Health Reform, Past and Present

William E. Petersen Symposium University of St. Thomas Opus College of Business James J. Mongan, MD President & CEO Partners HealthCare October 7, 2009

Outline of Remarks
Coverage Issues
Cost Issues
Future Challenges
Petersen Lecture 10.7.09

Health Financing Policy - Coverage
Facts on health care coverage
Why coverage is important
What we have tried to do
1974 Nixon proposal
1979 Carter proposal
1992 Clinton proposal
The Massachusetts story

Health Reform Outcome Predictions – July 15, 2009 Petersen Lecture 10.7.09
Bill passes, highly touted
Significant coverage improvements (50-60%)
Cost issues remain
Some concern over individual mandate backlash because of inadequate subsidies
Outcome Element Yes No Compromise Individual Mandate 
Phased in plus many “ hardship ” exclusions
Employer Mandate 
Small Massachusetts level penalties
Public Plan 
“ Light ” public plans – no Medicare limits, state level, triggered in
Payment Reform 
Payment cuts, not reforms – effective on Medicare only
Adequate Financing 
Without employer mandates and with limited tax revenues, payment cuts not sufficient to fund adequate subsidies

Health Financing Policy - Costs
Facts on health costs
Why costs are rising
Why we care about high costs
What we have tried to do
Regulate
Let markets work

Health Financing Policy Future Policy Issues Focused on Cost
Steps to control baseline level of spending
Address variance
Address operating efficiency
Address administrative costs
Barriers to action

Health Financing Policy Future Policy Issues Focused on Coverage
Major challenge – need for revenue
Cannot escape or evade
Likely any legislation will blend
Taxes
Employer payments
Individual payments
Key Issue – fairness of financing – who pays and how much

Health Financing Policy Key Issue for the Future
Balance between individual liberty and justice for all

Health Reform, Past and Present

by Center for Health & Medical Affairs, University of St. Thomas on Oct 08, 2009

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Health Reform, Past and Present — Presentation Transcript