Fixing what ails healthcare in America today

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Fixing what ails healthcare in America today

• People Over Politics

Frequently Asked Questions Supplement to People
Over Politics presentation. Last updated
1/26/2012.
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FAQ slides

• Who is paying for this?
• Details for business
• Details for individuals
• Why pay for people who are unhealthy?
• Why no single payer system?
• Is this socialized medicine?
• What about primary care?
• What about hospitals?
• What about lawsuits?
• Who is Doctors for America?
• How is Doctors for America funded?
• Will Doctors for America endorse candidates?

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Who is paying for this?

• If you make more than 200,000 (or you and your
  spouse make more than 250,000),
• for every extra 1,000
• you pay 9 more in Medicare taxes.

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Who is paying for this?

• A single person who makes
• 250,000 a year in wages
• will pay 450on the extra 50,000

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Who is paying for this?

• A couple that makes
• 1,000,000 a year in wages,
• will pay 6,750
• on the extra 750,000.

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Who is paying for this?

• If you make more than 200,000
• and you make money from investments,
• you pay 18.8 instead of 15 on the investment
  income.

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Who is paying for this?

• If your health insurance from your employer
• is worth more than 27,500
• you pay your regular tax rate
• for the extra cost
• (starts in 2018).

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Who is paying for this?

• Bottom Line
• People who make more than 200,000
• (or families that make more than 250,000)
• will pay extra taxes.

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Who is paying for this?

• Bottom Line
• If you make less than 200,000
• (or your family makes less than 250,000)
• no increase in taxes

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Who is paying for this?

• . . . unless
• you have really expensive insurance
• or
• you like tanning salons
• (10 tax increase)

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Who is paying for this?

• If you are a health care corporation, you pay
  extra fees and taxes
• Insurance companies 60 billion
• Drug companies 27 billion
• Some medical devices 20 billion

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Details for Businesses

• 60 of businesses offer insurance
• 40 of businesses do not
• If everyone offers insurance, it will level the
  playing field.

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Small Businesses

• 50 subsidy for insurance bought on the exchange
  starting 2014
• 35 subsidy for insurance now

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Small Businesses

• To qualify, a business must
• Have fewer than 25 full-time employees (FTEs)
• Pay average annual wages below 50,000 per FTE
• Contribute at least 50 of each employee's premium

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Small Businesses
For more information, visit smallbusinessmajority.
org
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Small Businesses
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Small Businesses
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Small Businesses
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Small Businesses
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Large Businesses

• Any company with more than 50 employees
• If any employee needs public assistance to afford
  insurance (Medicaid or insurance exchange
  subsidies), the company will be fined 2000 per
  person.
• Note in Massachusetts, employers insurance went
  up because of the individual mandate.

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Details for Individuals
Note These are the 2011 numbers and will be
slightly higher for 2014.
Lowest income 133 of the federal poverty
level Below this, people qualify for
Medicaid. Highest income 400 of the federal
poverty level
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Details for Individuals
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Details for Individuals
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Details for Individuals

• Pre-existing Condition Insurance Plans
• For individuals who have been uninsured for at
  least 6 months due to pre-existing conditions
• Temporary insurance through 2014
• Rates similar to health individuals of the same
  age
• PCIP.gov (or healthcare.gov)

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Details for Individuals
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Why should I pay for people who dont take care
of themselves?
Photo courtesy of http//www.flickr.com/photos/you
rdon/3855923910/
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Why should I pay for people who dont take care
of themselves?
You already do. Insurance The lucky many (the
healthy) pay for the unlucky few (the unhealthy).
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Why should I pay for people who dont take care
of themselves?
If we decide to only cover those who behave in a
healthy way, there might not be anyone left to
insure.
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Why should I pay for people who dont take care
of themselves?
We need to focus on prevention so we all live
healthier lives.
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Why no single-payer system?

• Large differences in public opinion on
• free market solutions
• government solutions
• Strong advocates on both sides, from public,
  physicians, health care industry, other industry,
  legislators.

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Why no single-payer system?
Laws are passed by votes in Congress. Need 218
Members of the House and 60 Senators to pass a
law. There have never been enough members of
Congress to vote for single payer.
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Why no single-payer system?

• Affordable Care Act is a law that combined
  approaches to pass a solution in 2010
• Government solutions
• Market-based solutions
• Public-private partnerships

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Why no single-payer system?

• States can experiment with single-payer and other
  systems as long as they
• Get to the same coverage and affordability
• For the same cost to the federal government.
• Vermont is working on a single-payer system.

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Is this socialized medicine?

• Affordable Care Act is a law that combined
  approaches to pass a solution in 2010
• Government solutions
• Market-based solutions
• Public-private partnerships

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Is this socialized medicine?
It expands the private insurance market. The
government is not taking over any hospitals,
doctor offices, doctors, etc. The law focuses
on making fair and better rules for everyone.
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Whats happening with Primary Care?

• The Affordable Care Act creates 16,000 more
  primary care providers by 2015.
• We need 25,000-30,000 more.
• And we need 125,000 more physicians across
  specialties by 2025.

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Whats happening with Primary Care?

• Adding just 1 primary care physician for every
  10,000 Americans could save 127,617 deaths every
  year.

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Whats happening with Primary Care?

• Payment to Primary Care
• Medicare 10 payment bonus for physicians who
  bill gt60 primary care codes (2011-2015)

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Whats happening with Primary Care?

• Payment to Primary Care
• Medicaid family medicine, general internal
  medicine, and pediatrics are reimbursed at 100
  of Medicare levels (2013-2014)

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Whats happening with Primary Care?

• National Health Service Corps
• Loan repayment for physicians who work in
  underserved areas
• Expanded from previous program, and allows some
  teaching time to qualify for full-time clinical
  work
• 1.5 billion more funding for thousands of
  additional spots

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Whats happening with Primary Care?

• Training
• Increased primary care residency slots
• Teaching Health Centers for clinic-based
  residency training

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What about lawsuits?

• Problems
• Medical errors happen.
• Many people are suing for bad reasons.
• Most people who are harmed by true medical errors
  dont get any compensation.
• The decision on two identical cases often is
  different depending on the lawyers and jury.
• Many doctors are doing more to patients because
  they are afraid of getting sued.
• Doctors in some specialties pay very high
  malpractice insurance, and some are dropping
  high-risk areas entirely (like obstetrics).
• Current malpractice system does not improve
  patient safety.

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What about lawsuits?
The Affordable Care Act set up a 50 million fund
for states and local groups to figure out better
solutions.
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What about lawsuits?
Comprehensive malpractice reform 2nd wave of
national reforms or State-by-state reforms
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What happens to hospital payments?
Changing Payments to Improve Quality Decrease
Medicare payments to hospitals by 1. If
hospitals meet or exceed national average, get
incentive payments.
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What happens to hospital payments?
Changing Payments to Improve Quality Hospitals
that do not meet the average get help improving
their quality.
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What happens to hospital payments?
Changing Payments to Improve Quality Improve Care
Quality Hospital Value-Based Purchasing Program
(VBP) Multiple quality measures Decrease 30-day
Hospital Readmissions For 2012 CHF, Acute MI,
Pneumonia Decrease Healthcare-Associated
Conditions For 2012 Decubitus ulcers, falls,
line infections
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Who is Doctors for America?

• A national movement of doctors and medical
  students working together to improve the health
  of the nation and to ensure that everyone has
  access to affordable, high-quality health care.

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Who is Doctors for America?

• 15,000 doctors and medical students in all 50
  states
• Average experience 10 years after training
• 50 private practice
• 50 primary care, 50 specialists
• 15 medical students

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Who is Doctors for America?Board 2011-2012
Dr. Vivek Murthy, MD MBAInternal Medicine
Hospitalist Boston, Massachusetts
Carol DuhMedical Student Nashville, Tennessee
Dr. Chris Lillis, MDPrivate Practice Internal
Medicine Fredericksburg, Virginia
Dr. Alice Chen, MDInternal Medicine
Hospitalist Los Angeles, California
Dr. Mona Mangat, MDSolo Practice
Allergist/Immunologist St. Petersburg, Florida
Dr. Evan Saulino, MD PhDFamily
Practice Portland, Oregon
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Who is Doctors for America?More Faces of Doctors
for America
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How is Doctors for America funded?

• Foundation grants
• Including Nathan Cummings Foundation, Herman and
  Frieda L. Miller Foundation
• Individual donations
• Physicians and medical student members
• Additional individual supporters
• Our work is done by many dedicated volunteers
  supported by 2 full-time staff.

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Its an election year. Will Doctors for America
endorse candidates?

• No.
• We operate under 501(c)(3) non-profit,
  non-partisan rules.

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To Learn More

• Doctors for America www.drsforamerica.org
• Official Information www.healthcare.gov
• Kaiser Family Foundation healthreform.kff.org/
• Commonwealth Fund www.commonwealthfund.org
• New England Journal of Medicine
  www.nejm.org/health-policy-and-reform

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Contact Us

• Have additional questions or suggestions?
• Catch inaccuracies in these slides?
• Want to learn more about being a part of the
  Doctors for America One Million Campaign?
• Contact us at info_at_drsforamerica.org

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• www.1millioncampaign.org