Health Care Reform My Perspective Harry O. Senekjian April 8, 2010

Health Care Reform My Perspective Harry O. Senekjian April 8, 2010

Insurance Premiums Workers’ Earnings Inflation Kaiser/HRET Survey of Employer-Sponsored Health Benefits, Bureau of Labor Statistics, Consumer Price Index

Unnecessary Procedures

U.S. Overhead Spending 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 Doctors Pros 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 Doctors Pros 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 Doctors Pros 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 Doctors Pros 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 CrimeThe 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 Healthcare Germany 1883 Switzerland1911 New Zealand1938 France 1945 United Kingdom1946 Sweden1947 USA1947* Japan1961 Canada1966 Australia1974 Italy1978 Spain1986 Taiwan1995 *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