PALO ALTO UNIVERSITY ROTARY CLUBFRIDAY JUNE 22 , 2012

KENNETH D. GRAHAMHEALTHCARE EXECUTIVE

Making Cents of Healthcare:America On The Verge

World-wide Demand for Healthcare

Insatiable demand for the latest thing in healthcare, now, and somebody else needs to pay for it.

1st World: Business and Insurers

2nd World: Government or Single Payer

3rd World: 1st World, UN, Foreign Aid, Charities

Empirical US Healthcare Policy

Give the voters what they want as long as they think someone else pays for it, and I get re-elected…

States Rights vs. Federal Powers?Liberty vs. Individual Accountability?Political Ambitions vs. Fiduciary Responsibility?

Reds vs. Blues AARP – American Association of Retired Persons American Medical Association American Hospital Association Agriculture: Tobacco, Sugar Big Pharmaceutical companies

Are We Americans Too Ambitious?

Ways for Humans to Die : 13,000Drugs + combinations & doses : 6,000Physical procedures: : 4,000Safety :

PerfectSatisfaction :

CompleteWhere : Every State, city, town, village,

pocket

Lots of problems, yet Death Rate has dropped every year for 10 years

Pieces of the $2.3 Trillion Pie

Health Costs today: 1 work day per week

Affordable Care Act 0f 2010: It’s the Law

Restrain Healthcare cost accelerationImprove Safety and QualityProvide Insurance access to ½ the uninsured

½ paid by Federal sources ½ paid by Play or Pay (buy insurance or pay-a-

tax)Incentivize providers to reduce “cost-shift”Restrain excess profits – all aroundSustain or accelerate innovationsContinue job creation in the healthcare sectorCompanion legislation HITECH: Electrify medical

records – See what we are paying for

U.S. Healthcare Insurance Reform Law 91 Provisions + individual mandate

HealthCare Insurance Reform on the Bubble

1. Options for the U.S. Supreme Court Support the current law Toss out Mandate and two other related provisions Strike down whole law Refer specific actions to Congress

Congress will refuse to act until after November elections

Options at risk All 92 provisions 3 specific mandates:

1. Individuals / companies have to buy insurance, or pay a small tax

2. Insurers must insure the sick 3. Insurers can’t charge differently among “Exchange patients”

How We Measure Health Outcomes

Clear Disparities in Health Outcomes

Too Political to Handle Directly

www. County Health Rankings .Org

Accountable Care?

Accountable (Health) Care Organizations (ACO) Integrated Systems: Hospitals+ MDs+ Insurance Provider cost improvements : 20% from Hospitals Insurers start to fill in gaps: in care, social models Physician’s adopt: protocols, electronics, efficiency of groups

Accountable Governments: Lifetime benefits?Accountable Employers: Free meals, 100% Insured?Accountable Individuals: Liberty, Ethics, Justice?

Healthcare providers are already absolutely required by law to care for every responsible, and irresponsible individual (violence, illegal drugs, reckless behaviors), even if it is at the providers own expense. (Cost Shift)

Whose fight is this anyway?

Democrats: ObamaCare (really? Insurance choice was Republican idea) Individual entitlement to healthcare (no govt. provider ?) Mandate : Play or Pay (Is it a tax, or is it not? ) Big Plan? ( Still 25 million left out?)

Republicans: Romney Care in Massachusetts (98% coverage, really!) No Tax-by-any-other-name (But, don’t mess with my

Medicare!) States Rights (presented as argument about individual

liberty) No proposed plan (50 million left out, most with no cl0ut)

Next: Confusion on Impact, Process, Timing Big Impact on Presidential campaign

A. The law is approved : Proceed to implement Republicans are activated to change the President and the Senate

B. The law is rejected:

1. Return to “Status Quo” of 2009, Democrats are activated to keep the President and the Senate

2. Withdraw all, including current popular provisions? Un-likely! Keep some popular provisions with increase in prices? 15%-20% Under 26-year olds coverage (its too popular and it is inexpensive) Drug donut-hole? Lifetime cap of $1 million? Lids on health insurance company profits?

3. Cold Turkey and permanent loss of insurance access for 50+ million? Probably 3 million under 26 will keep their coverage (its too popular and inexpensive) Slow Incremental, element by element, consideration by a Republican Congress

4. Slow Progression to a Tax Based or “Single Payer” reform

The Current Law can be implemented other ways

Congress can implement all the ObamaCare provisions (without the individual mandate) by imposing a tax, like the Social Security Tax or Medicare Tax, to pay for it.

The States can implement RomneyCare everywhere. 26 Attorney Generals file suit against the Federal Plan

35 States applied/received grants to implement Federal Plan

9 States did both….. Oops on consistency.

California, Hawaii, Oregon are example of States moving ahead regardless of Supreme Court… they will do their own plan

What’s Different With This Election’s Debate?

Supreme Court decision regarding funding politics: Super PACS

501 © 4 non-taxable “Issue Based Associations”: Secret donations

Blogs: Un-named accusers

Cable TV: “entertainment news”

A Nation on the Verge: How will we behave?

“Live by the law, and for the law” Superman, 1937

“Ask not what your country can do for you, ask what you can do for your country”

John Kennedy, 1961

“Can’t we all get along?” R0dney King, 1991

Palo Alto University Rotary

The Four-Way Test

1. Is it the TRUTH?

2. Is if FAIR to all concerned?

3. Will it build GOODWILL, and BETTER RELATIONSHIPS

4. Will it be BENEFICIAL to all concerned?