1 Int’l Models of Coverage...or, what Monty Python can teach Barack Obama about health care reform Jonathan Cohn Senior Editor, The New Republic

15 THE COMMONWEALTH FUND Percent AUSCANFRGERNETHNZUKUS Did not fill Rx or skipped doses Did not visit a doctor when had a medical problem Did not get recommended test, treatment, or follow-up Any of the above access problems because of cost Data collection: Harris Interactive, Inc. Source: 2008 Commonwealth Fund International Health Policy Survey of Sicker Adults. Base: Adults with any chronic condition Cost-Related Access Problems

3 Spending as % GDP

Doctor Visits Source: OECD

8 THE COMMONWEALTH FUND Percent AUSCANFRGERNETHNZUKUS Test results/records not available at time of appointment Duplicate tests: doctors ordered test that had already been done Either/both coordination problems Data collection: Harris Interactive, Inc. Source: 2008 Commonwealth Fund International Health Policy Survey of Sicker Adults. Base: Adults with any chronic condition Coordinated Care

10 THE COMMONWEALTH FUND Base: Adults with diabetes Percent received all four diabetes services* Data collection: Harris Interactive, Inc. Source: 2008 Commonwealth Fund International Health Policy Survey of Sicker Adults. * Hemoglobin A1c checked in past six months; feet examined for sores or irritations in past year; eye exam for diabetes in past year; and cholesterol checked in past year. Basic Diabetes Care

Source: McKinsey Global Institute e.asp Waiting Times

5 THE COMMONWEALTH FUND Same-day appointment6+ days wait or never able to get appointment Data collection: Harris Interactive, Inc. Source: 2008 Commonwealth Fund International Health Policy Survey of Sicker Adults. Base: Adults with any chronic condition (Percent) Waiting Times, Cont’d

6 THE COMMONWEALTH FUND Less than 4 weeksTwo months or longer Data collection: Harris Interactive, Inc. Source: 2008 Commonwealth Fund International Health Policy Survey of Sicker Adults. Base: Adults with any chronic condition who needed to see a specialist in past 2 years (Percent) Waiting Times, Cont’d Again

7 THE COMMONWEALTH FUND Base: Adults with any chronic condition who needed after-hours care Percent reported very/somewhat difficult getting care on nights, weekends, or holidays without going to ER Data collection: Harris Interactive, Inc. Source: 2008 Commonwealth Fund International Health Policy Survey of Sicker Adults Urgent Care Issues

CT Scanners Source: OECD

Ortho Procedures Source: McKinsey Global Institute e.asp

Life Expectancy Source: OECD

Life Expectancy After 65 Source: OECD

Potential Years of Life Lost Source: OECD

16 Cancer Survival, Part 1 Source: Coleman et al, Lancet Oncology

17 Cancer Survival, Part 2 Source: Coleman et al, Lancet Oncology

18 Cancer Survival, Part 3 Source: Gerard Anderson, JHU

14 THE COMMONWEALTH FUND Percent AUSCANFRGERNETHNZUKUS Only minor changes needed Fundamental changes needed Rebuild completely Data collection: Harris Interactive, Inc. Source: 2008 Commonwealth Fund International Health Policy Survey of Sicker Adults. Base: Adults with any chronic condition Perceptions of Health Systems

OH, CANADA Pure single-payer (or pretty damn close to it) The Good Financial protection Equity Primary care Continuity of care The Bad Waiting times Rigidity

ARS Question 13: Follow-up Overall, how do you believe the healthcare system in Canada compares to the United States system in cost, coverage and care? A. Much better B. Somewhat better C. Same as US D. Somewhat worse E. Much worse

LONDON FOG Nationalized medicine with a stiff upper lip The Good Financial protection Equity Primary Care NICE is nice The Bad Waiting times Speciality Care

ARS Question 14: Follow-up Overall, how do you believe the healthcare system in the United Kingdom compares to the United States system in cost, coverage and care? A. Much better B. Somewhat better C. Same as US D. Somewhat worse E. Much worse

ARS Question 15: Follow-up Do you believe that the United States should adopt a similar institute for studying the comparative effectiveness of treatments/care? A. Yes B. Yes, but US system should not limit care as much as the UK. C. No

DUTCH TREAT A health insurance market that works. (We think.) The Good Financial protection Equity with choice Primary care Continuity of care Quality incentives After-hours care The Bad Mandate gaps Worries about risk selection

ARS Question 16: Follow-up Overall, how do you believe the healthcare system in Holland compares to the United States system in cost, coverage and care? A. Much better B. Somewhat better C. Same as US D. Somewhat worse C. Much worse

ARS Question 17: Follow-up The United States should adopt quality and efficiency incentives similar to Holland? A. Strongly Agree B. Somewhat Agree C. Somewhat Disagree D. Strongly Disagree

FRENCH KISS If Medicare were served with a fine Bordeaux The Good Financial protection Equity plus choice Primary care High-tech care Choice and convenience The Bad Overtreatment Poor continuity Rural/urban disparities Quality incentives

ARS Question 18: Follow-up Overall, how do you believe the healthcare system in France compares to the United States system in cost, coverage and care? A. Much better B. Somewhat better C. Same as US D. Somewhat worse E. Much worse

ARS Question 19: Follow-up The United States should adopt a system similar to France, which is very close to the Medicare system in the United States? A. Strongly Agree B. Somewhat Agree C. Somewhat Disagree D. Strongly Disagree

HEALTH REFORM, IMAGINED I.e., if Jonathan were king Key elements Insurance structure and financing levels of France Quality incentives and care management of Holland Comparative effectiveness of Britain Provider choice of Canada Public research funding and institutions of U.S.

HEALTH REFORM, REALITY I.e., because the filibuster is king Key elements of Obama/Baucus/Kennedy Retain employer-sponsored insurance Pooling for small business and individuals Public plan option IT, comparative effectiveness, incentives for quality Financed by taxes + employer mandate Individual mandate maybe Key elements of Wyden/Bennett Transition from employer to individual insurance Pooling for everybody No public plan; private insurers as regulated utility Individual mandate for sure

ARS Question 21: Follow-up After hearing about consensus plan efforts at the federal level, do you believe they are headed in the right direction? A. Yes B. No, not extensive enough C. No, this is the wrong direction D. Unclear, not enough information

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