3 3-11 How We Got Here

Charity is no substitute
for justice withheld.
St. Augustine

U.S. Health System is Too Costly
We spend twice as much as other advanced countries
Medical bills leading to personal bankruptcy
Employee insurance costs threaten global competitiveness

Health Care Spending per Capita in 2004 a a Source: The Commonwealth Fund, calculated from OECD Health Data 2006. a 2003 a Adjusted for Differences in Cost of Living

Americans Pay Twice: First, through our TAXES -
Americans, including the uninsured , paid ~$1.2 TRILLION in 2009 in government subsidies to:
insurance companies
HMOs
hospital chains
drug companies
the health industry.

Public Spending on Health Care per Capita in 2004* Total Public spending Divided by Total National Population Adjusted for Differences in the cost of Living

Americans Pay Twice: A Second time, as PATIENTS -
Unlike taxpayers in other advanced nations, Americans then have to pay a second time for their health care. Americans spent $1.3 TRILLION in 2009, on top of what they paid in taxes, for;
care not covered by insurance
private insurance premiums
deductibles
co-payments
other direct payments.

Health Care Expenditure per Capita by Source of Funding in 2004 a b a 2003 b 2002 (Out-of-Pocket) a a Source: The Commonwealth Fund, calculated from OECD Health Data 2006. Adjusted for Differences in Cost of Living

U.S. Health System is of Poor Quality
Despite high quality of doctors and other health professionals, fragmentation of U.S. systems limits their ability to provide good care.
Up to 98,000 patient deaths annually due to system failures. (Institute of Medicine , 2000)
18,000 preventable deaths each year among those who are uninsured, due to the inability to access effective, timely care. (Institute of Medicine, 2003)

U.S. Health System is UNJUST
47 million Americans, most in working families whose taxes subsidize the health care system , have no insurance.
At least that many more are under insured . They have insurance, but it doesn’t begin to cover their needs.

The system perpetuates sharp racial disparities in health:
An African-American newborn has twice the chance of a white baby of dying before her first birthday.
Across the age spectrum, minority Americans have less access to needed health care.
Minority Americans live sicker and die younger.

ALL Americans pay more
and get less than people
in other advanced nations.

The Status Quo is Unsustainable
The Centers for Medicare and Medicaid Services (CMS) projects that the cost of Medicaid will double by 2019.
Health care inflation threatens the solvency of the Medicare trust funds.
Medical inflation, if not addressed, makes it all but impossible to reduce the national debt.

Every system is perfectly designed to achieve exactly the results it gets.
Dr. Donald Berwick
Founder, Institute for
Healthcare Improvement
Administrator, Centers for Medicare & Medicaid Svcs.

A Century of Bipartisan Effort
These problems are a century old, as are efforts to address them:
That any sane nation, having observed that you could provide for the supply of bread by giving bakers a pecuniary interest in baking for you, should go on to give a surgeon a pecuniary interest in cutting off your leg, is enough to make one despair of political humanity,”
George Bernard Shaw’s Preface to
“ Doctor’s Dilemma” (1906).

Lessons of the past century:
Real changes only occur when there is strong presidential leadership and control of Congress by the President’s party.
The parties’ rhetoric has been ideologically polarized, but they have often pursued similar policies in efforts to control cost and address gaps in coverage

The Massachusetts Story

ACA is MA Plan +
Same three legged stool – although subsidize up to 400% of poverty
But also adds financing
Reductions in Medicare overpayments
Tax on wealthiest families
And takes on cost control
Five innovative strategies provide a key first step towards tackling the cost problem

What Will ACA Do? Coverage
32 million more Americans (CBO)
15,000 persons each year will avoid death due to lack of insurance

Coverage for Those with Pre-Existing Conditions
A Consumer-Friendly Marketplace
Coverage Regardless of Workplace
Limits on Out-of-Pocket Costs
Subsidies for Middle-Income Families
Accountability for Insurer Spending
Protections against Losing Coverage
Affordable Care Act- The Basics

Tax Credits for Small Businesses
Addresses Health Disparities
Coverage for Young Adults
Coverage for Low-Income Families
Help for American Indians and Alaska Natives
Help for Seniors and People with Disabilities
Help for People Who Need Long-Term Services
Investment in Preventive Care
The basics. Part 2

Coverage for Those with Pre-Existing Conditions

A Consumer- Friendly Marketplace

Coverage Regardless Of Your Workplace

Limits on Out-of- Pocket Costs

Subsidies for Middle-Income Families

Accountability For Insurer Spending

Protection Against Losing Coverage

Tax Credits For Small Businesses

Addresses Health Disparities

Coverage For Young Adults

Coverage for Low-Income Families

Help for Seniors and People with Disabilities

Repeal Undoes it All
Poorer health, more deaths
Unfair, expensive insurance market that leads to economic instability and medical bankruptcy
A less efficient job market where individuals lack the freedom to change jobs
Continued free-riding by those who pass billions of dollars in care costs onto the insured
A massive decline in private insurance coverage
Huge and unsustainable increases in budget deficits reaching the trillions of dollars over coming decades

This is our best hope for our community
There is no proposal now on the table that covers even 10% as many persons as ACA

For more information :
On America’s health care system and how it measures up:
www.commonwealthfund.org
www.kff.org
- Atul Gawande, “ The Hot Spotters:Can we lower medical costs by giving the neediest patients better care? The New Yorker, 1-24-11 http://www.newyorker.com/reporting/2011/01/24/110124fa_fact_gawande?currentPage=all
Talk to the public about health reform, look to the Herndon Alliance to learn which messages work and don’t work:
http://herndonalliance.org/table/resources/

"For me, an area of moral clarity is: you're in front of someone who's suffering and you have the tools at your disposal to alleviate that suffering or even ehttp://www.facebook.com/tnjustice?v=box_3&ref=nfradicate it, and you act. "
-Paul Farmer, founder of Partners in Health and 2009 recipient of the Dietrich Bonheoffer award.

Gordon Bonnyman [email_address] Michele Johnson [email_address] www.tnjustice.org 615-255-0331 http://www.facebook.com/tnjustice?v=box_3&ref=nf

3 3-11 How We Got Here

by Michelle Bukowski

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3 3-11 How We Got Here Presentation Transcript