Our National Struggle for Health Care Reform in AmericaCompiled by: Jeff BiehlAccess HealthColumbus

Chapter 1… imagine if our K-12 education system operated like our health care “system”Scenario #1Education Plan Enrollment

We’d like to enroll our child in an education plan.

OK… where do you work?We’d like to enroll our child in an education plan.

OK… where do you work?We’d like to enroll our child in an education plan.Why does it matter?

OK… where do you work?We’d like to enroll our child in an education plan.Why does it matter?Because…we use a categorical eligibility system to determine your access to education and the cost.

here is a summary

here is a summaryEducation clinic… will I get my own desk?

Hello, Education Diagnostic Services… how may I help you?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?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?Scenario #2Determining ValueUnfortunately…we do not have that information available for customers.

We have a high deductible education plan… How much will the test cost?

We have a high deductible education plan… How much will the test cost?Well it depends..

We have a high deductible education plan… How much will the test cost?Well it depends..On what?

here is a summary

here is a summaryYikes!How can we find out the cost?

here is a summary... when we send you the bill.Yikes!How can we find out the cost?

It’s all about the policy - access to affordable K-12 is:a RIGHTuniversal and portablebased on a (public) floor, but not a (private) ceiling based on the (moral & economic) value of educationChapter 2What is the primary difference between our K-12 education &health care“systems”?

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 allAnalysis of theConsequences

The Simple Facts on our Current SituationU.S. only industrialized nation without policy to guide decisions on universal health careMost 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 nationThe definition of “vulnerable” has expanded to middle classNegatively impacts our competitiveness in a global economyNegatively impacts individual prosperity and innovation… 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

“Every system is perfectly designed to achieve the results it gets.”Donald Berwick, M.D.Institute for Healthcare Improvement (IHI)… a few simple facts

… a few simple facts

1.4 million uninsured Ohioans +154,000 Ohioans in the past 12 months2 million Ohioans:1 out of every 3 children &1 out of every 5 adults

1.4 million uninsured Ohioans Employer-based insurance is eroding…In Ohio < 60%+154,000 Ohioans in the past 12 months2 million Ohioans:1 out of every 3 children &1 out of every 5 adults

Source: Health Affairs, January 2008

USAUSA in last place on this quality measureSource: Health Affairs, January 2008

USASince we spend more than anyone else….Should we expect more value?USA in last place on this quality measureSource: Health Affairs, January 2008

U.S. health care expendituresSource: Centers for Medicare & Medicaid Services, Kaiser Foundation

U.S. health care expenditures$14,000+ per person in 2018(projected)$8,100+ per person in 2009(actual)Source: Centers for Medicare & Medicaid Services, Kaiser Foundation

U.S. health care expendituresAffordability~50% of Ohioans will require subsidy for coverage$14,000+ per person in 2018(projected)$8,100+ per person in 2009(actual)Source: Centers for Medicare & Medicaid Services, Kaiser Foundation

OhioansOhioans

Coverage does not always equal AccessOhioansOhioans

Coverage does not always equal AccessAll measures trended up> 40% since 2004OhioansOhioans

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

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

Chapter 5What are the 8 major “tension” points on the path for national health care reform?

1.Require insurance companies to cover all peopleSimilar to car insurance… required coverage

1.Will $200 to $750 penalty for opting out influence consumer behavior?Require insurance companies to cover all peopleSimilar to car insurance… required coverage

2.Subsidies for those below 300% poverty level$66,150 for family of 4What revenues will pay for the subsidy?

2.U.S.38 million(83%) uninsured < 300% povertySubsidies for those below 300% poverty level$66,150 for family of 4What revenues will pay for the subsidy?

3.Current System of Fee For Service = more is betterRewards for improving health

3.We need to transition to rewarding the actual value of care!Current System of Fee For Service = more is betterRewards for improving health

4.Standards for measuring & comparingBending inflationary curve

4.Important components to determine VALUEStandards for measuring & comparingBending inflationary curve

5.Right care, Right place, Right timePatient-centered health care

5.If everyone was insured today…. where would they go for primary care?Right care, Right place, Right timePatient-centered health care

6.Reduce disruptions due to changes in employmentReduce disruptions due to changes in eligibility categories

6.The average American will change careers 3 times!Reduce disruptions due to changes in employmentReduce disruptions due to changes in eligibility categories

7.Bend the health status curve?50+% is lifestyle and behaviorShare responsibility with provider for plan of care

7.How do we make health a priority?Bend the health status curve?50+% is lifestyle and behaviorShare responsibility with provider for plan of care

8.“Medicare for all” Current approach for 60% of Americans

8.Will a public plan erode benefits and/or increase costs for those with employer-based coverage?“Medicare for all” Current approach for 60% of Americans

“You can always count on Americans to do the right thing – after they’ve tried everything else.”~ Winston Churchilljbiehl@accesshealthcolumbus.org