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US Health System Reform Rhetoric vs. Reality

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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.
Fly UP