Some thoughts on health care policy

reform

Some thoughts on health care policy

reformNovember, 2010

Bobby Gladd, M.A.,

HIT Project Coordinator, HealthInsight

Regional Extension Center

The long-sought national goal

• Universal access• Improved quality

• Reduced cost

Can we do all of these, at once?Or is that naïve?

The now-sought national goal

U.S. population and NHE data

• 2010 U.S. National Health expenditure, ~$2.7 trillion (17% of GDP),

• 2010 U.S. population, ~310,000,000 people,

• ~$8,709 per capita!

U.S. population and NHE data

November 9th, 2010 news item:

“…employer health care costs for active employees are projected to rise 8.2% (after plan changes), to an average annual cost of $10,730 in 2011.”

- Wall Street Journal MarketWatch

U.S. population and NHE data

• 5 % of population consumes half of the NHE

• 50% of the population spends next to nothing on health care in any given year (~$50/month or less)

• The rest of us are somewhere in between

(Source: AHRQ, 2006)

U.S. population data, continued

• Of 310,000,000 gross population,

• 40,000,000 people age 65+• 154,000,000 civilian labor force• 14,800,000 civilian unemployed• 1,500,0000 active military• 2,000,000 incarcerated• 11,000,000 illegal immigrants

U.S. population data projections

Einer Elhauge, 1994

“Most knowledgeable observers believe we could today easily spend 100% of our GNP on health care without running out of services that would provide some positive health benefit to some patient.”

- "Allocating Health Care Morally," pg 1459

Brent James, MD, MStat, 1994

"Delivering optimal healing/curative treatment today only serves to ironically assure that you will likely face an older, sicker and much more expensive-to-treat patient in the future, and we will inevitably continue to face serious ethical social choices that go far beyond the clinical."

- opening session remarks, IHC HealthInsight QI training

Brent James, MD, MStat, 1994

“Every misspent dollar in the health care system is part of someone’s paycheck.”

- opening session remarks, IHC HealthInsight QI training

NCQA 2010 report: quality vs. cost

NCQA 2010 report: quality vs. cost

NCQA 2010 report: quality vs. cost

NCQA 2010 report: quality vs. cost

2000-2001, quality vs. cost, Medicare

2000: Worldwide longevity vs. cost

OK, at this point, what, if anything,can we agree on, given the evidence?

Significant disparities exist, with respect to

• access to care;

• per capita cost;

• clinical outcomes (“quality”),

• both within our country, and with respect to comparable industrialized nations.

But, even if you agree with the foregoing, what can/should we rationally do to improve things?

What, if anything, can/should we do now?

• Repeal “ObamaCare”

• Further de-regulate the health care free market (perhaps including pushing HSAs)

• Tort reform (to abate “defensive medicine”)

• Begin to phase out “fee-for-service” in favor of PCMHs and ACOs

• Move toward “Single Payer” (e.g, “Medicare for all,” essentially “Canadian Model”)

(Note: these are not all mutually exclusive)

One viewpoint of late

What, if anything, can/should we do now?

What, if anything, can/should we do now?

“To get to the point where all people have access to high-quality healthcare, affordably, we must focus our attention on how the healthcare delivery system determines costs and quality. Then we need to change that delivery model entirely…”

- John Toussaint, MD, Roger Gerard, PhD, “On The Mend”

What, if anything, can/should we do now?

”…We do not mean to suggest, however, that the external environment of healthcare repayment systems, insurance coverage, and regulations does not need to be overhauled. It is a badly broken system requiring major surgery. But we are convinced that the healthcare debate needs to start from a deep understanding of how healthcare value is actually delivered…”

- John Toussaint, MD, Roger Gerard, PhD, “On The Mend”

Thank you! Questions?

Bobby Gladd, HealthInsight REC

BGladd@healthinsight.orgbobbyg@bgladd.com

bgladd.blogspot.comregionalextensioncenter.blogspot.com

www.bgladd.com