1

2

Charity is no substitute

for justice withheld.

St. Augustine

3

U.S. Health System is Too Costly

• We spend twice as much as other advanced countries

• Medical bills leading to personal bankruptcy

• Employee insurance costs threaten global competitiveness

4

Health Care Spending per Capita in 2004

$2,083$2,249

$2,546$2,571

$2,876$3,005$3,041$3,159$3,165

$6,102

$0

$1,000

$2,000

$3,000

$4,000

$5,000

$6,000

$7,000

United

States

Canada France Netherlands Germany Australia OECD

Median

United

Kingdom

J apan New

Zealandaa

Source: The Commonwealth Fund, calculated from OECD Health Data 2006.a2003

a

Adjusted for Differences in Cost of Living

5

Americans Pay Twice: First, through our TAXES -

Americans, including the uninsured, paid ~$1.2 TRILLION in 2009 in government subsidies to:–insurance companies–HMOs–hospital chains–drug companies–the health industry.

6

Public Spending on Health Care per Capita in 2004*

Total Public spending Divided by Total National Population

Adjusted for Differences in the cost of Living

7

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 insurance– private insurance premiums– deductibles – co-payments– other direct payments.

8

9

Health Care Expenditure per Capita by Source of Funding in 2004

$803

$472 $313$582 $396 $389

$359

$2,572

$483 $342 $354

$2727$2,210 $2,475

$1,894$2,350

$1,940 $2,176 $1,917 $1,832 $1,611

$239

$238

$148$906

$444

$113$28$370

$0

$1,000

$2,000

$3,000

$4,000

$5,000

$6,000

$7,000

United

States

Canada France Netherlands Germany Australia United

Kingdom

OECD

Median

J apan New

Zealand

Private Spending

Out-of-Pocket Spending

Public Spending

a b

a2003b2002 (Out-of-Pocket)

aa

Source: The Commonwealth Fund, calculated from OECD Health Data 2006.

Adjusted for Differences in Cost of Living

10

U.S. Health System is of Poor Quality

• Despite 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)

11

12

13

U.S. Health System is UNJUST

• 47 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 doesn’t begin to cover their needs.

14

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.

15

U.S. Health System is UNJUST

ALL Americans pay more

and get less than people

in other advanced nations.

16

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.

17

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.

18

A Century of Bipartisan Effort

These 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 Shaw’s Preface to

“Doctor’s Dilemma” (1906).

19

A Century of Bipartisan Effort

20

Lessons of the past century:•Real changes only occur when there is strong presidential leadership and control of Congress by the President’s 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

21

The Massachusetts Story

22

ACA is MA Plan +

• Same three legged stool – although subsidize up to 400% of poverty

• But also adds financing– Reductions in Medicare overpayments– Tax on wealthiest families

• And takes on cost control– Five innovative strategies provide a key first

step towards tackling the cost problem

23

24

What Will ACA Do? Coverage

• 32 million more Americans (CBO)

• 15,000 persons each year will avoid death due to lack of insurance

25

Coverage for Those with Pre-Existing

Conditions

A Consumer-Friendly Marketplace

Coverage Regardless of Workplace

Limits on Out-of-Pocket Costs

Subsidies for Middle-Income Families

Accountability for Insurer Spending

Protections against Losing Coverage 

Affordable Care Act- The Basics

26

Tax Credits for Small Businesses

Addresses Health Disparities

Coverage for Young Adults 

Coverage for Low-Income Families

Help for American Indians and Alaska Natives

Help for Seniors and People with Disabilities

Help for People Who Need Long-Term Services

Investment in Preventive Care 

The basics. Part 2

27

Coverage for Those with Pre-Existing Conditions

28

AConsumer-

FriendlyMarketplace

29

Coverage Regardless

Of YourWorkplace

30

Limits onOut-of-PocketCosts

31

Subsidies forMiddle-Income

Families

32

AccountabilityFor InsurerSpending

33

ProtectionAgainst Losing

Coverage

34

Tax CreditsFor Small

Businesses

35

Addresses Health

Disparities

36

CoverageFor Young

Adults

37

Coverage forLow-Income

Families

38

Help for Seniors andPeople withDisabilities

39

Repeal Undoes it All

• Poorer health, more deaths • Unfair, expensive insurance market that leads to

economic instability and medical bankruptcy• A less efficient job market where individuals lack

the freedom to change jobs• Continued free-riding by those who pass billions

of dollars in care costs onto the insured• A massive decline in private insurance coverage• Huge and unsustainable increases in budget

deficits reaching the trillions of dollars over coming decades

40

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

41

For more information:

• On America’s health care system and how it measures up:– www.commonwealthfund.org– www.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 don’t work:

http://herndonalliance.org/table/resources/

42

• "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.

43

Gordon Bonnymangbonnyman@tnjustice.org

Michele Johnsonmjohnson@tnjustice.org

www.tnjustice.org615-255-0331

http://www.facebook.com/tnjustice?v=box_3&ref=nf