Arthur Garson MD, MPH

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Tackling healthcare reform

• Arthur Garson MD, MPH
• Senior VP and Dean, Academic Operations
• Baylor College of Medicine
• VP, Texas Children's Hospital
• Houston, TX
•  
• Sydney Smith MD
• Professor of Medicine
• Chief, Division of Cardiology
• Director, UNC Cardiovascular Center
• University of North Carolina at Chapel Hill
• Chapel Hill, NC

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The 2010 plan
Changes to the healthcare system

• 10 years ago, the US healthcare system was
  declared "broken."
• Since that time, the fixes promised by the health
  maintenance organizations have not materialized
• healthcare premiums are on the rise
• hassles for patients and physicians abound
• there are now almost 45 million people uninsured
• Problems that 10 years ago affected only isolated
  parts of society are rapidly spreading.

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Principle 1
Universal coverage

• Healthcare coverage should be required, just as
  automobile insurance is.
• Each citizen should be enrolled in the private
  health plan of his or her choice each member of
  a family could use a different plan plans could
  be changed on an annual basis. 
• Each previously uninsured citizen would receive
  an income-related payment to cover the cost of
  the basic plan the maximum payment would be
  equal to the cost of any local plan and would
  change with the cost of that plan.

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Principle 2
Privatepublic partnership

• An alternative to a straight government system
  would be a system that incorporates a mix of
  public and private participants.
• The Federal Employees Health Benefits Plan
  (FEHBP) is a model for such a program.
• Private health plans could compete on quality and
  cost.
• Physicians could work for more than one plan a
  person could pay a premium to see a physician in
  another health plan (for example, a cardiologist
  in one plan and an ophthalmologist in another).

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Principle 3
Employer-based insurance alternatives

• Currently, individuals often find their health
  benefits and job choices restricted many find
  themselves locked into jobs in order to keep
  their health coverage.
• Employees who wish to opt out of the
  employer-provided plan could have the employer's
  part of the premium sent to a regional agency.
• Employees could apply for an income-related
  federal tax subsidy to cover the remainder of the
  base premium those earning less than the federal
  poverty level would not pay for healthcare.
• These individuals could then arrange for their
  own health insurance in the same way that they
  already arrange their automobile insurance.

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Principle 4
Administrative simplification

• Each patient would have an electronic card
  containing encrypted medical history, health
  plan, and supplemental benefits that would be
  updated at each visit.
• Billing would be automatic on a fee-for-service
  basis for physicians, and by diagnosis-related
  groups for hospitals.
• Plans would receive a severity-adjusted premium,
  based on the number of patients with severe
  conditions.
• Plans would receive a quality bonus for achieving
  certain benchmarks plans with poor quality could
  be disqualified.
• This system of administrative simplification
  would eliminate many billing costs, simplify the
  quality infrastructure, and decrease the need for
  complex compliance programsespecially because
  the bill would be tied directly to the medical
  record.

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Principle 5
Emphasis on quality and on the patientphysician
relationship

• The national citizen health agency, in
  partnership with healthcare organizations, would
  establish quality parameters.
• Competition among plans will be based on the
  ability of physicians to be innovative both in
  caring for challenging patients and in keeping
  healthy patients well.
• Competition will be based on how individual
  patients rate a physician's ability to interact
  with them.
• Quality would be a two-way street individuals
  would be rewarded for healthy behavior.

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Principle 6
Current revenue redirected, newrevenue provided,
efficiency increased

• Estimated cost of covering the uninsured is 88.6
  billion.
• 23.5 billion that the federal and state
  governments currently pay for the uninsured can
  be redirected
• a reduction of at least 17 billion will be
  realized because hospital bad debt and charity
  care will be eliminated
• 43.9 billion will be received from employers not
  currently providing insurance coverage
• 51.1 billion will be saved by automating billing
  by physicians and health plans, eliminating
  pre-approval, automating quality review and
  reporting without retrospective chart review, and
  reducing the need for compliance programs

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A winwin situation

• Patients would be entitled to choice, would be
  guaranteed coverage, would be freed from "job
  lock," and would be spared the hassles of
  paperwork and pre-approval requirements.  
• Employers would be spared the administrative
  nightmares associated with healthcare coverage
  and would no longer be subject to the vagaries
  (and related premium increases) of catastrophic
  healthcare use.
• Insurers would receive payments based on the
  severity of patients' conditions and reap the
  rewards of online medical management. Plans could
  offer supplemental "second tier" care.
• Physicians would benefit from universal coverage
  (all patients can receive healthcare) physicians
  would be relieved of many administrative hassles
  with the continued benefit of prompt
  fee-for-service payment.

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The health of the nation
Societal perspective

• Within the uninsured population is an expanding
  number of patients with cardiovascular disease.
• Lower socioeconomic groups tend to have a higher
  prevalence of disease.
• It is more difficult to educate this group about
  prevention and compliance with medication.
• The problem of large groups of people with
  substantial disabilities, from stroke or
  cardiovascular disease, must be addressed form a
  societal standpoint.

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The health of the nation
Healthcare perspective

• The cost of treating a disease is exponentially
  higher than the cost of preventing it.
• Changes to come
• a better insurance system
• a broader emphasis on disease prevention
• a greater involvement of organizations such as
  the ACC and AHA in establishing performance
  measures
• a greater use of the internet to provide
  information to physicians and to patients  

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Political involvement

• Both the ACC and AHA have realized that
  physicians need to know their representatives and
  need to become involved in the political process.
• Physicians may be better off speaking out
  directly than hiring a third party to do it.
• The way of the future is for each organizationto
  establish relationships with elected
  representatives.
• In the long term, this strategy will probably be
  more effective than trying to get physicians
  elected to the senate or the congress.

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Healthcare reform

• Principles for healthcare reform will be
  discussed and refined on the basis of input from
  many organizations.
• Ultimately, a set of principals will be developed
  that physicians and patients can all agree on.
• In the process of using grassroots support, using
  physicians associations with legislators, and
  talking about healthcare reform over the next few
  years, the healthcare system may improve.

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Grassroots support

• The AHA has more than 4 million nonmedical
  volunteers leaders in the community who get
  involved because they are concerned about heart
  disease.
• When people begin to pull together, an effective
  grassroots movement can develop.
• Politicians understand that being elected depends
  on the ability to keep their constituents happy.
• When the constituency begins to unite behind
  ideas, change is possible.

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Political influence

• The major efforts of the AHA have been directed
  at funding for research and patient-related
  programs.
• The AHA is taking a long-term view it doesnt
  have a strong alliance with either of the
  parties.
• The public and physicians are in agreement about
  the need for healthcare reform.

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Healthcare reform
National attitudes

• Americans support changes in a health and welfare
  system that are designed to help families
  successfully complete the transition from welfare
  to work.
• The majority of those surveyed believe that the
  "working poor" should be eligible for the same
  benefits as those making the transition from
  welfare to work.
• The majority also believes that those who cannot
  take care of themselves, such as children, the
  elderly, and people with disabilities, should be
  eligible for social services paid by the
  government.

WK Kellogg Foundation Survey on Public
AttitudesToward Welfare Reform and the Nations
Healthcare System, January 1999
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The last word

• In a country that's now got a 1.3 trillion
  surplus, the idea that we can't provide a basic
  level of healthcare coverage for our citizens is
  nuts.

Dr Arthur Garson