Our National Struggle for Health Care Reform in America<br />Compiled by:  Jeff Biehl<br />Access HealthColumbus<br />
Chapter 1<br />… imagine if our K-12 education system operated like our health care “system”<br />Scenario #1Education Pla...
We’d like to enroll our child in an education plan.<br />
OK… where do you work?<br />We’d like to enroll our child in an education plan.<br />
OK… where do you work?<br />We’d like to enroll our child in an education plan.<br />Why does it matter?<br />
OK… where do you work?<br />We’d like to enroll our child in an education plan.<br />Why does it matter?<br />Because…we u...
here is a summary<br />
here is a summary<br />Education clinic… will I get my own desk?<br />
Hello, Education Diagnostic Services<br />… how may I help you?<br />Scenario #2Determining Value<br />
Hello, Education Diagnostic Services<br />… how may I help you?<br />We have a referral for testing services…  How does yo...
Hello, Education Diagnostic Services<br />… how may I help you?<br />We have a referral for testing services…  How does yo...
We have a high deductible education plan…  How much will the test cost?<br />
We have a high deductible education plan…  How much will the test cost?<br />Well it depends..<br />
We have a high deductible education plan…  How much will the test cost?<br />Well it depends..<br />On what?<br />
here is a summary<br />
here is a summary<br />Yikes!<br />How can we find out the cost?<br />
here is a summary<br />... when we send you the bill.<br />Yikes!<br />How can we find out the cost?<br />
It’s all about the policy - access to affordable K-12 is:<br /><ul><li>a RIGHT
universal and portable
based on a (public) floor, but not a (private) ceiling
based on the (moral & economic) value of  education</li></ul>Chapter 2<br />What is the primary difference between our K-1...
Chapter 3<br />… our lack of affordable and quality health care for all<br />Analysis of the<br />Consequences<br />
The Simple Facts on our Current Situation<br /><ul><li>U.S. only industrialized nation without policy to guide decisions o...
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</li></ul>… a few simple facts<br />
“Every system is perfectly designed to achieve the results it gets.”<br />Donald Berwick, M.D.<br />Institute for Healthca...
… a few simple facts<br />
1.4 million uninsured Ohioans <br />+154,000 Ohioans in the past 12 months2 million Ohioans:1 out of every 3 children &1 o...
1.4 million uninsured Ohioans <br />Employer-based insurance is eroding…<br />In Ohio &lt; 60%<br />+154,000 Ohioans in th...
Source:  Health Affairs, January 2008<br />
USA<br />USA in last place on this quality measure<br />Source:  Health Affairs, January 2008<br />
USA<br />Since we spend more than anyone else….<br />Should we expect more value?<br />USA in last place on this quality m...
U.S. health care expenditures<br />Source: Centers for Medicare & Medicaid Services, Kaiser Foundation<br />
U.S. health care expenditures<br />$14,000+ per person in 2018<br />(projected)<br />$8,100+ per person in 2009<br />(actu...
U.S. health care expenditures<br />Affordability<br />~50% of Ohioans will require subsidy for coverage<br />$14,000+ per ...
Ohioans<br />Ohioans<br />
Coverage does not always equal Access<br />Ohioans<br />Ohioans<br />
Coverage does not always equal Access<br />All measures trended up&gt; 40% since 2004<br />Ohioans<br />Ohioans<br />
Chapter 4<br />Why is reforming health care a struggle?<br />
Why is reforming health care a struggle?<br /><ul><li>We have not adopted a universal health care policy(other than we hav...
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</li></ul>-  Every party feels like a victim<br />-  No one feels empowered to act (on chang...
Chapter 5<br />What are the 8 major “tension” points on the path for national health care reform?<br />
1.<br />Require insurance companies to cover all people<br />Similar to car insurance…  required coverage<br />
1.<br />Will $200 to $750 penalty for opting out influence consumer behavior?<br />Require insurance companies to cover al...
2.<br />Subsidies for those below 300% poverty level<br />$66,150 for family of 4<br />What revenues will pay for the subs...
2.<br />U.S.38 million<br />(83%) uninsured &lt; 300% poverty<br />Subsidies for those below 300% poverty level<br />$66,1...
3.<br />Current System of Fee For Service = more is better<br />Rewards for improving health<br />
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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

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

  1. 1. Our National Struggle for Health Care Reform in America<br />Compiled by: Jeff Biehl<br />Access HealthColumbus<br />
  2. 2. Chapter 1<br />… imagine if our K-12 education system operated like our health care “system”<br />Scenario #1Education Plan Enrollment<br />
  3. 3. We’d like to enroll our child in an education plan.<br />
  4. 4. OK… where do you work?<br />We’d like to enroll our child in an education plan.<br />
  5. 5. OK… where do you work?<br />We’d like to enroll our child in an education plan.<br />Why does it matter?<br />
  6. 6. OK… where do you work?<br />We’d like to enroll our child in an education plan.<br />Why does it matter?<br />Because…we use a categorical eligibility system to determine your access to education and the cost.<br />
  7. 7. here is a summary<br />
  8. 8. here is a summary<br />Education clinic… will I get my own desk?<br />
  9. 9. Hello, Education Diagnostic Services<br />… how may I help you?<br />Scenario #2Determining Value<br />
  10. 10. Hello, Education Diagnostic Services<br />… how may I help you?<br />We have a referral for testing services… How does your quality compare to others?<br />Scenario #2Determining Value<br />
  11. 11. Hello, Education Diagnostic Services<br />… how may I help you?<br />We have a referral for testing services… How does your quality compare to others?<br />Scenario #2Determining Value<br />Unfortunately…<br />we do not have that information available for customers.<br />
  12. 12. We have a high deductible education plan… How much will the test cost?<br />
  13. 13. We have a high deductible education plan… How much will the test cost?<br />Well it depends..<br />
  14. 14. We have a high deductible education plan… How much will the test cost?<br />Well it depends..<br />On what?<br />
  15. 15. here is a summary<br />
  16. 16. here is a summary<br />Yikes!<br />How can we find out the cost?<br />
  17. 17. here is a summary<br />... when we send you the bill.<br />Yikes!<br />How can we find out the cost?<br />
  18. 18. It’s all about the policy - access to affordable K-12 is:<br /><ul><li>a RIGHT
  19. 19. universal and portable
  20. 20. based on a (public) floor, but not a (private) ceiling
  21. 21. based on the (moral & economic) value of education</li></ul>Chapter 2<br />What is the primary difference between our K-12 education <br />&health care<br />“systems”?<br />
  22. 22. Chapter 3<br />… our lack of affordable and quality health care for all<br />Analysis of the<br />Consequences<br />
  23. 23. The Simple Facts on our Current Situation<br /><ul><li>U.S. only industrialized nation without policy to guide decisions on universal health care
  24. 24. Most resources spent on sick care (not optimizing health)
  25. 25. Supply drives Demand (more is not always better)
  26. 26. The current situation is unaffordable for individuals & unsustainable for our nation
  27. 27. The definition of “vulnerable” has expanded to middle class
  28. 28. Negatively impacts our competitiveness in a global economy
  29. 29. Negatively impacts individual prosperity and innovation</li></ul>… a few simple facts<br />
  30. 30. “Every system is perfectly designed to achieve the results it gets.”<br />Donald Berwick, M.D.<br />Institute for Healthcare Improvement (IHI)<br />… a few simple facts<br />
  31. 31. … a few simple facts<br />
  32. 32.
  33. 33. 1.4 million uninsured Ohioans <br />+154,000 Ohioans in the past 12 months2 million Ohioans:1 out of every 3 children &1 out of every 5 adults<br />
  34. 34. 1.4 million uninsured Ohioans <br />Employer-based insurance is eroding…<br />In Ohio &lt; 60%<br />+154,000 Ohioans in the past 12 months2 million Ohioans:1 out of every 3 children &1 out of every 5 adults<br />
  35. 35. Source: Health Affairs, January 2008<br />
  36. 36. USA<br />USA in last place on this quality measure<br />Source: Health Affairs, January 2008<br />
  37. 37. USA<br />Since we spend more than anyone else….<br />Should we expect more value?<br />USA in last place on this quality measure<br />Source: Health Affairs, January 2008<br />
  38. 38. U.S. health care expenditures<br />Source: Centers for Medicare & Medicaid Services, Kaiser Foundation<br />
  39. 39. U.S. health care expenditures<br />$14,000+ per person in 2018<br />(projected)<br />$8,100+ per person in 2009<br />(actual)<br />Source: Centers for Medicare & Medicaid Services, Kaiser Foundation<br />
  40. 40. U.S. health care expenditures<br />Affordability<br />~50% of Ohioans will require subsidy for coverage<br />$14,000+ per person in 2018<br />(projected)<br />$8,100+ per person in 2009<br />(actual)<br />Source: Centers for Medicare & Medicaid Services, Kaiser Foundation<br />
  41. 41. Ohioans<br />Ohioans<br />
  42. 42. Coverage does not always equal Access<br />Ohioans<br />Ohioans<br />
  43. 43. Coverage does not always equal Access<br />All measures trended up&gt; 40% since 2004<br />Ohioans<br />Ohioans<br />
  44. 44. Chapter 4<br />Why is reforming health care a struggle?<br />
  45. 45. Why is reforming health care a struggle?<br /><ul><li>We have not adopted a universal health care policy(other than we have a right to use emergency rooms)
  46. 46. We avoid policies on how to balance end-of-life resources(conflicts with our sense of liberties)
  47. 47. When we talk about “savings” it means reducing another’s “income”
  48. 48. Health care is a “stuck” issue</li></ul>- Every party feels like a victim<br />- No one feels empowered to act (on changing the whole)<br />- We each protect our piece of the pie<br />
  49. 49. Chapter 5<br />What are the 8 major “tension” points on the path for national health care reform?<br />
  50. 50. 1.<br />Require insurance companies to cover all people<br />Similar to car insurance… required coverage<br />
  51. 51. 1.<br />Will $200 to $750 penalty for opting out influence consumer behavior?<br />Require insurance companies to cover all people<br />Similar to car insurance… required coverage<br />
  52. 52. 2.<br />Subsidies for those below 300% poverty level<br />$66,150 for family of 4<br />What revenues will pay for the subsidy?<br />
  53. 53. 2.<br />U.S.38 million<br />(83%) uninsured &lt; 300% poverty<br />Subsidies for those below 300% poverty level<br />$66,150 for family of 4<br />What revenues will pay for the subsidy?<br />
  54. 54. 3.<br />Current System of Fee For Service = more is better<br />Rewards for improving health<br />
  55. 55. 3.<br />We need to transition to rewarding the actual value of care!<br />Current System of Fee For Service = more is better<br />Rewards for improving health<br />
  56. 56. 4.<br />Standards for measuring & comparing<br />Bending inflationary curve<br />
  57. 57. 4.<br />Important components to determine VALUE<br />Standards for measuring & comparing<br />Bending inflationary curve<br />
  58. 58. 5.<br />Right care, Right place, Right time<br />Patient-centered health care<br />
  59. 59. 5.<br />If everyone was insured today…. where would they go for primary care?<br />Right care, Right place, Right time<br />Patient-centered health care<br />
  60. 60. 6.<br />Reduce disruptions due to changes in employment<br />Reduce disruptions due to changes in eligibility categories<br />
  61. 61. 6.<br />The average American will change careers 3 times!<br />Reduce disruptions due to changes in employment<br />Reduce disruptions due to changes in eligibility categories<br />
  62. 62. 7.<br />Bend the health status curve?<br />50+% is lifestyle and behavior<br />Share responsibility with provider for plan of care<br />
  63. 63. 7.<br />How do we make health a priority?<br />Bend the health status curve?<br />50+% is lifestyle and behavior<br />Share responsibility with provider for plan of care<br />
  64. 64. 8.<br />“Medicare for all”<br /> Current approach for 60% of Americans<br />
  65. 65. 8.<br />Will a public plan erode benefits and/or increase costs for those with employer-based coverage?<br />“Medicare for all”<br /> Current approach for 60% of Americans<br />
  66. 66. “You can always count on Americans to do the right thing – after they’ve tried everything else.”<br />~ Winston Churchill<br />jbiehl@accesshealthcolumbus.org<br />

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