The document outlines remarks delivered by James J. Mongan at the William E. Petersen Symposium on health financing policy, focusing on coverage and cost issues within the healthcare system. It discusses historical proposals and predicts outcomes related to health reform, including concerns about the individual mandate and financing challenges. Future policy issues are highlighted, emphasizing the balance between individual liberty and fairness in financing healthcare.

1. William E. Petersen Symposium University of St. Thomas Opus College of Business James J. Mongan, MD President & CEO Partners HealthCare October 7, 2009

2. Outline of Remarks Coverage Issues Cost Issues Future Challenges Petersen Lecture 10.7.09

3. Health Financing Policy - Coverage Facts on health care coverage Why coverage is important What we have tried to do 1974 Nixon proposal 1979 Carter proposal 1992 Clinton proposal The Massachusetts story Petersen Lecture 10.7.09

4. Health Reform Outcome Predictions – July 15, 2009 Petersen Lecture 10.7.09 Bill passes, highly touted Significant coverage improvements (50-60%) Cost issues remain Some concern over individual mandate backlash because of inadequate subsidies Outcome Element Yes No Compromise Individual Mandate  Phased in plus many “ hardship ” exclusions Employer Mandate  Small Massachusetts level penalties Public Plan  “ Light ” public plans – no Medicare limits, state level, triggered in Payment Reform  Payment cuts, not reforms – effective on Medicare only Adequate Financing  Without employer mandates and with limited tax revenues, payment cuts not sufficient to fund adequate subsidies

5. Health Financing Policy - Costs Facts on health costs Why costs are rising Why we care about high costs What we have tried to do Regulate Let markets work Petersen Lecture 10.7.09

6. Health Financing Policy Future Policy Issues Focused on Cost Steps to control baseline level of spending Address variance Address operating efficiency Address administrative costs Barriers to action Petersen Lecture 10.7.09

7. Petersen Lecture 10.7.09

8. Health Financing Policy Future Policy Issues Focused on Coverage Major challenge – need for revenue Cannot escape or evade Likely any legislation will blend Taxes Employer payments Individual payments Key Issue – fairness of financing – who pays and how much Petersen Lecture 10.7.09

9. Health Financing Policy Key Issue for the Future Balance between individual liberty and justice for all Petersen Lecture 10.7.09