Skip to Main Content

Universal Health Insurance

Dr. Tuckson speaks with two former presidents of the American Medical Association.
Season 13 Episode 4 Length 28:43 Premiere: 10/01/17

Health Insurance: Can We Achieve Coverage for All?

The issue of universal health insurance in the United States has been debated for more than a half-century, and presidents ranging from Harry Truman to Bill Clinton have staked their political fortunes on establishing a system for universal insurance in the past. Following President Barack Obama’s passage of the Patient Protection and Affordable Care Act in 2010, more Americans were able to obtain health insurance coverage than at any point before in the nation’s history, but the political backlash has been strong.

The heated debate over health insurance currently gripping the nation contains ideas ranging from a “Medicare for all” plan proposed by Sen. Bernie Sanders (I-Vermont) to various Republican-backed plans that retreat from the idea of universal health insurance administered by the federal government and instead emphasize market-oriented approaches that give states, businesses, and individuals more freedom – and responsibility – in choosing their level of coverage.

In this episode of Kentucky Health, host Dr. Wayne Tuckson welcomes two former presidents of the American Medical Association and M.D.s who practice medicine in Kentucky to discuss the viability of establishing a universal health insurance program in the U.S., and what may be gained if universal health care is achieved.

Dr. Ardis Dee Hoven is a professor at the University of Kentucky College of Medicine. A specialist in internal medicine and infectious disease, she was president of the AMA from 2013-14 and is a member of UK’s Hall of Distinguished Alumni. Dr. Steven Stack is an emergency room physician at St. Joseph East Hospital in Lexington. He served as AMA president from 2015-16.

When asked if health care is an individual right in this country, Stack responds that framing it that way is a distraction to a certain extent because establishing a universal health care system also affects society at large. “I think health care is an inherent societal good,” he says. “I think that it’s in everyone’s best interest, the individual and society, that we provide health coverage at least at a basic level for everybody. Without your health, as the saying goes, you don’t have a lot.”

Where the Debate over the Affordable Care Act is Headed
Stack says that even supporters of the Affordable Care Act acknowledge that it has problems and needs to be reformed. For example, he notes that although millions of Americans gained health insurance via the ACA, either through the new insurance exchanges or by signing up for expanding Medicaid, there are still gaps in access. He notes that oftentimes, a patient will visit his emergency room with an infection or some other condition that requires a prescription, but after he orders one, the patient doesn’t have adequate insurance coverage for prescription drugs and cannot afford the medicine. Eventually, the patient will return in worse condition and require hospitalization.

“It’s penny-wise and pound foolish,” Stack says, “because if they could have a $20 prescription that would take care of the problem, or they could wait six more days and have to be hospitalized when it’s progressed, it’s a lot more expensive to treat it six days later when they’re in the hospital rather than six days earlier when they don’t require the hospital. But also it’s clearly a lot worse off for the patient.”

Overall, both Stack and Hoven believe that the Affordable Care Act has done more good than harm to America’s health care system. Hoven says that before the ACA was passed, the uninsured rate in the U.S. was around 20 or 21 percent. After 2010, those rates decreased significantly, but the change was not uniform across the country due to a Supreme Court decision that allowed states to choose whether or not they could expand Medicaid. For those that did, eligibility for Medicaid increased to 138 percent of the federal poverty level. In Kentucky, that resulted in around 400,000 new enrollees to the program.

One aspect of the ACA that has not received as much coverage in the current political debate over whether it should be altered or ended is its introduction of preventive medicine regulations for providers and insurance companies. These are designed to, over time, bring more people into the health care system as lifetime patients who get regular checkups. Both Hoven and Stack say that these provisions should be given more time to work.

“I think there’s no question [the ACA has been a benefit],” says Hoven. “We saw the uninsured rates drop significantly in this country. I think it’s not been long enough for us to see the improvements in the health outcomes because so much of that depends on the prevention and the wellness care. What the Affordable Care Act also did was make sure that prevention care was totally covered. So there would be no co-pay or cost sharing or out-of-pocket for mammograms, colonoscopies, flu shots – those things people could get and could access without having to pay for it. So the prevention piece is a very important part of this.”

Many critics of the ACA argue that its costs are unsustainable for federal and state governments in the long term. There is also an ongoing philosophical divide about the role of the government in mandating health care, Stack says. But the ER physician also says that it’s a mistake to think that the more fragmented insurance system that existed before the ACA was more efficient and less costly.

“It is a false conclusion to say that if we don’t pay for health care through insurance that we’re not paying for it,” he says. “Because in the emergency department I see this all the time: someone’s got to be charged extra money to be able to make sure that we can pay for all of the folks who never pay anything. It would be far better and make far more sense to create a rational system to ensure that everybody has access to some reasonable level of care, so that we don’t have to do this crazy cost-shifting. We can do it in a way that’s rational and gets people better outcomes, and overall hopefully at least improves the value proposition.”

Ways to Reform the System and Improve the Nation’s Health
Ultimately, both guests believe that the U.S. needs to craft and implement a system of universal insurance coverage for at least basic health care services. A lot of the focus should be on modernizing the existing health care infrastructure to eliminate inefficiencies and unnecessary costs. According to Hoven, around 25 percent of U.S. health care costs are administrative costs. The regulatory requirements, even after the ACA’s passage, are still so complex that a small army of administrators is needed to make sure everything is in compliance, she says.

“We also provide the most exasperating, duplicative, unnecessary and fragmented care, because a patient may see multiple physicians, have multiple tests repeated,” Hoven adds. “The right arm doesn’t know what the left arm is doing, partially because we can’t talk to each other electronically and communicate information, and we waste so much money in doing this.”

Stack says that many pharmaceutical and medical equipment companies are also responsible for driving up costs in the current system. More broadly, he points out that the medical community has undergone a seismic shift in how care is provided over the past century due to rapid innovations in medical science and knowledge. He argues that the payment framework has not adjusted to this change, and the costs, both financially and in overall health quality, are significant.

“This can’t be underestimated: the profound shift from health care being for acute illness to chronic illness,” Stack says. He explains that most cancer diagnoses made during the early- and mid-20th century were terminal, and diseases such as diabetes also resulted in a shortened lifespan. “Nowadays, you live with diabetes your entire life, and you can have a great quality of life,” he says. “Nowadays you can have breast cancer at 33, be cured and live to 50 and have colon cancer, and be cured and live to have lymphoma or leukemia when you’re 75. So we have shifted the burden from acute to chronic care, and the vast amount of health care expenditures now occur in chronic care, not acute. These are problems that have derived from our success in treating people.”

Emphasizing health care as a lifelong pursuit, instead of treating a disease or condition after the fact, is at the core of the universal coverage policy that both Hoven and Stack envision for the future. Stack tells the story of a recent patient to his ER, a homeless alcoholic that he has treated three times, to illustrate his point.

According to Stack, the man’s social problems – his homelessness, his addiction, his lack of a job – are driving his poor health. Stack finds that many doctors, especially those in the emergency room, are social workers in a sense in that they are treating the specific health outcomes of larger, long-term conditions that affect individual’s lives. He believes that allocating more resources on the front end, be it in preventive care services or even an expanded social safety net for food and shelter, will substantially reduce health costs over time. But these types of far-reaching discussions are lacking in the public policy arena, he contends. “We can solve the problem affordably, or we can fail to solve it unaffordably,” he says.

Sponsored by:

The "Let's Learn Kentucky" logo in white on a teal background, the copy, "An easy-to-navigate resource hub for parents and caregivers", and an illustration of a child stacking letter blocks A to E, along with a button that says, "Learn More".The "Let's Learn Kentucky" logo in white on a teal background, the copy, "This easy-to-navigate resource hub for parents and caregivers focuses on a child's early years -- an especially important developmental time.", and an illustration of a child stacking letter blocks A to E, along with a button that says, "Learn More".

Season 13 Episodes

Public Health in Kentucky

S13 E25 Length 29:24 Premiere Date 04/15/18

Pain Treatment in the Age of Opioid Addiction

S13 E24 Length 28:57 Premiere Date 04/08/18

The Louisville Health Equity Report

S13 E23 Length 28:09 Premiere Date 04/01/18

Smoking in Kentucky: Hidden Cost Obvious Impact

S13 E22 Length 28:54 Premiere Date 03/25/18

Kidney Function and Renal Disease

S13 E21 Length 28:32 Premiere Date 02/25/18

Brain Tumors

S13 E20 Length 28:44 Premiere Date 02/18/18

Gastroenterology and Motility

S13 E19 Length 27:37 Premiere Date 02/11/18

Many Years, Many Medicines, Many Problems

S13 E18 Length 28:38 Premiere Date 02/04/18

A Day in the Life of an Ophthalmologist

S13 E17 Length 27:32 Premiere Date 01/28/18

A Day in the Life of a Thoracic Surgeon

S13 E16 Length 27:27 Premiere Date 01/21/18

Incontinence and Female Sexual Dysfunction

S13 E15 Length 27:51 Premiere Date 01/14/18

Building Healthy Communities

S13 E14 Length 28:44 Premiere Date 01/07/18

Music and Medicine

S13 E13 Length 28:34 Premiere Date 12/17/17

Health Ministries

S13 E12 Length 28:29 Premiere Date 12/10/17

Preventing Heart Disease

S13 E11 Length 28:40 Premiere Date 11/19/17

Prostate Cancer

S13 E10 Length 28:42 Premiere Date 11/12/17

Skin Diseases and Conditions

S13 E9 Length 26:22 Premiere Date 11/05/17

Treating Drug Addiction

S13 E8 Length 28:12 Premiere Date 10/29/17

Importance of Anesthesia

S13 E7 Length 28:34 Premiere Date 10/22/17

Public Sanitation Infrastructure

S13 E6 Length 26:39 Premiere Date 10/15/17

Health and the Outdoors

S13 E5 Length 28:47 Premiere Date 10/08/17

Universal Health Insurance

S13 E4 Length 28:43 Premiere Date 10/01/17

Strategies for Quitting Tobacco

S13 E3 Length 26:38 Premiere Date 09/25/17

Rural Physicians' Perspectives

S13 E2 Length 26:53 Premiere Date 09/17/17

Health Care in Rural Kentucky

S13 E1 Length 27:38 Premiere Date 09/12/17

See All Episodes

caret down

TV Schedules

Jump to Recent Airdates

Upcoming

Medications: A Modern Miracle, But Are They Safe and Available

Premiered On: 10/03/2021

Dr. Tuckson speaks with Angela Sandlin, PharmD, pharmacy director at Baptist Health LaGrange, about medication safety, availability and effectiveness.

  • Sunday September 25, 2022 7:00 am ET on KET2
  • Sunday September 25, 2022 6:00 am CT on KET2
  • Sunday September 25, 2022 9:00 am ET on KETKY
  • Sunday September 25, 2022 8:00 am CT on KETKY

Lung Cancer: Improving Treatment and Decreasing the Mortality

Premiered On: 10/10/2021

Though lung cancer remains the leading cause of death from cancer in the United States, there is cause for optimism. Dr. Tuckson talks to Jason Chesney, M.D., director of the UofL Health-Brown Cancer Center in Louisville, about new developments in the treatment of lung cancer.

  • Sunday September 25, 2022 12:30 pm ET on KET
  • Sunday September 25, 2022 11:30 am CT on KET
  • Sunday September 25, 2022 5:30 pm ET on KETKY
  • Sunday September 25, 2022 4:30 pm CT on KETKY
  • Monday September 26, 2022 2:00 pm ET on KET2
  • Monday September 26, 2022 1:00 pm CT on KET2
  • Friday September 30, 2022 1:30 pm ET on KETKY
  • Friday September 30, 2022 12:30 pm CT on KETKY
  • Sunday October 2, 2022 12:30 am ET on KETKY
  • Saturday October 1, 2022 11:30 pm CT on KETKY
  • Sunday October 2, 2022 7:00 am ET on KET2
  • Sunday October 2, 2022 6:00 am CT on KET2
  • Sunday October 2, 2022 9:00 am ET on KETKY
  • Sunday October 2, 2022 8:00 am CT on KETKY

Supplies Over Seas: Meeting Medical Supply Needs at Home and Overseas

  • Sunday October 2, 2022 12:30 pm ET on KET
  • Sunday October 2, 2022 11:30 am CT on KET
  • Sunday October 2, 2022 5:30 pm ET on KETKY
  • Sunday October 2, 2022 4:30 pm CT on KETKY
  • Monday October 3, 2022 2:00 pm ET on KET2
  • Monday October 3, 2022 1:00 pm CT on KET2
  • Friday October 7, 2022 1:30 pm ET on KETKY
  • Friday October 7, 2022 12:30 pm CT on KETKY
  • Sunday October 9, 2022 12:30 am ET on KETKY
  • Saturday October 8, 2022 11:30 pm CT on KETKY
  • Sunday October 9, 2022 7:00 am ET on KET2
  • Sunday October 9, 2022 6:00 am CT on KET2
  • Sunday October 9, 2022 9:00 am ET on KETKY
  • Sunday October 9, 2022 8:00 am CT on KETKY

Vitamins and Minerals: Supplements v. Eating Right

  • Sunday October 9, 2022 12:30 pm ET on KET
  • Sunday October 9, 2022 11:30 am CT on KET
  • Sunday October 9, 2022 5:30 pm ET on KETKY
  • Sunday October 9, 2022 4:30 pm CT on KETKY
  • Monday October 10, 2022 2:00 pm ET on KET2
  • Monday October 10, 2022 1:00 pm CT on KET2
  • Friday October 14, 2022 1:30 pm ET on KETKY
  • Friday October 14, 2022 12:30 pm CT on KETKY
  • Sunday October 16, 2022 12:30 am ET on KETKY
  • Saturday October 15, 2022 11:30 pm CT on KETKY
  • Sunday October 16, 2022 7:00 am ET on KET2
  • Sunday October 16, 2022 6:00 am CT on KET2
  • Sunday October 16, 2022 9:00 am ET on KETKY
  • Sunday October 16, 2022 8:00 am CT on KETKY

COVID-19 and Monkeypox: Lessons Learned and Forgotten

  • Sunday October 16, 2022 12:30 pm ET on KET
  • Sunday October 16, 2022 11:30 am CT on KET
  • Sunday October 16, 2022 5:30 pm ET on KETKY
  • Sunday October 16, 2022 4:30 pm CT on KETKY
  • Monday October 17, 2022 2:00 pm ET on KET2
  • Monday October 17, 2022 1:00 pm CT on KET2
  • Friday October 21, 2022 1:30 pm ET on KETKY
  • Friday October 21, 2022 12:30 pm CT on KETKY
  • Sunday October 23, 2022 12:30 am ET on KETKY
  • Saturday October 22, 2022 11:30 pm CT on KETKY
  • Sunday October 23, 2022 7:00 am ET on KET2
  • Sunday October 23, 2022 6:00 am CT on KET2
  • Sunday October 23, 2022 9:00 am ET on KETKY
  • Sunday October 23, 2022 8:00 am CT on KETKY

KCHIP and Expanded Medicaid: How Has This Benefitted the Health of the Commonwealth?

  • Sunday October 23, 2022 12:30 pm ET on KET
  • Sunday October 23, 2022 11:30 am CT on KET
  • Sunday October 23, 2022 5:30 pm ET on KETKY
  • Sunday October 23, 2022 4:30 pm CT on KETKY
  • Monday October 24, 2022 2:00 pm ET on KET2
  • Monday October 24, 2022 1:00 pm CT on KET2
Jump to Upcoming Airdates

Recent

Medications: A Modern Miracle, But Are They Safe and Available - S17 E1

  • Sunday September 25, 2022 12:30 am ET on KETKY
  • Saturday September 24, 2022 11:30 pm CT on KETKY
  • Friday September 23, 2022 1:30 pm ET on KETKY
  • Friday September 23, 2022 12:30 pm CT on KETKY
  • Monday September 19, 2022 2:00 pm ET on KET2
  • Monday September 19, 2022 1:00 pm CT on KET2
  • Sunday September 18, 2022 5:30 pm ET on KETKY
  • Sunday September 18, 2022 4:30 pm CT on KETKY
  • Sunday September 18, 2022 12:30 pm ET on KET
  • Sunday September 18, 2022 11:30 am CT on KET

Migraines and Headaches: They Are Serious and Can Be Incapacitating - S17 E25

  • Sunday September 18, 2022 9:00 am ET on KETKY
  • Sunday September 18, 2022 8:00 am CT on KETKY
  • Sunday September 18, 2022 7:00 am ET on KET2
  • Sunday September 18, 2022 6:00 am CT on KET2
  • Sunday September 18, 2022 12:30 am ET on KETKY
  • Saturday September 17, 2022 11:30 pm CT on KETKY
  • Friday September 16, 2022 1:30 pm ET on KETKY
  • Friday September 16, 2022 12:30 pm CT on KETKY
  • Monday September 12, 2022 2:00 pm ET on KET2
  • Monday September 12, 2022 1:00 pm CT on KET2
  • Sunday September 11, 2022 5:30 pm ET on KETKY
  • Sunday September 11, 2022 4:30 pm CT on KETKY
  • Sunday September 11, 2022 12:30 pm ET on KET
  • Sunday September 11, 2022 11:30 am CT on KET

Ankle Replacement: It's Not Just for Hips, Knees and Shoulders - S17 E24

  • Sunday September 11, 2022 9:00 am ET on KETKY
  • Sunday September 11, 2022 8:00 am CT on KETKY
  • Sunday September 11, 2022 7:00 am ET on KET2
  • Sunday September 11, 2022 6:00 am CT on KET2
  • Sunday September 11, 2022 12:30 am ET on KETKY
  • Saturday September 10, 2022 11:30 pm CT on KETKY
  • Friday September 9, 2022 1:30 pm ET on KETKY
  • Friday September 9, 2022 12:30 pm CT on KETKY
  • Monday September 5, 2022 2:00 pm ET on KET2
  • Monday September 5, 2022 1:00 pm CT on KET2
  • Sunday September 4, 2022 5:30 pm ET on KETKY
  • Sunday September 4, 2022 4:30 pm CT on KETKY
  • Sunday September 4, 2022 12:30 pm ET on KET
  • Sunday September 4, 2022 11:30 am CT on KET

Blood Transfusions: Blood Management and Blood Health - S17 E23

  • Sunday September 4, 2022 9:00 am ET on KETKY
  • Sunday September 4, 2022 8:00 am CT on KETKY
  • Sunday September 4, 2022 7:00 am ET on KET2
  • Sunday September 4, 2022 6:00 am CT on KET2
  • Sunday September 4, 2022 12:30 am ET on KETKY
  • Saturday September 3, 2022 11:30 pm CT on KETKY
  • Friday September 2, 2022 1:30 pm ET on KETKY
  • Friday September 2, 2022 12:30 pm CT on KETKY
  • Monday August 29, 2022 2:00 pm ET on KET2
  • Monday August 29, 2022 1:00 pm CT on KET2
  • Sunday August 28, 2022 5:30 pm ET on KETKY
  • Sunday August 28, 2022 4:30 pm CT on KETKY
  • Sunday August 28, 2022 12:30 pm ET on KET
  • Sunday August 28, 2022 11:30 am CT on KET

The Red Cross: Feeding, Caring and Sheltering Us Following Natural and Man-Made Disasters - S17 E22

  • Sunday August 28, 2022 9:00 am ET on KETKY
  • Sunday August 28, 2022 8:00 am CT on KETKY
  • Sunday August 28, 2022 7:00 am ET on KET2
  • Sunday August 28, 2022 6:00 am CT on KET2
  • Sunday August 28, 2022 12:30 am ET on KETKY
  • Saturday August 27, 2022 11:30 pm CT on KETKY
  • Friday August 26, 2022 1:30 pm ET on KETKY
  • Friday August 26, 2022 12:30 pm CT on KETKY
Top

Explore KET