3 3-11 How We Got Here

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Slide show by Gordon Bonnyman and Michele Johnson for CTP Health & Justice Symposium at Vanderbilt University on March 3, 2011

Text of 3 3-11 How We Got Here

Slide 1

Charity is no substitute for justice withheld.St. Augustine

U.S. Health System is Too Costly We spend twice as much as other advanced countries Medical bills leading to personal bankruptcyEmployee insurance costs threaten global competitiveness

Health Care Spending per Capita in 2004aaSource: The Commonwealth Fund, calculated from OECD Health Data 2006.a2003aAdjusted for Differences in Cost of Living

cmccain - Omit? I don't think it's necessary - Gordon can just cite some of the figures.

Americans Pay Twice: First, through our TAXES -

Americans, including the uninsured, paid ~$1.2 TRILLION in 2009 in government subsidies to:insurance companiesHMOshospital chainsdrug companiesthe health industry.

cmccain - Merge and condense this slide with the following one?

Public Spending on Health Care per Capita in 2004*Total Public spending Divided by Total National PopulationAdjusted for Differences in the cost of Living

Americans Pay Twice:A Second time, as PATIENTS -

Unlike taxpayers in other advanced nations, Americans then have to pay a second time for their health care. Americans spent $1.3 TRILLION in 2009, on top of what they paid in taxes, for;care not covered by insuranceprivate insurance premiumsdeductibles co-paymentsother direct payments.

Health Care Expenditure per Capita by Source of Funding in 2004aba2003b2002 (Out-of-Pocket)aaSource: The Commonwealth Fund, calculated from OECD Health Data 2006.Adjusted for Differences in Cost of Living

cmccain - Omit? It's good, but it may not add much.

U.S. Health System is of Poor QualityDespite high quality of doctors and other health professionals, fragmentation of U.S. systems limits their ability to provide good care.

Up to 98,000 patient deaths annually due to system failures. (Institute of Medicine, 2000)

18,000 preventable deaths each year among those who are uninsured, due to the inability to access effective, timely care. (Institute of Medicine, 2003)

U.S. Health System is UNJUST47 million Americans, most in working families whose taxes subsidize the health care system, have no insurance.

At least that many more are underinsured. They have insurance, but it doesnt begin to cover their needs.

U.S. Health System is UNJUST The system perpetuates sharp racial disparities in health:An African-American newborn has twice the chance of a white baby of dying before her first birthday.Across the age spectrum, minority Americans have less access to needed health care.Minority Americans live sicker and die younger.

U.S. Health System is UNJUST

ALL Americans pay more and get less than people in other advanced nations.

The Status Quo is Unsustainable

The Centers for Medicare and Medicaid Services (CMS) projects that the cost of Medicaid will double by 2019. Health care inflation threatens the solvency of the Medicare trust funds.

Medical inflation, if not addressed, makes it all but impossible to reduce the national debt.

Every system is perfectly designed to achieve exactly the results it gets.

Dr. Donald Berwick Founder, Institute for Healthcare Improvement Administrator, Centers for Medicare & Medicaid Svcs.

A Century of Bipartisan EffortThese problems are a century old, as are efforts to address them: That any sane nation, having observed that you could provide for the supply of bread by giving bakers a pecuniary interest in baking for you, should go on to give a surgeon a pecuniary interest in cutting off your leg, is enough to make one despair of political humanity, George Bernard Shaws Preface to Doctors Dilemma (1906).

A Century of Bipartisan Effort

Lessons of the past century:Real changes only occur when there is strong presidential leadership and control of Congress by the Presidents party.The parties rhetoric has been ideologically polarized, but they have often pursued similar policies in efforts to control cost and address gaps in coverage

A Century of Bipartisan Effort

The Massachusetts Story

ACA is MA Plan +Same three legged stool although subsidize up to 400% of povertyBut also adds financingReductions in Medicare overpaymentsTax on wealthiest familiesAnd takes on cost controlFive innovative strategies provide a key first step towards tackling the cost problem

What Will ACA Do? Coverage32 million more Americans (CBO)15,000 persons each year will avoid death due to lack of insurance

Coverage for Those with Pre-Existing ConditionsA Consumer-Friendly MarketplaceCoverage Regardless of WorkplaceLimits on Out-of-Pocket CostsSubsidies for Middle-Income FamiliesAccountability for Insurer SpendingProtections against Losing Coverage

Affordable Care Act- The Basics

Tax Credits for Small BusinessesAddresses Health DisparitiesCoverage for Young AdultsCoverage for Low-Income FamiliesHelp for American Indians and Alaska NativesHelp for Seniors and People with DisabilitiesHelp for People Who Need Long-Term ServicesInvestment in Preventive Care

The basics. Part 2

Coverage for Those with Pre-Existing Conditions

AConsumer- FriendlyMarketplace

Coverage RegardlessOf YourWorkplace

Limits onOut-of-PocketCosts

Subsidies forMiddle-IncomeFamilies

AccountabilityFor InsurerSpending

ProtectionAgainst LosingCoverage

Tax CreditsFor SmallBusinesses

Addresses Health Disparities

CoverageFor YoungAdults

Coverage forLow-IncomeFamilies

Help for Seniors andPeople withDisabilities

Repeal Undoes it All

Poorer health, more deaths Unfair, expensive insurance market that leads to economic instability and medical bankruptcyA less efficient job market where individuals lack the freedom to change jobsContinued free-riding by those who pass billions of dollars in care costs onto the insuredA massive decline in private insurance coverageHuge and unsustainable increases in budget deficits reaching the trillions of dollars over coming decades

This is our best hope for our community

There is no proposal now on the table that covers even 10% as many persons as ACA

For more information:

On Americas health care system and how it measures up:www.commonwealthfund.orgwww.kff.org-Atul Gawande, The Hot Spotters:Can we lower medical costs by giving the neediest patients better care? The New Yorker, 1-24-11 http://www.newyorker.com/reporting/2011/01/24/110124fa_fact_gawande?currentPage=all Talk to the public about health reform, look to the Herndon Alliance to learn which messages work and dont work: http://herndonalliance.org/table/resources/

"For me, an area of moral clarity is: you're in front of someone who's suffering and you have the tools at your disposal to alleviate that suffering or even ehttp://www.facebook.com/tnjustice?v=box_3&ref=nfradicate it, and you act. " -Paul Farmer, founder of Partners in Health and 2009 recipient of the Dietrich Bonheoffer award.

Gordon Bonnymangbonnyman@tnjustice.orgMichele Johnsonmjohnson@tnjustice.orgwww.tnjustice.org615-255-0331http://www.facebook.com/tnjustice?v=box_3&ref=nf

American taxpayers pay more to subsidize their health care system than citizens in ANY other country. The U.S provides far greater public subsidies to its health care industry than do countries that have socialized medicine.

With health care accounting for 17.3% of GDP and growing, the drag on employers and individuals continues to increase:The number of uninsured will continue to grow.The coverage of the uninsured will shrink.The competitive disadvantages of American industry will worsen.This logjam was broken by a middle ground approach in MA Key insight: marry incremental with universalBuild on the strengths of the existing systemBut fill in the weaknesses

Three Legged StoolReformed insurance marketsSubsidized insurance below 300% poverty Individual mandateOther featuresVery modest employer obligation ($300/year)Connector to promote insurance competition

Six key facts are all you need to know:More than 300,000 newly insured uninsurance rate below 4% - 60% decline100,000 + rise in employer coverage crowd inExactly on budget projections from 2005Non-group premiums down 50% relative to nationGroup premiums unchanged75% public approval

Coverage impacts estimated by CBO are somewhat conservative relative to MA

$143 billion over the 2010-2019 period

We join the rest of the industrialized world. ***

SecurityOne of the most fundamental sources of unfairness in our society is our broken non-group insurance systemCan be denied insurance if illPre-existing conditions excluded from coverageSick charged many multiples of healthyThe ACA fixes this by ending discriminatory pricing in the non-group market and the denial of coverage or pre-existing conditionsStop denials of coverage

Eliminate higher premiums based on health status or gender

*Standardize plans

Promote competition

Provide coverage like members of Congress getWhats the Issue:Current regulation of insurance markets is run by a hodgepodge of state and federal rules. There is little standardization of the information that insurers must provide, making it difficult for consumers to understand exactly what is and is not covered and to compare other aspects of insurance plans. Non-competitive non-group insurance market reduces competitive pressure on insurersDifficult to comparison shop = little pressure to keep prices lowExchanges force non-group insurers to competeCBO: Prices fall by > 10% for comparable productsMassachusetts: Prices in the Connector 50% lower than previous non-group prices

What Health Reform Will Do:A new, regulated ma