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My presentation slide deck for a talk to a Nevada healthcare management group.

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  1. 1. Some thoughts onhealth care policy reform November, 2010 Bobby Gladd, M.A., HIT Project Coordinator, HealthInsight Regional Extension Center
  2. 2. The long-sought national goal • Universal access • Improved quality • Reduced cost Can we do all of these, at once? Or is that naïve?
  3. 3. The now-sought national goal
  4. 4. U.S. population and NHE data • 2010 U.S. National Health expenditure, ~$2.7 trillion (17% of GDP),• 2010 U.S. population, ~310,000,000 people, • ~$8,709 per capita!
  5. 5. U.S. population and NHE dataNovember 9th, 2010 news item:“…employer health care costs for activeemployees are projected to rise 8.2%(after plan changes), to an average annualcost of $10,730 in 2011.”- Wall Street Journal MarketWatch
  6. 6. U.S. population and NHE data • 5 % of population consumes half of the NHE• 50% of the population spends next to nothing on health care in any given year (~$50/month or less) • The rest of us are somewhere in between (Source: AHRQ, 2006)
  7. 7. U.S. population data, continued • Of 310,000,000 gross population, • 40,000,000 people age 65+ • 154,000,000 civilian labor force • 14,800,000 civilian unemployed • 1,500,0000 active military • 2,000,000 incarcerated • 11,000,000 illegal immigrants
  8. 8. U.S. population data projections
  9. 9. Einer Elhauge, 1994“Most knowledgeable observers believewe could today easily spend 100% ofour GNP on health care without runningout of services that would provide somepositive health benefit to some patient.” - "Allocating Health Care Morally," pg 1459
  10. 10. Brent James, MD, MStat, 1994"Delivering optimal healing/curativetreatment today only serves toironically assure that you will likelyface an older, sicker and much moreexpensive-to-treat patient in thefuture, and we will inevitablycontinue to face serious ethical socialchoices that go far beyond theclinical." - opening session remarks, IHC HealthInsight QI training
  11. 11. Brent James, MD, MStat, 1994“Every misspent dollar in thehealth care system is part ofsomeone’s paycheck.”- opening session remarks, IHC HealthInsight QI training
  12. 12. NCQA 2010 report: quality vs. cost
  13. 13. NCQA 2010 report: quality vs. cost
  14. 14. NCQA 2010 report: quality vs. cost
  15. 15. NCQA 2010 report: quality vs. cost
  16. 16. 2000-2001, quality vs. cost, Medicare
  17. 17. 2000: Worldwide longevity vs. cost
  18. 18. OK, at this point, what, if anything,can we agree on, given the evidence?Significant disparities exist, with respect to• access to care;• per capita cost;• clinical outcomes (“quality”),• both within our country, and with respect to comparable industrialized nations.But, even if you agree with the foregoing, whatcan/should we rationally do to improve things?
  19. 19. What, if anything, can/should we do now? • Repeal “ObamaCare” • Further de-regulate the health care free market (perhaps including pushing HSAs) • Tort reform (to abate “defensive medicine”) • Begin to phase out “fee-for-service” in favor of PCMHs and ACOs • Move toward “Single Payer” (e.g, “Medicare for all,” essentially “Canadian Model”) (Note: these are not all mutually exclusive)
  20. 20. One viewpoint of late
  21. 21. What, if anything, can/should we do now?
  22. 22. What, if anything, can/should we do now? “To get to the point where all people have access to high-quality healthcare, affordably, we must focus our attention on how the healthcare delivery system determines costs and quality. Then we need to change that delivery model entirely…” - John Toussaint, MD, Roger Gerard, PhD, “On The Mend”
  23. 23. What, if anything, can/should we do now? ”…We do not mean to suggest, however, that the external environment of healthcare repayment systems, insurance coverage, and regulations does not need to be overhauled. It is a badly broken system requiring major surgery. But we are convinced that the healthcare debate needs to start from a deep understanding of how healthcare value is actually delivered…” - John Toussaint, MD, Roger Gerard, PhD, “On The Mend”
  24. 24. Thank you! Questions? Bobby Gladd, HealthInsight REC