versus the Hippocratic Oath

Economic consequences of ACA to individuals, families, businesses, job creation and the nation's fiscal well-being

The Veterans' Administration – is the VA system a viable health care model for America?

February 4: Real Health Care Reform – a way out of this mess / Real Health Care Reform – allowing the health care market to work

-Real Health Care Reform – a way out of this mess

Reform of the United States tax code – leveling the playing field

A universal tax credit for health care

Expanded Health Savings Accounts (HSAs)

Pre-existing conditions, high-risk pools and 'health-status' insurance

High Deductible Catastrophic Health Insurance – insurance as it was meant to be; reference pricing

Buying health care insurance across state lines – an antidote to the McCarran-Ferguson Act

Tort reform – useful but not a panacea

-Real Health Care Reform – allowing the health care market to work

Is price competition possible for health care services?

Is price transparency possible for health care services?

Milton Friedman's four categories of spending

A case study – The Surgery Center of Oklahoma (SCO) with special guest: G. Keith Smith, MD - Anesthesiologist, CEO and Founder of SCO

About the Instructor

Jeffrey A. Singer

Jeffrey A. Singer is a general surgeon in private practice in metropolitan Phoenix, AZ. He is principal and founder of Valley Surgical Clinics, Ltd., the largest and oldest group private surgical practice in Arizona. He was integrally involved in the creation and passage of the Arizona Health Care Freedom Act, and serves as treasurer of the US Health Freedom Coalition, which promotes state constitutional protections of freedom of choice in health care decisions. He is a regular contributor to Arizona Medicine, the journal of the Arizona Medical Association. He writes and speaks extensively on regional and national public policy, with a specific focus on the areas of health care policy and the harmful effects of drug prohibition. He received his B.A. from Brooklyn College (CUNY) and his M.D. from New York Medical College. He is a Fellow of the American College of Surgeons and and adjunct scholar at the Cato Institute in Washington, DC.

John R. Ammon

John R. Ammon is a practicing anesthesiologist in metropolitan Phoenix, Arizona. He has been in practice for 36 years since training at the Massachusetts General Hospital/Harvard Medical School program and fellowship training in cardiovascular anesthesiology at the Stanford University Medical Center.  He has served on medical school faculties at the University of Pittsburgh and the University of Arizona throughout his career in private practice.  Dr. Ammon served as a director of the American Board of Anesthesiology, the certifying board for anesthesiologists, from 1987 to 1999, and as its president from 1998 to 1999.  He was chair of the In-Training Council in the specialty of anesthesiology for seven years.  He is the founder and first president of the Arizona chapter of Docs4PatientCare, an organization dedicated to protecting the sanctity of the doctor-patient relationship and advocating for genuine reform of health care insurance and financing and limiting the government's role in health care decision making.


ASU SkySong

1475 N. Scottsdale Road




Location Details


SkySong Building 1 (North)


201 Global



Required Materials

Registration closes on January 1. Full refunds are available up until January 1, 2015. No refunds will be issued after that date. Partial refunds will not be issued.