Transcript C-Change - US Chamber of Commerce

Health Care Reform:
After The 2008 Election
Humphrey Taylor
Chairman, The Harris Poll
Harris Interactive
www.harrisinteractive.com
April 16, 2008
©2007, Harris Interactive Inc.
Presented by
All rights reserved.
U.S. Chamber
Washington, DC
Agenda
 What public thinks
 What business managers think
 The Case for Reform:
- What does America get for the money it spends?
- how US compares with other countries
 What will Health Care Reform look like (eventually)
 How will Health Care Reform be achieved?
 When will reform happen?
©2007, Harris Interactive Inc.
 And then what?
HARRIS INTERACTIVE
2
Most People Think Health Care and Health Insurance
Should Be Entitlements (2003 Data)
Base: All Adults
Entitlement
65%
Kind of
Product or
Service
12%
Source: Harris Interactive Health Care News, October 27, 2003
HARRIS INTERACTIVE
©2007, Harris Interactive Inc.
Not Sure
23%
3
The Public Strongly Favors Fundamental Changes
to the System
Base: All Adults
On the whole, the healthcare system
works pretty well and ONLY MINOR
CHANGES ARE NECESSARY to make
it work better
13%
There are some good things in our
healthare system but FUNDAMENTAL
CHANGES ARE NEEDED to make it
work better
50%
The healthcare system has so much
wrong with it that WE NEED TO
COMPLETELY REBUILD IT
6%
Source: Harris Interactive, Strategic Health Perspectives, 2007
HARRIS INTERACTIVE
©2007, Harris Interactive Inc.
Not Sure
31%
4
Four Out of Five People Think Total Cost of
Health Care Is Too High
“Thinking again about health care in the country as a whole: Are you generally satisfied or
dissatisfied with the total cost of health care in this country?”
Base: All Adults
Satisfied
17%
81%
Dissatisfied
2%
Source: Gallup Poll, November 2007
HARRIS INTERACTIVE
©2007, Harris Interactive Inc.
Not Sure
5
Two-To-One Majority Believes It Is Responsibility of
Federal Government to Make Sure Everyone Has
Health Insurance
“Do you think it is the responsibility of the federal government to make sure all Americans have health care
coverage, or is that not the responsibility of the federal government?”
Base: All Adults
Is responsibility of federal
government
64%
Is not responsibility of federal
government
3%
Source: Gallup Poll, November 2007
HARRIS INTERACTIVE
©2007, Harris Interactive Inc.
Not Sure
33%
6
Most Republicans Think the U.S. Health Care System
is the Best in the World; Democrats Disagree
Do you think that in general the U.S. has the best health care system or are there
other countries with better health care systems?
Base: All Adults
Total
Republican
Democrat
Independent
%
%
%
%
U.S. has the best
45
68
32
40
Other countries
have better
39
19
52
46
Don’t know /
Refused
15
13
16
14
Source: Harris Interactive and Harvard School of Public Health, 2008
HARRIS INTERACTIVE
©2007, Harris Interactive Inc.
Party ID
7
U.S. Seen As “Best” on Quality and Waiting Times
but not on Access or Cost
Thinking about the countries I have just mentioned, would you say that in general the United
States has a better health care system or a worse health care system than these countries
when it comes to:
Base: All Adults
U.S. System Is
Better
Worse
Quality of care that patients
receive
%
55
16
Waiting times to see
specialists or be admitted to
the hospital
%
53
16
Making sure everyone can
get affordable health care
%
26
52
Controlling health care
costs
%
21
56
Source: Harris Interactive
HARRIS INTERACTIVE
©2007, Harris Interactive Inc.
Total
8
Only a Minority Want New Government-Run System
to Replace System Based Mainly on Private
Insurance
“Which of the following approaches for providing health care in the United States would you prefer: replacing the
current health care system with a new government run health care system, or maintaining the current system
based mostly on private health insurance?”
Replace Present
System
41%
Maintain (Private
Insurance)
11%
Source: Gallup Poll, November 2007
HARRIS INTERACTIVE
©2007, Harris Interactive Inc.
Not Sure
48%
9
Most Americans Think That the Country Spending
More Money on Health Care Would Be Good
BUT
1. They believe there is a lot of waste, inefficiency and fraud in the
system now
AND
©2007, Harris Interactive Inc.
2. They don’t want to pay much more out-of-pocket or in taxes.
HARRIS INTERACTIVE
10
Large Majority Wants Health Care Reform
BUT
No consensus on the specifics
- Role of government
- Role of employers
- How to pay for it
©2007, Harris Interactive Inc.
- Level of tiering, etc.
HARRIS INTERACTIVE
11
Americans Want Universal Coverage But What They
Don't Want Makes Reform Very Difficult
They don’t want:- Much higher taxes
- Higher out-of-pocket costs
- To damage the economy or increase unemployment
- Bigger government
- Rationing
- Reduced quality
©2007, Harris Interactive Inc.
- Reduced choice
HARRIS INTERACTIVE
12
Very Few Employers Believe Healthcare System
Works Well
Which of the following statements comes closest to expressing your overall view of
the healthcare system in this country?
2000
2007
%
%
On the whole the healthcare system works pretty
well and only minor changes are necessary to
make it work better
24
14
There are some good things in our healthcare
system, but fundamental change is needed to
make it work better
66
70
Our healthcare system has so much wrong with it
that we need to completely rebuild it
10
16
Don’t know
2
-
- No respondents
Source: Harris Interactive Strategic Health Perspectives 2007
HARRIS INTERACTIVE
©2007, Harris Interactive Inc.
Base: All Employees
13
Most Corporate Benefits’ Managers Not Feeling A Lot Of
Pressure To Cut Costs
How much pressure do you feel from top management to cut costs in the health
benefits area?
%
A great deal of pressure
16
Some pressure
42
Not much pressure
25
No pressure at all
16
Not sure
1
Source: Harris Interactive Strategic Health Perspectives 2007
HARRIS INTERACTIVE
©2007, Harris Interactive Inc.
Employers who provide coverage
14
No Consensus Among Employers On Who, If
Anyone, Should Be Responsible for Universal
Coverage
In your opinion, who should be primarily responsible for making sure that all Americans have
healthcare?
Base: All Employers
Each individual or family
28
Federal government
37
State government
15
Employers
4
Other
8
No one
2
Not sure
6
Source: Harris Interactive Strategic Health Perspectives 2007
HARRIS INTERACTIVE
©2007, Harris Interactive Inc.
%
15
Few Employers Support Government Insuring Their
Employees
How well does each of the following statements describe your company’s position on
employer-sponsored healthcare? (Those very or somewhat well)
Base: All employers who provide coverage
We have to stay involved in health benefits otherwise the
government will take over healthcare and our employees
will not be well served
61
Healthcare is not our company’s core competency and we
would welcome any opportunity to transfer the
responsibility to the government`
18
Healthcare is not our company’s core competency and we
would welcome any opportunity to transfer the
responsibility to individual employees
41
Source: Harris Interactive Strategic Health Perspectives 2007
HARRIS INTERACTIVE
©2007, Harris Interactive Inc.
%
16
With or Without “Reform” the “System” Will Continue
to Change Rapidly (A)
• New medical technology
• Erosion of employer-provided coverage
• Aging of baby boomers
• Obesity epidemic
• Growing focus on multiple chronic conditions
And More …….
HARRIS INTERACTIVE
©2007, Harris Interactive Inc.
• Retail clinics and $4Generics
17
With or Without “Reform” the “System” Will Continue
to Change Rapidly (B)
• The quality movement
• Price (and quality) transparency
• Health Information Technology (HIT)
• State legislation and reform
©2007, Harris Interactive Inc.
• Focus on cost-effectiveness of care
HARRIS INTERACTIVE
18
What The Candidates Are Not Talking About —
But The Next President Should
Sources: Annual Reports of Social Security and Medicare Board of Trustees, CBO
©2007, Harris Interactive Inc.
$30 Trillion +
Unfunded Liability?
19
HARRIS INTERACTIVE
19
One Result of Current Trends: Increased
Productivity
The demand for medical care – particularly for agerelated conditions – will increase much faster than the
supply of physicians.
So
(Somehow!) The system will provide more care with
fewer physicians (per 100,000 people).
©2007, Harris Interactive Inc.
But we haven’t figured out how best to do that.
HARRIS INTERACTIVE
20
You All Know Americans Spend Much More $s On
Health Care Than Anyone Else
I have always been puzzled by the question.
©2007, Harris Interactive Inc.
What do we get for our money?
HARRIS INTERACTIVE
21
Not Longer Life Expectancy
41 Countries Now Have Longer Life Expectancy
Than US
 U.S. ranks #42
 20 years earlier it ranked #11
 Countries ahead of us include most developed
countries - Jordan and the Cayman Islands
Source: U.S. Census Bureau and National Center for Health Statistics
HARRIS INTERACTIVE
©2007, Harris Interactive Inc.
 U.S. life expectancy has been rising but more slowly
than many other countries
22
Not Better Infant Mortality
International Comparison (1999)
RANK
1
Hong Kong
2
Japan
3.4
3
Sweden
3.4
19
Ireland
5.5
20
New Zealand
5.5
21
Portugal
26
Cuba
28
USA - Total
3.1
5.6
7.1
0.1
1.1
2.1
3.1
4.1
Source: National Center to Health Statistics, 2007
HARRIS INTERACTIVE
5.1
6.1
7.1
8.1
©2007, Harris Interactive Inc.
6.4
23
Not More Doctors
Number of Practicing Physicians per 1,000 Population
in 2004
4.0
3.6
3.4
3.4
3.2
3.0
2.6
2.4
2.3
2.2
2.1
2
2.0
1.0
0.0
Germany
OECD
Median
Australia
Source: OECD
HARRIS INTERACTIVE
United
States
United
Kingdom
New
Zealand
Canada
Japan
©2007, Harris Interactive Inc.
Netherlands France
24
Not More Hospital Beds
Number of Acute Care Hospital Beds per 1,000
Population in 2004
9.0
8.4
8.0
7.0
6.4
6.0
5.0
3.8
4.0
3.7
3.6
3.6
3.2
3.0
3
2.8
2.8
2.0
1.0
0.0
Germany
France
OECD
Median
United Australia
Kingdom
Source: OECD
HARRIS INTERACTIVE
New
Zealand
Canada Netherlands United
States
©2007, Harris Interactive Inc.
Japan
25
Not More Doctors Visits
Average Annual Number of Physician Visits
Per Capita in 2004
16.0
14.0
13.8
12.0
10.0
8.0
6.7
6.1
6.1
6
6.0
5.3
5.3
3.9
4.0
3.2
2.0
Japan
France
Canada
OECD
Median
Australia Netherlands
United
Kingdom
United
States
New
Zealand
©2007, Harris Interactive Inc.
0.0
Source: OECD
HARRIS INTERACTIVE
26
Not More Surgical Procedures
In-Patient Surgical Procedure Per 1000
Population (2002)
U.S.
88
OECD Average
75
Germany
97
Switzerland
98
110
Austria
133
0
20
40
60
80
Source: OECD/McKinsey Jan 2007
HARRIS INTERACTIVE
100
120
140
©2007, Harris Interactive Inc.
Ireland
27
Much Higher Administrative Costs
“The United States spent … nearly six times as much as the
OECD average (on “administration and insurance”) …
because of its unique multiple-payor system and the
complexities of administering Medicare, Medicaid and privateinsurance products”.
©2007, Harris Interactive Inc.
Source: McKinsey, January 2007
HARRIS INTERACTIVE
28
Not Better Outcomes (1)
Kidney Transplant 5-year Relative Survival Rate
Standardized Performance on Quality Indicator
100=Worst Result; Higher Score=Better Results
120
113
100
104
104
106
United Kingdom
New Zealand
Australia
100
80
60
40
0
United States
Source: P.S. Hussey, et al, Health Affairs, 2004
HARRIS INTERACTIVE
Canada
©2007, Harris Interactive Inc.
20
29
Not Better Outcomes (2)
Asthma Mortality Rate, Ages 5-39
(Note: Years vary from 2000-2004)
Per 100,000 people
1.00
0.75
0.50
0.490
0.457
0.370
0.300
0.300
0.240
0.25
0.160
0.127
0.110
0.00
United
States
Australia
France
New
Zealand
Source: OECD
HARRIS INTERACTIVE
Japan
Germany Netherlands Canada
©2007, Harris Interactive Inc.
United
Kingdom
30
Not Better Outcomes (3)
Deaths Due to Surgical or Medical Mishaps per 100,000
Population in 2004
0.8
0.7
0.7
0.6
0.6
0.5
0.5
0.5
0.5
0.4
0.4
0.4
0.3
0.2
0.2
Japan
Netherlands
0.2
0.1
United
States
Germany
Canada
France
United
Kingdom
Source: OECD
HARRIS INTERACTIVE
Australia
OECD
Median
©2007, Harris Interactive Inc.
0.0
31
2002-2003 Rank
1.
France
2.
Japan
3.
Australia
4.
Spain
5.
Italy
6.
Canada
7.
Norway
8.
Netherlands
9.
Sweden
10.
Greece
11.
Austria
12.
Germany
13.
Finland
14.
New Zealand
15.
Denmark
16.
United Kingdom
17.
Ireland
18.
Portugal
19.
United States
1997-1998 Rank
1
2
4
3
6
7
10
8
5
9
12
11
16
14
13
18
19
17
15
Source: Ellen Nolte and C. Martin McKee, Measuring the Health o Nations; updating an earlier analysis.
Health Affairs, Jan/Feb 2008
HARRIS INTERACTIVE
©2007, Harris Interactive Inc.
Not Better Outcomes (4)
US Slips in Ranking on “Preventable Deaths” to #19
32
Ireland
Austria
United Kingdom
Finland
Australia
Norway
Portugal
Italy
New Zealand
Netherlands
Germany
France
Canada
Japan
Greece
Spain
Denmark
Sweden
United States
% Decline (Improvement)
23
22
21
20
19
19
19
17
17
16
16
14
14
13
13
12
11
7
4
Source: Ellen Nolte and C. Martin McKee, Measuring the Health o Nations; updating an earlier analysis.
Health Affairs, Jan/Feb 2008
HARRIS INTERACTIVE
©2007, Harris Interactive Inc.
Not Better Outcomes (5)
Improvement (Percentage Decline) in “Amenable Causes of
Death” Between 1997/98 and 2002-03 Lower in the United States
Than in other 18 Countries Studied
33
EIGHT OF TEN COMMON DISEASES ARE MORE PREVALENT IN
U.S. THAN IN 10 EUROPEAN COUNTRIES
Diagnosed prevalence of ten conditions among non-institutionalized adults aged 50
and older (U.S. compared to Austria, Denmark, France, Germany, Greece, Italy,
Netherlands, Spain, Sweden, Switzerland)
Europe
By how much US
Prevalence exceeds
European Prevalence
%
%
Heart disease
21.8
11.4
91%
High blood pressure
50.0
32.9
52%
High cholesterol
21.7
19.6
11%
Stroke / cerebrovascular
disease
5.3
3.5
51%
Diabetes
16.4
10.9
50%
Chronic lung disease
9.7
5.4
80%
Asthma
4.4
4.3
2%
Arthritis
53.8
21.3
152%
Osteoporosis
5.0
7.8
-36%
Cancer
12.2
5.4
126%
Mean excess of US prevalence over European prevalence: 58%
Source: Kenneth E. Thorpe et al, Differences in Disease Prevalence as a Source of US-European Health Spending
Gap, health Affairs, October 2, 2007 (and calculations by H. Taylor)
HARRIS INTERACTIVE
©2007, Harris Interactive Inc.
United States
34
Not More/Better HIT
Overall Country Comparisons on the Use of HIT
Percent Reporting 7 or More
Out of 14 Functions*
100
87
83
72
75
59
50
32
25
19
8
0
UK
AUS
NET
GER
Count of 14: EMR, EMR access other doctors, outside office, patient; routine
use electronic ordering tests, prescriptions, access test results, access hospital
records; computer for reminders, Rx alerts, prompt tests results; easy to list
diagnosis, medications, patients due for care.
Source: 2006 Commonwealth Fund International Health Policy Survey
of Primary Care Physicians (Harris Interactive)
HARRIS INTERACTIVE
US
CAN
©2007, Harris Interactive Inc.
NZ
35
Not More P4P
Primary Care Doctors’ Reports of Any Financial Incentives
Targeted on Quality of Care
100
95
79
72
75
58
50
43
41
30
25
0
NZ
AUS
NET
GER
CAN
Receive of have potential to receive payment for: clinical care targets, high
patient ratings, managing chronic disease/complex needs, preventive care, or
QI activities.
Source: 2006 Commonwealth fund International Health Policy Survey of
Primary Care Physicians (Harris Interactive)
HARRIS INTERACTIVE
US
©2007, Harris Interactive Inc.
UK
36
However (!) - Americans Have Relatively Short
Waiting Time For Elective/Non-Emergency Surgery
Percentage of adults who needed non-emergency surgery who hade to wait more than one month
Canada
65%
United Kingdom
57%
Netherlands
48%
Australia
45%
New Zealand
44%
USA
28%
Source: Harris Interactive / The Commonwealth Fund, 2007
HARRIS INTERACTIVE
©2007, Harris Interactive Inc.
Germany
37%
37
U.S. System More Unpopular Than Systems in Six
Other Countries
Percentage of adults who say “system works pretty well and only minor changes are necessary”
Netherlands
42%
Canada
26%
United Kingdom
26%
New Zealand
26%
Australia
24%
Germany
16%
Source: Harris Interactive / The Commonwealth Fund, 2007
HARRIS INTERACTIVE
©2007, Harris Interactive Inc.
USA
20%
38
What The Data Tell Us About The US Health Care
System Compared to Most Other Western
Democracies
It is
• By far the most expensive
• The most inequitable
• The least efficient
©2007, Harris Interactive Inc.
• One of the most unpopular
HARRIS INTERACTIVE
39
Even the U.S. Health Insurance Industry Agrees
“The U.S. does not perform as well on a number of … health
outcomes and system measures as many other industrialized
nations”.
“European nations with various approaches all manage to offer
universal coverage at a lower cost and often with better
collective results”.
Source: AHIP document provided at meeting on
European Systems of Universal Health
Care, Washington, D.C., October 31, 2007
HARRIS INTERACTIVE
©2007, Harris Interactive Inc.
America’s Health Insurance Plans (AHIP)
40
The Health Care System of the Future
 One day the USA will have more or less universal coverage
 The question is:
– What will it look like?
– How will we get there?
©2007, Harris Interactive Inc.
– When will it happen?
HARRIS INTERACTIVE
41
What? (1)
 Much wider coverage but not totally universal
 Not achieved by small incremental steps (but perhaps by several
big steps)
 Pluralistic system with roles for
– Employers
– For-profit and not-for-profit health plans
©2007, Harris Interactive Inc.
– Individual insurance
HARRIS INTERACTIVE
42
What? (2)
 A multi-payer system with government, individuals and employers
all paying (a lot!)
 More mandates
 An expansion of some government programs
 A multi-tiered system with a modest safety net
 An emphasis on choice (if you can afford to choose)
 More incentives based on measures of efficacy, safety, quality, cost
©2007, Harris Interactive Inc.
 Tougher price controls
HARRIS INTERACTIVE
43
What? (3)
The American system will be very complicated.
©2007, Harris Interactive Inc.
It will emphasize (or pay lip service to?) the market and competition
HARRIS INTERACTIVE
44
What We Will Not Get
 A “national health service”
 Government employment of most physicians
 Government ownership of most hospitals
©2007, Harris Interactive Inc.
 Universal government insurance
HARRIS INTERACTIVE
45
U.S. System May Look Somewhat Like Systems in:
Germany
Switzerland
Netherlands
(and a bit of Australia?)
But Not Like
U.K.
Scandinavia
HARRIS INTERACTIVE
©2007, Harris Interactive Inc.
Canada
46
How?
Reform will happen only if there is:
 An aroused and supportive public
 A “virtual parliament”
 A president:
– Who makes this a huge priority
– With great political skills (with public and Congress)
©2007, Harris Interactive Inc.
– With high poll ratings (60% plus)
HARRIS INTERACTIVE
47
When?
 Best time probably in first year after a landslide victory
– Election years make it tougher
– Most presidential parties lose congressional seats in midterm elections
 2009?
 2013?
©2007, Harris Interactive Inc.
 2017?
HARRIS INTERACTIVE
48
And After Reform?
 All healthcare systems are almost always in “crisis”
©2007, Harris Interactive Inc.
 Even after major reforms, the pressures to change and improve the
system, will never end
HARRIS INTERACTIVE
49
©2007, Harris Interactive Inc.
Thank You!
HARRIS INTERACTIVE
50