Keith J. Mueller, Ph.D.

Interim Dean, College of Public Health

University of Nebraska Medical Center

August 31, 2009

Washington, DC

Starting with Teddy Roosevelt

Franklin Roosevelt and Social Security

Harry Truman and fear of socialism

Lyndon Johnson and Medicare/Medicaid

Richard Nixon loses Wilbur Mills to scandal

Jimmy Carter tries to start with children

George H.W. Bush and tax credits as a starter

Bill Clinton and the Health Security Act (first time committees reported out)

???

Affordable coverage

Foundation for expenditure control

Workforce improvement

Critical to Rural

Focused on individual and small employers

Critical role of exchange and outreach

Federal pieces: guaranteed issues, guaranteed renewability, no pre-existing; predicated on individual mandate

How to guarantee access to an affordable plan that:

uses local providers

is there long term

Need public plan for that?

Role and size of Medicaid

Enforcing a mandate

Wellness trumps everything else, but is elusive

Pricing a difficult way to get this done

Shifting the delivery system to ACO’s and PCMH’s

Primary care focus, will it work?

A national commission

Should there be state commissions?

Rural Road Map

Public Health

Integrated Services

Use of technology

Workforce training

Health care for people requires grass roots led innovation

Broaden focus to populations and places

http://www.unmc.edu/publichealth/healthservices.htm

http://www.unmc.edu/ruprihealth/

http://www.unmc.edu/publichealth/chparhr.htm