An independent health care policy analyst told the Marthasville Area Chamber of Commerce that America is on the “precipice of real change in health care,” and predicted an ultimate outcome of improved care set in motion by the new law that goes into effect next year. Thomas McAuliffe with the nonpartisan philanthropic organization Missouri Foundation for Health (MFFH), spoke to the Chamber Tuesday night in a public forum held at the Emmaus Homes campus in Warren County. The event was sponsored by Mercy. “This new health care law is the fire that’s starting the torch,” McAuliffe said. “It’s not the end of the race, but rather the beginning,” acknowledging that the new law is not perfect. “Lots of Missourians are very much wanting really good unbiased information on the Affordable Care Act, or ‘ObamaCare,’ and the Missouri Foundation for Health is committed to providing this.” The analyst said he has read the 2,500-page law three times. McAuliffe told the group that his organization had done an opinion poll of Missourians, and that 54 percent of citizens said they did not like ObamaCare. But when pollsters asked if they liked specific aspects of the law, such as getting rid of pre-existing condition exclusions, zero co-pays for primary care physician visits and subsidies to purchase insurance, every one of these components received a positive response across political party lines. “Missourians didn’t like the law, but liked what is in the law,” McAuliffe said. McAuliffe was asked if he thought the country was moving to socialized medicine. “We’re going to reach a crisis point where people and businesses can’t afford health care as it is currently delivered to such a point that we’re going to have to ask somebody to step in, and I suspect that somebody will be the federal government,” McAuliffe said. Price variation in services is one of the significant underpinnings of the need for reform, he told Chamber members, noting that the price of an MRI from state to state may vary substantially. “There is no price standardization along that continuum,” said McAuliffe. “It’s that kind of wild variation in price that may cause the federal government to step in.” On the topic of socialized medicine and how this might be implemented in the United States, McAuliffe said he believes it would look a lot like Medicare, where individuals would pay a certain amount or be charged a tax for access to medical care. “The concept is the same among different countries that have these systems: You pay for your health care instead of paying a broker for insurance,” he explained. England and Ireland have socialized health care, and offer the flexibility for supplemental insurance that enables the individual to choose his or her own provider for various specialties. “It’s exactly like our Medicare system now, where you buy supplemental insurance to go to a different provider for different care,” he said. One audience member equated it to education and the choice of being able to send your child to public or private school. “Good analogy,” McAuliffe responded. “I believe that is where we’re headed.” Hospital systems will get bigger under the new law, with the idea that the bigger they are, the more efficient they will be in providing services, he said.

Health Care Exchanges: Subsidies Will Bring Down Costs Starting in 2014, every state is going to have a health care “exchange,” a marketplace where individuals can go to buy insurance. “Think of exchanges as a farmers’ market. You’ll be able to go to a website and choose from providers and different plan types based on how much insurance you want,” McAuliffe said. “For the first time, you will actually be able to compare costs and coverage right there on the web page.” For most people, McAuliffe said, the price of the insurance will be too high to afford. “More than half — 57 percent — will get some form of subsidy,” said McAuliffe. “Based on annual income from $0 up to $88,000 for a family of four, households would be required to pay from 2 percent to 9.5 percent of insurance,” McAuliffe added. “The other cost will be paid for by the federal government. “These subsidies are actually going to bring the cost of insurance down, because as these costs grow as a percentage of our national budget, the federal government is going to step in and really battle with hospitals for the cost of care, as it now does for the VA and Medicare,” he said. McAuliffe stated he believes that in the next 10 years these subsidies will funnel the country in the direction of Medicare for all, as the cost to the federal budget becomes so laden that leaders ask, ‘Why are we giving all this money to the insurance companies instead of to providers, who are actually providing our care?’”

‘The Best Health Care in the World’ “We think that in America, we have the best health care, but we don’t,” McAuliffe said, citing a study from the Institute of Medicine that compared quality of care of individuals by income group among 12 peer nations and found that U.S. health care was not the leader. “If you are over 50, you’re likely to live longer than your children,” said McAuliffe, citing studies that show the quality of life has been declining precipitously among younger generations. “One of the problems is access to health insurance and medical care.” Historically, McAuliffe said, the U.S. healthcare system has focused on life or death, but the new law seeks to shift the focus on quality of life.

Trouble Ahead as Boomers Retire “As Baby Boomers retire, we’re going to have fewer people supporting more people for longer and with less money,” said McAuliffe. “This is going to force the country to have a discussion about end-of-life,” referring to the “efficacy of costly treatments that don’t have the most positive results.” The United States is exceptional in relying on employer-paid insurance, calling it “the absolute worst way” of offering insurance and health care. “We’ve created a system where there is no skin in the game," he said. "Employers are going to be getting out of this business because they don’t need to be in it,” he said. “This is an individual’s business.”

‘Care Will Be Better’ “I expect care in America will be better,” said McAuliffe, citing Mercy Hospitals’ new coordinated team care models in which patients will consult with dieticians, nutritionists and other experts in addition to their primary care doctor or physician’s assistant. “Your care will be better,” he said. “Medicare is asking hospitals to do that and is going to pay them to do that.” The health care law as passed is posted on www.covermissouri.org. Caduceus image