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Health Care Reform My Perspective Harry O. Senekjian April 8, 2010.
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Transcript of Health Care Reform My Perspective Harry O. Senekjian April 8, 2010.
Insurance Premiums • Workers’ Earnings • Inflation 1999-2008
119%
34%
29%
0%
20%
40%
60%
80%
100%
120%
140%
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
Health Insurance Premiums
Workers' Earnings
Overall Inflation
Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 2000-2008. Bureau of Labor Statistics, Consumer Price Index
U.S. Overhead Spending
19.9%
26.5%
3.1%
0%
10%
20%
30%
Medicare Commercial Carriers Investor-Owned Blues
International Journal of Health Services 2005; 35(1): 64-90
Early Benefits of Reform
• Young adults will be able to stay on their parent’s insurance until age 26 years
• Seniors will receive a rebate to help fill the doughnut hole in their Medicare drug coverage
• Insurers will have to cover children with pre-existing conditions
• Small businesses will receive tax credits to cover 35% of their health care premiums
Early Benefits of Reform
• Insurers will no longer be able to cancel coverage when someone becomes ill
• New plans must pay for preventive care without co-payments
• A temporary re-insurance program will help businesses pay for early retiree health benefits
What the Bill Means for DoctorsPros and Cons
• About 16 million Americans will be added to the Medicaid program. Reimbursement will be raised to Medicare levels for primary care physicians in 2013– New business models– Inner city practices may spring up– Payment instead of unpaid charity care– More primary care doctors will be trained
What the Bill Means for DoctorsPros and Cons
• Funding the plan and controlling expenses
A new tax will be levied on high earners
Individuals making greater than $200,000
($250,000 for married couples) will pay a
3.8% Medicare Part A tax
What the Plan Means for DoctorsPros and Cons
• Tort reform is overlooked– It fails to lessen the number of lawsuits
brought against doctors by plaintiffs looking for a quick jackpot
– It neglects to address the issue of defensive medicine
What the Bill Means for DoctorsPros and Cons
• Continued chaos with payment rates
• Prevention and wellness– There are no financial incentives for patients
to encourage them to lower cholesterol, quit smoking, lose weight or in other ways to take responsibility for their health
Massachusetts Health Reform
New Coverage
•< 150% Poverty - Medicaid HMO
•150% - 300% poverty - Partial subsidy
•> 300% poverty – Buy Your Own
Massachusetts: Required Coverage(Income > $31k)
• Premium: $4,800 Annually (56 year old)
• $2000 deductible
• 20% co-insurance AFTER deductible is reached
Crimes and Punishments in Massachusetts
The Crime The Fine
Violation of Child Labor Laws $50
Employers Failing to Partially Subsidize a Poor Health Plan for Workers
$295
Illegal Sale of Firearms, First Offense $500 max.
Driving Under the Influence, First Offense $500 min.
Domestic Assault $1000 max.
Cruelty to or Malicious Killing of Animals $1000 max.
Communication of a Terrorist Threat $1000 min.
Being Uninsured In Massachusetts $1068
Massachusetts 2006
“Every uninsured citizen in Massachusetts will soon have affordable health insurance and the costs of health care will be reduced.
Gov. Romney.”
Sources: Wall Street Journal 4/11/06 and New York Times 4/5/06.
“The bill does what health experts say no other state has been able to do: provide a mechanism for all of its citizens to obtain health insurance.”
Massachusetts 1988
“I am very proud of the fact that Massachusetts will be the first state in the country to enact universal health insurance.”
Gov. Dukakis`
Sources: New York Times 4/14/88 and 4/26/88
“Massachusetts last week ventured where no state has gone before: it guaranteed health insurance for every resident.”
Sources:Washington Post 6/9/92 and 3/20/`93
Oregon 1992
“Today our dreams of providing effective and affordable health care to all Oregonians has come true.”
Gov. Roberts
“The most far-reaching health care reform in the nation.”
International Timeline of Universal HealthcareGermany 1883
Switzerland 1911New Zealand 1938France 1945United Kingdom 1946Sweden 1947USA 1947*Japan 1961Canada 1966Australia 1974Italy 1978Spain 1986Taiwan 1995
*President Truman proposed but failed to pass National Health Insurance
Phony vs. Real Reform
Phony
• Choice of HMO/insurer
• Coverage = Copays, exclusions etc.
• Security = Lose it if you can’t work or can’t pay
• Savings = Less care
Real
• Choice of doctor and hospital
• Coverage = First $, Comprehensive
• Security = For everyone, forever
• Savings >$400 bil on bureaucracy