“Talking Health” Webinar: Health Reform: The

Key Issues

Robert Laszewski

Health Policy and Strategy Associates, LLC

Washington, DC

The Recent Town Hall Chorus Demanding We “Not Change It” Says the Job Has Not Been Done Reporting on the Current State

of America’s Health Care System

As much as 30%* of what we spend on health care in American is waste––the 70% that remains is the valuable part of the American health care

system.

The real question in this debate needs to be over the best way to separate the 30% that is waste

from the 70% that is valuable.

*(http://www.ama-assn.org/amednews/2009/04/27/gvsa0427.htm)

Promising It All

• At 17% of GDP today and racing toward 22% of GDP in ten years both sides promise they can reverse the health care cost trend without consequences.

• Voter anxiety over health care includes an anxiety that they will lose something.

• Of course they will.

• The debate should not be about whether one side or the other will take something away but which way will do the best job of having the least impact on quality.

• Who can get rid of the 30% that is waste and keep the 70% that is value?

“It’s Different This Time”

• The problem of health care costs and health care security is more acute.

• But there is no broad consensus on key issues.• Once again it is a partisan effort.• Special interests are no less adamant about defending

their turf and have done so incredibly well in the Democratic bills.

• The public’s understanding of key issues is generally poor and filled with myths.

• Both sides have exploited these myths and repeated them for their advantage.

• The press has done little to help––more reporting than clarifying.

Myths in the Health Care Debate

• The Democratic health care bills would “bend the curve” toward bringing costs under control.

• Republicans claim the Democratic bills would undermine the “best health care system in the world” by “raiding” Medicare and taking health care choices away from consumers by eventually “rationing care.”

Democratic Bills “Will Bend the Curve”

• A “deficit neutral” outcome will not reduce health care costs. (healthpolicyandmarket.blogspot.com/2009/08/making-health-care-reform-deficit.html)

• Why do we need to raise taxes if excessive costs are the problem? (http://healthpolicyandmarket.blogspot.com/2009/06/raising-taxes-to-pay-for-health-care.html)

• The CBO––and about every other expert––says things like health information technology, comparative effectiveness research, and wellness will have a very small impact on costs. (http://healthpolicyandmarket.blogspot.com/2009/01/five-myths-of-health-care-reformhealth.html)

• The Democratic bills pay more out to the health care special interests than they take away from them. (http://healthpolicyandmarket.blogspot.com/2009/08/health-reform-bills-would-be-great-for.html)

Republican Myths• Reforming the medical malpractice system will

significantly improve costs. (http://www.rwjf.org/pr/product.jsp?id=35368)

• The interstate sale of health insurance will dramatically reduce costs––the proof?

• We have the greatest health care system in the world. (http://www.dartmouthatlas.org/atlases.shtm)

• Don’t Republicans want to make the health care system more affordable?

• Doesn’t making the health care system more affordable mean taking money out of the system?

• Isn’t limiting how much money you give a consumer through maximums on tax credits or maximum amounts in Health Savings Accounts a way to limit expenditure and therefore care?

The American People Need to Know:

• This system is unsustainable––for government, employers, and consumers.

• Choices have to be made.

• Those choices––whether liberal or conservative––will have consequences.

• The fundamental question: How do we preserve the 70% that is valuable but get rid of the 30% that makes our system unaffordable?