How to Talk To Business about Health care reform

1. How to Talk To Business about Health care reform Deborah Richter, MD

2. Goals of your talk • Change their perception to view healthcare as a public good rather an itemized purchase in the marketplace • To understand that we can’t fix anything without a healthcare system • To understand we are paying the whole bill anyway • If you get these points across, the business case for single payer is much easier

3. The Business Perspective • They are paying too much for healthcare • The reason costs are so high is people are using too much care • The uninsured are not their responsibility • They don’t trust the government

4. What Business Does Understand • Systems • Budgets • Fixed Costs • Efficiency

5. The American Health Care Crisis Deborah Richter, MD

6. Overview • Review of the problems • Why we are in this mess • What we can do about it

7. The American health care system is neither healthy, caring, nor a system… Walter Cronkite

8. U.S. Health Expenditures 2009 $2.5 trillion 30% Source: Health Affairs Jan/Feb 2009

9. National Health Spendingas a share of Gross Domestic Product Projected Actual Percentage GDP Source: Centers for Medicare & Medicaid Services

10. Japan Has a $1400 competitive advantage on every car they sell $/Car Source: Modern Healthcare 10/24/05: 14

11. Health Insurance Costs Keep Rising

12. Fewer Firms Are Offering Insurance…

13. 46 MillionUninsured

14. 18,314 Die Every Year Due to Lack of Health Insurance Source: Care Without Coverage;Institute of Medicine,2002

15. Major Concepts • Few people are using healthcare at any one time • Most costs are fixed • We are already paying the whole bill • We don’t have a health care system so we can’t fix anything

16. National Health Spending:Per Person Actual Projected Per capita expenditures Source: Centers for Medicare & Medicaid Services

17. National Health Spending:Per Person Actual Projected Per capita expenditures Source: Centers for Medicare & Medicaid Services

18. What are the costs?

19. JOE Is he the problem?

20. The 80/20 rule: Most people use very little healthcare 73% 80% uses less than $1400 of care per year Percent of health Care Expenditures 13% 6% 4% 0% 0% 0% 1% 1% 2% Source:Agency for Healthcare Research and Quality MEPS, 1999

21. Few are using most of the healthcare 73% 20% use 86% of the care Percent of health Care Expenditures 13% 6% 4% 0% 0% 0% 1% 1% 2% Source:Agency for Healthcare Research and Quality MEPS, 1999

23. U.S. Health Expenditures 70% spent on services & infrastructure Source: Health Affairs Jan/Feb 2009 30%

24. Health Care Infrastructure: As of 2004, the U.S. had: • 13.5 million health care jobs • 7,228 hospitals with a total of 955,768 staffed beds • 210,939 physician’s offices • 70,589 nursing homes • 19,006 home care agencies • 121,172 dentist’s offices • 3 million administrative jobs Source: National Center for Health Statistics& Bureau of Labor Statistics

25. The Implications of Fixed costs • The cost of the infrastructure is there whether or not it is used (nurse, hospital) • Trying to save money by keeping patients out of the hospital is like trying to save money on schools by keeping kids home for the day

26. Question: • Whose responsibility should it be to pay for the health care services we all expect to be there should we need them?

28. How do wePAYfor health care?

29. Health Care Financing • We have no state or national healthcare policy • We finance health care services on a wing and a prayer (no dedicated funds) • Financing of health care amounts to a shell game… no payer wants to pay the fixed costs of health care • When that fails we ask the public to step in (risk shift)

30. If you were an insurance company CEO, who would you want to insure? 73% AVOID THESE PEOPLE Percent of health Care Expenditures 13% 6% 4% 0% 0% 0% 1% 1% 2% Source:Agency for Healthcare Research and Quality MEPS, 1999

31. Administration is the Fastest Growing job in Health Care Source: Bureau of Labor Statistics and NCHS

32. One-Third of Health Spending is Consumed by Administration Administrative Costs ($2000 per person) Clinical Care 31% 69% Source: Woolhandler, et al, New England Journal of Medicine, August 2003 & Int. Jrnl. Of Hlth. Services, 2004

33. Individual health insurance Taxes for Medicare and Medicaid Lower wages Out of pocket Private employers pay for health insurance Property taxes Higher prices for goods Health insurance for public employees In the End Individual Households Pay for All of Health Care INDIVIDUAL HOUSEHOLDS

34. Most of Healthcare is already publicly financed Individuals 20% Taxpayers 60% {Medicare, Medicaid. Public employees, tax subsidies} 20% Private employers Source: NEJM 1999; 340:109; Health Affairs 2000; 19(3):150

35. Do we really have the best health care in the world?

36. Health Care Overspending McKinsey Global Institute Dec 2008 $650 billion- the amount overspent on health care compared with other industrialized nations with no discernable benefit to population health.

37. We spend twice as much on health care as other nations do $ Per person OECD, 2006. Data for Japan is an estimate

38. US Health Costs Rise Faster than Other Countries’ Costs Source: Health United States 2005, Natl. Center for Health Statistics

39. We pay higher taxes OECD, 2006 & Health Affairs 2002; 21(4): 99

40. Out of Pocket Costs are Higher $/per capita Source: OECD 2006 Data are for 2004 or for most recent year available Figures adjusted for purchasing power parity

41. We are one of the Youngest Populations in the Industrialized World OECD, 2006 (2003 Data)

42. Fewer Americans Smoke Compared with Other Nations OECD, 2006 (2003 Data)

43. We Drink Less Alcohol OECD, 2006 (2003 Data)

44. But… We Don’t Live as Long OECD, 2006 (2003 Data)

45. More Babies Diein the U.S. in the first year of life OECD, 2006 Data are for 2004 or more recent year available

46. Our Quality is Not the Best in the world Survival Rates for 5 Countries Source: Health Affairs Vol 23:#3 , 2004

47. We Do an Average Number of Bone Marrow Transplantsper million people OECD, 2006 (2003 Data)

48. We Do More Heart Transplantsper million people OECD, 2006 (2003 Data)

49. We are Average in Number of Renal Transplants (2001/2002) Transplants/million population OECD, 2004

50. We are Average in the Number of MRI Units MRIs/ million population Source: OECD, 2005 Note: data are for 2004 ,or most recent year available