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'50TH

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