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3 3-11 How We Got Here


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Slide show by Gordon Bonnyman and Michele Johnson for CTP Health & Justice Symposium at Vanderbilt University on March 3, 2011

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3 3-11 How We Got Here

  1. 2. <ul><li>Charity is no substitute </li></ul><ul><li>for justice withheld. </li></ul>St. Augustine
  2. 3. U.S. Health System is Too Costly <ul><li>We spend twice as much as other advanced countries </li></ul><ul><li>Medical bills leading to personal bankruptcy </li></ul><ul><li>Employee insurance costs threaten global competitiveness </li></ul>
  3. 4. Health Care Spending per Capita in 2004 a a Source: The Commonwealth Fund, calculated from OECD Health Data 2006. a 2003 a Adjusted for Differences in Cost of Living
  4. 5. Americans Pay Twice: First, through our TAXES - <ul><li>Americans, including the uninsured , paid ~$1.2 TRILLION in 2009 in government subsidies to: </li></ul><ul><ul><li>insurance companies </li></ul></ul><ul><ul><li>HMOs </li></ul></ul><ul><ul><li>hospital chains </li></ul></ul><ul><ul><li>drug companies </li></ul></ul><ul><ul><li>the health industry. </li></ul></ul>
  5. 6. Public Spending on Health Care per Capita in 2004* Total Public spending Divided by Total National Population Adjusted for Differences in the cost of Living
  6. 7. Americans Pay Twice: A Second time, as PATIENTS - <ul><li>Unlike taxpayers in other advanced nations, Americans then have to pay a second time for their health care. Americans spent $1.3 TRILLION in 2009, on top of what they paid in taxes, for; </li></ul><ul><ul><li>care not covered by insurance </li></ul></ul><ul><ul><li>private insurance premiums </li></ul></ul><ul><ul><li>deductibles </li></ul></ul><ul><ul><li>co-payments </li></ul></ul><ul><ul><li>other direct payments. </li></ul></ul>
  7. 9. Health Care Expenditure per Capita by Source of Funding in 2004 a b a 2003 b 2002 (Out-of-Pocket) a a Source: The Commonwealth Fund, calculated from OECD Health Data 2006. Adjusted for Differences in Cost of Living
  8. 10. U.S. Health System is of Poor Quality <ul><li>Despite high quality of doctors and other health professionals, fragmentation of U.S. systems limits their ability to provide good care. </li></ul><ul><li>Up to 98,000 patient deaths annually due to system failures. (Institute of Medicine , 2000) </li></ul><ul><li>18,000 preventable deaths each year among those who are uninsured, due to the inability to access effective, timely care. (Institute of Medicine, 2003) </li></ul>
  9. 13. U.S. Health System is UNJUST <ul><li>47 million Americans, most in working families whose taxes subsidize the health care system , have no insurance. </li></ul><ul><li>At least that many more are under insured . They have insurance, but it doesn’t begin to cover their needs. </li></ul>
  10. 14. U.S. Health System is UNJUST <ul><li>The system perpetuates sharp racial disparities in health: </li></ul><ul><ul><li>An African-American newborn has twice the chance of a white baby of dying before her first birthday. </li></ul></ul><ul><ul><li>Across the age spectrum, minority Americans have less access to needed health care. </li></ul></ul><ul><ul><li>Minority Americans live sicker and die younger. </li></ul></ul>
  11. 15. U.S. Health System is UNJUST <ul><li>ALL Americans pay more </li></ul><ul><li>and get less than people </li></ul><ul><li>in other advanced nations. </li></ul>
  12. 16. The Status Quo is Unsustainable <ul><li>The Centers for Medicare and Medicaid Services (CMS) projects that the cost of Medicaid will double by 2019. </li></ul><ul><li>Health care inflation threatens the solvency of the Medicare trust funds. </li></ul><ul><li>Medical inflation, if not addressed, makes it all but impossible to reduce the national debt. </li></ul>
  13. 17. <ul><li>Every system is perfectly designed to achieve exactly the results it gets. </li></ul><ul><ul><ul><ul><ul><li> Dr. Donald Berwick </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li> Founder, Institute for </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Healthcare Improvement </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li> Administrator, Centers for Medicare & Medicaid Svcs. </li></ul></ul></ul></ul></ul>
  14. 18. A Century of Bipartisan Effort <ul><li>These problems are a century old, as are efforts to address them: </li></ul><ul><li>That any sane nation, having observed that you could provide for the supply of bread by giving bakers a pecuniary interest in baking for you, should go on to give a surgeon a pecuniary interest in cutting off your leg, is enough to make one despair of political humanity,” </li></ul><ul><li>George Bernard Shaw’s Preface to </li></ul><ul><li>“ Doctor’s Dilemma” (1906). </li></ul>
  15. 19. A Century of Bipartisan Effort
  16. 20. <ul><li>Lessons of the past century: </li></ul><ul><li>Real changes only occur when there is strong presidential leadership and control of Congress by the President’s party. </li></ul><ul><li>The parties’ rhetoric has been ideologically polarized, but they have often pursued similar policies in efforts to control cost and address gaps in coverage </li></ul>A Century of Bipartisan Effort
  17. 21. The Massachusetts Story
  18. 22. ACA is MA Plan + <ul><li>Same three legged stool – although subsidize up to 400% of poverty </li></ul><ul><li>But also adds financing </li></ul><ul><ul><li>Reductions in Medicare overpayments </li></ul></ul><ul><ul><li>Tax on wealthiest families </li></ul></ul><ul><li>And takes on cost control </li></ul><ul><ul><li>Five innovative strategies provide a key first step towards tackling the cost problem </li></ul></ul>
  19. 24. What Will ACA Do? Coverage <ul><li>32 million more Americans (CBO) </li></ul><ul><li>15,000 persons each year will avoid death due to lack of insurance </li></ul>
  20. 25. <ul><li>Coverage for Those with Pre-Existing Conditions </li></ul><ul><li>A Consumer-Friendly Marketplace </li></ul><ul><li>Coverage Regardless of Workplace </li></ul><ul><li>Limits on Out-of-Pocket Costs </li></ul><ul><li>Subsidies for Middle-Income Families </li></ul><ul><li>Accountability for Insurer Spending </li></ul><ul><li>Protections against Losing Coverage  </li></ul>Affordable Care Act- The Basics
  21. 26. <ul><li>Tax Credits for Small Businesses </li></ul><ul><li>Addresses Health Disparities </li></ul><ul><li>Coverage for Young Adults  </li></ul><ul><li>Coverage for Low-Income Families </li></ul><ul><li>Help for American Indians and Alaska Natives </li></ul><ul><li>Help for Seniors and People with Disabilities </li></ul><ul><li>Help for People Who Need Long-Term Services </li></ul><ul><li>Investment in Preventive Care  </li></ul>The basics. Part 2
  22. 27. Coverage for Those with Pre-Existing Conditions
  23. 28. A Consumer- Friendly Marketplace
  24. 29. Coverage Regardless Of Your Workplace
  25. 30. Limits on Out-of- Pocket Costs
  26. 31. Subsidies for Middle-Income Families
  27. 32. Accountability For Insurer Spending
  28. 33. Protection Against Losing Coverage
  29. 34. Tax Credits For Small Businesses
  30. 35. Addresses Health Disparities
  31. 36. Coverage For Young Adults
  32. 37. Coverage for Low-Income Families
  33. 38. Help for Seniors and People with Disabilities
  34. 39. Repeal Undoes it All <ul><li>Poorer health, more deaths </li></ul><ul><li>Unfair, expensive insurance market that leads to economic instability and medical bankruptcy </li></ul><ul><li>A less efficient job market where individuals lack the freedom to change jobs </li></ul><ul><li>Continued free-riding by those who pass billions of dollars in care costs onto the insured </li></ul><ul><li>A massive decline in private insurance coverage </li></ul><ul><li>Huge and unsustainable increases in budget deficits reaching the trillions of dollars over coming decades </li></ul>
  35. 40. This is our best hope for our community <ul><li>There is no proposal now on the table that covers even 10% as many persons as ACA </li></ul>
  36. 41. <ul><li>For more information : </li></ul><ul><li>On America’s health care system and how it measures up: </li></ul><ul><ul><li> </li></ul></ul><ul><ul><li> </li></ul></ul><ul><li>- Atul Gawande, “ The Hot Spotters:Can we lower medical costs by giving the neediest patients better care? The New Yorker, 1-24-11 </li></ul><ul><li>Talk to the public about health reform, look to the Herndon Alliance to learn which messages work and don’t work: </li></ul><ul><li> </li></ul>
  37. 42. <ul><li>&quot;For me, an area of moral clarity is: you're in front of someone who's suffering and you have the tools at your disposal to alleviate that suffering or even e it, and you act. &quot; </li></ul><ul><li>-Paul Farmer, founder of Partners in Health and 2009 recipient of the Dietrich Bonheoffer award. </li></ul>
  38. 43. Gordon Bonnyman [email_address] Michele Johnson [email_address] 615-255-0331