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

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