Presentation delivered at Symposium on Health Care Policy Reform, Columbus Ohio, 10/27/09

1. Our National Struggle for Health Care Reform in America Compiled by: Jeff Biehl Access HealthColumbus

2. Chapter 1 … imagine if our K-12 education system operated like our health care “system” Scenario #1Education Plan Enrollment

3. We’d like to enroll our child in an education plan.

4. OK… where do you work? We’d like to enroll our child in an education plan.

5. OK… where do you work? We’d like to enroll our child in an education plan. Why does it matter?

6. 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.

7. here is a summary

8. here is a summary Education clinic… will I get my own desk?

9. Hello, Education Diagnostic Services … how may I help you? Scenario #2Determining Value

10. 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

11. 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.

12. We have a high deductible education plan… How much will the test cost?

13. We have a high deductible education plan… How much will the test cost? Well it depends..

14. We have a high deductible education plan… How much will the test cost? Well it depends.. On what?

15. here is a summary

16. here is a summary Yikes! How can we find out the cost?

17. here is a summary ... when we send you the bill. Yikes! How can we find out the cost?

19. universal and portable

20. based on a (public) floor, but not a (private) ceiling

21. based on the (moral & economic) value of educationChapter 2 What is the primary difference between our K-12 education &health care “systems”?

22. Chapter 3 … our lack of affordable and quality health care for all Analysis of the Consequences

24. Most resources spent on sick care (not optimizing health)

25. Supply drives Demand (more is not always better)

26. The current situation is unaffordable for individuals & unsustainable for our nation

27. The definition of “vulnerable” has expanded to middle class

28. Negatively impacts our competitiveness in a global economy

29. Negatively impacts individual prosperity and innovation… a few simple facts

30. “Every system is perfectly designed to achieve the results it gets.” Donald Berwick, M.D. Institute for Healthcare Improvement (IHI) … a few simple facts

31. … a few simple facts

33. 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

34. 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

35. Source: Health Affairs, January 2008

36. USA USA in last place on this quality measure Source: Health Affairs, January 2008

37. 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

38. U.S. health care expenditures Source: Centers for Medicare & Medicaid Services, Kaiser Foundation

39. 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

40. 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

41. Ohioans Ohioans

42. Coverage does not always equal Access Ohioans Ohioans

43. Coverage does not always equal Access All measures trended up> 40% since 2004 Ohioans Ohioans

44. Chapter 4 Why is reforming health care a struggle?

46. We avoid policies on how to balance end-of-life resources(conflicts with our sense of liberties)

47. When we talk about “savings” it means reducing another’s “income”

48. 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

49. Chapter 5 What are the 8 major “tension” points on the path for national health care reform?

50. 1. Require insurance companies to cover all people Similar to car insurance… required coverage

51. 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

52. 2. Subsidies for those below 300% poverty level $66,150 for family of 4 What revenues will pay for the subsidy?

53. 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?

54. 3. Current System of Fee For Service = more is better Rewards for improving health

55. 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

56. 4. Standards for measuring & comparing Bending inflationary curve

57. 4. Important components to determine VALUE Standards for measuring & comparing Bending inflationary curve

58. 5. Right care, Right place, Right time Patient-centered health care

59. 5. If everyone was insured today…. where would they go for primary care? Right care, Right place, Right time Patient-centered health care

60. 6. Reduce disruptions due to changes in employment Reduce disruptions due to changes in eligibility categories

61. 6. The average American will change careers 3 times! Reduce disruptions due to changes in employment Reduce disruptions due to changes in eligibility categories

62. 7. Bend the health status curve? 50+% is lifestyle and behavior Share responsibility with provider for plan of care

63. 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

64. 8. “Medicare for all” Current approach for 60% of Americans

65. 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

66. “You can always count on Americans to do the right thing – after they’ve tried everything else.” ~ Winston Churchill jbiehl@accesshealthcolumbus.org