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1. Historically, managed care organizations and now ACA provisions emphasize physicians’ responsibilities to control patient access to expensive specialty care. Some argue that physicians’ incentives to control patient access to specialty care are unethical because it introduces financial factors into treatment decisions. Others say it improves quality by promoting the use of the most appropriate levels of care. Take a position on this issue and explain your view.

2. Physician specialization has yielded highly successful patient care results and has helped make the U.S. medical care system the most advanced in the world. It has also made it the most expensive. In what ways has specialization contributed to inefficiency in our health care delivery system? With what impact on consumers?

3. Given the increasing longevity of Americans and the costs of providing long-term care, anticipation of the costs should be a major element of every family’s financial planning. Current information suggests however, that very few families or individuals give this consideration. What factors might impede this advance planning? What measures might be effective in raising awareness among the Americans about this important matter?

4. The value of informal long-term care provided by family members and friends is estimated at over $450 billion annually, more than double the national expenditures for skilled nursing and home care combined. Much of this cost would fall to government if it were not for this informal system. Would you support government assistance for informal caregivers, through mechanisms such as tax reduction incentives, or subsidy for respite care? Why or why not? If not, what alternative measures would you propose to help keep the informal system intact?