Isaac's Health Care Archimedes talk at Apollo College

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These are slides for a talk I gave at Apollo College of Nursing on 11.4.08 - Election Day. The topic of the two hour presentation was Health Care reform, the Archimedes movement, and leadership in health care. The slides are heavily modified from a basic version that many speakers from the Archimedes Movement use. This was my second talk at Apollo college. Thank you so much Jessica for inviting me, and to all you nursing students for listening so intently.

cheers
Isaac

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  • Isaac's Health Care Archimedes talk at Apollo College

    1. 1. The Archimedes Movement Isaac Holeman www.WeCanDoBetter.org [email_address] <ul><ul><li>We Can Do Better </li></ul></ul><ul><ul><li>A Project of the Archimedes Movement </li></ul></ul><ul><ul><li>www.WeCanDoBetter.org </li></ul></ul>
    2. 2. Why are you here? Isaac Holeman www.WeCanDoBetter.org [email_address]
    3. 3. We are the Archimedes Movement Isaac Holeman www.WeCanDoBetter.org [email_address]
    4. 4. We are active citizens Isaac Holeman www.WeCanDoBetter.org [email_address]
    5. 5. Why are we here? How did we get here? What do we really want? How do we get there?
    6. 6. Get ready for a demographic tidal wave How did we get here? What do we really want? How do we get there?
    7. 7. The KEY to understanding the health care debate <ul><li>Financing </li></ul><ul><ul><li>How we pay for care </li></ul></ul><ul><li>Delivery </li></ul><ul><ul><li>What we are buying </li></ul></ul><ul><ul><li>How care is organized and delivered </li></ul></ul><ul><ul><li>Return on investment in terms of health </li></ul></ul>How did we get here? What do we really want? How do we get there?
    8. 8. Problems with our delivery system <ul><li>Archaic structure </li></ul><ul><li>We have failed to evolve to meet changing demands </li></ul><ul><li>Political gridlock </li></ul>How did we get here? What do we really want? How do we get there?
    9. 9. Infectious disease model not designed to treat chronic disease How did we get here? What do we really want? How do we get there?
    10. 10. Infectious disease model not designed to treat chronic disease How did we get here? What do we really want? How do we get there?
    11. 11. Infectious disease model not designed to treat chronic disease How did we get here? What do we really want? How do we get there?
    12. 12. Infectious disease model not designed to treat chronic disease How did we get here? What do we really want? How do we get there?
    13. 13. Chronic disease = dying How did we get here? What do we really want? How do we get there? Back when our health system was being created
    14. 14. Evolution of the System <ul><li>Conditions that were once fatal have become chronic </li></ul><ul><li>Solo or small practice group practices working independently </li></ul><ul><li>Lack of data </li></ul>How did we get here? What do we really want? How do we get there?
    15. 15. Three outdated structures in our delivery system <ul><li>1954 Preferential tax treatment to employer sponsored coverage </li></ul><ul><li>1965 Enactment of Medicare </li></ul><ul><li>1965 Enactment of Medicaid </li></ul>How did we get here? What do we really want? How do we get there?
    16. 16. Employer Sponsored Coverage: an accident in history <ul><li>Labor shortage WWII </li></ul><ul><li>Wage and price controls </li></ul><ul><li>Companies sought to offer a “non-monetary” benefit </li></ul>How did we get here? What do we really want? How do we get there?
    17. 17. Employer Sponsored Coverage: bad for a mobile economy <ul><li>Public subsidy >$200B per year </li></ul><ul><li>Paid by all taxpayers, including those without coverage </li></ul>How did we get here? What do we really want? How do we get there?
    18. 18. Medicare: hasn’t adjusted for demographic boom <ul><li>Elderly used to be poorest segment of society </li></ul><ul><li>Financed by taxes on those who are working </li></ul><ul><li>Does not cover long-term care services for an aging population </li></ul>How did we get here? What do we really want? How do we get there?
    19. 19. Medicaid: categorical eligibility was a bad idea <ul><li>To improve financial access for certain categories of the poor </li></ul><ul><li>Poor children </li></ul><ul><li>Blind and disabled </li></ul><ul><li>Elderly needing long term care </li></ul><ul><li>Pregnant women </li></ul>How did we get here? What do we really want? How do we get there?
    20. 20. Coverage Gap Medicaid Medicare Employment-based coverage Private Public 50 million Americans (You, your friends) How did we get here? What do we really want? How do we get there?
    21. 21. Cost Shift (shifting accountability) ER Change Eligibility Drop Coverage Public Private How did we get here? What do we really want? How do we get there? You, your friends
    22. 22. The Current Debate: we are barking up the wrong tree <ul><li>It’s not a financing problem </li></ul><ul><li>Why do we ask how to give the uninsured access to the INFECTIOUS DISEASE FOCUSED system? </li></ul>How did we get here? What do we really want? How do we get there?
    23. 23. Buying more hover crafts won’t help them drive on the freeway How did we get here? What do we really want? How do we get there?
    24. 24. What can we do about it? How did we get here? What do we really want? How do we get there?
    25. 25. The Greatest Generation <ul><li>Higher Education </li></ul><ul><li>Interstate Highway System </li></ul><ul><li>Transmission Grid </li></ul><ul><li>Went to the Moon (and back!) </li></ul><ul><li>Cured polio, eradicated smallpox </li></ul>How did we get here? What do we really want? How do we get there?
    26. 26. Agreeing on a Shared Vision <ul><li>What is the purpose of our health care system? </li></ul>How did we get here? What do we really want? How do we get there?
    27. 27. Agreeing on a Shared Vision <ul><li>Without first agreeing on where we want to end up, there is no political pathway by which to get there. </li></ul>How did we get here? What do we really want? How do we get there?
    28. 28. Institute for Healthcare Improvement: Triple Aim <ul><li>Improve population health </li></ul><ul><li>Reduce per capita cost </li></ul><ul><li>Improve the patient experience </li></ul><ul><ul><li>Outcomes </li></ul></ul><ul><ul><li>Safety </li></ul></ul><ul><ul><li>Satisfaction </li></ul></ul>How did we get here? What do we really want? How do we get there?
    29. 29. Chronic Care How did we get here? What do we really want? How do we get there?
    30. 30. People with Chronic Conditions: Percent of Health Care Spending <ul><li>1% of population 35% </li></ul><ul><li>5% of population 50% </li></ul><ul><li>10% of population 70% </li></ul>George Halvorson, Health Reform Now How did we get here? What do we really want? How do we get there?
    31. 31. Managing Chronic Disease <ul><li>It requires: </li></ul><ul><ul><li>Early intervention </li></ul></ul><ul><ul><li>Coordinated care teams </li></ul></ul><ul><ul><li>Educated patients </li></ul></ul><ul><ul><li>Rapid response </li></ul></ul><ul><ul><li>Doing the right thing at the right time </li></ul></ul>George Halvorson, Health Reform Now How did we get here? What do we really want? How do we get there?
    32. 32. In order to focus on the delivery system, we need… <ul><li>Purpose of public health care $ </li></ul><ul><li>We all pay, we should all benefit </li></ul><ul><li>Focus on health, not just billable health services </li></ul>How did we get here? What do we really want? How do we get there?
    33. 33. <ul><li>Focus on Public Resources </li></ul><ul><li>Maximize the Benefit </li></ul><ul><li>Categorical Eligibility </li></ul><ul><li>Public Education as a Model </li></ul>Finding Solutions How did we get here? What do we really want? How do we get there?
    34. 34. Economic Stakeholders <ul><ul><li>Health professionals </li></ul></ul><ul><ul><li>Hospitals and other providers </li></ul></ul><ul><ul><li>Uninsured </li></ul></ul><ul><ul><li>Workers with good employer-sponsored coverage </li></ul></ul><ul><ul><li>Seniors on Medicare </li></ul></ul><ul><ul><li>Those with disabilities and other special needs </li></ul></ul><ul><ul><li>Employers </li></ul></ul><ul><ul><li>Insurers and health plans </li></ul></ul><ul><ul><li>Pharmaceutical manufacturers </li></ul></ul><ul><ul><li>Medical device manufacturers </li></ul></ul><ul><ul><li>Others… </li></ul></ul>How did we get here? What do we really want? How do we get there?
    35. 35. Politics & Economics <ul><ul><li>1:11 jobs in U.S. is in the health care sector </li></ul></ul><ul><ul><li>1:7 dollars in our economy is related to health care </li></ul></ul><ul><ul><li>16% of Americans have no health insurance </li></ul></ul><ul><ul><li>84% do have health insurance </li></ul></ul>How did we get here? What do we really want? How do we get there?
    36. 36. Barack Obama <ul><li>Expand public and private insurance </li></ul><ul><li>Reduce premiums with small biz tax credit </li></ul><ul><li>Fed subsidized insurance </li></ul>How did we get here? What do we really want? How do we get there?
    37. 37. Barack Obama: expected results <ul><li>Long term increase premiums for young and healthy </li></ul><ul><li>Reduce premiums for older sicker </li></ul><ul><li>(near) Universal access to infectious disease model of care </li></ul>How did we get here? What do we really want? How do we get there?
    38. 38. John McCain <ul><li>Increase private insurance only </li></ul><ul><li>Tax credit instead of exempting employer coverage </li></ul><ul><li>Save money by deregulating state insurance laws </li></ul><ul><li>Guaranteed access pool (state level) </li></ul>How did we get here? What do we really want? How do we get there?
    39. 39. John McCain: expected results <ul><li>Lower premiums for healthier </li></ul><ul><li>Higher for older and sicker people </li></ul>How did we get here? What do we really want? How do we get there?
    40. 40. John McCain <ul><li>“ Opening up the health insurance market to more vigorous nationwide competition, as we have done over the last decade in banking, would provide more choices of innovative products less burdened by the worst excesses of state-based regulation.” </li></ul><ul><li>John McCain, September 2008 </li></ul>How did we get here? What do we really want? How do we get there?
    41. 41. John McCain & Barack Obama <ul><li>Health coordination & disease management in medicare </li></ul><ul><li>Health IT - medical records </li></ul><ul><li>Don’t explain how to pay for it </li></ul><ul><li>Cost containment an afterthought </li></ul><ul><li>Not talking about Medicare </li></ul>How did we get here? What do we really want? How do we get there?
    42. 42. John McCain & Barack Obama <ul><li>What’s missing? A lot! </li></ul><ul><li>It’s being defined as an insurance problem </li></ul><ul><li>The real problem is finding a shared vision, changing our delivery system </li></ul><ul><li>Find an accurate diagnosis of problem - financing and access are not biggest part </li></ul>How did we get here? What do we really want? How do we get there?
    43. 43. How did we get here? What do we really want? How do we get there?
    44. 44. The questions need to be <ul><li>What do we want the system to achieve? </li></ul><ul><li>What role should I play? </li></ul>How did we get here? What do we really want? How do we get there?
    45. 45. Leadership Starts With Us <ul><li>What can you teach your friends, family, patients? </li></ul><ul><li>Local dialogue vs national leadership </li></ul><ul><li>Join our email list </li></ul><ul><li>Attend a chapter meeting </li></ul><ul><li>Join the movement </li></ul>How did we get here? What do we really want? How do we get there?
    46. 46. A role for nurses? <ul><ul><li>“ Thus a legitimate and necessary role for the nurse is to work to change the larger structure and process of society in ways that will promote the individual’s health and well-being” </li></ul></ul><ul><ul><li>-- Stuart & Laraia, Principles of Psychiatric Nursing </li></ul></ul>
    47. 47. Take Home Messages <ul><ul><li>Financing and delivery are separate </li></ul></ul><ul><ul><li>We have an infectious disease system, need a chronic disease system </li></ul></ul><ul><ul><li>Must agree on a vision - triple aim? </li></ul></ul><ul><ul><li>Leadership starts with you </li></ul></ul>Isaac Holeman www.WeCanDoBetter.org [email_address]
    48. 48. The Archimedes Movement <ul><ul><li>“ The realization that our illogical, mistaken health care system can’t go on forever has dawned, and so it will end. The question now is what replaces it.” </li></ul></ul><ul><ul><ul><ul><li>-- Ezra Klein, Los Angeles Times , Dec. 26, 2006 </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Thank You! </li></ul></ul></ul></ul>Isaac Holeman www.WeCanDoBetter.org [email_address]

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