Health Care ReformMy Perspective

Harry O. Senekjian

April 8, 2010

Health Care ReformMy Perspective

Harry O. Senekjian

April 8, 2010

Insurance Premiums • Workers’ Earnings • Inflation 1999-2008

119%

34%

29%

0%

20%

40%

60%

80%

100%

120%

140%

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

Health Insurance Premiums

Workers' Earnings

Overall Inflation

Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 2000-2008. Bureau of Labor Statistics, Consumer Price Index

Unnecessary Procedures

U.S. Overhead Spending

19.9%

26.5%

3.1%

0%

10%

20%

30%

Medicare Commercial Carriers Investor-Owned Blues

International Journal of Health Services 2005; 35(1): 64-90

Early Benefits of Reform

• Young adults will be able to stay on their parent’s insurance until age 26 years

• Seniors will receive a rebate to help fill the doughnut hole in their Medicare drug coverage

• Insurers will have to cover children with pre-existing conditions

• Small businesses will receive tax credits to cover 35% of their health care premiums

Early Benefits of Reform

• Insurers will no longer be able to cancel coverage when someone becomes ill

• New plans must pay for preventive care without co-payments

• A temporary re-insurance program will help businesses pay for early retiree health benefits

What the Bill Means for DoctorsPros and Cons

• About 16 million Americans will be added to the Medicaid program. Reimbursement will be raised to Medicare levels for primary care physicians in 2013– New business models– Inner city practices may spring up– Payment instead of unpaid charity care– More primary care doctors will be trained

What the Bill Means for DoctorsPros and Cons

• Funding the plan and controlling expenses

A new tax will be levied on high earners

Individuals making greater than $200,000

($250,000 for married couples) will pay a

3.8% Medicare Part A tax

What the Plan Means for DoctorsPros and Cons

• Tort reform is overlooked– It fails to lessen the number of lawsuits

brought against doctors by plaintiffs looking for a quick jackpot

– It neglects to address the issue of defensive medicine

What the Bill Means for DoctorsPros and Cons

• Continued chaos with payment rates

• Prevention and wellness– There are no financial incentives for patients

to encourage them to lower cholesterol, quit smoking, lose weight or in other ways to take responsibility for their health

The Massachusetts Reform: Headed Towards Failure

Massachusetts Health Reform

New Coverage

•< 150% Poverty - Medicaid HMO

•150% - 300% poverty - Partial subsidy

•> 300% poverty – Buy Your Own

Massachusetts: Required Coverage(Income > $31k)

• Premium: $4,800 Annually (56 year old)

• $2000 deductible

• 20% co-insurance AFTER deductible is reached

Crimes and Punishments in Massachusetts

The Crime The Fine

Violation of Child Labor Laws $50

Employers Failing to Partially Subsidize a Poor Health Plan for Workers

$295

Illegal Sale of Firearms, First Offense $500 max.

Driving Under the Influence, First Offense $500 min.

Domestic Assault $1000 max.

Cruelty to or Malicious Killing of Animals $1000 max.

Communication of a Terrorist Threat $1000 min.

Being Uninsured In Massachusetts $1068

Massachusetts 2006

“Every uninsured citizen in Massachusetts will soon have affordable health insurance and the costs of health care will be reduced.

Gov. Romney.”

Sources: Wall Street Journal 4/11/06 and New York Times 4/5/06.

“The bill does what health experts say no other state has been able to do: provide a mechanism for all of its citizens to obtain health insurance.”

Massachusetts 1988

“I am very proud of the fact that Massachusetts will be the first state in the country to enact universal health insurance.”

Gov. Dukakis`

Sources: New York Times 4/14/88 and 4/26/88

“Massachusetts last week ventured where no state has gone before: it guaranteed health insurance for every resident.”

Sources:Washington Post 6/9/92 and 3/20/`93

Oregon 1992

“Today our dreams of providing effective and affordable health care to all Oregonians has come true.”

Gov. Roberts

“The most far-reaching health care reform in the nation.”

International Timeline of Universal HealthcareGermany 1883

Switzerland 1911New Zealand 1938France 1945United Kingdom 1946Sweden 1947USA 1947*Japan 1961Canada 1966Australia 1974Italy 1978Spain 1986Taiwan 1995

*President Truman proposed but failed to pass National Health Insurance

Phony vs. Real Reform

Phony

• Choice of HMO/insurer

• Coverage = Copays, exclusions etc.

• Security = Lose it if you can’t work or can’t pay

• Savings = Less care

Real

• Choice of doctor and hospital

• Coverage = First $, Comprehensive

• Security = For everyone, forever

• Savings >$400 bil on bureaucracy