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National Center for Policy AnalysisMaking Ideas Change the World
Solving America’s Health Care Crisis
Presentation to
The National Congress on Health Reform
John C. Goodman
September 22, 2008
National Center for Policy AnalysisMaking Ideas Change the World
National Center for Policy AnalysisMaking Ideas Change the World
Problems
CostCost QualityQuality AccessAccess
National Center for Policy AnalysisMaking Ideas Change the World
Thinking About Health Care
Queen of HeartsQueen of Hearts
Seven DwarfsSeven Dwarfs
Little Red Riding HoodLittle Red Riding Hood
National Center for Policy AnalysisMaking Ideas Change the World
Problems
CostCost
National Center for Policy AnalysisMaking Ideas Change the World
National Center for Policy AnalysisMaking Ideas Change the World
Medicare and Medicaid as a Percent of Federal Budget
Source: Congressional Budget Office.
Today 2025 2050
National Center for Policy AnalysisMaking Ideas Change the World
Marginal Federal Income Tax Rates Needed to Fund Current
Federal Programs in 2050
Source: Congressional Budget Office.
Upper-IncomeMiddle-Income
National Center for Policy AnalysisMaking Ideas Change the World
Illusory Solution
One-Time Cost Reduction
National Center for Policy AnalysisMaking Ideas Change the World
Health Care Spending
Time
$
One Time Policy Change
Old SpendingPath
New SpendingPath
National Center for Policy AnalysisMaking Ideas Change the World
Shifting Costs
Illusory Solution
National Center for Policy AnalysisMaking Ideas Change the World
Ratio of Physician Income to Average Worker Income
Source: Uwe E. Reinhardt, Peter S. Hussey and Gerard F. Anderson, “Cross-National Comparisons Of Health Systems Using OECD Data, 1999,” Health Affairs, Vol. 21, No. 3, May/June 2002.
United States Germany Canada Sweden United Kingdom
National Center for Policy AnalysisMaking Ideas Change the World
Choosing between Health Care and Other Goods and Services
Real Solutions
National Center for Policy AnalysisMaking Ideas Change the World
From
Hillary Care 1.0
to
Hillary Care 2.0
Health Reforms That Don’t Work
National Center for Policy AnalysisMaking Ideas Change the World
Problems
CostCost QualityQuality
National Center for Policy AnalysisMaking Ideas Change the World
Quality
RAND study on Inadequate CareRAND study on Inadequate Care
IOM Study on Medical ErrorsIOM Study on Medical Errors
No Electronic Medical RecordsNo Electronic Medical Records
National Center for Policy AnalysisMaking Ideas Change the World
National Center for Policy AnalysisMaking Ideas Change the World
Why No Phone?
National Center for Policy AnalysisMaking Ideas Change the World
Why No Email?
National Center for Policy AnalysisMaking Ideas Change the World
Why No Computers?
National Center for Policy AnalysisMaking Ideas Change the World
Why Not Better Drug Advice?
National Center for Policy AnalysisMaking Ideas Change the World
Why No Patient Education?
National Center for Policy AnalysisMaking Ideas Change the World
What is the Source of Every Major Problem?
National Center for Policy AnalysisMaking Ideas Change the World
The Way We Pay Doctors
National Center for Policy AnalysisMaking Ideas Change the World
Payment for Physicians’ Services
90%Third-Party
Payers
10%Out-of-Pocket
National Center for Policy AnalysisMaking Ideas Change the World
No Price Competition
No Quality Competition
National Center for Policy AnalysisMaking Ideas Change the World
Exceptions to the Rule
Cosmetic SurgeryCosmetic Surgery
National Center for Policy AnalysisMaking Ideas Change the World
Exceptions to the Rule
Cosmetic SurgeryCosmetic Surgery Lasik SurgeryLasik Surgery
National Center for Policy AnalysisMaking Ideas Change the World
Exceptions to the Rule
Cosmetic SurgeryCosmetic Surgery Lasik SurgeryLasik Surgery Walk-in ClinicsWalk-in Clinics
National Center for Policy AnalysisMaking Ideas Change the World
Exceptions to the Rule
Cosmetic SurgeryCosmetic Surgery Lasik SurgeryLasik Surgery Walk-in ClinicsWalk-in Clinics Telephone Consultation – for payTelephone Consultation – for pay
National Center for Policy AnalysisMaking Ideas Change the World
Exceptions to the Rule
Cosmetic SurgeryCosmetic Surgery Lasik SurgeryLasik Surgery Walk-in ClinicsWalk-in Clinics Telephone Consultation – for payTelephone Consultation – for pay Email Consultations – for payEmail Consultations – for pay
National Center for Policy AnalysisMaking Ideas Change the World
Exceptions to the Rule
Cosmetic SurgeryCosmetic Surgery Lasik SurgeryLasik Surgery Walk-in ClinicsWalk-in Clinics Telephone Consultation – for payTelephone Consultation – for pay Email Consultations – for payEmail Consultations – for pay Concierge DoctorsConcierge Doctors
National Center for Policy AnalysisMaking Ideas Change the World
Exceptions to the Rule Cosmetic SurgeryCosmetic Surgery Lasik SurgeryLasik Surgery Walk-in ClinicsWalk-in Clinics Telephone Consultation – for payTelephone Consultation – for pay Email Consultations – for payEmail Consultations – for pay Concierge DoctorsConcierge Doctors Medical TourismMedical Tourism
National Center for Policy AnalysisMaking Ideas Change the World
Illusory Solution
Paying for Performance
National Center for Policy AnalysisMaking Ideas Change the World
Paying for Performance
Buyers Setting the Quality Standards
Illusory Solution
National Center for Policy AnalysisMaking Ideas Change the World
Providers Compete for Patients Based on Price and Quality
Real Solution
National Center for Policy AnalysisMaking Ideas Change the World
From
Hillary Care 1.0
to
Hillary Care 2.0
Health Reforms That Don’t Work
National Center for Policy AnalysisMaking Ideas Change the World
Problems
CostCost QualityQuality AccessAccess
National Center for Policy AnalysisMaking Ideas Change the World
National Center for Policy AnalysisMaking Ideas Change the World
Expanding Government Insurance Programs
Illusory Solution
National Center for Policy AnalysisMaking Ideas Change the World
Crowd Out: Percent of New CoverageOffset by a Decline in Private Coverage
Source: Jonathan Gruber.
Medicaid Expansion
(Low Estimate)
Medicaid Expansion
(High Estimate)
S-CHIP
National Center for Policy AnalysisMaking Ideas Change the World
Creating Access to the Private Marketplace
Real Solution
National Center for Policy AnalysisMaking Ideas Change the World
From
Hillary Care 1.0
to
Hillary Care 2.0
Health Reforms That Don’t Work
National Center for Policy AnalysisMaking Ideas Change the World
National Center for Policy AnalysisMaking Ideas Change the World
National Center for Policy AnalysisMaking Ideas Change the World
National Center for Policy AnalysisMaking Ideas Change the World
National Center for Policy AnalysisMaking Ideas Change the World
Remembering the Message
Queen of HeartsQueen of Hearts
Seven DwarfsSeven Dwarfs
Little Red Riding HoodLittle Red Riding Hood
National Center for Policy AnalysisMaking Ideas Change the World
National Center for Policy Analysis
Making Ideas Change the World
