Deck 14: All Those Levers and Still No Fulcrum

Question 1

In the analogy of the lever and the fulcrum, why is the ACA considered a fulcrum?

A) It is the handle that is used to move health care delivery.
B) It is the item that is moved by the lever of health care delivery.
C) It is the base against which a lever can operate to move health care delivery.
D) It is the force applied to any lever to move health care delivery.

Answer 1

C

Question 2

Why is the ACA shaky as a base for moving health care delivery?

A) It can be easily damaged by lobbyists, congressional committees, or White House staff members.
B) It has the full support of the executive and legislative branches of the federal government.
C) It has been declared unconstitutional by the Supreme Court.
D) It relies upon budget decisions made by governors at the state level.

Answer 2

A

Question 3

Why might programs on the state level be less exposed to risk than federal programs or agencies?

A) States have a much smaller budget than the federal government does.
B) Governors are not as powerful as the president, and thus are less able to make changes.
C) State bureaucracies make it more difficult to make changes once programs are agreed upon.
D) States have a higher burden than the federal government to meet their financial obligations.

Answer 3

D

Question 4

Why are employers an unreliable fulcrum?

A) They take their cut and pass on any added costs.
B) They maximize revenue.
C) They opt out of defined benefit programs.
D) They are at risk of being cut from the budget.

Question 5

In a 2013 survey of 200 health care industry executives, ______ were strongly positive about our ability to improve both quality and inflation-adjusted cost.

A) 1%
B) 8%
C) 16%
D) 22%

Question 6

In a 2013 survey of 200 health care industry executives, ______ were strongly positive about the current quality of U.S. health care.

A) 1%
B) 8%
C) 16%
D) 22%

Question 7

What is an advantage of the on-the-one-hand and on-the-other-hand approach?

A) It can declare one approach as unequivocally superior.
B) It is based on objective information.
C) It is a scholarly approach.
D) It allows for differing value systems.

Question 8

Which of the following is NOT a constraint on the free-market approach to health insurance?

A) The impact of cost shifting has already been achieved and the effect may be smaller than anticipated.
B) Shifting more costs to the consumer will result in reduced utilization.
C) Information on quality and price is so opaque that the market cannot function effectively.
D) Some purchasers are capable of researching a medical condition and some are not.

Question 9

Gawande suggests that a U.S. universal coverage objective could be met by:

A) Medicare-for-all.
B) Medicaid-for-all.
C) Healthcare.gov-for-all.
D) any of the above.

Question 10

Which of these is a source of pressure on low-income families to pay a larger share of their income for health care?

A) Rising income
B) Increased pay-for-performance
C) Prevention programs
D) Competition for the needs of other economic sectors

Question 11

The opposing position to the argument that there has to be acceptance of some market forces in the process of providing health care in the United States is that:

A) health care is a highly imperfect marketplace.
B) the United States has long valued individualism.
C) the United States has a free-market economic system.
D) the United States does not currently have a single-payer system.

Question 12

Which of the following is a factor in the collapse of dependence on employers as the primary source of funding for health care for employees and their families?

A) A growing health care marketplace
B) Lack of information to make informed decisions
C) Insufficient skills to participate in the health care market
D) Increasing international competition

Question 13

Which of the following is a key reason that employer-sponsored insurance is responsible for waste and overutilization in health care?

A) There are no limits on deductibles consumers must pay.
B) It allows consumers to opt out of defined benefit programs.
C) It insulates consumers from economic consequences.
D) It does not allow businesses to opt out of defined benefit programs.

Question 14

What problem may still exist even if changes are instituted to give quality and price information directly to the consumer?

A) Hospital prices are not firmly established.
B) Interpreting the data may be difficult to do.
C) Quality outcomes are not available for specific institutions.
D) This will shift additional costs to the consumer.

Question 15

What might be a result if physicians were to set up their own specialty hospitals?

A) More specialists would be on salary in academic medical centers.
B) More specialists would be on salary in community settings.
C) The number of referrals would increase.
D) It could lead to additional restraints on referrals.

Question 16

How many different, complete sets of regulatory requirements are there for the health care system?

A) Two
B) Three
C) Four
D) Five

Question 17

Predictions that the ACA will lead to a single-payer system are based on which of the following assumptions?

A) The ACA will lead to less government intervention.
B) The ACA will lead to retrenchment.
C) The ACA will be a failed strategy.
D) The ACA will be a successful first step.

Question 18

Which of the following would probably be necessary to see further major change in health care policy?

A) An increase in the proportion of the GDP devoted to health care
B) A threat to the U.S. economy by other events that would lead to a total package of changes
C) A change in the political party in power in the federal government
D) A decrease in the influx of foreign capital

Question 19

Which of the following may reduce administrative costs in some segments of the health care industry?

A) Increased patient participation in making choices
B) Efficiency improvement in other sectors
C) Increased use of modern information technology
D) Individual and employer mandates of the ACA

Question 20

A longer-term unraveling of the U.S. health care system could occur:

A) As information technology is introduced.
B) As administrative costs come down.
C) As the bulk of the Baby Boomers age out of the workforce.
D) As the country reaches full employment.

Question 21

In the analogy of the lever and the fulcrum, the passage of the ACA is the lever.

Question 22

Employers are an unreliable fulcrum because they continue to opt out of defined benefit programs.

Question 23

Bureaucrats are cautious because their agencies can disappear from the congressional budget at any time.

Question 24

One argument in favor of the single-payer system is that many segments of U.S. society cannot afford to participate in the marketplace.

Question 25

Gawande argues that single-payer is the only way to achieve universal coverage in the United States.

Question 26

The argument that employer-sponsored insurance insulates consumers from the economic consequences of waste and overutilization is a weak one.

Question 27

The effort to shift more costs to the consumer may not reduce utilization because much of its impact has already been achieved through increased deductibles and copays.

Question 28

One factor that may allow educated consumers to make informed market decisions is that they feel confident enough in their knowledge to act on it.

Question 29

As the health care sector industrializes, it strengthens physician bargaining power.

Question 30

A 2006 prediction that the U.S. health care system would unravel is likely to be realized within the next couple of years.