U.S. Health System ReformRhetoric vs. Reality

U.S. Health System ReformRhetoric vs. Reality

Joseph M. Heyman, MDChair, Board of Trustees

Employer-sponsored61%

Uninsured18%Medicaid/

Public Health Insurance16%

Private/Non-group

5%

Where does insurance come from?

Family health coverage in MI

2000 2007

Employer + Employee

$6,817 $12,151

Employer $5,869 $9,587

Employee $948 $2,564

Cutting back on care

U.S. Health Care Spending

2008: $2.4 Trillion

2018: $4.4 Trillion2018: $4.4 Trillion

5

American College of Physicians, Ann Intern Med 2008;148:55-7

Australia Canada GermanyNew

ZealandUnited

KingdomUnited States

Overall Ranking (2007) 3.5 5 2 3.5 1 6Quality Care 4 6 2.5 2.5 1 5

Right Care 5 6 3 4 2 1

Safe Care 4 5 1 3 2 6

Coordinated Care 3 6 4 2 1 5

Pt-Centered Care 3 6 2 1 4 5

Access 3 5 1 2 4 6

Efficiency 4 5 3 2 1 6

Equity 2 5 4 3 1 6

Healthy Lives 1 3 2 4.5 4.5 6

Expenditures per Capita,2004 $2,876 $3,165 $3,005 $2,083 $2,546 $6,102

Percentage of national health expenditures spent on health

administration, 2003

American College of Physicians, Ann Intern Med 2008;148:55-75

7.3%

0%1%2%3%4%5%6%7%8%

France

Finla

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Japan

Canada

United K

ingdom

Netherla

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Austria

Austra

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Ger

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Support for Health System Reform

“We can no longer afford to put health care reform on hold.”

~ President Barack Obama, Feb. 24, 2009

“Rising health costs undermine our strength in the global marketplace.”

~ Sens. Baucus and Kennedy, Feb. 26, 2009 WSJ

“We can achieve health-care reform in America . . . if we do it in a truly bipartisan basis.”

~ Sen. John McCain, Feb. 25, 2009, CNN

Moderator: Melody Barnes

Moderator: Bob Kocher

Sen. Byron Dorgan (D-ND)

Sen. Mike Enzi (R-WY)

Sen. Sheldon Whitehouse (D-RI)

Sen. Orrin Hatch (R-UT)

Rep. Rob Andrews (D-NJ)

Rep. Baron Hill (D-IN)

Rep. Jan Schakowsky (D-IL)

Rep. Jo Ann Emerson (R-MO)

Rep. Allyson Schwartz (D-PA)

Rep. Earl Pomeroy (D-ND)

Rep. John Conyers (D-MI)

SEIU, Dennis Rivera

Business Roundtable, Ken Powell (CEO of General Mills)

American Hospital Association, Rich Umbdenstock

American Cancer Society, Daniel Smith

American Nurses Association, Rebecca Patton

Blue Cross Blue Shield Association, Scott Serota

Consortium for Citizens with Disabilities (CCD) Health Task Force, Peter Thomas

Planned Parenthood, Cecile Richards

National Council of La Raza (NCLR), Janet Murguia

Moderator: Valerie Jarrett

Moderator: Zeke Emanuel

Sen. Chris Dodd (D-CT)

Sen. Robert Bennett (R-UT)

Sen. Bernie Sanders (I-VT)

Sen. Debbie Stabenow (D-MI)

Rep. Steny Hoyer (D-MD)

Rep. Roy Blunt (R-MO)

Rep. Miller (D-CA)

Rep. Buck McKeon (R-CA)

Rep. Rosa DeLauro (D-CT)

Rep. Michael Burgess (R-TX)

Rep. Nathan Deal (R-GA)

National Association of Manufacturers, John Engler

Federation of American Hospitals, Chip Kahn

University of Chicago Medical School, Eric Whitaker

Pfizer, Jeff Kindler

PICO, Scott Hersey Reed

National Partnership for Women and Families, Deb Ness

Racial and Ethnic Health Disparities, Fredette West

Alliance for Retired Americans, Ed Coyle

Moderator: Peter Orszag

Moderator: Secretary Shinseki

Sen. Barbara Mikulski (D-MD)

Sen. Tom Harkin (D-IA)

Sen. Sherrod Brown (D-OH)

Sen. Judd Gregg (R-NH)

Rep. Charles Rangel (D-NY)

Rep. Dave Camp (R-MI)

Rep. Frank Pallone (D-NJ)

Rep. Lois Capps (D-CA)

Rep. Wally Herger (R-CA)

Rep. Xavier Becerra (D-CA)

Rep. Patrick Kennedy (D-RI)

Rep. Eric Cantor (R-VA)

United Food and Commercial Workers International Union (UFCW), Joe Hansen

National Federation of Independent Business (NFIB), Dan Danner

Catholic Health Association, Sister Carol Keehan

Hispanic Medical Association, Elena Rios

America's Health Insurance Plans (AHIP), Karen Ignani

Campaign for Mental Health Reform, Bill Emmett

Asian and Pacific Islander Health Forum, Dr. Ho Tran

Rep. Donna Christensen (D-VI)

Rep. Tim Murphy (R-PA)

Families USA, Ron Pollack

Center for American Progress, John Podesta

Moderator: Nancy-Ann DeParle

Moderator: Diana Farrel

Sen. Max Baucus (D-MT)

Sen. Charles Grassley (R-IA)

Sen. Jeanne Shaheen (D-NH)

Rep. Henry Waxman (D-CA)

Rep. Joe Barton (R-TX)

Rep. Jim Cooper (D-TN)

AFL-CIO, Gerry Shea

Small Business Majority, John Arensmeyer

American Medical Association, Nancy Nielsen

PhRMA, Billy Tauzin

National Indian Health Board, Stacey Bohlen

National Association of People Living with AIDS, Frank Oldham

Moderator: Larry Summers

Moderator: Neera Tanden

Sen. Jay Rockefeller (D-WV)

Sen. Jeff Bingaman (D-NM)

Sen. Ron Wyden (D-OR)

Rep. John Dingell (D-MI)

Rep. Lucille Roybal-Allard (D-CA)

Rep. Mike Ross (D-AR)

Rep. Pete Stark (by phone) (D-CA)

Teamsters, Jim Hoffa

U.S. Chamber of Commerce, Tom Donahue

National Medical Association, Mohammad Akhter

Children's Defense Fund, Marian Wright Edelman

AARP, Bill Novelli

HCAN, Richard Kirsch

University of Miami, Donna Shalala

White House Forum on Health Reform Attendees

Everyday Americans

Commitment

~AHIP Chief Executive Karen Ignagni, at the Obama health care summit, March 5, 2009

“You have our commitment to play, to contribute and to help pass healthcare reform this year.”

AMA working closely with:

• Obama Administration

• Senate HELP and Finance

• House Ways and Means; Energy and Commerce

• Health Reform Dialogue Group

• State attorneys general

• State medical societies

Health System Reform

• Provide health care coverage for all

• Improve quality

• Promote wellness and prevention

• Reform public programs

• Reform health care delivery systems

• Reduce cost and increase value

46 million uninsured Americans is a national disgrace

The AMA Plan

•Affordability

•Choice

•Fairness

Promoting health and wellness

Determinants of health

www.ama-assn.org/go/lifesteps

Annual costs of chronic disease

•Heart disease and stroke $448B•Smoking and tobacco use $193B•Diabetes $174B•Obesity $117B•Cancer $89B•Arthritis $81B•Pregnancy complications $1B (pre-delivery) Total = $1.1Trillion

Source: http://www.cdc.gov/nccdphp/overview.htm

The Medicare Dilemma

-50%

-40%

-30%

-20%

-10%

0%

10%

20%

30%

40%

50%

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Practice Costs

Medicare Cuts

Michigan physicians likely would…

Discontinue seeing Medicare patients 12%

Decrease the number of Medicare patients

44%

Continue to accept Medicare, but be unable to invest in staff, technology or quality improvement measures

40%

Make no changes   4%

Stimulus Rhetoric vs. Reality

• Health Information Technology (HIT)

• Comparative Effectiveness Research (CER)

• The first step toward

health system reform

• www.ama-assn.org/go/patients

Together we are stronger.