W w w. h a r r i s i n t e r a c t i v e. c o m ©2007, Harris Interactive Inc. All rights reserved....

w w w . h a r r i s i n t e r a c t i v e . c o m

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Health Care Reform:Health Care Reform:After The 2008 ElectionAfter The 2008 Election

Presented by

Humphrey TaylorChairman, The Harris Poll

Harris Interactive

April 16, 2008

U.S. Chamber Washington, DC

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H A R R I S I N T E R A C T I V E

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?

And then what?

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Most People Think Health Care and Health Insurance Should Be Entitlements (2003 Data)

Not Sure

Kind ofProduct or

Service

Entitlement 65%

23%

12%

Base: All Adults

Source: Harris Interactive Health Care News, October 27, 2003

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The Public Strongly Favors Fundamental Changes to the System

Not Sure

The healthcare system has so muchwrong with it that WE NEED TO

COMPLETELY REBUILD IT

There are some good things in ourhealthare system but FUNDAMENTAL

CHANGES ARE NEEDED to make itwork better

On the whole, the healthcare systemworks pretty well and ONLY MINOR

CHANGES ARE NECESSARY to makeit work better

50%

31%

6%

Base: All Adults

13%

Source: Harris Interactive, Strategic Health Perspectives, 2007

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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

Not Sure

Dissatisfied

Satisfied 17%

81%

2%

Source: Gallup Poll, November 2007

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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

Not Sure

Is not responsibility of federalgovernment

Is responsibility of federalgovernment

3%

33%

64%


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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?

Total

Party ID

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

Base: All Adults

Source: Harris Interactive and Harvard School of Public Health, 2008

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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:

Total

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

Base: All Adults

Source: Harris Interactive

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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?”

Not Sure

Maintain (PrivateInsurance)

Replace PresentSystem 41%

48%

11%


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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

2. They don’t want to pay much more out-of-pocket or in taxes.

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Large Majority Wants Health Care Reform

BUT

No consensus on the specifics- Role of government

- Role of employers

- How to pay for it

- Level of tiering, etc.

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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

- Reduced choice

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Very Few Employers Believe Healthcare System Works WellWhich 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

Base: All Employees

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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?

Employers who provide coverage %

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

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No Consensus Among Employers On Who, If Anyone, Should Be Responsible for Universal CoverageIn your opinion, who should be primarily responsible for making sure that all Americans have

healthcare?

%

Each individual or family 28

Federal government 37

State government 15

Employers 4

Other 8

No one 2

Not sure 6


Base: All Employers

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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)

%

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


Base: All employers who provide coverage

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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

• Retail clinics and $4Generics

And More …….

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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

• Focus on cost-effectiveness of care

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19

Sources: Annual Reports of Social Security and Medicare Board of Trustees, CBO

$30 Trillion +Unfunded Liability?

What The Candidates Are Not Talking About — But The Next President Should

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One Result of Current Trends: Increased Productivity

The demand for medical care – particularly for age-related 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).

But we haven’t figured out how best to do that.

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You All Know Americans Spend Much More $s On Health Care Than Anyone Else

I have always been puzzled by the question.

What do we get for our money?

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Not Longer Life Expectancy41 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

U.S. life expectancy has been rising but more slowly than many other countries

Source: U.S. Census Bureau and National Center for Health Statistics

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Not Better Infant MortalityInternational Comparison (1999)

3.1

3.4

3.4

5.5

5.5

5.6

6.4

7.1

0.1 1.1 2.1 3.1 4.1 5.1 6.1 7.1 8.1

Hong Kong

Japan

Sweden

Ireland

New Zealand

Portugal

Cuba

USA - Total

Source: National Center to Health Statistics, 2007

RANK

1

2

3

19

20

21

26

28

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Not More DoctorsNumber of Practicing Physicians per 1,000 Populationin 2004

3.63.4 3.4

3.2

2.62.4 2.3 2.2 2.1 2

0.0

1.0

2.0

3.0

4.0

Netherlands France Germany OECDMedian

Australia UnitedStates

UnitedKingdom

NewZealand

Canada Japan

Source: OECD

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Not More Hospital BedsNumber of Acute Care Hospital Beds per 1,000 Population in 2004

8.4

6.4

3.8 3.7 3.6 3.63.2 3 2.8 2.8

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0

9.0

Japan Germany France OECDMedian

UnitedKingdom

Australia NewZealand

Canada Netherlands UnitedStates

Source: OECD

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Not More Doctors VisitsAverage Annual Number of Physician Visits Per Capita in 2004

13.8

6.76.1 6.1 6

5.3 5.3

3.93.2

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

Japan France Canada OECDMedian

Australia Netherlands UnitedKingdom

UnitedStates

NewZealand

Source: OECD

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Not More Surgical ProceduresIn-Patient Surgical Procedure Per 1000 Population (2002)

88

75

97

98

110

133

0 20 40 60 80 100 120 140

U.S.

OECD Average

Germany

Switzerland

Ireland

Austria

Source: OECD/McKinsey Jan 2007

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“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 private-insurance products”.

Source: McKinsey, January 2007

Much Higher Administrative Costs

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Not Better Outcomes (1)Kidney Transplant 5-year Relative Survival Rate

100104 104 106

113

0

20

40

60

80

100

120

United States United Kingdom New Zealand Australia Canada

Source: P.S. Hussey, et al, Health Affairs, 2004

Standardized Performance on Quality Indicator

100=Worst Result; Higher Score=Better Results

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Not Better Outcomes (2)Asthma Mortality Rate, Ages 5-39(Note: Years vary from 2000-2004)

0.4900.457

0.370

0.300 0.3000.240

0.1600.127 0.110

0.00

0.25

0.50

0.75

1.00

UnitedKingdom

UnitedStates

Australia France NewZealand

Japan Germany Netherlands Canada

Source: OECD

Per 100,000 people

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Not Better Outcomes (3)Deaths Due to Surgical or Medical Mishaps per 100,000 Population in 2004

0.7

0.6

0.5 0.5 0.5

0.4 0.4

0.2 0.2

0.0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

UnitedStates

Germany Canada France UnitedKingdom

Australia OECDMedian

Japan Netherlands

Source: OECD

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Not Better Outcomes (4)US Slips in Ranking on “Preventable Deaths” to #19

2002-2003 Rank 1997-1998 Rank 1. France 1 2. Japan 2 3. Australia 4 4. Spain 3 5. Italy 6 6. Canada 7 7. Norway 10 8. Netherlands 8 9. Sweden 510. Greece 911. Austria 1212. Germany 1113. Finland 1614. New Zealand 1415. Denmark 1316. United Kingdom 1817. Ireland 1918. Portugal 1719. United States 15

Source: Ellen Nolte and C. Martin McKee, Measuring the Health o Nations; updating an earlier analysis. Health Affairs, Jan/Feb 2008

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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

% Decline (Improvement)

Ireland 23Austria 22United Kingdom 21Finland 20Australia 19Norway 19Portugal 19Italy 17New Zealand 17Netherlands 16Germany 16France 14Canada 14Japan 13Greece 13Spain 12Denmark 11Sweden 7United States 4

Source: Ellen Nolte and C. Martin McKee, Measuring the Health o Nations; updating an earlier analysis. Health Affairs, Jan/Feb 2008

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EIGHT OF TEN COMMON DISEASES ARE MORE PREVALENT IN U.S. THAN IN 10 EUROPEAN COUNTRIESDiagnosed 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)

United States 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)

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Not More/Better HITOverall Country Comparisons on the Use of HIT

8783

72

59

32

19

8

0

25

50

75

100

NZ UK AUS NET GER US CAN

Percent Reporting 7 or More Out of 14 Functions*

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)

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Not More P4PPrimary Care Doctors’ Reports of Any Financial Incentives Targeted on Quality of Care

95

7972

58

43 41

30

0

25

50

75

100

UK NZ AUS NET GER CAN US

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)

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However (!) - Americans Have Relatively Short Waiting Time For Elective/Non-Emergency Surgery

Germany

USA

New Zealand

Australia

Netherlands

United Kingdom

Canada

28%

37%

44%

45%

48%

57%

65%

Percentage of adults who needed non-emergency surgery who hade to wait more than one month

Source: Harris Interactive / The Commonwealth Fund, 2007

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U.S. System More Unpopular Than Systems in Six Other Countries

USA

Germany

Australia

New Zealand

United Kingdom

Canada

Netherlands

16%

20%

24%

26%

26%

26%

42%

Percentage of adults who say “system works pretty well and only minor changes are necessary”

Source: Harris Interactive / The Commonwealth Fund, 2007

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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

• One of the most unpopular

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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”.

America’s Health Insurance Plans (AHIP)

Source: AHIP document provided at meeting on European Systems of Universal Health Care, Washington, D.C., October 31, 2007

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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?

– When will it happen?

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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

– Individual insurance

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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

Tougher price controls

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What? (3)

The American system will be very complicated.

It will emphasize (or pay lip service to?) the market and competition

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What We Will Not Get

A “national health service”

Government employment of most physicians

Government ownership of most hospitals

Universal government insurance

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U.S. System May Look Somewhat Like Systems in:

Germany

Switzerland

Netherlands

(and a bit of Australia?)

But Not Like

U.K.

Canada

Scandinavia

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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)

– With high poll ratings (60% plus)

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When?

Best time probably in first year after a landslide victory

– Election years make it tougher

– Most presidential parties lose congressional seats in mid-term elections

2009?

2013?

2017?

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And After Reform?

All healthcare systems are almost always in “crisis”

Even after major reforms, the pressures to change and improve the system, will never end

W w w. h a r r i s i n t e r a c t i v e. c o m ©2007, Harris Interactive Inc. All rights reserved....

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