1. Health Care Costs: Managed Care, Prospective Payment, and Reimbursement Trends

11. Where does insurance come from? Employer-sponsored 61% Private/ Non-group 5% Uninsured 18% Medicaid/ Public Health Insurance 16%

12. Family health coverage in MI

13. Cutting back on care

14. U.S. Health Care Spending 2018: $4.4 Trillion 2008: $2.4 Trillion

16. 5 American College of Physicians, Ann Intern Med 2008;148:55-7

18. Percentage of national health expenditures spent on health administration, 2003 American College of Physicians, Ann Intern Med 2008;148:55-75

19. Support for Health System Reform “We can no longer afford to put health care reform on hold.” ~ President Barack Obama, Feb. 24, 2009 “Rising health costs undermine our strength in the global marketplace.” ~ Sens. Baucus and Kennedy, Feb. 26, 2009 WSJ “We can achieve health-care reform in America . . . if we do it in a truly bipartisan basis.” ~ Sen. John McCain, Feb. 25, 2009, CNN

23. Commitment “You have our commitment to play, to contribute and to help pass healthcare reform this year.” ~ AHIP Chief Executive Karen Ignagni, at the Obama health care summit, March 5, 2009

24. AMA working closely with: • Obama Administration • Senate HELP and Finance • House Ways and Means; Energy and Commerce • Health Reform Dialogue Group • State attorneys general • State medical societies

25. Health System Reform • Provide health care coverage for all • Improve quality • Promote wellness and prevention • Reform public programs • Reform health care delivery systems • Reduce cost and increase value

26. 46 million uninsured Americans is a national disgrace

30. The AMA Plan • Affordability • Choice • Fairness

31. Promoting health and wellness

32. Determinants of health

33. www.ama-assn.org/go/lifesteps

34. Annual costs of chronic disease • Heart disease and stroke $448B • Smoking and tobacco use $193B • Diabetes $174B • Obesity $117B • Cancer $89B • Arthritis $81B • Pregnancy complications $1B • (pre-delivery)Total = $1.1Trillion Source: http://www.cdc.gov/nccdphp/overview.htm

35. The Medicare Dilemma Practice Costs Medicare Cuts

36. Michigan physicians likely would…

39. Stimulus Rhetoric vs. Reality • Health Information Technology (HIT) • Comparative Effectiveness Research (CER) • The first step toward health system reform • www.ama-assn.org/go/patients

41. THANK YOU!