OUR$HEALTH$CARE$SYSTEM: WHATS$NEXT ERIC$L.$LEVER,$M.D. - PowerPoint PPT Presentation

OUR$HEALTH$CARE$SYSTEM: WHAT’S$NEXT ERIC$L.$LEVER,$M.D.

ABOUT&ME • GREW&UP&IN&SOUTHERN&CALIFORNIA • EDUCATED&AT&UC&BERKELEY&AND&STANFORD • IN&MEDICINE&34&YEARS,&IN&PRACTICE&OF&GI&25&YEARS • FORMER&CHIEF&OF&GASTROENTEROLOGY,&KAISER&DOWNEY • WORKED&IN&ALL&HEALTH&DELIVERY&SYSTEMS: PRIVATE&PRACTIVE,&HMO,&PUBLIC&COUNTY&HOSPITALS,&VA& HOSPITAL,&ACADEMIC&MEDICAL&CENTER • POLITICAL&ACTIVIST&SINCE&THE&AGE&OF&17

OVERVIEW'OF'OUR'SYSTEM WE'PAY'DOUBLE'ANY'OTHER'COUNTRY,'OUTCOMES'ABOUT'50 TH • WHY? MULTIPLE'HEALTH'DELIVERY'AND'PAYMENT'SYSTEMS • MEDICARE,'MEDICAID,'INSURANCE,'INDIGENT'AND'PUBLIC'CARE PRE;PAID'AND'FEE;FOR;SERVICE INSURANCE:' SHARING'OF'RISK • OR HEALTH'CARE'AS'A'COMMODITY: TOO'EXPENSIVE!

OUR$GOALS • UNIVERSAL$HEALTH$CARE: NOT$EVERYONE’S$GOAL! • AFFORDABLE$HEALTH$CARE THE$MEDICAL$AND$FINANCIAL$CASE$FOR$UNIVERSAL$ COVERAGE

THE$AFFORDABLE$CARE$ACT: A$GOOD$START INSURED$MORE$THAN$20$MILLION,$ABOUT$½$OF$PREVIOUSLY$UNINSURED • ESTABLISHED$HEALTH$CARE$AS$A$“RIGHT” • EXPANDED$MEDICAID$TO$130%$OF$POVERTY$LEVEL • CREATED$EXCHANGES,$SUBSIDIES$TO$MAKE$PREMIUMS$AFFORDABLE • ELIMINATED$LIFETIME$CAPS$AND$PREBEXISTING$CONDITION$EXCLUSIONS • CAPPED$PROFIT$AND$ADMINISTRATIVE$EXPENSE$AT$20% • CHILDREN$INSURED$ON$PARENT’S$POLICY$TO$AGE$26 • ESTABLISH$PAY$FOR$GOOD$OUTCOMES,$NOT$FOR$SERVICES • ENABLED$STATES$TO$ESTABLISH$INDIVIDUAL$SYSTEMS • TAX$REVENUES$ON$INSURERS,$WEALTHY,$MEDICAL$DEVICES$AND$DRUGS • HIGHBRISK$CORRIDOR$PAYMENTS$REDUCE$INSURER$RISK •

HISTORY(OF(THE(ACA • PROPOSED(BY(NIXON • PROPOSED(BY(CARTER • DEVELOPED(BY(HERITAGE(FOUNDTION • PROPOSED(BY(CLINTON • ADOPTED(AS(ROMNEYCARE;(VERY( SUCCESSFUL! • ADOPTED(IN(2010(WITHOUT(A(SINGLE( REPUBLICAN(VOTE((FILIBUSTERED)

THE$AFFORDABILITY$PROBLEM • FEE$FOR$SERVICE$CARE • FOR$PROFIT$HEALTH$CARE • AVOIDING$ARTIFICIAL$SHORTAGES • PROVIDING$REAL$COMPETITION • THE$RISK$POOL • LIABILITY$AND$DEFENSIVE$MEDICINE

HOW$THE$ACA$HELPED • MOVED$FROM$FEE0FOR0SERVICE$TO$PAY$FOR$ OUTCOMES,$PREVENTIVE$CARE$AND$ ACCOUNTABLE$CARE$ORGANIZATIONS • CAPPED$NONMEDICAL$SPENDING,$PROVIDED$ REFUNDS$TO$RATE0PAYERS • IMPROVED$THE$RISK$POOL$BY$INCLUDING$ YOUNGER$AND$HEALTHIER$MEMBERS • CREATED$COMPETITION$WITHIN$EXCHANGES

WHAT%ACA%DIDN’T%FIX • HEALTH%CARE%STILL%FOR%PROFIT • PRIVATE%INSURERS%STILL%IN%CHARGE • COMPETITION%LIMITED,%ONLY%FEW%COMPANIES%IN% EACH%STATE • ARTIFICIAL%SHORTAGES%OF%PROVIDERS,%NURSES,% MEDICATIONS,%AND%FACILITIES • GOP%ELIMINATION%OF%RISK%CORRIDOR%INCREASED% PREMIUM%AND%INSURER%DROPOUT

HOW$TO$FIX$IT • UNIVERSAL$COVERAGE:$BEST$RISK$POOL • MEDICARE$OPTION$WITH$PREMIUM$BASED$ON$ AGE$AND$INCOME • KEEP$ALL$DELIVERY$MODELS:$CHOICE! • REINSTATE$RISK$CORRIDOR$PAYMENTS • NEGOTIATE$LOWER$DRUG$PRICES • INCREASE$PUBLIC$MEDICAL/NURSING$ EDUCATION$AND$TRAINING • INCENT$STATES$TO$INNOVATE$(SINGLE$PAYOR?)

THE$REPUBLICAN$AGENDA BLOCK$FUND$MEDICAID,$VOUCHERIZE$MEDICARE,$PRIVATIZE$SOCIAL$ • SECURITY AHCA:$“THE$DISMANTLE$MEDICAID$ACT” • FREEZES$MEDICAID$EXPANSION$AND$FUNDING ELIMINATES$TAXES$THAT$FUND$ACA$IN$2018 ELIMINATES$MANDATE$TO$SHRINK$PARTICIPATION SUBSIDIES$SHRINK,$BASED$ON$AGE$NOT$INCOME RETAINS$(FOR$NOW)$POPULAR$FEATURES$OF$ACA BRINGS$BACK$RISK$CORRIDOR$FUNDS,$BUT$NOT$ENOUGH RESULTS: • SHRINKS$AND$STARVES$MEDICAID,$50%$COST$TO$STATES SHRINKS$SUBSIDIES$TO$50%$OF$CURRENT$LEVELS CBO:$ELIMINATES$COVERAGE$ON$ALL$24$MILLION$WHO$GAINED$ COVERAGE$OVER$10$YEARS$AND$EXPLODES$DEFICIT

WHAT%WE%CAN%DO • DEFEAT%THE%REPUBLICAN%BILL% • FIGHT%VOUCHERIZATION%OF%MEDICARE:%NEXT! • SUPPORT%SINGLE%PAYOR SB%562%IN%CALIFORNIA%SENATE HB%672%IN%CONGRESS • BRAND%NEW%CONGRESS%2018 • ELECT%A%DEMOCRATIC%PRESIDENT%IN%2020