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National Center for Policy Analysis Making Ideas Change the World

Solving America’s Health Care Crisis Presentation to The National Congress on Health Reform John C. Goodman September 22, 2008. National Center for Policy Analysis Making Ideas Change the World. Problems. Cost Quality Access. Thinking About Health Care. Queen of Hearts Seven Dwarfs

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National Center for Policy Analysis Making Ideas Change the World

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  1. Solving America’s Health Care CrisisPresentation toThe National Congress on Health ReformJohn C. GoodmanSeptember 22, 2008 National Center for Policy Analysis Making Ideas Change the World

  2. Problems • Cost • Quality • Access

  3. Thinking About Health Care Queen of Hearts Seven Dwarfs Little Red Riding Hood

  4. Problems • Cost

  5. Medicare and Medicaid as a Percent of Federal Budget 2050 Today 2025 Source: Congressional Budget Office.

  6. Marginal Federal Income Tax Rates Needed to Fund Current Federal Programs in 2050 Middle-Income Upper-Income Source: Congressional Budget Office.

  7. Illusory Solution One-Time Cost Reduction

  8. Health Care Spending $ Old SpendingPath New SpendingPath Time One Time Policy Change

  9. Illusory Solution Shifting Costs

  10. Ratio of Physician Income to Average Worker Income United States Germany Canada Sweden United Kingdom Source: Uwe E. Reinhardt, Peter S. Hussey and Gerard F. Anderson, “Cross-National Comparisons Of Health Systems Using OECD Data, 1999,” Health Affairs, Vol. 21, No. 3, May/June 2002.

  11. Real Solutions Choosing between Health Care and Other Goods and Services

  12. Health Reforms That Don’t Work FromHillary Care 1.0toHillary Care 2.0

  13. Problems • Cost • Quality

  14. Quality • RAND study on Inadequate Care • IOM Study on Medical Errors • No Electronic Medical Records

  15. Why No Phone?

  16. Why No Email?

  17. Why No Computers?

  18. Why Not Better Drug Advice?

  19. Why No Patient Education?

  20. What is the Source of Every Major Problem?

  21. The Way We Pay Doctors

  22. Payment for Physicians’ Services 90% Third-Party Payers 10% Out-of-Pocket

  23. No Price Competition No Quality Competition

  24. Exceptions to the Rule • Cosmetic Surgery

  25. Exceptions to the Rule • Cosmetic Surgery • Lasik Surgery

  26. Exceptions to the Rule • Cosmetic Surgery • Lasik Surgery • Walk-in Clinics

  27. Exceptions to the Rule • Cosmetic Surgery • Lasik Surgery • Walk-in Clinics • Telephone Consultation – for pay

  28. Exceptions to the Rule • Cosmetic Surgery • Lasik Surgery • Walk-in Clinics • Telephone Consultation – for pay • Email Consultations – for pay

  29. Exceptions to the Rule • Cosmetic Surgery • Lasik Surgery • Walk-in Clinics • Telephone Consultation – for pay • Email Consultations – for pay • Concierge Doctors

  30. Exceptions to the Rule • Cosmetic Surgery • Lasik Surgery • Walk-in Clinics • Telephone Consultation – for pay • Email Consultations – for pay • Concierge Doctors • Medical Tourism

  31. Illusory Solution Paying for Performance

  32. Illusory Solution Paying for PerformanceBuyers Setting the Quality Standards

  33. Real Solution Providers Compete for Patients Based on Price and Quality

  34. Health Reforms That Don’t Work FromHillary Care 1.0toHillary Care 2.0

  35. Problems • Cost • Quality • Access

  36. Illusory Solution Expanding Government Insurance Programs

  37. Crowd Out: Percent of New CoverageOffset by a Decline in Private Coverage S-CHIP Medicaid Expansion (Low Estimate) Medicaid Expansion (High Estimate) Source: Jonathan Gruber.

  38. Real Solution Creating Access to the Private Marketplace

  39. Health Reforms That Don’t Work FromHillary Care 1.0toHillary Care 2.0

  40. Remembering the Message Queen of Hearts Seven Dwarfs Little Red Riding Hood

  41. National Center for Policy Analysis Making Ideas Change the World

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