1. Dr. David A. Ansell, Chief Medical Officer, Rush University From County to Congress: 35 years as a primary care physician on Chicago’s Westside and the unfinished business of health reform

2. I’m David Ansell I have no disclosures

3. A Talk in 3 Parts Part 1: 3 hospitals, 1 street, 2 worlds Part 2: A poll Part 3: Achieving the Triple Aim: the promise of real health reform- improved Medicare for All

4. Part 1: 3 hospitals,1 street, 2 worlds

5. I am Chief Medical Officer at Rush University Medical Center.

6. 3 hospitals, 2 worlds, 1 street

8. 35 years ago……

9. Health Care a Human Right

10. Rudolph Virchow: Father of “Social Medicine”

11. Cook County Hospital

12. Once a storied teaching institution

13. One of the best in the United States

14. But by 1978, at the crossroads at the war for health equity in the United States

15. Run down, threatened with closure

16. An increasingly militant Black population demanding better care

17. And young physicians and nurses intolerant of second class care.

18. “County” is a coming of age story.

19. We were “Doctors within borders.”

20. We fought to save and rebuild the hospital.

21. The Patients

23. We believed we could improve things

24. Patient dumping…..ended

25. COUNTY: Breast Cancer Screening Program ©2003 RUSH University Medical Center

26. We won the fight for a new hospital and public health care system in Chicago

27. The Death Gap 36

28. The US Racial/Rich/Poor Death Gap …Going in the Wrong Direction

29. Chicago Black Women 62% More Likely To Die Of Breast Cancer Age-Adjusted Female Breast Cancer Mortality for Chicago, Per 100,000 Population. Prepared by The Sinai Urban Health Institute Deaths per 100,000 women 1981- 1983 1984- 1986 1987- 1989 1990- 1992 1993- 1995 1996- 1998 1999- 2001 2002- 2004 50 40 30 20 10 0 38 24 35 39 Black White 38 per 100,000 is 62% more deaths than 24 per 100,000 38 per 100,000 is 62% more deaths than 24 per 100,000 2005- 2007

30. Not Just Chicago: The Death Gap Is National Prepared by The Sinai Urban Health Institute

31. Geography Of the Death Gap Chicago Community Areas with the Highest Annual Breast Cancer Mortality Rates 2000 - 2005 Predominately African American Communities Non- African American Communities Hospitals with American College of Surgeons Approved Cancer Programs

32. Poor, uninsured women prone to late-stage breast cancer, says U. of Utah study – March 5, 2013 Risk of a late diagnosis 80% higher among the uninsured

33. Illegal immigrant gets kidney Loyola covers costs of transplant December 09, 2012 "Why can't we be treated the same?" he asked while sitting in his hospital room. "Health care should be a human right, not a privilege. At least give us the chance to fight for our lives with dignity."

34. Part 2: A survey of doctors

35. A caution about surveys

36. Don’t forget: You can copy- paste this slide into other presentations, and move or resize the poll. Poll: Dr. Ansell's presentation is

37. Don’t forget: You can copy- paste this slide into other presentations, and move or resize the poll. Poll: My patients often have difficulty with h...

38. Don’t forget: You can copy- paste this slide into other presentations, and move or resize the poll. Poll: The US health care system works well, on...

39. Don’t forget: You can copy- paste this slide into other presentations, and move or resize the poll. Poll: Insurance restrictions to patients for m...

40. Don’t forget: You can copy- paste this slide into other presentations, and move or resize the poll. Poll: I am very satisfied with the practice of...

41. 41 Doctors’ Perception of Patient Access Barriers Percent reporting their patients OFTEN have: AUSCANFRGERNETHNZNORSWESWIZUKUS Difficulty paying out-of-pocket costs 25262921422646161359 Difficulty getting diagnostic tests 16384127759101531423 Long waits to see a specialist 60735968217560491028 Source: 2012 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.

42. 42 Percent Physician Views of the Health System “System Works Well, Only Minor Changes Needed” Source: 2012 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.

43. 43 Insurance Restrictions on Medication or Treatment for Patients Pose Major Time Concerns for Doctors Source: 2012 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.

44. 44 Percent Physician Satisfaction with Practicing Medicine Source: 2012 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.

45. Part 3: The promise of real health reform

46. The Triple Aim: Better Care, Better Population Health, Lower Cost

47. Better Care: Health insurance and health outcomes 1982- Rand Health Insurance Experiment Patients with no co-pays received more preventive services 2010- Health Insurance and Mortality Uninsured have a 40% higher mortality than insured - 45,000 annual deaths 2012- Oregon Medicaid Experiment People randomized to Medicaid have better outcomes

48. The Oregon Experiment Medicaid enrollees are 25% more likely to indicate that they're in good, very good, or excellent health They are 25% less likely to screen positive for depression. They are even 30% more likely to report that they are pretty happy or very happy (vs. not too happy).

49. Increasing Co-Pays for Medicare Recipients decreases outpatient visits and increases hospitalization rates Trivedi AN et al. N Engl J Med 2010;362:320-328.

50. We Spend More but Live Less Canada average life expectancy for 2007. Italy life expectancy for 2008. Australia, Japan, Portugal, and Turkey healthcare spending for 2008. Greece healthcare spending for 2007. Source: OECD updated November 2011.

51. Cost: International Comparison of Spending on Health, 1980-2008 51 Source: OECD Health Data 2010 (Oct. 2010)

52. Who Delivers Health Care? Growth in Physicians and Administrators since 1970 Source: BLS & Himmelstein/Woolhandler/Lewontin Analysis of CPS Data

53. Americans Pay World’s Highest Taxes For Healthcare Per Capita Health Spending, 2002 OECD and “Paying for National Health Insurance—And Not Getting It” Health Affairs: July / August 2003

54. Affordable Care Act: Separate and Unequal Health Care

55. Better Care: Does the Affordable Care Act Achieve It? “If you like your health care insurance… you can keep it” But, if you do not like it….. Marketplaces Medicaid expansion

56. Health Insurance Markets Platinum: 10 % co-payGold: 20% co-pay

57. Health Insurance Markets Silver: 30 % co-payBronze: 40% co-pay

58. Bisgaier J, Rhodes KV. N Engl J Med 2011;364:2324-2333 Better Care? Medicaid Expansion % of Clinics Scheduling Appointments

59. Differential Incentives leads to Inequality

60. A Raucous and Sometimes Confusing Debate

61. Why I am optimistic about Improved Medicare for All

62. Why I Became a Doctor

63. A guaranteed “right” to health care is the moral issue of our time The cost of the US health care system is unsustainable The Affordable Care Act will perpetuate separate and unequal health care Only with “Improved Medicare for All” can we achieve the Triple Aim