US Health System Reform Rhetoric vs. Reality
U.S. Health System Reform Rhetoric vs. Reality Joseph M. Heyman, MD Chair, Board of Trustees Where does insurance come from? Employer-sponsored 61% Private/ Non-group 5% Medicaid/ Public Health Insurance 16% Uninsured 18% Family health coverage in MI 2000 2007 Employer + Employee $6,817 $12,151 Employer $5,869 $9,587 Employee $948 $2,564 Cutting back on care U.S. Health Care Spending 2018: $4.4 Trillion 2008: $2.4 Trillion Australia Overall Ranking (2007) Canada Germany New Zealand United Kingdom United States 3.5 5 2 3.5 1 6 4 6 2.5 2.5 1 5 Right Care 5 6 3 4 2 1 Safe Care 4 5 1 3 2 6 Coordinated Care 3 6 4 2 1 5 Pt-Centered Care 3 6 2 1 4 5 Access 3 5 1 2 4 6 Efficiency 4 5 3 2 1 6 Equity 2 5 54 3 1 6 Healthy Lives 1 3 2 4.5 4.5 6 Quality Care Expenditures per Capita,2004 $2,876 $3,165 $3,005 American College of Physicians, Ann Intern Med 2008;148:55-7 $2,083 $2,546 $6,102 Percentage of national health expenditures spent on health administration, 2003 7.3% Fr an ce Fi nl an d Ja pa Un Ca n ite na d Ki da n Ne gd om th er la nd Au s st Au ria s Sw tra itz lia er la nd G Un erm an ite y d St at es 8% 7% 6% 5% 4% 3% 2% 1% 0% American College of Physicians, Ann Intern Med 2008;148:55-75 Support for Health System Reform “We can no longer afford to put health care reform on hold.” ~ President Barack Obama, Feb. 24, 2009 “Rising health costs undermine our strength in the global marketplace.” ~ Sens. Baucus and Kennedy, Feb. 26, 2009 WSJ “We can achieve health-care reform in America . . . if we do it in a truly bipartisan basis.” ~ Sen. John McCain, Feb. 25, 2009, CNN Moderator: Melody Barnes Rep. Michael Burgess (R-TX) Families USA, Ron Pollack Moderator: Bob Kocher Rep. Nathan Deal (R-GA) Center for American Progress, John Podesta Sen. Byron Dorgan (D-ND) National Association of Manufacturers, John Engler Moderator: Nancy-Ann DeParle Sen. Mike Enzi (R-WY) Federation of American Hospitals, Chip Kahn Moderator: Diana Farrel Sen. Sheldon Whitehouse (D-RI) University of Chicago Medical School, Eric Whitaker Sen. Max Baucus (D-MT) Sen. Orrin Hatch (R-UT) Pfizer, Jeff Kindler Sen. Charles Grassley (R-IA) Rep. Rob Andrews (D-NJ) PICO, Scott Hersey Reed Sen. Jeanne Shaheen (D-NH) Rep. Baron Hill (D-IN) National Partnership for Women and Families, Deb Ness Rep. Henry Waxman (D-CA) Rep. Jan Schakowsky (D-IL) Racial and Ethnic Health Disparities, Fredette West Rep. Joe Barton (R-TX) Rep. Jo Ann Emerson (R-MO) Alliance for Retired Americans, Ed Coyle Rep. Jim Cooper (D-TN) Rep. Allyson Schwartz (D-PA) Moderator: Peter Orszag AFL-CIO, Gerry Shea Rep. Earl Pomeroy (D-ND) Moderator: Secretary Shinseki Small Business Majority, John Arensmeyer Rep. John Conyers (D-MI) Sen. Barbara Mikulski (D-MD) American Medical Association, Nancy Nielsen SEIU, Dennis Rivera Sen. Tom Harkin (D-IA) PhRMA, Billy Tauzin Business Roundtable, Ken Powell (CEO of General Mills) Sen. Sherrod Brown (D-OH) National Indian Health Board, Stacey Bohlen American Hospital Association, Rich Umbdenstock Sen. Judd Gregg (R-NH) American Cancer Society, Daniel Smith Rep. Charles Rangel (D-NY) National Association of People Living with AIDS, Frank Oldham American Nurses Association, Rebecca Patton Rep. Dave Camp (R-MI) Moderator: Larry Summers Blue Cross Blue Shield Association, Scott Serota Rep. Frank Pallone (D-NJ) Moderator: Neera Tanden Consortium for Citizens with Disabilities (CCD) Health Task Force, Peter Thomas Rep. Lois Capps (D-CA) Sen. Jay Rockefeller (D-WV) Rep. Wally Herger (R-CA) Sen. Jeff Bingaman (D-NM) Planned Parenthood, Cecile Richards Rep. Xavier Becerra (D-CA) Sen. Ron Wyden (D-OR) National Council of La Raza (NCLR), Janet Murguia Rep. Patrick Kennedy (D-RI) Rep. John Dingell (D-MI) Moderator: Valerie Jarrett Rep. Eric Cantor (R-VA) Rep. Lucille Roybal-Allard (D-CA) Moderator: Zeke Emanuel United Food and Commercial Workers International Union (UFCW), Joe Hansen Rep. Mike Ross (D-AR) Teamsters, Jim Hoffa Sen. Bernie Sanders (I-VT) National Federation of Independent Business (NFIB), Dan Danner Sen. Debbie Stabenow (D-MI) Catholic Health Association, Sister Carol Keehan National Medical Association, Mohammad Akhter Rep. Steny Hoyer (D-MD) Hispanic Medical Association, Elena Rios Children's Defense Fund, Marian Wright Edelman Rep. Roy Blunt (R-MO) America's Health Insurance Plans (AHIP), Karen Ignani AARP, Bill Novelli Rep. Miller (D-CA) Campaign for Mental Health Reform, Bill Emmett HCAN, Richard Kirsch Rep. Buck McKeon (R-CA) Asian and Pacific Islander Health Forum, Dr. Ho Tran University of Miami, Donna Shalala Rep. Rosa DeLauro (D-CT) Rep. Donna Christensen (D-VI) White House Forum on Health Reform Attendees Rep. Tim Murphy (R-PA) Everyday Americans Sen. Chris Dodd (D-CT) Sen. Robert Bennett (R-UT) Rep. Pete Stark (by phone) (D-CA) U.S. Chamber of Commerce, Tom Donahue Commitment “You have our commitment to play, to contribute and to help pass healthcare reform this year.” ~AHIP Chief Executive Karen Ignagni, at the Obama health care summit, March 5, 2009 AMA working closely with: • Obama Administration • Senate HELP and Finance • House Ways and Means; Energy and Commerce • Health Reform Dialogue Group • State attorneys general • State medical societies Health System Reform • Provide health care coverage for all • Improve quality • Promote wellness and prevention • Reform public programs • Reform health care delivery systems • Reduce cost and increase value 46 million uninsured Americans is a national disgrace The AMA Plan • Affordability • Choice • Fairness Promoting health and wellness Determinants of health Environmental Factors 20% Health Behaviors 50% Genetics 20% Access to Care 10% www.ama-assn.org/go/lifesteps Annual costs of chronic disease •Heart disease and stroke $448B •Smoking and tobacco use $193B •Diabetes $174B •Obesity $117B •Cancer $89B •Arthritis $81B •Pregnancy complications $1B (pre-delivery) Total = $1.1Trillion Source: http://www.cdc.gov/nccdphp/overview.htm The Medicare Dilemma 50% 40% 30% Practice Costs 20% 10% 0% -10% -20% -30% Medicare Cuts -40% -50% 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Michigan physicians likely would… Discontinue seeing Medicare patients 12% Decrease the number of Medicare 44% patients Continue to accept Medicare, but be 40% unable to invest in staff, technology or quality improvement measures Make no changes 4% Stimulus Rhetoric vs. Reality • Health Information Technology (HIT) • Comparative Effectiveness Research (CER) • The first step toward health system reform • www.ama-assn.org/go/patients Together we are stronger.