1 R. S. Galvin, MD

September 21, 2007Alliance for Health Reform

• Three Key Points • Stratify or Die• ‘You Break It, You Own

It”• Don’t Mess with ERISA

• General Thoughts on

Reform

by Robert S. Galvin and Suzanne Delbanco

2 R. S. Galvin, MD

September 21, 2007Alliance for Health Reform

Do Employers Want To Preserve ESI

or Find An Exit Strategy?

3 R. S. Galvin, MD

September 21, 2007Alliance for Health Reform

Is ESI Good or Bad

for the Health Care

System?

4 R. S. Galvin, MD

September 21, 2007Alliance for Health Reform

Responsive

Innovative

Not Bound By Politics

Voluntary-Uninsured

Portability

Administrative Complexity

5 R. S. Galvin, MD

September 21, 2007Alliance for Health Reform

“You Break It , You Own It”

•“There’s No Such Thing as an Accident”

• “Every System is Perfectly Designed to Deliver the Results It Delivers.”

•One Person’s Wasteful Technology is Another Person’s Medical Miracle

6 R. S. Galvin, MD

September 21, 2007Alliance for Health Reform

Don’t Mess With ERISA

• ~90+ Million Americans Covered - And Satisfied

• 50 Separate Benefit Designs A Costly, Administrative Nightmare

• Eroding What Works To Fix What Doesn’t Is Doomed Policy Approach

Employers United On This Topic

7 R. S. Galvin, MD

September 21, 2007Alliance for Health Reform

Access Alone Is Not Health Reform

ACCESS

QUALITY

COST

HospitalRisk-Adjusted Mortality Rate

(RAMR)Columbia Presbyterian 3.93*

Lenox Hill 2.26

NYU Hospitals Center 1.95

Weil Cornell – NYP 0.95*

*Statistically Significant Source: 1999 – 2001 NY State Hospital and Surgeon Outcomes Report

Surgeon RAMR

State Total 2.25

Smith, C 4.15

Information Is Critical

9 R. S. Galvin, MD

September 21, 2007Alliance for Health Reform

Employer Mind-Set

• Does Change Address My Specific Issue?

• Will I Be Better Off?

• Is Responsibility Shared?

• How Do I Maintain Control?

Deal or No Deal: Employers More Open To Change . . . .But It Has To

Help Run The Business