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Reforming US Health Care

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There are some things even God doesn t understand. That s why He created politicians. Jeanne Scott s Not Very Sophisticated Guide to the Politics of the ... – PowerPoint PPT presentation

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Title: Reforming US Health Care


1
There are some things even God doesnt
understand. Thats why He created politicians.
2
NPAG 2007 Hyatt Regency Chicago September 23, 2007
Reform U.S. Health Care Or Else!
Jeanne Scott talking-head-in-chief health-politics
.com
3
(No Transcript)
4
Jeanne Scotts Not Very Sophisticated Guide to
the Politics of the United States of America
Liberals
Conservatives
The Great Unwashed Middle
  • Unions
  • Hard working people who believe in bad luck
  • Rich People from Hollywood
  • Macrobiotics and Vegans
  • Pro Choice Advocates
  • And assorted left wing wackos, including but not
    limited to hippie scum, tree-huggers,
    philanderers, reprobates, left leaning
    columnists, and outright communists.
  • Social Conservatives
  • Hard working people who dont believe in bad luck
  • Rich People (Non-Hollywood)
  • Pro Life Advocates
  • And assorted right wing wackos, including but not
    limited to xenophobic talk show hosts and their
    followers and a small number of powerful members
    of the NRA who exercise disproportionate power
  • Markets fuel growth
  • Americans believe in fairness not equity
  • Inspire dont conspire
  • Willingness to change and innovate
  • A Call for Sacrifice

5
Change As Viewed By Each
Liberals
Conservatives
The Great Unwashed Middle
  • Access is the priority
  • Cost control through wrestling for resources
    top down budgeted and even price controls
  • Discounted FFS as payment
  • Hamster Care that is cheaper
  • Nothing wrong with the delivery system just need
    to get people access to it
  • Over-insurance is the problem
  • Increase HDHP
  • Expand Consumer engagement
  • Hamster care
  • Nothing wrong with the delivery system as long as
    consumers are willing to pay for it
  • Delivery system reform is the priority
  • Transparency of BOTH cost and quality
  • Value Purchasing to exploit the variation in cost
    and quality
  • Capitation/P4P/ Reimbursement Reform
  • Delivery system can and should be completely
    re-engineered

6
Rising Health Insurance Costs
7
Outsourcing of Health Care ???
  • Outsourcing is no longer limited to blue collar
    industrial and back-office white collar jobs
  • Software development and programming
  • Accounting and legal services
  • Health care claims processing (Northern Ireland,
    the Philippines)
  • And the latest new developments
  • Medical transcription
  • Radiology and other telemedicine services
  • Sending patients to India and other Asian
    locations for surgeries and specialty services,
    (already an option under the British NHP)
  • Blue Cross-Blue Shield of South Carolina offering
    overseas option to members and marketing
    nationwide
  • Blue Shield of California, HealthNet offering
    Mexican HMOs

8
I took the above masthead from a web site --
Companion Global Healthcare a subsidiary of
Blue Cross-Blue Shield of South Carolina.
  • Companion Global Healthcare in the News
  • Overseas Option for S.C. BlueCross Members
    Featured on NBC Nightly News - May 16, 2007
  • Companion Global Healthcare, Doctors Care Reach
    Agreement for Aftercare Services - May 10, 2007
  • BlueCross BlueShield of South Carolina and
    BlueChoice HealthPlan Pioneer Global Healthcare
    Alternative - February 8, 2007

9
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10
  • Rising medical costs are taking a toll
  • on the auto industrys bottom line and
    ultimately are threatening American
    manufacturers' ability to compete in the global
    marketplace. Congress needs to apply some serious
    medicine to address the nation's severe health
    care problems.
  • -- General Motors chairman and CEO G.
    Richard Wagoner Jr.

11
Health care insurance, once an employment
benefit taken virtually for granted, has become
a bed-rock issue in todays American industrial
labor-management environment. As the employee
share of the cost has increased, people are
starting to become more aware of the actual cost
of health care and increasingly are seeing
the cost of health care insurance as a critical
political issue one upon which they will make
a voting decision.
A new study from the University of Michigan
indicates that 27 of employers surveyed would
like to eliminate health care coverage for their
employees entirely. 85 said that the employee
share will have to go up by 50 or more.
12
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13
  • "I fear that we may have already committed more
    physical resources to the baby-boom generation in
    its retirement years than our economy has the
    capacity to deliver."

"Congress in the future will have to weigh the
benefits of continued access, on current terms,
to advances in medical technology against other
fiscal initiatives."
Alan Greenspan November 25, 2005
14
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15
Dire Warnings from the Comptroller General
"I would argue that the most serious threat to
the United States is not someone hiding in a cave
in Afghanistan or Pakistan but our own fiscal
irresponsibility."
"I'm going to show you some numberstheyre all
big and theyre all bad."
David Walker, Comptroller General of the United
States
"You know the American people, I tell you, they
are absolutely starved for two things the truth,
and leadership."
  • Boomers will be eligible for Medicare in just
    three years and when those boomers start retiring
    en masse, then that will be a tsunami of spending
    that could swamp our ship of state if we don't
    get serious."

"Any politician who tells you that we can solve
our problem without reforming Social Security,
Medicare, and Medicaid is not telling you the
truth."
16
  • Gosh Darn All Those Pesky Uninsured People
  • 44.6 Million officially uninsured in 2006
  • (9.5M of which are children)
  • 2007 Consumers Report Estimate
  • 60 Million Underinsured
  • 40 of Americans with no or in adequate health
    insurance

17
Never Fear, the Answer is Simple
ALL AMERICANS HAVE ACCESS TO HEALTH CARE. AFTER
ALL, YOU JUST GO TO AN EMERGENCY ROOM! - GEORGE
W. BUSH, Cleveland, Ohio, August, 2007
  • 29 Industrialized Nations, 28 With NHI
  • EMTALA-Driven Uncompensated Care/Emergency Room
    Crisis
  • 37th Ranking in World
  • 15.9 GDP
  • Movement Away From
    Employment-Based Coverage
  • The States Arent Waiting Oregon, Maine, New
    Hampshire, California I, Maryland, Massachusetts,
    California II, Pennsylvania, Illinois, California
    III, Wisconsin,
  • Texas

18
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19
S-CHIP REAUTHORIZATION DEBATE
  • This month, the Senate Finance Committee Approved
    5-Year 60 Billion Increase to be Financed by 61
    Tobacco Tax Increase
  • Pay-Go Rules Apply
  • Importantly, GOP Senators Hatch and Grassley Took
    the Lead In pushing This Through
    Democratic-Controlled Finance Committee
  • Would Fund Care for Children (but no additional
    adults) in Families Up to 400 of the
    Poverty-Level
  • (About 81,000)
  • House Version Calls for 50 Billion Mostly
    Financed Through a Smaller Tobacco Tax and Cuts
    in Payments to Medicare Advantage Plans
  • The White House Announced it Would Veto
    any Such Increase

20
Caring for the uninsured is estimated to cost
115 Billion in Transferred Costs to other Payers
and Bad Debt how many would that same 115
Billion cover in a better system?
21
This is How Americans Currently Get Their
Healthcare Insurance
Uninsured 46.8M (16)
Employer 153.7M (52)
Medicaid/ SCHIP 37.5M (13)
Dual Eligible 8.0M (3)
Medicare 31.9M (11)
TriCare 3.4M (1)
Private Non-Employer 9.5M (3)
Employer Retiree 3.3M (1)
22
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23
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24
Per Capita Health Expenditures, U.S. and
Selected Countries, 2003   
25
Health Expenditures as a Share of GDP, U.S. and
Selected Countries, 2003    
26
Inflation-Adjusted Physician Income is Decreasing
Across The Board
SOURCE Center For Studying Health System Change
Community Tracking Study 15 June 2006
27
Quality Shortfalls Getting it Right 50 of the
Time
  • Adults receive about half
  • of recommended care
  • 54.9 Overall care
  • 54.9 Preventive care
  • 53.5 Acute care
  • 56.1 Chronic care

Source McGlynn EA, et al., The Quality of
Health Care Delivered to Adults in the United
States, New England Journal of Medicine, Vol.
348, No. 26, June 26, 2003, pp. 2635-2645
28
Quality of Care Today We are Worse than Shaq
from the Line
Reported October 30 that several hospitals have
hired airline pilots to explain safety
procedures and processes to their staff
29
International Obesity 2003 Percent of Population
over 15 with BMI gt30
Source OECD, 2005
30
Obesity Drivers
  • We are eating more (duh!)
  • We are eating out more (In 1970 34 of the food
    budget was consumed outside the home in late
    1990s it was 47)
  • Everything is supersized at home and at McDonalds
  • We stopped smoking
  • We are all working too much especially women
  • We dont exercise enough because we are all
    working too much
  • The only people who are exercising and eating
    right are people who were thin in the first
    place or bulimic celebrities or rich people who
    dont work or French fashion models

31
Obesity is an Illness
32
The Future of Health Care
  • Fat People Meet Skinny Benefits

33
Consumer Responsibility Arguments For and Against
For
Against
  • Consumers insulated from the cost of care
  • If they had to pay they would use it less
  • If they had to pay they would take more
    responsibility
  • Consumers should have the right to choose
  • When consumers choose and pay the market is
    working
  • The 5/55 Problem
  • One day in an American hospital and consumers
    exceed maximum deductible, so
  • Catastrophic coverage is a green light for
    esoterica
  • Does it save money overall?
  • Poor people with chronic illnesses will be
    disproportionately affected

34
Across the board, HDHP consumers have more
compliance problems
Treatment compliance problems
Currently insured in employer-sponsored or
self-purchased plan Currently enrolled in high
deductible health plan
35
The Good, the Bad and the Ugly of Non-Compliance
  • The Good Unnecessary care is foregone
  • The Bad You dont take the Lipitor and it hurts
    in the long run
  • The Ugly You dont take the asthma medication
    you go to the ER

36
Internet Information is ALWAYS Helpful
37
ELECTRONIC HEALTH RECORDS HAVE LIMITED EFFECT ON
QUALITY OF CARE, STUDY FINDS
  • "In clinic visits in which doctors did use and
    didn't use electronic health records, we didn't
    find clear evidence that EHR use was associated
    with better quality."
  • "There's nothing magical about electronic health
    records. You need to have tools in place that
    take advantage of technology to show improvements
    in quality. You need to do additional work
    instead of just turning on the computer."
  • -- Dr. Jeffrey Linder, at Bostons Brigham and
    Womens Hospital, study co-author

38
Voters View of Health Care Will Health Care Be a
Political Issue in 2008?
Dates 6/8-11 5/31-6/5 5/18-23 4/26-29 4/23-26 4/20-23 4/20-23 4/13-15 4/9-12 3/9-4/1
Org. NBC/WSJ KFF CBS/ NYT NPR Gallup Harris NBC/ WSJ Gallup/ USA Today CBS DIAGEO
1 Issue Iraq Iraq Iraq Iraq Iraq Iraq Iraq Iraq Iraq Iraq
Health Care Rank 2 2 5 2 2 2 2 3 3 2
Surveys included open-ended and list-style
questions about priorities for government to
address, issues for candidates to discuss, most
important problems facing the nation, and most
important issue to your vote.
39
Thinking About the 2008 Presidential and
Congressional Elections, Which Issues Do You
Most Want to Hear About From the Candidates?
40
Four Scenarios for US Health Care 2007-2017
Tiering of Healthcare Tiers ? Us Jeannes
Odds 3-2
Minor Delivery System Reform
Disruptive Innovation Wal-Martization of
Health Care Jeannes Odds 5-1
Bigger Government by Request Daughter of
Single-Payer Jeannes Odds 2-1
Major Delivery System Reform
Mostly or Almost Universal Health Care Jeannes
Odds 4-1
41
Scenario 1 Tiers ? Us
  • SUVing of health care
  • CDHC (Consumer-Directed Health Care) and HDHP
    (High-Deductible Health Plans)
  • Continued disparities and tiers
  • High end providers do well, low end suffers
  • Probability over 10 years 40

42
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43
The Bush SOTU 2007
  • Using Tax Policy to Address the Uninsured
  • Families buying individual insurance could deduct
    up to 15,000 of the costs, regardless of the
    cost to them
  • (thus encouraging people to buy low-cost,
    high-deductible coverage)
  • Families with employment-based insurance would be
    taxed on the value of that insurance in excess of
    15,000
  • Amounts would be indexed to inflation but not to
    increases in health costs

44
President Bush Puts His Eggs in the Health
Savings Account Basket
Expand Health/Medical Savings Accounts Allow
Individuals and Families to Set Aside as Much as
5,150 a Year, Tax Free Bushs FY2007 Budget
would increase the allowable amount to 10,300
45
Scenario 1 Tiers ? Us Impact on Health Care
System
  • Health Plans
  • Move toward HDHP and CDHC
  • Sell whatever anyone will buy
  • But always experience rate
  • Rising numbers of uninsured and underinsured
  • Providers
  • Well-heeled, well situated, well run providers
    continue to thrive and distance themselves from
    the pack on quality, safety, and service (one
    third) aided by P4P
  • Basket cases that deal with the poor and the
    lower middle class
  • A health system for the top third

46
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47
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48
Scenario 2 Bigger Government by Request
  • Baby-Boomer backlash against cost-shifting
  • Democrats run on shoring up and expanding
    Medicare for middle aged and elderly
  • Government regulates health care even more
  • Slowing innovation, reducing provider payment,
    and limiting profiteering
  • Probability over 10 years 30

49
Hillary-care Giuliani-care Obama-care
McCain-care etc. etc.
  • Would-be, Wanna-be, Could-be, Might-be
  • 2008 Presidents are falling over one another in
    proposing health plans for Americans

50
Democrats see this as their issue
51
What the Democrats are Saying
  • Hillary Clinton Im battle-scarred but ready to
    take on the issue.
  • Require employers who do not purchase private
    health insurance for their employees to pay into
    a pool for a Medicare-for-all-type plan
  • Emphasize computerized medical record-keeping
  • Implement purchasing initiatives to reduce drug
    prices
  • Emphasize prevention of disease
  • Reform the private insurance market by
    prohibiting insurers from declining coverage
    based on pre-existing conditions (guaranteed
    issue)
  • Reduce national health care spending by 120
    billion/year
  • Universal coverage wouldnt be achievable until
    near the end of her second term

52
What the Democrats are Saying
  • Barack Obama The public will judge my
    presidency by what I do for healthcare.
  • Promises to deliver universal healthcare by the
    end of his first term
  • Employer Mandate Play or Pay, provide employee
    health insurance or pay a tax
  • No individual mandate (unlike other Democrats and
    Romney as Governor and Schwarzenegger)
  • Creates a National Health Insurance Exchange to
    monitor insurance companies in offering the
    coverage. In essence, Obama's plan retains the
    private insurance system but injects additional
    money into the system to pay for the expanded
    coverage
  • Expand S-CHIP and require all children to be
    covered
  • Allow states to continue to experiment with
    health care reform initiatives
  • Reduce costs through computerized records,
    reimportation of drugs and greater use of
    generics, emphasizing prevention
  • Raise taxes on those making more than
    250,000/year to pay for the estimated 50-65
    billion cost

53
What the Democrats are Saying
  • John Edwards Any politicians who say they can
    provide universal health care and other promises
    while ending the federal deficit are not being
    honest.
  • Medicare plan for all Americans, but not
    necessarily a single-payer plan that will be
    decided by giving everyone a choice
  • Promote competition between private insurers and
    government
  • Pay or play system for employers, provide
    employee health insurance or pay a tax
  • Establish regional purchasing pools to enable
    consumers to bargain for lower premiums
  • Require insurers to pay out at least 85 of
    premium income in benefits, i.e., minimum loss
    ratio
  • Cost containment (hmm, does this mean more
    regulation?)
  • Will raise taxes on those making more than
    200,000/year to pay for the estimated 90-120
    billion cost of his plan

54
(No Transcript)
55
What the Democrats are Saying
  • Bill Richardson The cornerstone of my plan will
    be to allow all Americans to buy the same
    coverage as Congress.
  • Expand Medicare, allowing those 55 and older to
    buy in
  • Allow working families to buy coverage through
    FEHBP (the same plan as Congress)
  • Impose an individual mandate
  • Mandate that private insurers accept all
    (guaranteed issue)
  • Refundable health insurance tax credits to all
    based on income
  • Streamline existing regulatory system and expand
    health I.T.
  • Establish a cooperative relationship" between
    individuals, businesses and states "catalyzed by
    the government"
  • Heroes Health Cards for military veterans to
    improve their care
  • Cap interest payments on credit card medical debt
  • No need to raise taxes, his plan will be financed
    through savings by getting out of Iraq and
    reducing military spending.

56
What the Democrats are Saying
  • Christopher Dodd (Senator from Connecticut)
  • Create a Health Care General Fund (HCGF) with
    employers having a a play or pay mandate,
    exempting employers of 10 or fewer employees
  • Individual mandate, for those without employer
    health insurance, buying from HCGF at a price
    based upon their income
  • Expand Medicaid and cover all children up to 300
    of poverty level
  • Encourage chronic disease management using
    clinical information technology
  • Allow nurses to unionize even if they have
    supervisory responsibilities

57
What the Democrats are Saying
Joe Biden Senator from Delaware
  • Expand health insurance for children and relieve
    families and businesses of catastrophic health
    care expenses
  • Support states pursuing alternatives and
    experimenting with universal coverage plans
  • Use the experience of these states to develop a
    national universal health system

58
What the Democrats are Saying
  • Dennis Kucinich (Congressman from Ohio)
  • Sponsor of HR 676 that would establish a
    single-payer universal health care plan for all
    Americans called the United States National
    Health Insurance Plan completely funded by taxes
    and run by the government

59
But a few Republicans are also talking health
care
  • But one cant run

60
The Gubernator Gov. Arnold Schwarzenegger (R.
Calif.)
  • employers with 10 or more employees would have to
    offer health insurance for workers or pay a fee
    of 4 of payroll to a state pool that would help
    workers purchase coverage, with the amount that
    they pay based on income
  • employees could pay for health insurance with
    pretax income
  • health insurers would be required to sell
    policies to all state residents, regardless of
    whether they have medical conditions
  • residents who refuse to obtain health insurance
    could face reductions in their state income tax
    refunds or have their wages garnished
  • Medi-Cal, the state Medicaid program, would be
    extended to all adults with annual incomes of as
    much as 100 of the federal poverty level and to
    children -- regardless of their immigration
    status -- in households with annual incomes of as
    much as 300 of the federal poverty level
  • additional subsidies would be available to help
    state residents with annual incomes of as much as
    250 of the federal poverty level purchase health
    insurance

61
The Gubernator
  • the proposal would increase by 4 billion
    reimbursements to health care providers under
    Medi-Cal
  • physicians would have to pay 2 of their revenues
  • hospitals would have to pay 4 of their revenue
    to help cover the cost of the program
  • the proposal would be financed in part with about
    5 billion in federal matching funds that the
    state will receive as a result of restructured
    health care programs and with state funds
    currently used for charity care

62
The Romney When He Was Governor Plan Individual
Mandate Healthcare for Everyone
  • employers, most of whom already offer insurance,
    would be encouraged to continue doing so
    voluntarily Romney vetoed a Democratic proposal
    to tax employers not offering health insurance
  • individuals who don't have insurance would have
    to sign on to one of two insurance pools
  • Commonwealth Care through which people of
    moderate income and small businesses could buy
    insurance from private insurers at a special
    rate. It would not be subsidized by the state.
  • Safety Net Care for residents with incomes up to
    300 of the federal poverty level, which is
    28,700 for a single person. Policies would have
    no annual deductible and would be subsidized by
    the state, with policyholders paying 1.3 to 5.8
    of their income, or 2.30 to 32.31 a week, for
    an individual plan.
  • individuals who do not get insurance from their
    jobs or buy it through one of the programs would
    lose their personal tax exemption of 3,300
    worth about 175 for an average taxpayer face
    withholding of their income tax refund, or if
    they get medical care, their wages could be
    garnished for payment

63
The Romney as Presidential Candidate Plan
  • Disavow mandate in his original Massachusetts
    plan
  • No mandates, individual or employer
  • Phase-out employment-based insurance, all
    insurance should be individual
  • Tax-incentives to encourage transition
  • Encourage high-deductible, low cost insurance and
    encourage people to use less healthcare, thus
    reducing costs
  • Allow the states greater freedom to experiment
    with alternative private sector initiatives,
    eliminating many insurance regulations that
    raise costs, allow cross-state sales of health
    insurance

64
Rudy Giuliani
The health care system requires a "paradigm
shift" toward the individual health insurance
market. Currently, about 17 million residents
have individual health insurance, compared with
about 175 million who have employer-sponsored
coverage. Giuliani said that he opposes proposals
to require all residents to obtain health
insurance because government subsidies would be
required for those who could not afford a policy,
which in turn would drive up costs.
  • Phase-Out the U.S. Employment-Based Health Care
    System
  • Families eligible for 15,000 tax credit to buy
    individual health insurance
  • Allow families to keep the difference of they buy
    less expensive plans
  • Release Health Care Insurance from State
    Regulations and Mandates and Allow Cross-Border
    Purchases
  • All Purchases of Health Insurance Would be
    Tax-Deductible, Regardless of Whether They Were
    Purchased Through and Employer or Individually
  • Block grants to states to encourage innovation,
    reduce health costs, enroll eligible uninsured
    and address adverse selection issues
  • Increase price and quality transparency
  • Reform medical liability system
  • Expand Health Savings Accounts
  • Invest in Health I.T. to reduce errors and
    improve efficiency

65
Mike Huckabee (former Governor of Arkansas)
  • Keep health care in the private sector
  • Improve private sector delivery system to rein in
    costs
  • Tax breaks and paid days off for employees who
    engage in healthy behavior

66
Sam Brownback Senator from Kansas
  • Establish price transparency throughout health
    system so that consumers, not government can make
    the decision (hmm, what about quality)
  • Insure freedom of choice in health coverage so
    consumers can choose health coverage that is
    right for them, even across state lines
  • Create a lifetime electronic medical record,
    giving consumers control over its use to insure
    privacy

67
Tom Tancredo (Congressman from Colorado)
  • Enforce immigration laws and funnel savings into
    health care (exactly what savings are these,
    Congressman?)
  • Provide access to lower cost insurance by
    establishing association health plans for
    non-group covered citizens and legal immigrants
  • Provide national relief to the states to help
    cover the unemployed citizens and legal aliens
    (are we getting a message here Congressman about
    illegal immigration?)

Photo taken from his official campaign web site
68
Not yet heard from
  • Former Tennessee Senator, television and movie
    actor Fred Thompson has made no statements (as of
    August 15, 2007) on health care
  • Texas Congressman Ron Paul (a physician) has
    nothing on his web site on health care
    (www.ronpaul2008.com)
  • California Congressman Duncan Hunter has nothing
    on his web site on health care (www.gohunter2008.c
    om)

69
Already Out
  • Former Wisconsin Governor and Secretary of Health
    and Human Services Tommy Thompson (the other
    Thompson who based on his DHHS tenure may
    really have had something to say. Tommy, we
    hardly knew ya)

70
(No Transcript)
71
Scenario 2 Bigger Government by Request Impact
on the Health Care System
  • Health Plans
  • Plans become more regulated
  • Delegated to becoming back-office processors
  • Transaction supporters not market makers
  • Providers
  • Hospitals are secure but under-funded for major
    capital initiatives
  • Top tier institutions make it on philanthropy and
    differentiated care for the affluent elite
  • Only cost-reducing technologies are rewarded
  • P4P You gotta perform to avoid a pay cut

72
Scenario 3 Disruptive Innovation
  • Cheapo plans proliferate (high deductibles and
    retail primary care) forcing cheaper delivery
    models to emerge
  • New disruptive competitors emerge at a lower
    price point, e.g., Revolution Health, Wal-Mart,
    Kaiser Lite
  • Almost as good, and a lot cheaper
  • Probability over 10 years 10

73
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74
Feature Article BENEFITS Going the Distance for
Health Savings. Could overseas travel for
lower-cost surgeries become an option in
employer-sponsored health plans?
March 2007 Issue
75
Have Surgery. Go Sightseeing. By PAUL B.
BROWN Published March 24, 2007 WOULD you be
willing to have non-urgent medical procedures
done overseas, if you could recover in a fine
hotel and your employer not only picked up all
the costs, but actually paid you for having the
work done outside the United States? You may be
faced with that decision, if HR Magazine is right
in its prediction that medical tourism will
become one of the benefits corporations will be
offering soon. Medical tourism, or medical travel
as it is also called, involves traveling to
respected medical facilities in countries like
India, Thailand or Singapore to have
non-life-threatening medical procedures done,
Betty Liddick writes. It also often involves
recuperation at a resort, or tourist destination,
all for less than what treatment alone would cost
in the United States. The price is obviously the
appeal to employers. According to examples cited
in the article Going the Distance for Health
Savings, the cost of sending a worker overseas
for procedures like removing a gallbladder can be
at least 50 percent less than that of having the
work done in the United States, even if the
employer pays for the worker to spend recovery
time in a fine hotel. To encourage employees to
go overseas, some companies are willing to give
employees a percentage of what is saved in
medical costs. The crucial question about medical
tourism, which Ms. Liddick describes as a small
but growing health care trend, is, of course,
whether the quality of care is equal to what
could be received at home. No one knows the
answer to that, said one expert quoted in the
article. Frankly, were not in a position to
meaningfully evaluate and compare American
hospitals, let alone offshore ones.
76
Scenario 3 Disruptive Innovation Impact on the
Health Care System
  • Health Plans
  • Health Plan HDHP grow enormously
  • New competitors in ambulatory space allow cheaper
    alternatives
  • Contract with India for the high-tech stuff
  • Providers
  • Outpatient alternatives grow from Minute Clinics
    to outpatient surgery chains to federally funded
    safety net community clinics
  • Hospitals are either struggling as government
    (under)funded geriatric ICUs or thriving as body
    repair shops for affluent baby-boomers
  • Primary Care becomes the ultimate P4P its all
    retail

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Scenario 4 Mostly Universal Health Care
  • Mandatory universal individual insurance is
    passed
  • National policy commitment to restructure health
    care financing and delivery
  • True managed health care
  • Focus on public health and prevention
  • Probability over ten years 20

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Scenario 4 Universal Health Care Impact on the
Health Care System
  • Health Plans
  • Health plans as active agents for health delivery
    transformation
  • Sources of innovation in DSM and new
    reimbursement models
  • Get smart or get out
  • Providers
  • Chronic Care management done right innovation
    in community based chronic care
  • New reimbursement systems Daughter of
    Capitation force market leaders into
    fundamental clinical system redesign
  • Acute care is evidence-based and standardized
  • Innovation concentrated in designated centers of
    excellence
  • P4P means better payment and earns the provider
    the right to serve

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Four Scenarios for US Health Care 2007-2017
Tiering of Healthcare Tiers ? Us Jeannes
Odds 3-2
Minor Delivery System Reform
Disruptive Innovation Wal-Martization of
Health Care Jeannes Odds 5-1
Bigger Government by Request Daughter of
Single-Payer Jeannes Odds 2-1
Major Delivery System Reform
Mostly or Almost Universal Health Care Jeannes
Odds 4-1
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Issues and Impacts
  • High end patients and providers will always do
    well
  • How bad will it be for the rest of us?
  • True cost reducing technologies will always have
    appeal
  • True clinical breakthroughs that are radically
    better than existing modalities and therapies
    will always be rewarded
  • Healthcare is a superior good and will take a
    larger share of national wealth
  • But who pays for what and how will be central
    difficult questions for business, government, and
    households around the world forever
  • Transforming for good Its all about
    Information and Incentives

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Issues and Impacts
  • No matter what, we will need better value
    measures and more transparency of measures
  • Value based purchasing and P4P will become more
    prevalent and have a powerful influence on
    providers and vendors
  • Consumers will become more engaged in value
    decisions but we cannot rely on them absolutely
  • The systems of health care need to be
    continuously improved to deliver greater value
  • Will require clinical skills, process skills, use
    of cutting edge technology and big-time
    capabilities
  • Most of all, it will require vision, values and
    leadership

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Theres Not Much We Have to Change. Except
  • Our values
  • Our Strategic Focus From Pimp My Ride to
    Primary Care and Prevention
  • Our Reimbursement System
  • Our Delivery System
  • Our Individual and Collective Behavior
  • Our Expectations

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