1. 1 Int’l Models of Coverage...or, what Monty Python can teach Barack Obama about health care reform Jonathan Cohn Senior Editor, The New Republic

2. 15 THE COMMONWEALTH FUND Percent AUSCANFRGERNETHNZUKUS Did not fill Rx or skipped doses 20181312318743 Did not visit a doctor when had a medical problem 2191115322436 Did not get recommended test, treatment, or follow-up 251113 318638 Any of the above access problems because of cost 362523267311354 Data collection: Harris Interactive, Inc. Source: 2008 Commonwealth Fund International Health Policy Survey of Sicker Adults. Base: Adults with any chronic condition Cost-Related Access Problems

3. 3 Spending as % GDP

4. Doctor Visits Source: OECD

5. 8 THE COMMONWEALTH FUND Percent AUSCANFRGERNETHNZUKUS Test results/records not available at time of appointment 1619151211171524 Duplicate tests: doctors ordered test that had already been done 12111018410720 Either/both coordination problems 2325222614212034 Data collection: Harris Interactive, Inc. Source: 2008 Commonwealth Fund International Health Policy Survey of Sicker Adults. Base: Adults with any chronic condition Coordinated Care

6. 10 THE COMMONWEALTH FUND Base: Adults with diabetes Percent received all four diabetes services* Data collection: Harris Interactive, Inc. Source: 2008 Commonwealth Fund International Health Policy Survey of Sicker Adults. * Hemoglobin A1c checked in past six months; feet examined for sores or irritations in past year; eye exam for diabetes in past year; and cholesterol checked in past year. Basic Diabetes Care

7. Source: McKinsey Global Institute http://www.mckinsey.com/mgi/rp/healthcare/accounting_cost_healthcar e.asp Waiting Times

8. 5 THE COMMONWEALTH FUND Same-day appointment6+ days wait or never able to get appointment Data collection: Harris Interactive, Inc. Source: 2008 Commonwealth Fund International Health Policy Survey of Sicker Adults. Base: Adults with any chronic condition (Percent) Waiting Times, Cont’d

9. 6 THE COMMONWEALTH FUND Less than 4 weeksTwo months or longer Data collection: Harris Interactive, Inc. Source: 2008 Commonwealth Fund International Health Policy Survey of Sicker Adults. Base: Adults with any chronic condition who needed to see a specialist in past 2 years (Percent) Waiting Times, Cont’d Again

10. 7 THE COMMONWEALTH FUND Base: Adults with any chronic condition who needed after-hours care Percent reported very/somewhat difficult getting care on nights, weekends, or holidays without going to ER Data collection: Harris Interactive, Inc. Source: 2008 Commonwealth Fund International Health Policy Survey of Sicker Adults. 62 56 36 30 39 44 60 Urgent Care Issues

11. CT Scanners Source: OECD

12. Ortho Procedures Source: McKinsey Global Institute http://www.mckinsey.com/mgi/rp/healthcare/accounting_cost_healthcar e.asp

13. Life Expectancy Source: OECD

14. Life Expectancy After 65 Source: OECD

15. Potential Years of Life Lost Source: OECD

16. 16 Cancer Survival, Part 1 Source: Coleman et al, Lancet Oncology

17. 17 Cancer Survival, Part 2 Source: Coleman et al, Lancet Oncology

18. 18 Cancer Survival, Part 3 Source: Gerard Anderson, JHU

19. 14 THE COMMONWEALTH FUND Percent AUSCANFRGERNETHNZUKUS Only minor changes needed 2232412142293820 Fundamental changes needed 575033514648 46 Rebuild completely 201623269211233 Data collection: Harris Interactive, Inc. Source: 2008 Commonwealth Fund International Health Policy Survey of Sicker Adults. Base: Adults with any chronic condition Perceptions of Health Systems

20. OH, CANADA Pure single-payer (or pretty damn close to it) The Good Financial protection Equity Primary care Continuity of care The Bad Waiting times Rigidity

21. ARS Question 13: Follow-up Overall, how do you believe the healthcare system in Canada compares to the United States system in cost, coverage and care? A. Much better B. Somewhat better C. Same as US D. Somewhat worse E. Much worse

22. LONDON FOG Nationalized medicine with a stiff upper lip The Good Financial protection Equity Primary Care NICE is nice The Bad Waiting times Speciality Care

23. ARS Question 14: Follow-up Overall, how do you believe the healthcare system in the United Kingdom compares to the United States system in cost, coverage and care? A. Much better B. Somewhat better C. Same as US D. Somewhat worse E. Much worse

24. ARS Question 15: Follow-up Do you believe that the United States should adopt a similar institute for studying the comparative effectiveness of treatments/care? A. Yes B. Yes, but US system should not limit care as much as the UK. C. No

25. DUTCH TREAT A health insurance market that works. (We think.) The Good Financial protection Equity with choice Primary care Continuity of care Quality incentives After-hours care The Bad Mandate gaps Worries about risk selection

26. ARS Question 16: Follow-up Overall, how do you believe the healthcare system in Holland compares to the United States system in cost, coverage and care? A. Much better B. Somewhat better C. Same as US D. Somewhat worse C. Much worse

27. ARS Question 17: Follow-up The United States should adopt quality and efficiency incentives similar to Holland? A. Strongly Agree B. Somewhat Agree C. Somewhat Disagree D. Strongly Disagree

28. FRENCH KISS If Medicare were served with a fine Bordeaux The Good Financial protection Equity plus choice Primary care High-tech care Choice and convenience The Bad Overtreatment Poor continuity Rural/urban disparities Quality incentives

29. ARS Question 18: Follow-up Overall, how do you believe the healthcare system in France compares to the United States system in cost, coverage and care? A. Much better B. Somewhat better C. Same as US D. Somewhat worse E. Much worse

30. ARS Question 19: Follow-up The United States should adopt a system similar to France, which is very close to the Medicare system in the United States? A. Strongly Agree B. Somewhat Agree C. Somewhat Disagree D. Strongly Disagree

31. HEALTH REFORM, IMAGINED I.e., if Jonathan were king Key elements Insurance structure and financing levels of France Quality incentives and care management of Holland Comparative effectiveness of Britain Provider choice of Canada Public research funding and institutions of U.S.

32. HEALTH REFORM, REALITY I.e., because the filibuster is king Key elements of Obama/Baucus/Kennedy Retain employer-sponsored insurance Pooling for small business and individuals Public plan option IT, comparative effectiveness, incentives for quality Financed by taxes + employer mandate Individual mandate maybe Key elements of Wyden/Bennett Transition from employer to individual insurance Pooling for everybody No public plan; private insurers as regulated utility Individual mandate for sure

33. ARS Question 21: Follow-up After hearing about consensus plan efforts at the federal level, do you believe they are headed in the right direction? A. Yes B. No, not extensive enough C. No, this is the wrong direction D. Unclear, not enough information

34. A Word From Our Sponsor (Er, Speaker) To read the book Sick, visit www.sickthebook.com www.sickthebook.com To follow the health care debate, visit www.tnr.com/thetreatment www.tnr.com/thetreatment To contact the speaker, e-mail jcohn@tnr.com jcohn@tnr.com