The Archimedes Movement Isaac Holeman www.WeCanDoBetter.org [email_address] We Can Do Better A Project of the Archimedes Movement www.WeCanDoBetter.org

We Can Do Better

A Project of the Archimedes Movement

www.WeCanDoBetter.org

Why are you here? Isaac Holeman www.WeCanDoBetter.org [email_address]

We are the Archimedes Movement Isaac Holeman www.WeCanDoBetter.org [email_address]

We are active citizens Isaac Holeman www.WeCanDoBetter.org [email_address]

Why are we here? How did we get here? What do we really want? How do we get there?

Get ready for a demographic tidal wave How did we get here? What do we really want? How do we get there?

The KEY to understanding the health care debate Financing How we pay for care Delivery What we are buying How care is organized and delivered Return on investment in terms of health How did we get here? What do we really want? How do we get there?

Financing

How we pay for care

Delivery

What we are buying

How care is organized and delivered

Return on investment in terms of health

Problems with our delivery system Archaic structure We have failed to evolve to meet changing demands Political gridlock How did we get here? What do we really want? How do we get there?

Archaic structure

We have failed to evolve to meet changing demands

Political gridlock

Infectious disease model not designed to treat chronic disease How did we get here? What do we really want? How do we get there?

Infectious disease model not designed to treat chronic disease How did we get here? What do we really want? How do we get there?

Infectious disease model not designed to treat chronic disease How did we get here? What do we really want? How do we get there?

Infectious disease model not designed to treat chronic disease How did we get here? What do we really want? How do we get there?

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

Evolution of the System Conditions that were once fatal have become chronic Solo or small practice group practices working independently Lack of data How did we get here? What do we really want? How do we get there?

Conditions that were once fatal have become chronic

Solo or small practice group practices working independently

Lack of data

Three outdated structures in our delivery system 1954 Preferential tax treatment to employer sponsored coverage 1965 Enactment of Medicare 1965 Enactment of Medicaid How did we get here? What do we really want? How do we get there?

1954 Preferential tax treatment to employer sponsored coverage

1965 Enactment of Medicare

1965 Enactment of Medicaid

Employer Sponsored Coverage: an accident in history Labor shortage WWII Wage and price controls Companies sought to offer a “non-monetary” benefit How did we get here? What do we really want? How do we get there?

Labor shortage WWII

Wage and price controls

Companies sought to offer a “non-monetary” benefit

Employer Sponsored Coverage: bad for a mobile economy Public subsidy >$200B per year Paid by all taxpayers, including those without coverage How did we get here? What do we really want? How do we get there?

Public subsidy >$200B per year

Paid by all taxpayers, including those without coverage

Medicare: hasn’t adjusted for demographic boom Elderly used to be poorest segment of society Financed by taxes on those who are working Does not cover long-term care services for an aging population How did we get here? What do we really want? How do we get there?

Elderly used to be poorest segment of society

Financed by taxes on those who are working

Does not cover long-term care services for an aging population

Medicaid: categorical eligibility was a bad idea To improve financial access for certain categories of the poor Poor children Blind and disabled Elderly needing long term care Pregnant women How did we get here? What do we really want? How do we get there?

To improve financial access for certain categories of the poor

Poor children

Blind and disabled

Elderly needing long term care

Pregnant women

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?

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

The Current Debate: we are barking up the wrong tree It’s not a financing problem Why do we ask how to give the uninsured access to the INFECTIOUS DISEASE FOCUSED system? How did we get here? What do we really want? How do we get there?

It’s not a financing problem

Why do we ask how to give the uninsured access to the INFECTIOUS DISEASE FOCUSED system?

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?

What can we do about it? How did we get here? What do we really want? How do we get there?

The Greatest Generation Higher Education Interstate Highway System Transmission Grid Went to the Moon (and back!) Cured polio, eradicated smallpox How did we get here? What do we really want? How do we get there?

Higher Education

Interstate Highway System

Transmission Grid

Went to the Moon (and back!)

Cured polio, eradicated smallpox

Agreeing on a Shared Vision What is the purpose of our health care system? How did we get here? What do we really want? How do we get there?

What is the purpose of our health care system?

Agreeing on a Shared Vision Without first agreeing on where we want to end up, there is no political pathway by which to get there. How did we get here? What do we really want? How do we get there?

Without first agreeing on where we want to end up, there is no political pathway by which to get there.

Institute for Healthcare Improvement: Triple Aim Improve population health Reduce per capita cost Improve the patient experience Outcomes Safety Satisfaction How did we get here? What do we really want? How do we get there?

Improve population health

Reduce per capita cost

Improve the patient experience

Outcomes

Safety

Satisfaction

Chronic Care How did we get here? What do we really want? How do we get there?

People with Chronic Conditions: Percent of Health Care Spending 1% of population 35% 5% of population 50% 10% of population 70% George Halvorson, Health Reform Now How did we get here? What do we really want? How do we get there?

1% of population 35%

5% of population 50%

10% of population 70%

Managing Chronic Disease It requires: Early intervention Coordinated care teams Educated patients Rapid response Doing the right thing at the right time George Halvorson, Health Reform Now How did we get here? What do we really want? How do we get there?

It requires:

Early intervention

Coordinated care teams

Educated patients

Rapid response

Doing the right thing at the right time

In order to focus on the delivery system, we need… Purpose of public health care $ We all pay, we should all benefit Focus on health, not just billable health services How did we get here? What do we really want? How do we get there?

Purpose of public health care $

We all pay, we should all benefit

Focus on health, not just billable health services

Focus on Public Resources Maximize the Benefit Categorical Eligibility Public Education as a Model Finding Solutions How did we get here? What do we really want? How do we get there?

Focus on Public Resources

Maximize the Benefit

Categorical Eligibility

Public Education as a Model

Economic Stakeholders Health professionals Hospitals and other providers Uninsured Workers with good employer-sponsored coverage Seniors on Medicare Those with disabilities and other special needs Employers Insurers and health plans Pharmaceutical manufacturers Medical device manufacturers Others… How did we get here? What do we really want? How do we get there?

Health professionals

Hospitals and other providers

Uninsured

Workers with good employer-sponsored coverage

Seniors on Medicare

Those with disabilities and other special needs

Employers

Insurers and health plans

Pharmaceutical manufacturers

Medical device manufacturers

Others…

Politics & Economics 1:11 jobs in U.S. is in the health care sector 1:7 dollars in our economy is related to health care 16% of Americans have no health insurance 84% do have health insurance How did we get here? What do we really want? How do we get there?

1:11 jobs in U.S. is in the health care sector

1:7 dollars in our economy is related to health care

16% of Americans have no health insurance

84% do have health insurance

Barack Obama Expand public and private insurance Reduce premiums with small biz tax credit Fed subsidized insurance How did we get here? What do we really want? How do we get there?

Expand public and private insurance

Reduce premiums with small biz tax credit

Fed subsidized insurance

Barack Obama: expected results Long term increase premiums for young and healthy Reduce premiums for older sicker (near) Universal access to infectious disease model of care How did we get here? What do we really want? How do we get there?

Long term increase premiums for young and healthy

Reduce premiums for older sicker

(near) Universal access to infectious disease model of care

John McCain Increase private insurance only Tax credit instead of exempting employer coverage Save money by deregulating state insurance laws Guaranteed access pool (state level) How did we get here? What do we really want? How do we get there?

Increase private insurance only

Tax credit instead of exempting employer coverage

Save money by deregulating state insurance laws

Guaranteed access pool (state level)

John McCain: expected results Lower premiums for healthier Higher for older and sicker people How did we get here? What do we really want? How do we get there?

Lower premiums for healthier

Higher for older and sicker people

John McCain “ 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.” John McCain, September 2008 How did we get here? What do we really want? How do we get there?

“ 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.”

John McCain, September 2008

John McCain & Barack Obama Health coordination & disease management in medicare Health IT - medical records Don’t explain how to pay for it Cost containment an afterthought Not talking about Medicare How did we get here? What do we really want? How do we get there?

Health coordination & disease management in medicare

Health IT - medical records

Don’t explain how to pay for it

Cost containment an afterthought

Not talking about Medicare

John McCain & Barack Obama What’s missing? A lot! It’s being defined as an insurance problem The real problem is finding a shared vision, changing our delivery system Find an accurate diagnosis of problem - financing and access are not biggest part How did we get here? What do we really want? How do we get there?

What’s missing? A lot!

It’s being defined as an insurance problem

The real problem is finding a shared vision, changing our delivery system

Find an accurate diagnosis of problem - financing and access are not biggest part

How did we get here? What do we really want? How do we get there?

The questions need to be What do we want the system to achieve? What role should I play? How did we get here? What do we really want? How do we get there?

What do we want the system to achieve?

What role should I play?

Leadership Starts With Us What can you teach your friends, family, patients? Local dialogue vs national leadership Join our email list Attend a chapter meeting Join the movement How did we get here? What do we really want? How do we get there?

What can you teach your friends, family, patients?

Local dialogue vs national leadership

Join our email list

Attend a chapter meeting

Join the movement

A role for nurses? “ 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” -- Stuart & Laraia, Principles of Psychiatric Nursing

“ 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”

-- Stuart & Laraia, Principles of Psychiatric Nursing

Take Home Messages Financing and delivery are separate We have an infectious disease system, need a chronic disease system Must agree on a vision - triple aim? Leadership starts with you Isaac Holeman www.WeCanDoBetter.org [email_address]

Financing and delivery are separate

We have an infectious disease system, need a chronic disease system

Must agree on a vision - triple aim?

Leadership starts with you

The Archimedes Movement “ 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.” -- Ezra Klein, Los Angeles Times , Dec. 26, 2006 Thank You! Isaac Holeman www.WeCanDoBetter.org [email_address]

“ 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.”

-- Ezra Klein, Los Angeles Times , Dec. 26, 2006

Thank You!