Transcript Why We Must Start Comprehensive Health Reform, Now Len

Why We Must Start
Comprehensive Health Reform, Now
Len Nichols, Ph.D.
Director, Center For Health Policy Research and Ethics
College of Health And Human Services
George Mason University
UC Irvine Paul Merage School of Business
February 25, 2010
Irvine, CA
1
Medicare is unsustainable now
(percent of GDP, projected)
8
7.3
7
6
4.5
5
4
3.2
3
2
1
0
2008
2020
2035
Source: Medicare Trustees Report:, 2009.
2
Publicly Held Debt as Percentage of GDP
Debt Held by the Public (% GDP)
120.0
100.0
80.0
60.0
40.0
20.0
0.0
1940
1950
1960
1970
1980
1990
2000
2010
2020
Year
Source: Council of Economic Advisors, CBO.
3
Delivery System Parts of Reform
• Business as usual will end (we can’t afford it)
–
–
–
–
–
–
MA to bidding + bonus payments
Market basket update reductions
Address mis-priced procedures
Independent Payment Advisory Board
Patient Centered Outcomes Research Institute
Quality and accountability throughout
• Change incentives where Fed govt has jurisdiction
– Center for payment innovation
– Payment pilots
• Incentives to adopt “pay for value” systems of future
• Secretary can expand duration and scope
– Excise tax on high cost plans
Hospital Margin Facts
(MEDPAC)
High
Pressure
Medium
Pressure
Low Pressure
Medicare
margins
3.7%
-3.3%
-10.8%
NonMedicare
margin
-1.1%
6.3%
13.6%
Share of all
Hs
32%
15%
53%
Share of
major
teaching Hs
61%
19%
20%
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