2009-10 Our National Struggle for Health Care Reform in America

Our National Struggle for Health Care Reform

in America

Compiled by: Jeff BiehlAccess HealthColumbus

Chapter 1

… imagine if our K-12

education system operated like our

health care “system”

Scenario #1Education Plan Enrollment

OK… where do you work?

Why does it matter?

We’d like to enroll our child in an

education plan.

Because…

we use a categorical eligibility system to

determine your access to education

and the cost.

> 50 employees

OK to enroll

2 to 50 employees

OK to enroll… but cost will vary by 40%

selfemployed

Depends… any pre-existing education conditions?

Unemployed OK to enroll if low-income.

Otherwise will need to find an education clinic

here is a summary

Education clinic…

will I get my own desk?

Scenario #2Determining Value

Hello, Education Diagnostic Services

… how may I help you?

We have a referral for testing

services… How does your quality

compare to others?

Unfortunately…

we do not have that information available

for customers.

Well it depends..

We have a high deductible

education plan… How much will the test cost?

On what?

Education network:

Does our center participate?

Education benefit plan:

What are your coverage levels?

Contract: Ourreimbursement agreement with your education plan.

Unfortunately, we can’t share this information with customers.

Yikes!How can

we find out the cost?

here is a summary

... when we send you the bill.

Chapter 2

What is the primary difference between

our K-12 education

&health care“systems”?

It’s all about the policy -access to affordable K-12 is:

a RIGHT

universal and portable

based on a (public) floor, but not a (private) ceiling

based on the (moral & economic) value of education

Chapter 3

… our lack of affordable and

quality health care for all

Analysis of theConsequences

… a few simple facts

U.S. only industrialized nation without policy to guide decisions on universal health care

Most resources spent on sick care (not optimizing health)

Supply drives Demand (more is not always better)

The current situation is unaffordable for individuals & unsustainable for our nation

The definition of “vulnerable” has expanded to middle class

Negatively impacts our competitiveness in a global economy

Negatively impacts individual prosperity and innovation

The Simple Facts on our Current Situation

… a few simple facts

The fragmentation of our delivery system is a fundamental contributor to the poor overall performance of the U.S. health care system.

~ The Commonwealth Fund

“Every system is perfectly designed to achieve the

results it gets.”

Donald Berwick, M.D.Institute for Healthcare Improvement (IHI)

Coverage Cost Quality Access

… a few simple facts

Coverage

57.6%

4.2%

12.3%

13.4%

0.9%11.6%

Ohio: Health Insurance StatusSource: Kaiser Foundation 2008

Employer

Individual

Medicaid

Medicare

Other Public

Uninsured

1.4 million uninsured Ohioans

+154,000 Ohioans in the past 12 months

2 million Ohioans:1 out of every 3 children

&1 out of every 5 adults

Employer-based insurance is

eroding…

In Ohio < 60%

Quality

0 50 100

France

Japan

Spain

Norway

Sweden

Greece

Finland

Denmark

UK

USA

Deaths that should not occur in the presence of effective health care

Age-Standardized Death Rates (Per 100,000)

Preventable Mortality

Source: Health Affairs, January 2008

USA

Since we spend more than

anyone else….

Should we expect more value?

USA in last place on

this quality measure

Cost

$0.0

$1.0

$2.0

$3.0

$4.0

$5.0

1990 2000 2009 2018

in trillions

U.S. health care expenditures

Source: Centers for Medicare & Medicaid Services, Kaiser Foundation

$14,000+ per person

in 2018(projected)

$8,100+ per person

in 2009(actual)

Affordability~50% of

Ohioans will require

subsidy for coverage

Access

1,162,737

1,070,189

1,206,579

No regular source of

health care

Went without needed dental

service

Went without needed

prescription drugs

2008 Ohio Family Health SurveyAdults 18-64 (insured & uninsured)

OhioansCoverage does not always equal AccessOhioans

Ohioans

All measures trended up

> 40% since 2004

Chapter 4Why is reforming health care a struggle?

Why is reforming health care a struggle?

We have not adopted a universal health care policy(other than we have a right to use emergency rooms)

We avoid policies on how to balance end-of-life resources(conflicts with our sense of liberties)

When we talk about “savings” it means reducing another’s “income”

Health care is a “stuck” issue

- Every party feels like a victim

- No one feels empowered to act (on changing the whole)

- We each protect our piece of the pie

Chapter 5

What are the 8 major “tension”

points on the path for national health

care reform?

Insurance

Mandate

Guaranteed

Issue

Require insurance

companies to cover all

people

Similar to car

insurance… required coverage

Will $200 to $750 penalty for opting out

influence consumer behavior?

1.

2. Affordable for

Individuals & Families

Sustainable for Society

What revenues

will pay for the

subsidy?

Subsidies for those below

300% poverty level

$66,150 for family of 4

U.S.38 million

(83%) uninsured

< 300% poverty

3.Align

IncentivesPayment Reform

Current System of

Fee For Service = more is better

Rewards for improving

health

We need to transition to

rewarding the actual

value of care!

4.Quality Cost

Bending inflationary

curve

Standards for

measuring &

comparing

Important components to determine

VALUE

5.Access to

CareCare

Coordination

Patient-centered

health care

Right care, Right place, Right time

If everyone was insured

today…. where would

they go for primary care?

6.Continuity Portability

Reduce disruptions

due to changes in

employment

Reduce disruptions

due to changes in eligibility categories

The average American will

change careers 3 times!

7. Enhance Health &

Well-Being

Activated & Informed

Consumers

Share responsibility with provider

for plan of care

Bend the health status

curve?

50+% is lifestyle and

behavior

How do we make health a priority?

8.Public

Health Plan

Employer Based Health Plans

Current approach for

60% of Americans

“Medicare for all”

Will a public plan erode

benefits and/or increase costs for those with

employer-based coverage?

“You can always count on Americans to do the right thing – after they’ve tried

everything else.”

~ Winston Churchill

jbiehl@accesshealthcolumbus.org