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Presentation delivered at Symposium on Health Care Policy Reform, Columbus Ohio, 10/27/09
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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