U.S. Health System Reform Rhetoric vs. Reality Joseph M. Heyman, MD Chair, Board of Trustees

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

Family health coverage in MI Employer + Employee $6,817 $12,151 Employer $5,869 $9,587 Employee $948 $2,564

Cutting back on care

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

5 American College of Physicians, Ann Intern Med 2008;148:55-7 AustraliaCanadaGermany New Zealand United Kingdom United States Overall Ranking (2007) Quality Care Right Care Safe Care Coordinated Care Pt-Centered Care Access Efficiency Equity Healthy Lives Expenditures per Capita,2004 $2,876$3,165$3,005$2,083$2,546$6,102

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

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

Moderator: Melody Barnes Moderator: Bob Kocher Sen. Byron Dorgan (D-ND) Sen. Mike Enzi (R-WY) Sen. Sheldon Whitehouse (D-RI) Sen. Orrin Hatch (R-UT) Rep. Rob Andrews (D-NJ) Rep. Baron Hill (D-IN) Rep. Jan Schakowsky (D-IL) Rep. Jo Ann Emerson (R-MO) Rep. Allyson Schwartz (D-PA) Rep. Earl Pomeroy (D-ND) Rep. John Conyers (D-MI) SEIU, Dennis Rivera Business Roundtable, Ken Powell (CEO of General Mills) American Hospital Association, Rich Umbdenstock American Cancer Society, Daniel Smith American Nurses Association, Rebecca Patton Blue Cross Blue Shield Association, Scott Serota Consortium for Citizens with Disabilities (CCD) Health Task Force, Peter Thomas Planned Parenthood, Cecile Richards National Council of La Raza (NCLR), Janet Murguia Moderator: Valerie Jarrett Moderator: Zeke Emanuel Sen. Chris Dodd (D-CT) Sen. Robert Bennett (R-UT) Sen. Bernie Sanders (I-VT) Sen. Debbie Stabenow (D-MI) Rep. Steny Hoyer (D-MD) Rep. Roy Blunt (R-MO) Rep. Miller (D-CA) Rep. Buck McKeon (R-CA) Rep. Rosa DeLauro (D-CT) Rep. Michael Burgess (R-TX) Rep. Nathan Deal (R-GA) National Association of Manufacturers, John Engler Federation of American Hospitals, Chip Kahn University of Chicago Medical School, Eric Whitaker Pfizer, Jeff Kindler PICO, Scott Hersey Reed National Partnership for Women and Families, Deb Ness Racial and Ethnic Health Disparities, Fredette West Alliance for Retired Americans, Ed Coyle Moderator: Peter Orszag Moderator: Secretary Shinseki Sen. Barbara Mikulski (D-MD) Sen. Tom Harkin (D-IA) Sen. Sherrod Brown (D-OH) Sen. Judd Gregg (R-NH) Rep. Charles Rangel (D-NY) Rep. Dave Camp (R-MI) Rep. Frank Pallone (D-NJ) Rep. Lois Capps (D-CA) Rep. Wally Herger (R-CA) Rep. Xavier Becerra (D-CA) Rep. Patrick Kennedy (D-RI) Rep. Eric Cantor (R-VA) United Food and Commercial Workers International Union (UFCW), Joe Hansen National Federation of Independent Business (NFIB), Dan Danner Catholic Health Association, Sister Carol Keehan Hispanic Medical Association, Elena Rios America's Health Insurance Plans (AHIP), Karen Ignani Campaign for Mental Health Reform, Bill Emmett Asian and Pacific Islander Health Forum, Dr. Ho Tran Rep. Donna Christensen (D-VI) Rep. Tim Murphy (R-PA) Families USA, Ron Pollack Center for American Progress, John Podesta Moderator: Nancy-Ann DeParle Moderator: Diana Farrel Sen. Max Baucus (D-MT) Sen. Charles Grassley (R-IA) Sen. Jeanne Shaheen (D-NH) Rep. Henry Waxman (D-CA) Rep. Joe Barton (R-TX) Rep. Jim Cooper (D-TN) AFL-CIO, Gerry Shea Small Business Majority, John Arensmeyer American Medical Association, Nancy Nielsen PhRMA, Billy Tauzin National Indian Health Board, Stacey Bohlen National Association of People Living with AIDS, Frank Oldham Moderator: Larry Summers Moderator: Neera Tanden Sen. Jay Rockefeller (D-WV) Sen. Jeff Bingaman (D-NM) Sen. Ron Wyden (D-OR) Rep. John Dingell (D-MI) Rep. Lucille Roybal-Allard (D-CA) Rep. Mike Ross (D-AR) Rep. Pete Stark (by phone) (D-CA) Teamsters, Jim Hoffa U.S. Chamber of Commerce, Tom Donahue National Medical Association, Mohammad Akhter Children's Defense Fund, Marian Wright Edelman AARP, Bill Novelli HCAN, Richard Kirsch University of Miami, Donna Shalala White House Forum on Health Reform Attendees Everyday Americans

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

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

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

46 million uninsured Americans is a national disgrace

The AMA Plan Affordability Choice Fairness

Promoting health and wellness

Determinants of health

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:

The Medicare Dilemma Practice Costs Medicare Cuts

Michigan physicians likely would… Discontinue seeing Medicare patients12% Decrease the number of Medicare patients 44% Continue to accept Medicare, but be unable to invest in staff, technology or quality improvement measures 40% Make no changes 4%

Stimulus Rhetoric vs. Reality Health Information Technology (HIT) Comparative Effectiveness Research (CER) The first step toward health system reform

Together we are stronger.