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Health Care Reform: . Facts and Myths Prepared by: Robert Briskin , M.D. Fellow American College of Physicians VIP PRIMARY CARE ASSOCIATES. QUESTIONS.
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Health Care Reform: Facts and Myths Prepared by: Robert Briskin, M.D. Fellow American College of Physicians VIP PRIMARY CARE ASSOCIATES
QUESTIONS • Where does the United States rank internationally in measures of health care quality and access to care, compared with all other industrialized nations? • How much does the U.S. spend for every man, woman, and child for health care services, including the 47 million without insurance? How does this compare with other industrialized countries? • How much does the cost of the uninsured cost every family in America?
Why Reform? The United States spends far more $ on health care both as a dollar amount & as a percentage of GDP than any other country in the world. In 2007, the total National Health Expenditures were $2.25 trillion, which is slated to increase to $4 trillion by 2015, or 20% of our GDP. This amount equals $7000 per every man, woman, & child in the U.S., even though about 47 million Americans (15% of total) lack health insurance!
Why Reform? • Medicare is going broke without reform! • This year, the Medicare Hospital Insurance Trust Fund is expected to pay out more in hospital benefits and other expenditures than it receives in taxes and other dedicated revenues. • Growing annual deficits are projected to exhaust HI reserves in 2019 completely!
Why Reform? • The cost of uninsured health care to every American family is estimated to be about $1000 per year and the total medical costs for the uninsured exceeds $115 billion per year! • A study in the American Journal of Medicine found that 62% of American bankruptcies are linked to medical bills, and remarkably, 78% of these people actually had health insurance!
Why Reform? • Lack of health insurance costs us over 18,000 unnecessary deaths annually, according to a study by the I.O.M. • Rising drug & health care costs will eat away at retirement income. • The lack of affordable, universal health care coverage and access decreases our international competiveness and will continue to negatively impact our quality of life.
International Comparisons • The non-partisan Commonwealth Fund established an 18 member international expert committee on international measures of high quality health care. • The U.S. was not the top scorer in any of the 11 international indicators of health outcomes, quality, equity, and efficiency, despite the fact we spend double that spent by Canada, France, Japan, and the U.K., all of which rank higher by these measures.
International Comparisons • The U.S. ranks last among industrialized countries for infant mortality. • The U.S. ranks 15th out of 19 countries in deaths potentially preventable with timely and effective medical care. • The U.S. ranks last on performance measures such as life expectancy, preventable mortality, & low % of adults with limitations on their activities, compared with Australia, Canada, the U.K.
5 Myths about World Health Care: T.R. Reid • 1. “It’s all socialized medicine out there.” • FACT: Many wealthy countries, such as Germany, The Netherlands, Japan, & Switzerland provide universal coverage using private doctors, private hospitals, and insurance plans. • FACT: In Germany, Switzerland, and the Netherlands, seniors stick with private insurance companies for life.
5 myths about World Health Care • 2. “Overseas, care is rationed through limited choices & long lines.” • FACT: In Japan, waiting times are so short, most patients don’t bother to make an appointment! • FACT: Although Canada is plagued by long waits for non-emergency services, other countries such as Germany, Britain, & Australia outperform the U.S. on waiting times for elective surgeries.
5 Myths About World Health Care 3. “Foreign health care systems are inefficient, bloated bureaucracies” FACT: U.S. health insurance companies have the highest administrative costs in the world, spending 20-30 cents of each HC $ on nonmedical costs, such as paperwork, reviewing claims, & marketing. FACT: France covers everyone & spends 4% on administration. FACT: Japan is #1 in efficiency & value.
5 myths about World Health Care 5 Myths About World Health Care 4. “Cost controls stifle innovation” • FACT: In the U.S., an MRI scan of the neck region costs about $1500. In Japan, the identical scan costs $98. • FACT: France pioneered the latest techniques in hip and knee replacement. • FACT: Many “wonder drugs” promoted on U.S. television were developed in British, Swiss, Japanese, or Israeli labs.
5 Myths About World Health Care • 5. “Gov’t health insurance has to be cruel” • FACT: American health insurance companies routinely reject applicants with “pre-existing conditions”. They employ armies of adjustors to deny claims and even deny coverage to accident victims while in the hospital. • FACT: Foreign health insurance companies must accept all applicants and they can’t cancel as long as premiums are paid.
“The Assault on Truth” • “Obamacare” will result in a government takeover of health care and socialized medicine”. • FACT: Our President has rejected the idea of a “single payer” system. • FACT: A “public option” may be created to offer coverage to those lacking employer-based health insurance coverage.
“The Assault on Truth” • “Private insurance will be eliminated”. • FACT: Currently, 177 million Americans have either employer or individual health insurance. A public option would allow millions of uninsured to obtain coverage, and if more efficient and cost-effective, would bring down private insurance costs. • FACT: Millions of workers will keep their employer-sponsored insurance.
“The Assault on Truth” • “Will the government encourage euthanasia to save costs?” • FACT: NO! A provision on page 425 of the health care reform bill allowed Medicare to pay physicians to discuss Living Wills and end of life planning, including appointing health care surrogates, learning about Hospice services when appropriate, etc. • FACT: Medicare sets no age limit on things like bypass surgery, while private insurers often do.
“The Assault on the Truth” • “The government will ration care”. • FACT: NOT TRUE! There is no rationing of health care services under Medicare, nor would there be any under a “Public Option”. • FACT: As opposed to private insurance companies which often place limits on total enrollee health expenditures, the proposals would prohibit annual or lifetime limits on coverage.
“The Assault on the Truth” • “Medicare will be eliminated or gutted to pay for reform” • FACT: Cost savings under Medicare would be achieved by cutting the excessive subsidies the government pays to “Medicare Advantage” (HMO) plans, by reducing fraud & abuse, greater efficiencies through the use of EHR & would actually cover more evidenced-based preventative care.
AARP Perspective • The AARP has not endorsed any comprehensive reform bill: Their goals: • Lower drug costs and strengthen Medicare. Close the “donut hole”, ensure patients’ access to their doctors, keep copays low, & crack down on fraud & wasteful spending. • Protect your health care choices: choose your own doctor & your health insurance plan.
AARP Perspective: Goals: • End discrimination by insurance companies: prevent insurance companies from denying you coverage based on a pre-existing condition or use age to price Americans 50-64 out of affordable, quality health insurance. Guarantee stable, affordable coverage: ensure you the security of affordable, quality health insurance if you lose or change jobs.
Florida’s Hospital Update • Estimated cost of Bad Debt & Charity Care for year 2007: $2.5 Billion • Approximately 21% of Florida’s non-elderly population are uninsured. Uncompensated care as a % of total costs: • Florida- 8.2% • U.S.- 5.7%
Solutions • Tort Reform: Medical Liability Reform: • 1. The cost of “defensive medicine” adds billions of dollars in unnecessary expensive diagnostic testing to protect doctors from frivolous lawsuits. National estimates range as high as $200 billion per year. This cost does not exist anywhere else in the world. • 2. Medical Malpractice Premiums have become unaffordable in many states, particularly Florida, Nevada, Michigan, Illinois, & the District of Columbia.
Solutions: • Tort Reform: • 3. A Massachusetts Medical Society survey indicated that 83% of physicians cited fear of being sued in their decision to practice defensive medicine. • 4. In Texas, since a cap on non-economic damages was passed, doctor’s insurance rates declined by 27% & doctors applying to practice in Texas increased by 57%. • 5. A national cap on non-economic damages could save well over $100 billion per year and go a long way toward paying for universal coverage.
Solutions • Insurance Reform: • Eliminate pre-existing condition exclusions. • Eliminate annual/ lifetime caps on benefits. • Ensure portability of coverage. • Establish minimum standards for % of premium $ which goes toward health care, i.e. 90% of premium dollar.
Solutions • A Public Option or “Cooperative” • Allowing the uninsured to purchase health insurance through a public plan or a public-private partnership. • Does not eliminate private insurance. • Does not lead to “rationing of care”. • Increases choice for consumers and will lower insurance costs through increased competition.
Solutions • Change physician payment incentives: • 1. Create and implement “medical homes”, emphasizing cost-effective care coordination. • 2. Tilt payments toward “optimal health outcomes” rather than relying exclusively on procedural services. • 3. Reward efficiencies and reductions in medical errors through the use of Electronic Health Records & patient safety protocols.
Solutions • Patient Healthy Lifestyle Incentives & shared decision-making with their doctors: • Tax incentives for adherence to healthy lifestyles, including smoking cessation, healthy diets, exercise, & financial disincentives for unhealthy behaviors. • Encourage and expand Health Savings Accounts to more properly align the incentives for doctors and patients, and provide for greater payment for nutritional & exercise services.
Solutions • Control of Pharmaceutical Costs through competitive purchasing arrangments and greater competition • Drug costs should be brought more in line with what citizens of Canada, European countries, Israel, Australia, and New Zealand pay. • Reductions in “direct to consumer advertising” & limits on excessive price increases for pharmaceuticals.
Solutions • Hospital Charge Reforms: • Greater transparency in billing. • Elimination of “price gouging” for private pay patients. • Greater facilitation in helping patients with payment plans & access to cost-effective non-emergency services (Rediclinics, etc.).
Solutions • Direct Practices: • Doctors throughout the country have been offering patients enhanced access and preventative health services in exchange for an annual fee. These fees typically range between $1500- $2500 per year, but can be as low as $600 or as high as over $5000. The advantages are no wait times, same day appointments, personalized referral scheduling, individualized wellness plans, home visits, among other benefits.
Solutions • Direct Practices: • These practices can be offered to include all primary care services in the membership fee, and can be combined with high deductible insurance products, so that the total premiums may be less than previously available and the patients have immediate, direct access to their doctors “anytime, anywhere”. • Reduces need for ER services & decreases unnecessary testing.
Health Care Reform • Robert Briskin, M.D., Fellow American College of Physicians • Founder and President, VIP Primary Care Associates, P.A. • 210 Jupiter Lakes Blvd., Ste. 3205 • Jupiter, Florida 33458 • 561-746-9404 • www.vipprimarycare.com • E-mail: vipprimarycare@yahoo.com
