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

    • Our National Struggle for Health Care Reform in America
      Compiled by: Jeff Biehl
      Access 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 summary
      Education 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 Value
      Unfortunately…
      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 summary
      Yikes!
      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 RIGHT
      • universal and portable
      • based on a (public) floor, but not a (private) ceiling
      • based on the (moral & economic) value of education
      Chapter 2
      What is the primary difference between our K-12 education
      &health care
      “systems”?
    • Chapter 3
      … our lack of affordable and quality health care for all
      Analysis of the
      Consequences
    • The Simple Facts on our Current Situation
      • 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
      … a few simple facts
    • “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
    • USA
      USA in last place on this quality measure
      Source: Health Affairs, January 2008
    • 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
    • U.S. health care expenditures
      Source: 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 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
    • Ohioans
      Ohioans
    • Coverage does not always equal Access
      Ohioans
      Ohioans
    • Coverage does not always equal Access
      All measures trended up> 40% since 2004
      Ohioans
      Ohioans
    • Chapter 4
      Why 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
    • Chapter 5
      What are the 8 major “tension” points on the path for national health care reform?
    • 1.
      Require insurance companies to cover all people
      Similar to car insurance… required coverage
    • 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
    • 2.
      Subsidies for those below 300% poverty level
      $66,150 for family of 4
      What revenues will pay for the subsidy?
    • 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?
    • 3.
      Current System of Fee For Service = more is better
      Rewards for improving health
    • 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
    • 4.
      Standards for measuring & comparing
      Bending inflationary curve
    • 4.
      Important components to determine VALUE
      Standards for measuring & comparing
      Bending inflationary curve
    • 5.
      Right care, Right place, Right time
      Patient-centered health care
    • 5.
      If everyone was insured today…. where would they go for primary care?
      Right care, Right place, Right time
      Patient-centered health care
    • 6.
      Reduce disruptions due to changes in employment
      Reduce disruptions due to changes in eligibility categories
    • 6.
      The average American will change careers 3 times!
      Reduce disruptions due to changes in employment
      Reduce disruptions due to changes in eligibility categories
    • 7.
      Bend the health status curve?
      50+% is lifestyle and behavior
      Share responsibility with provider for plan of care
    • 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
    • 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 Churchill
      jbiehl@accesshealthcolumbus.org