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2009-10 Our National Struggle for Health Care Reform in America
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2009-10 Our National Struggle for Health Care Reform in America

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Presentation delivered at Symposium on Health Care Policy Reform, Columbus Ohio, 10/27/09

Presentation delivered at Symposium on Health Care Policy Reform, Columbus Ohio, 10/27/09


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  • 1. Our National Struggle for Health Care Reform in America
    Compiled by: Jeff Biehl
    Access HealthColumbus
  • 2. Chapter 1
    … imagine if our K-12 education system operated like our health care “system”
    Scenario #1Education Plan Enrollment
  • 3. We’d like to enroll our child in an education plan.
  • 4. OK… where do you work?
    We’d like to enroll our child in an education plan.
  • 5. OK… where do you work?
    We’d like to enroll our child in an education plan.
    Why does it matter?
  • 6. 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.
  • 7. here is a summary
  • 8. here is a summary
    Education clinic… will I get my own desk?
  • 9. Hello, Education Diagnostic Services
    … how may I help you?
    Scenario #2Determining Value
  • 10. 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
  • 11. 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
    Unfortunately…
    we do not have that information available for customers.
  • 12. We have a high deductible education plan… How much will the test cost?
  • 13. We have a high deductible education plan… How much will the test cost?
    Well it depends..
  • 14. We have a high deductible education plan… How much will the test cost?
    Well it depends..
    On what?
  • 15. here is a summary
  • 16. here is a summary
    Yikes!
    How can we find out the cost?
  • 17. here is a summary
    ... when we send you the bill.
    Yikes!
    How can we find out the cost?
  • 18. It’s all about the policy - access to affordable K-12 is:
    • a RIGHT
    • 19. universal and portable
    • 20. based on a (public) floor, but not a (private) ceiling
    • 21. based on the (moral & economic) value of education
    Chapter 2
    What is the primary difference between our K-12 education
    &health care
    “systems”?
  • 22. Chapter 3
    … our lack of affordable and quality health care for all
    Analysis of the
    Consequences
  • 23. The Simple Facts on our Current Situation
    • U.S. only industrialized nation without policy to guide decisions on universal health care
    • 24. Most resources spent on sick care (not optimizing health)
    • 25. Supply drives Demand (more is not always better)
    • 26. The current situation is unaffordable for individuals & unsustainable for our nation
    • 27. The definition of “vulnerable” has expanded to middle class
    • 28. Negatively impacts our competitiveness in a global economy
    • 29. Negatively impacts individual prosperity and innovation
    … a few simple facts
  • 30. “Every system is perfectly designed to achieve the results it gets.”
    Donald Berwick, M.D.
    Institute for Healthcare Improvement (IHI)
    … a few simple facts
  • 31. … a few simple facts
  • 32.
  • 33. 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
  • 34. 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
  • 35. Source: Health Affairs, January 2008
  • 36. USA
    USA in last place on this quality measure
    Source: Health Affairs, January 2008
  • 37. USA
    Since we spend more than anyone else….
    Should we expect more value?
    USA in last place on this quality measure
    Source: Health Affairs, January 2008
  • 38. U.S. health care expenditures
    Source: Centers for Medicare & Medicaid Services, Kaiser Foundation
  • 39. 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
  • 40. U.S. health care expenditures
    Affordability
    ~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
  • 41. Ohioans
    Ohioans
  • 42. Coverage does not always equal Access
    Ohioans
    Ohioans
  • 43. Coverage does not always equal Access
    All measures trended up> 40% since 2004
    Ohioans
    Ohioans
  • 44. Chapter 4
    Why is reforming health care a struggle?
  • 45. 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)
    • 46. We avoid policies on how to balance end-of-life resources(conflicts with our sense of liberties)
    • 47. When we talk about “savings” it means reducing another’s “income”
    • 48. 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
  • 49. Chapter 5
    What are the 8 major “tension” points on the path for national health care reform?
  • 50. 1.
    Require insurance companies to cover all people
    Similar to car insurance… required coverage
  • 51. 1.
    Will $200 to $750 penalty for opting out influence consumer behavior?
    Require insurance companies to cover all people
    Similar to car insurance… required coverage
  • 52. 2.
    Subsidies for those below 300% poverty level
    $66,150 for family of 4
    What revenues will pay for the subsidy?
  • 53. 2.
    U.S.38 million
    (83%) uninsured < 300% poverty
    Subsidies for those below 300% poverty level
    $66,150 for family of 4
    What revenues will pay for the subsidy?
  • 54. 3.
    Current System of Fee For Service = more is better
    Rewards for improving health
  • 55. 3.
    We need to transition to rewarding the actual value of care!
    Current System of Fee For Service = more is better
    Rewards for improving health
  • 56. 4.
    Standards for measuring & comparing
    Bending inflationary curve
  • 57. 4.
    Important components to determine VALUE
    Standards for measuring & comparing
    Bending inflationary curve
  • 58. 5.
    Right care, Right place, Right time
    Patient-centered health care
  • 59. 5.
    If everyone was insured today…. where would they go for primary care?
    Right care, Right place, Right time
    Patient-centered health care
  • 60. 6.
    Reduce disruptions due to changes in employment
    Reduce disruptions due to changes in eligibility categories
  • 61. 6.
    The average American will change careers 3 times!
    Reduce disruptions due to changes in employment
    Reduce disruptions due to changes in eligibility categories
  • 62. 7.
    Bend the health status curve?
    50+% is lifestyle and behavior
    Share responsibility with provider for plan of care
  • 63. 7.
    How do we make health a priority?
    Bend the health status curve?
    50+% is lifestyle and behavior
    Share responsibility with provider for plan of care
  • 64. 8.
    “Medicare for all”
    Current approach for 60% of Americans
  • 65. 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
  • 66. “You can always count on Americans to do the right thing – after they’ve tried everything else.”
    ~ Winston Churchill
    jbiehl@accesshealthcolumbus.org