50th Anniversary – Medicare & Medicaid Event: 50 Years, Millions Of Healthier Lives


WELCOME Everyone. Welcome TO THE 50TH ANNIVERSARY
CELEBRATION OF MEDICARE AND MEDICARE PROGRAMS. AND FOR MANY OF YOU WHO MAY FEEL LIKE THE
50TH CELEBRATION YOU’VE ATTENDED THIS WEEK. HERE IS WHAT WE’RE CELEBRATING. MORE THAN A GENERATION OF SENIORS WHO WITH
THE MEDICAL CARE THEY NEEDED WITHOUT DEPLETING THEIR LIFE SAVINGS. PEOPLE LIVING WITH DISABILITIES CARE FOR AT
HOME AND IN THEIR COMMUNITIES. THE MILLIONS OF CHILDREN STARTING THEIR LIVES
HEALTHY AND KEPT OUT OF POVERTY. THE CELEBRATION OF MEDICARE AND MEDICAID IS
BOTH A COLLECTIVE SUCCESS AND A COLLECTIVE WORK IN PROGRESS. WE’RE HONORED TO BE JOINED TODAY AT THE HUMPHREY
BUILDING HERE IN WASHINGTON BY MANY OF THE PEOPLE RESPONSIBLE FOR THESE STORIES YOU SEE
BEFORE YOU. HHS, CARE PROVIDERS, BENEFICIARY ADVOCATES,
MANAGED CARE PROVIDERS, CIVIC LEADERS, THE NUMBER OF ELECTED OFFICIALS FROM BOTH PARTIES. I WANT TO SEND A PERSONAL THANK YOU TO THOSE
ELECTED OFFICIALS WHO TOOK THE TIME TO JOIN US. WE ARE HONORED TO BE JOINED BY FORMER CONGRESSWOMAN
ALLYSON SCHWARTZ. AT HHS, WE’RE PROUD OF OUR PARTNERSHIP WITH
CONGRESS TO CONSTANTLY IMPROVE THESE VITAL PROGRAMS. I’D ALSO LIKE TO THANK AND WELCOME SEVERAL
FORMER LEADERS OF THIS DEPARTMENT WHO HONORED US BY RETURNING TODAY, FORMER ADMINISTRATOR
BILL TOBY. [APPLAUSE] AND MIKE HASH FORMER DIRECTOR OF THE OFFICE
OF HEALTH AND ALSO A FORMER ADMINISTRATOR. [APPLAUSE] IT IS A PARTICULAR HONOR TO HAVE WITH US FORMER
SECRETARY MIKE LEAVITT. [APPLAUSE] MIKE LED THIS DEPARTMENT AND THE MEDICARE
AND MEDICAID PROGRAMS THROUGH SOME OF THE MOST SIGNIFICANT BENEFIT CHANGES BY MAKING
PRESCRIPTION DRUG ACCESS ACCESSIBLE TO MILLIONS OF PEOPLE. THE LEGACY OF THAT WORK IS AN INCREDIBLY IMPORTANT
AND VITAL PART OF WHAT MEDICARE HAS BECOME. SO AS WE CELEBRATE MEDICARE AND MEDICARE,
I’D SAY THEY LOOK PRETTY GOOD FOR 50. BY ALL REPORTS, THE QUALITY OF CARE IS HIGHER
THAN EVER. THE BENEFICIARIES REPORT IN SURVEY AFTER SURVEY
EXTREMELY HIGH SATISFACTION RATES AND THE COST TRENDS ARE AT HISTORICALLY WELLMANAGED
LEVELS FIVE YEARS RUNNING AND THAT IS KEEPING THE PROGRAM AFFORDABLE TODAY AND AVAILABLE
FOR ALL OF US WHO WILL NEED THE PROGRAMS IN THE FUTURE. THE ONE THING WE KNOW IS THAT IN THE NEXT
50 YEARS MOVING FORWARD NEW CHALLENGES AND NEW OPPORTUNITIES AND WE AT HHS NEED TO BE
READY AND GET BUSY NOW TO MAKE THE NEXT 50 YEARS SUCCESSFUL. SO TODAY WE ARE PLEASED THAT SECRETARY BURWELL
WILL PROVIDE FAR REACHING COMMENTS ABOUT THE PAST, THE PRESENT, AND THE FUTURE OF THESE
PROGRAMS, AND OUR SOCIETY AND WE’LL HAVE A CONVERSATION TODAY WITH AN EXCELLENT PANEL
OF EXPERTS TO GIVE US A 360 DEGREE VIEW AND ASSESS WHERE TO GO FROM HERE. NOW, WHEN YOU GET OUT OF WASHINGTON, IT’S
NOT THE POLICY MINUTIA OR EVEN THE MAJOR CRITICAL INITIATIVES THAT WE WORK ON EVERY DAY THAT
MATTERS TO PEOPLE. AS ALL OF US KNOW, WHEN SOMEONE IN YOUR FAMILY
FALLS SERIOUSLY ILL OR IS DISABLED, NOTHING IS MORE IMPORTANT THAN THEIR CARE, THEIR COMFORT,
AND THEIR ABILITY TO RETURN TO EVERYDAY LIFE. UPWARDS OF TEN MILLION TIMES TODAY AND EVERY
DAY IN THIS COUNTRY, SOMEONE WILL FILL A PRESCRIPTION, CHECK THEIR FATHER INTO A NURSING HOME, UPGRADE
THEIR WHEELCHAIR TO IMPROVE THEIR FUNCTIONAL STATUS, GET VISITED IN THEIR HOME BY A PERSONAL
CAREGIVER, SEE A DOCTOR ON THE WAY TO A HEALTHY DELIVERY, OR RECEIVE COUNTLESS OTHER NECESSARY
SERVICES COVERED BY MEDICARE AND MEDICAID. 50 STORIES LINE THE BACK OF THE ROOM IN AN
AMAZING DISPLAY. THEY REPRESENT THE MORE THAN 100 MILLION STORIES
JUST LIKE THEM. SO THAT WE START THIS PROGRAM IN THE RIGHT
PLACE, LET’S HEAR FROM SOME OF THE PEOPLE RIGHT NOW. [VIDEO PLAYING] [END OF VIDEO]. SO I THINK WE HAVE FOUND OUR NEW SPOKESPERSON. OUR NEXT SPEAKER HAS ACTUALLY A PHRASE FOR
THE PEOPLE WE JUST SAW. THEY ARE OUR BOSSES. SERVING WITH SECRETARY BURWELL IS TO BE CONSTANTLY
REMINDED OF WHY WE ARE HERE AND WHY WE NEED TO GET THE JOB DONE RIGHT, PARTICULARLY WHEN
IT COMES TO MOVING MEDICARE AND MEDICAID INTO THE FUTURE ENSURING THESE PROGRAMS HELP IMPROVE
THE WAY CARE IS DELIVERED TO ALL AMERICANS. PLEASE WELCOME SECRETARY BURWELL. [APPLAUSE]>>THANK YOU, ANDY, AND GOOD MORNING TO EVERYONE. I WANT TO THANK ALL OF OUR SPECIAL GUESTS
HERE TODAY. OUR FORMER MEMBERS OF CONGRESS, OUR FORMER
SECRETARY LEAVITT, THANK YOU SO MUCH FOR COMING OUT AND BEING A PART OF THIS. OUR OTHER HHS FORMER LEADERSHIP AND CURRENT
LEADERSHIP THAT ARE ALL SEATED HERE TODAY. ALSO THANKING OUR PANELISTS, SISTER CAROL,
STEVEN, DIANE, NANCY AND JASON, WHO I THINK WILL BE JOINING US, TOO. WE HAVE A FANTASTIC GROUP ALL THIS BE HEARING
A LITTLE BIT MORE ABOUT, AND THEY ARE REPRESENTING CONSUMERS, PROVIDERS, AND ALL OF THOSE WHO
MAKE THIS SYSTEM STRONG. IT’S WONDERFUL TO BE HERE TODAY FOR SUCH A GREAT CELEBRATION. THE ANNIVERSARY IS ESPECIALLY QUITE TIMELY
FOR ME BECAUSE JUST A MONTH AGO I TURNED 50. AND ACTUALLY, MEDICARE AND MEDICARE AND I
HAVE A NUMBER OF THINGS IN COMMON. WE BOTH JUST JOINED SOCIAL MEDIA. I HATE TO ADMIT THAT. WE BOTH LOOK OUT FOR OUR PARENTS, AND WE HAVE
A COMMON GOAL. SERVING THE AMERICAN PEOPLE. AND AFTER 50 YEARS, IT IS HARD TO IMAGINE
A WORLD THAT IS WITHOUT MEDICARE AND MEDICAID. IT WAS A PLACE WHERE, WITH VERY FEW EXCEPTIONS,
SENIORS HAD TO RELY ON STRAINED AVINGS OR THEIR FAMILY’S GOODWILL TO GET BY. THOSE WHO HAD EITHER LESS IN POVERTY OR SECURITY
AND IT WAS A WORLD WHERE FAMILIES AND EVEN CHILDREN, WITH THE MERCY OF CHARITABLE CARE
AND A CHANCE WHEN IT CAME TO THEIR HEALTH. IT WAS A WORLD WHERE THOSE WITH DISABILITIES
STRUGGLED TO GET BY. THE ESTABLISHMENT OF MEDICARE AND MEDICARE
DIDN’T JUST PUT AN END TO THIS INJUSTICE. IT TRANSFORMED OUR NATION’S HEALTHCARE. NO OTHER PROGRAM HAS CHANGED SO MANY LIVES,
OF OUR FAMILIES, OUR FRIENDS, OUR NEIGHBORS, AND NO OTHER PROGRAM HAS GIVEN SO MANY SO
MUCH HOPE. IN 1965, MORE THAN HALF OF THE NATION’S SENIORS
WERE UNINSURED. THE NEED WAS SO GREAT THAT THERE WAS ACTUALLY
A FEAR THAT WITH THE BILL’S PASSAGE THERE WOULD BE A RUSH ON HOSPITALS FOR CARE THAT
HAD BEEN PUT OFF. HOSPITALS WERE FINE, BUT ENROLLEES DID FLOOD OFFICES ACROSS THE COUNTRY
TO SIGN UP. IN THE FIRST WEEK ALONE MORE THAN ONE MILLION
SENIORS ENROLLED IN MEDICARE. TODAY, MORE THAN ONE IN THREE AMERICANS HAVE
HEALTH COVERAGE THROUGH MEDICARE AND MEDICAID. TOGETHER, THESE PROGRAMS HAVE DRAMATICALLY
INCREASED THE NUMBER OUR FELLOW CITIZEN WHO CAN ACCESS QUALITY CARE. ABOUT 55 MILLION SENIORS AND PEOPLE WITH DISABILITIES
DEPEND ON MEDICARE TO GET THE PREVENTIVE SERVICES THAT PROTECT THEM FROM GETTING SICK. IT HELPS THEM STAY MOBILE AND INDEPENDENT. IT GETS THEM THE TREATMENTS THEY NEED, WHEN
THEY NEED THEM. AND MORE THAN 70 MILLION AMERICANS HAVE THAT
SAME SENSE OF SECURITY, THANKS TO MEDICAID. BECAUSE OF THIS UNIQUE PARTNERSHIP BETWEEN
THE FEDERAL GOVERNMENT AND STATE, MILLIONS OF CHILDREN, PREGNANT WOMEN, PEOPLE WITH DISABILITIES,
AND HARDWORKING LOW INCOME FOLKS, MANY OF WHOM ACTUALLY WORK FULLTIME, CAN GET THE CARE
THEY NEED. MEDICAID HAS BEEN A DRIVING FORCE BEHIND OUR
NATION’S SUCCESS IN CUTTING THE RATE OF UNINSURED CHILDREN IN HALF SINCE THE 1990S AND WITH
THE AFFORDABLE CARE ACT’S EXPANSION EFFORTS, WE ARE MAKING BIG PROGRESS FOR ADULTS AS WELL.
AND WITH OUR AGING POPULATION, AMERICANS WILL RELY ON THOSE PROGRAMS EVEN MORE IN THE COMING
YEARS. EVERY DAY, 10,000 AMERICANS TURN 65 AND ENROLL
IN MEDICARE. AND WITH MANY STATES EXPANDING MEDICAID UNDER
THE AFFORDABLE CARE ACT, 12.3 MILLION MORE AMERICANS HAVE GAINED COVERAGE UNDER MEDICAID
AND CHIP SINCE OCTOBER OF 2013. OF COURSE, WE WANT ALL STATES TO EXPAND THIS
IMPORTANT COVERAGE AND IF EVERY STATE EXPANDED, WE’D HAVE FOUR MILLION MORE AMERICANS WHO
COULD HAVE THAT ACCESS TO QUALITY AFFORDABLE CARE. WE WANT TO WORK WITH STATES TO FIND
APPROACHES THAT WORK FOR THEM. WITH BENEFITS AND PROTECTIONS FROM THE ACA
COVERAGE HAS IMPROVED. FOR BENEFICIARIES OF THESE PROGRAMS AND ALL
AMERICANS WHO WERE ALREADY COVERED. THREE OUT OF EVERY FIVE MEDICARE ADVANTAGE
ENROLLEES ARE IN A PLAN THAT IS RATED AT FOUR OR FIVE STARS.^ THAT’S UP FROM ONE IN FIVE
IN 2009. AND MEDICARE IS HELPING MANY TAKE CONTROL
OF THEIR HEALTH, GETTING THEM ACCESS TO PREVENTIVE SERVICES AND HELPING THEM MANAGE CHRONIC CONDITIONS
IN WAYS THAT BEFORE THEY NEVER COULD HAVE AFFORD. THIS QUALITY CARE CAN HAVE AN IMPACT THAT
GOES BEYOND HEALTH. A RECENT STUDY FROM THE NATIONAL BUREAU OF
ECONOMIC RESEARCH SHOWED THAT CHILDREN WITH MEDICAID COVERAGE EARN MORE AS ADULTS AND
CONTRIBUTE BACK TO OUR ECONOMY. FOR 50 YEARS, MEDICARE AND MEDICAID HAVE SHOWN
HOW EFFECTIVE POLICY CAN DRAMATICALLY IMPROVE THE LIVES OF MILLIONS OF AMERICANS. BUT THEY SERVE ANOTHER VITAL ROLE IN OUR HEALTHCARE
SYSTEM. THEY ARE A CATALYST FOR CHANGE. AND IN THE 1960’S WHEN THE RACIAL DIVISION
AND DISCRIMINATION PERMEATED OUR NATION AND OUR HEALTHCARE SYSTEM WITH MANY MEDICAL INSTITUTIONS
DENYING ACCESS TO AFRICAN AMERICAN DOCTORS AND PATIENTS, MEDICARE AND MEDICAID REQUIRED
INTEGRATION. IT HELPED STARTED TEAR DOWN BARRIERS TO HEALTHCARE
AND BRIDGE THE GAP IN HEALTH DISPARITIES. TODAY, THESE PROGRAMS ARE HELPING US LEAD
IN ANOTHER TRANSFORMATION. WE ARE BUILDING A HEALTHCARE SYSTEM THAT DELIVERS
BETTER CARE, SPENDS OUR HEALTH DOLLARS MORE WISELY, AND PUTS EDUCATED AND EMPOWERED CONSUMERS
AT THE CENTER OF CARE TO KEEP THEM HEALTHY. BY LEVERAGING MEDICARE AND MEDICAID’S MARKET
INFLUENCE AND USING NEW TOOLS GIVEN TO US BY THE ACA, WE’VE BEEN WORKING TO PAY PROVIDERS
FOR QUALITY OF CARE RATHER THAN THE QUANTITY OF SERVICES. TO UNLOCK HEALTH DATA AND TO FIND BETTER WAYS
TO PROVIDE CARE. EARLY RESULTS FROM OUR PIONEER ACCOUNTABLE
CARE ORGANIZATION MODEL SHOWED THAT COORDINATION EFFORTS, SAVED MEDICARE 384 MILLION IN JUST
TWO YEARS. WHILE PROVIDING HIGH QUALITY CARE TO PATIENTS. IN JANUARY, WE ANNOUNCED HISTORIC GOALS TO
MOVE MEDICARE PAYMENTS TO FOCUS ON HOW WELL RATHER THAN HOW MUCH PROVIDERS ARE PAID FOR PATIENTS. AND JUST A FEW WEEKS AGO, WE ANNOUNCED A NEW
PAYMENT MODEL TO ENCOURAGE BETTER COORDINATION AMONG PROVIDERS AND GREATER FOCUS ON PATIENT
OUTCOMES. THIS NEW MEDICARE MODEL WILL CREATE ONE PAYMENT
WITH QUALITY MEASURES FOR THE SURGERY AND RELATED CARE. SO RATHER THAN INCENTIVES FOR EACH XRAY, CHECKUP,
OR PHYSICAL THERAPY SESSION THAT’S PART OF A HIP OR KNEE REPLACEMENT, PROVIDERS WILL
HAVE AN INCENTIVE TO FOCUS ON THE QUALITY AND TOTAL COST OF PERFORMING THE JOINT REPLACEMENT
AS WELL AS THE RECOVERY AFTER. MEDICAID IS DRIVING INNOVATION AS WELL, WORKING
CLOSELY WITH STATES, WE ARE HOPING OPENING NEW HORIZONS OF COORDINATED QUALITY CARE FOR
PEOPLE WHO USE THIS PROGRAM. SOME EXAMPLES ARE MISSOURI’S HEALTH HOME PROGRAMS
AND MINNESOTA’S HENNEPIN HEALTH. THEY ARE BOTH LOWERING THE NEED FOR COSTLY
HOSPITALIZATIONS AND RAISING HEALTH OUTCOMES OF PEOPLE WITH HEART DISEASE AND DIABETES. MEDICAID IS PUSHING OUR HEALTH SYSTEM FORWARD
AND NEW AND INNOVATIVE MODELS AND NEW IDEAS ARE BEING WORKED WITH EVERY STATE. FOR HALF A CENTURY, THESE PROGRAMS HAVE BEEN
AT THE CENTER OF THE NATION’S HEALTHCARE. TODAY, THEY ARE ALSO AT THE FOREFRONT. HERE AT HHS, OUR TEAM WORKS HARD TO SUPPORT
THESE PROGRAMS, AND I AM PROUD OF THE CONTRIBUTIONS THEY MAKE EVERY DAY TO KEEP MEDICARE AND MEDICAID
STRONG. TODAY, MEDICARE AND MEDICAID ARE WELL MANAGED
THANKS TO THE WORK THAT HAPPENS HERE AND IN THE CMS OFFICES ACROSS THIS COUNTRY. AND I KNOW THAT ALL OF YOU WITH US TODAY HAVE
PLAYED A PART IN BUILDING THIS LEGACY. SO THANK YOU FOR ALL THAT YOU DO, WHATEVER
YOUR ROLE, NO MATTER HOW SMALL OR BIG, FOR MEDICARE AND MEDICAID PROGRAMS AND THE MILLIONS
OF AMERICANS WHO DEPEND ON THEM DEPEND ON YOU. 50 YEARS AGO WE MADE A PROMISE. WE PLEDGED THAT IN A COUNTRY WITH SO MANY
HAVE SO MUCH WE WOULD NOT LET INSECURITY AND INDIGNITY BECOME THE DESTINY OF THE MOST VULNERABLE
AMONG US. OUR PARENTS AND GRANDPARENTS AND STRUGGLING
MOMS AND DADS, OUR CHILDREN, VETERANS, AND THOSE WHO HEALTH HAS COME BETWEEN THEM AND
PAYCHECK. AS PRESIDENT JOHNSON SAID, THIS IS A TRADITION
WE SHARE TODAY. IT CALLS UPON US NEVER TO BE INDIFFERENT TOWARDS
DESPAIR. IT COMMANDS US NEVER TO TURN AWAY FROM HELPLESSNESS.
IT DIRECTS US TO NEVER IGNORE OR SPURN THOSE IN A LAND THAT IS BURSTING WITH ABUNDANCE. MEDICAID AND MEDICARE AREN’T JUST ABOUT HEALTHCARE. THEY ARE ABOUT WHO WE ARE AS A NATION, ABOUT
LIVING UP TO OUR OWN VALUES AND DREAMING THAT WE CAN ALWAYS BE MORE. THANK YOU FOR ALL YOUR WORK TO KEEP US TRUE
TO THIS TRADITION AND TO THOSE VALUES. HERE IS TO ANOTHER 50 YEARS AND BEYOND. THANK YOU. [APPLAUSE]>>THANK YOU, SECRETARY BURWELL. BEFORE WE INTRODUCE OUR PANEL, I’D BE BE REMISS
IF I DIDN’T RECOGNIZE THE WORK OF THE AGENCY EVERY DAY THAT IS CARRIED HAS CARRIED OUT
THE CHARGE FOR SERVING MEDICARE AND MEDICAID BENEFICIARIES. THE STAFF THAT WAS ORIGINALLY THE SOCIAL SECURITY
ADMINISTRATION,THEN HCFA AND WHAT IS NOW CMS. AROUND THE COUNTRY WHEN CMS STAFF WERE ASKED
HOW THEY WOULD CHOOSE TO CELEBRATE THIS ANNIVERSARY TODAY, THEY UNIVERSALLY CHOSE TO ENGAGE IN
THEIR COMMUNITIES WHERE OUR BENEFICIARIES LIVED AND MARK HOW THE LIVES HAVE BEEN FOREVER
CHANGED. LET ME GIVE A SENSE OF THE ARRAY OF LOCAL
EVENTS OCCURRING ACROSS THE COUNTRY THIS WEEK. AT THE CARTER CENTER IN ATLANTA. AT THE FIRST YMCA IN BOSTON, THE NATIONAL
CONSTITUTION CENTER IN ATLANTA. THE CHINESE BENEVOLENT ASSOCIATION IN NEW
YORK, SENIOR CENTERS IN CHICAGO AND SEATTLE AND UNIVERSITY OF MIAMI, AT SAN FRANCISCO
GENERAL HOSPITAL. THE DENVER PUBLIC LIBRARY, THE LBJ LIBRARY
IN AUSTIN AND THE TRUMAN LIBRARY IN MISSOURI. OUR STAFF ARE GATHERING THIS WEEK WITH BENEFICIARIES,
POLICYMAKERS, EXPERTS, ADVOCATES, COMMUNITY LEADERS, AND CARE PROVIDERS IN LOCAL EVENTS
ALL TO FOCUS ON HOW TO MAKE THEIR COMMUNITIES BETTER AND STRONGER AND BETTER CARED FOR. RATHER THAN JUST TELL YOU ABOUT CMS STAFF,
THE STAFF TOOK THIS OCCASION TO SUBMIT THEIR OWN STORIES ABOUT THEIR TIME AND THEIR CAREER
HERE. LET’S TAKE A LOOK. [VIDEO PLAYING]. [END OF VIDEO]. [APPLAUSE]>>WELL I HOPE YOU GOT A LITTLE CHANCE TO
SEE WHAT I GET THE PRIVILEGE OF SEEING EVERY DAY. THE INCREDIBLE SPIRIT, COMMITMENT AND PASSION
OF THE EXTRAORDINARY PEOPLE WHO SERVE AND THE MEDICARE AND MEDICAID BENEFICIARIES IN
THESE PROGRAMS EVERY DAY. WE HAVE A NUMBER OF STAFF MEMBERS WHO HAVE
SERVED THE BENEFICIARIES FOR 20, 30, AND THERE IS ALMOST 60 CMSERS WHO HAVE SERVED FOR OVER
40 YEARS. NOW, ON OUR 50TH ANNIVERSARY, I’M HONORED
TO RECOGNIZE THAT WE HAVE SIX EMPLOYEES WHO HAVE BEEN AT CMS OR A PREDECESSOR FOR 50 YEARS
OR MORE. OUR LONGEST SERVING STAFF MEMBER, HOWEVER,
HAS SERVED FOR 57 YEARS AND IS STILL GOING STRONG. AND WHILE YOU CAN’T HAVE A FAVORITE EMPLOYEE,
I AM TOLD, TODAY I DO. PAT PIERORAZIO, WHO IS HERE WITH US TODAY. IN PAT’S 57 YEARS OF SERVICE, SHE HAS PERSONALLY
HANDLED OVER 25,000 BENEFICIARY CASES. [APPLAUSE] AND PAT HAS PROMISED ME THAT WHEN I’M A MEDICARE
RECIPIENT, SHE WILL PERSONALLY HANDLE MY BENEFITS. [LAUGHTER] NOT THAT ANYBODY CAN FOLLOW PAT,
BUT I NOW WANT TO CALL OUR PANEL TO THE STAGE. YOU HAVE ALL SEEN THEIR BIOS, AND KNOW THE
STATUS ABOUT THEM AS THEY COME UP. SISTER CAROL KEEHAN IS THE PRESIDENT OF CATHOLIC
HEALTH ASSOCIATION AND ONE OF THE STRONGEST AND MOST THOUGHTFUL VOICES FOR THE HEALTHCARE
SYSTEM IN THE US. DIANE ROWLAND FROM THE KAISER FAMILY FOUNDATION
DIRECTS THE COMMISSION ON MEDICAID AND THE UNINSURED AND SERVES AS THE CHAIR OF MACPAC. SHE’S ONE OF OUR COUNTRY’S LEADING EXPERTS
ON MEDICAID AND MEDICARE. JASON FURMAN, CHAIR OF THE ECONOMIC COUNCIL
OF ECONOMIC ADVISORS AND IS OUR COUNTRY’S CHIEF ECONOMIST. STEVE SAFYER, A PHYSICIAN AND CEO OF MONTEFIORE,
IS ONE OF THE LEADING PRACTITIONERS IN CREATING BOTH AN ACCOUNTABLE AND EQUITABLE HEALTH SYSTEM.
NANCY LEAMOND, AND BY THE WAY THEY ARE NOT IN THE ORDER I CALLED, WHO IS A CHIEF ENGAGEMENT
OFFICER FOR AARP AND ONE OF OUR NATIONAL LEADERS ON HEALTH AND REQUIREMENT SECURITY RETIREMENT
FOR SECURITY FOR OLDER AMERICANS. [APPLAUSE] ALL RIGHT. SO LET’S START BY TAKING A QUICK 360 DEGREE
VIEW OF THESE PROGRAMS. LET’S HEAR FROM THE EXPERTS. DEPENDING ON WHERE YOU SIT, YOU CAN LOOK AT
MEDICARE, MEDICAID THROUGH A PUBLIC POLICY LENS, A CARE DELIVERY LENS, A CONSUMER ADVOCATE
LENS AND CERTAINLY THERE IS THE ECONOMIC LENS BUT THERE IS ALSO A SET OF MORAL UNDERPINNINGS
FOR THESE PROGRAMS AND THAT’S WHERE I WANT TO START. SO I’LL START, YOU SISTER CAROL. START OUT FOR MAKING THE CASE FOR THESE PROGRAMS
AND WHY THEY ARE SO IMPORTANT TO OUR NATION.>>WELL, FIRST OF ALL, CAN I JUST ECHO YOUR
THANK YOU? NONE OF THESE PROGRAMS WORK WITHOUT THE HARD
WORK YOU AND THE FOLKS AT CMS DO EVERY SINGLE DAY, AND WE FEEL THAT IN OUR CLINICS AND IN
OUR HOSPITALS, WE KNOW WHAT AN INCREDIBLE DIFFERENCE YOU MAKE, SO THANK YOU AND CONGRATULATIONS
ON YOUR ANNIVERSARY. [APPLAUSE] WE HAD ABOUT 17 MILLION PEOPLE WHEN WE PASSED
THIS BILL OVER 65, AND WE EXPECT WITHIN THE NEXT COUPLE YEARS TO HAVE WELL OVER 50 MILLION. AT THAT TIME, OF THOSE 16 OR 17 MILLION, 28%
OF THEM LIVED IN POVERTY. TODAY, 9.5% OF THEM LIVE IN POVERTY. WHAT IS THE BIGGEST THING THAT CAUSES BANKRUPTCIES
IN THIS COUNTRY? MEDICAL EXPENSES. THE COST OF HEALTHCARE IN 65 VERSUS THE COST
OF HEALTHCARE IN 2015 CAN’T EVEN BE EXAGGERATED. AND SO WE WOULD HAVE INCREDIBLE POVERTY AND
WE WOULD HAVE INCREDIBLE, HEALTH DEFICITS. SO YOU HAVE NOT ONLY TAKEN A PROGRAM AT A
TIME WHEN HEALTHCARE WAS SIMPLER, AS A NUMBER OF SENIORS GREW AND GREW. YOU’VE HELPED THIS PROGRAM TO GROW WITH THEM. WE’VE HAD A PROGRAM THAT HAS TAKEN THESE REAL
NEEDS OF SENIORS, GIVEN THEM THE BEST HEALTHCARE AS WE MADE ADVANCE AFTER ADVANCE. THE QUALITY OF THEIR LIVES. PEOPLE 70 YEARS OLD IN 1965, DID NOT DO ANY
OF THE THINGS OR HAVE ANY OF THE QUALITY OF LIFE WE HAVE TODAY. THEY WEREN’T SKIING, THEY WEREN’TTRAVELING
ALL OVER THE WORLD. YOU HAVE DONE THAT. AND WE AS A NATION HAVE DONE THAT. AND IT REPRESENTS SOME OF THE BEST VALUES
IN OUR COUNTRY. SO THANK YOU.>>THANK YOU. DIANE, HELP US WITH THE PERSPECTIVE OF THE
AMERICAN PUBLIC. KAISER FAMILY FOUNDATION DOES SIGNIFICANT
RESEARCH TO TRACK HOW THE AMERICAN PUBLIC FEELS ABOUT THESE PROGRAMS. WHAT DO PEOPLE WANT AND HOW SHOULD THAT BE
INCLUDED IN OUR THINKING?>>IT’S ALWAYS BEEN CLEAR THAT THE PUBLIC
IS VERY FOND OF THE MEDICARE PROGRAM AND EMBRACES IT AND ESPECIALLY THE BENEFICIARIES BUT EVEN
OTHERS. AND THREE QUARTERS OF THE AMERICAN PUBLIC
HAVE JUST IN OUR RECENT POLL SAID THAT MEDICARE IS A VERY IMPORTANT PROGRAM. BUT MANY DON’T THINK THAT MEDICAID COMES ALONG
AT THE SAME LEVEL. BUT THE REAL SURPRISE IS THAT MEDICAID HAS
BECOME A REAL FABRIC PART OF OUR HEALTHCARE SYSTEM AND PEOPLE KNOW IT AND OVER TWO THIRDS
OF THE AMERICAN PUBLIC RANK MEDICAID AS A VERY IMPORTANT PROGRAM. I THINK PART OF THAT
AS MEDICAID HAS EXPANDED ITS COVERAGE FOR LOW INCOME FAMILIES AND HAS PLAYED SUCH A
VITAL ROLE IN PROVIDING LONG TERM SERVICES AND SUPPORT TO INDIVIDUALS, THAT NOW OVER
THREE QUARTERS OF THE AMERICAN PUBLIC KNOWS SOMEONE OR HAS BEEN TOUCHED BY SOMEONE OR
HAS BEEN THEMSELVES BENEFITED FROM THE PROGRAM. SO THESE PROGRAMS ARE REALLY CRITICAL AND
WELL RESPECTED NOW IN THE PUBLICS VIEW AND I THINK THAT’S AN IMPORTANT REMEMBRANCE
AS WE GO FORWARD TO FIGURE OUT HOW TO TAKE CARE OF THEM IN THE NEXT 50 YEARS. JASON, WHAT’S THE ECONOMIC PERSPECTIVE IN
THE CONTEXT OF BOTH THE FEDERAL BUDGET AND OUR ECONOMY AS A WHOLE?
SO FIRST OF ALL THANK SO MUCH FOR HAVING ME HERE. I’M IN A ROOM FILLED WITH PEOPLE WHO
DEDICATE THEIR LIVES TO THESE PROGRAMS. FOR ME IT’S JUST ONE OF MANY THINGS I DO. BUT
ONE OF THE REASONS I DO IT IS SO IMPORTANT FOR THE SAKE OF HEALTHCARE BUT ALSO BECAUSE
IT MATTERS FOR OUR ECONOMY. I THINK IT’S INTERESTING THAT NO ONE LOOKS TO ME FOR MORAL
OR SPIRITUAL ADVICE AND THEY PROBABLY DON’T GO TO SISTER CAROL FOR ECONOMIC LESSONS BUT
IT’S IMPOSSIBLE TO MAKE THE MORAL ARGUMENT FOR HEALTH CARE WITHOUT MAKING A LOT OF THE
ECONOMIC POINTS WHICH YOU JUST MADE SO WELL. AND IT’S HARD FOR ME TO MAKE THE ECONOMIC
CASE WITHOUT BRINGING IT BACK TO THE MORALITY. AND THE RESEARCH FOR MEDICAID HAS BEEN AN
EXCITING SET OF RESEARCH RECENTLY THAT HAS ECONOMICS WE ARE INCREASINGLY ABLE TO FOLLOW
PEOPLE OVER LONGER PERIODS OF TIME. AND THE LONG TERM CONSEQUENCE OF MEDICAID IS HIGHER
WAGES. THE EVIDENCE THERE IS STRONGEST FOR WOMEN
BUT YOU SEE IT BROADLY. THE HIGHER WAGES RESULT IN HIGHER TAX REVENUES
THAT ACTUALLY END UP PAYING BACK A LOT OF THE COST OF MEDICAID TO BEGIN WITH AND THE
CHILDREN RECEIVE MEDICAID. YEARS LATER THEY ARE MORE LIKELY TO GRADUATE
FROM HIGH SCHOOL. THEY ARE MORE LIKELY TO GO TO COLLEGE. AND IN TRYING TO UNDERSTAND WHY THAT IS THE
MOST PLAUSIBLE REASON IS THE SIMPLEST REASON. IF YOU ARE HEALTHIER, YOU ARE GOING TO BE
ABLE TO MORE LIKELY TO GRADUATE FROM HIGH SCHOOL, MORE LIKELY TO GO TO PLEDGE AND EARN
MORE, MORE LIKELY TO PAY MORE IN TAXES, MORE LIKELY TO HELP OUR ECONOMY AS A WHOLE. TURNING TO MEDICARE, I THINK SISTER CAROL
ABOUT A LOT OF OF THE BENEFITS AND JUST HAVING A SOCIETY IN WHICH YOU PROTECT PEOPLE FROM
SOME OF THE WORSE CONSEQUENCES FREES PEOPLE UP TO TAKE MORE RISKS IT DOESN’T REQUIRE THEM
TO SAVE AND SAVE AND SAVE AND SAVE WITHOUT PUTTING THAT MONEY TO GOOD USE. IT ALLOWS US AS A SOCIETY TO BE MORE DYNAMIC
AND BE MORE INNOVATIVE. SO I THINK THIS FABRIC OF OUR ECONOMY, FROM
MEDICAID, MEDICARE AND THE SOCIAL INSURANCE SYSTEM, MORE BROADLY HAS ALL THE DIRECT MORAL
BENEFITS BUT ALSO HAS AN IMPORTANT ECONOMIC SET OF SIDE BENEFITS OR EVEN CORE BENEFITS
AS WELL.>>GREAT, THANK YOU, JASON.>>SO STEVEN, WHERE THE RUBBER MEETS THE ROAD,
AT THE LEVEL OF PROVIDING CARE, MAKING SURE CARE IS AVAILABLE FOR PEOPLE, MAKING SURE
THAT THE CARE IS HIGH QUALITY, IT’S NO EASY TASK. CAN YOU GIVE US AN ON THE GROUND SENSE OF
A VIEW OF THESE PROGRAMS AND WHAT THAT MEANS?>>ABSOLUTELY. AND I’M IN A PRIVILEGED POSITION BECAUSE
I AGREE WITH EVERYTHING SAID AND I WON’T REPEAT IT. FROM THE MORAL IMPERATIVE POINT OF VIEW, COMING
FROM A REGION THAT WE SERVE OF ABOUT THREE MILLION PEOPLE>>FOR THOSE WHO DON’T KNOW, THE BRONX.>>THE BRONX, NEW YORK IS OUR HOME BASE AND
UP THROUGH WEST CHESTER AND THE HUDSON VALLEY. WHEN YOU THINK WEST CHESTER, YOU THINK UPSCALE
BUT MUCH OF WEST CHESTER REFLECT THE SOCIOECONOMIC STATUS AS THE BRONX. SO EASILY TWO THIRDS OF OUR POPULATION IS
IN MEDICARE AND MEDICAID AND THERE IS A LARGE IMMIGRANT POPULATION THAT’S IN NEITHER. SO FROM A MORAL IMPERATIVE THE WAY I THINK
ABOUT IT AND I THINK MOST OF THE 30,000 EMPLOYEES, IF NOT ALL, THINK ABOUT IT IS THAT HEALTHCARE
SHOULD BE A HUMAN RIGHT AND NOT A PRIVILEGE. WE HAVE ONE OF THE STRONGEST CONSTITUTIONS
IN THE WORLD, DURABLE AND PROTECTIVE OF HUMAN RIGHTS. BUT IT WAS AN IMPERFECT DOCUMENT FROM THE
BEGINNING. THERE WAS SLAVERY. AFTER THE SLAVES WERE FREED, PEOPLE COULDN’T
VOTE. THE SAME PRESIDENT MADE POSSIBLE VOTING AS
A RIGHT IN THIS COUNTRY. WOMEN’S RIGHT TO VOTE IN THIS COUNTRY DIDN’T
HAPPEN UNTIL THE PAST CENTURY. SO THERE WERE THINGS THAT WERE MISSING AND
THE WAY I THINK ABOUT MEDICARE AND MEDICAID IS THAT IT BEGINS TO CREATE A NEW FOUNDATION
FOR THAT HUMAN RIGHT, WHICH IS HEALTHCARE. AND IN TAKING CARE OF THE POPULATION WE TAKE
CARE OF, IT’S AN ESSENTIAL INGREDIENT. AS WE BEGIN TO MOVE INTO THE FUTURE, I THINK
WE CAN IMPROVE UPON IT AND MAKE IT EVEN STRONGER.>>FINALLY TO WRAP UP THE 360 VIEW, I WANT
TO TALK ABOUT THE AND CONSUMER SPECIFICALLY UNDERSTAND HOW THESE PROGRAMS FEEL AND WHAT
THEY MEAN TO THREE DIFFERENT GROUPS OF PEOPLE. SENIORS, PEOPLE WITH DISABILITY, AND LOWVINCOME
FAMILIES. I WANT TO START WITH YOU, NANCY. WHAT DO THESE PROGRAMS MEAN FOR SENIORS?>>WELL, THANK YOU FOR HAVING ME TODAY. I APPRECIATE A LOT, ESPECIALLY BEING WITH
THE CMS STAFF.^ I STARTED MY CAREER NOT QUITE 50 YEARS AGO IN THE MEDICAID PROGRAM ACROSS
THE STREET IN WHAT WAS THEN CRS, I THINK. SO IT’S VERY NICE TO BE IN THE COMPANY OF
FORMER COLLEAGUES. IT’S HARD TO UNDERSTAND UNDERSTATE AND I THINK
BOTH THE SECRETARY AND THE VIDEO DID PROBABLY A BETTER JOB THAN I CAN OF HOW IMPORTANT THIS
PROGRAM IS TO THE SENIORS IN AMERICA. IT IS QUITE LITERALLY A HEALTHCARE AND ECONOMIC
LIFELINE. HARD TO IMAGINE THAT WHEN MEDICARE PASSED
ONLY ONE OUT OF EVERY FOUR PEOPLE HAD HEALTH INSURANCE.^ AND IF YOU GOT SICK, IT LITERALLY
COULD BE FINANCIAL DEVASTATION. THIS IS IMPORTANT TO AARP BECAUSE OUR FOUNDER
STARTED THE ORGANIZATION AFTER VISITING A FORMER COLLEAGUE WHO WAS LIVING IN A CHICKEN
COUPE BECAUSE SHE COULDN’T IMPORTANT AFFORD TO PAY FOR HEALTHCARE AND HOUSING AND THAT
WAS THE BEGINNING OF THE NATIONAL RETIRED TEACHERS ASSOCIATION, WHICH BECAME AARP, AND
OF COURSE TODAY WE HAVE 44.9 MILLION POEPLE AH SENIORS WHO ARE ENJOYING MEDICARE. I THINK WHAT’S IMPORTANT IS IT IS AN UNUSUALLY
POPULAR PROGRAM ACROSS ALL AGES WITHIN THE SPECTRUM AND ALL KINDS OF POINTS OF VIEW. AND PART OF THAT I THINK IS THAT PEOPLE CONTRIBUTE
TO MEDICARE. THAT’S A CHALLENGE FOR SOME STILL IN TERMS
OF COST, BUT THERE ARE PREMIUMS, DEDUCTIBLES AND COPAYS. SO IT’S EVERYBODY’S PROGRAM THEMSELVES. AND
I THINK THAT’S A VERY IMPORTANT POINT TO MAKE. MEDICARE, IN FACT, FOR THE AVERAGE BENEFICIARY,
DOESN’T COVER AROUND $4500. SO IT IS VITAL BUT IT IS ALSO PART OF THAT
KIND OF DAILY EXPENSE. AS IS OFTEN THE CASE I THINK THAT POINT WAS
CAPTURED THE BEST BY A NEW YORKER CARTOON. PICTURE A NUMBER OF UNSAVORY CHARACTERS SITTING
AROUND THE TABLE WITH WHISKEY BOTTLES AND CIGARS AND ONE SAYS FOR ME CRIME PAYS, WHAT
MEDICARE DOESN’T COVER” AND THAT KIND OF PUTS IT IN PERSPECTIVE FOR SOME. WE’VE MADE IMPROVEMENTS IN MEDICARE OVER THE
LAST FEW YEARS, THE AFFORDABLE CARE ACT IMPROVED COVERAGE FOR PRESCRIPTION DRUGS AND ADDED
A LOT OF PREVENTIVE SERVICES THAT ARE IMPORTANT TO SENIORS. AT THE SAME TIME IT DOESN’T COVER DENTAL,
HEARING, VISION, A LOT OF CHALLENGES FOR SENIORS AHEAD. BUT WITH ALL OF THIS, THE POINT IS AND I THINK
PEOPLE HAVE MADE IT BEAUTIFULLY I THINK IN THE TWO VIDEOS, THAT THIS PROGRAM IS ESSENTIAL
FOR THE WELL BEING OF A VERY SUBSTANTIAL PART OF OUR COUNTRY.>>THANK YOU. SISTER CAROL, HOW ABOUT PEOPLE LIVING WITH
DISABILITIES?>>FOR PEOPLE LIVING WITH DISABILITIES, THIS
IS THE ONLY REAL LIFELINE. AND THESE ARE PEOPLE WHO AND YOU SAW THAT
WITH THE CMS EMPLOYEE WITH SIGNIFICANT DISABILITY. BUT AT WORK WORK EVERY DAY. AND A LOT OF THESE FOLKS ARE AT WORK EVERY
DAY. THEY WORK AS HARD AS THEY POSSIBLY CAN. THEY PUSHED THEMSELVES HARDER THAN WE DO,
BUT THEIR NEEDS ARE SO INCREDIBLE THAT A BASIC INSURANCE PROGRAM WON’T COVER IT. AND AS THEY AGE, THEIR NEEDS GET EVEN MORE
SIGNIFICANT. SO AND THEN THERE ARE THOSE WHO NO MATTER
HOW HARD THEY WANT TO, CAN’T WORK. CAN’T FIND EMPLOYMENT. AND ABSOLUTELY DON’T WANT TO JUST BE CLOSETED
AWAY. AND FOR THEM, THESE ARE PROGRAMS THAT ALLOW
THEM TO LIVE WITH DIGNITY, TO HAVE HELP IN THEIR HOME, TO GET SOME TRANSPORTATION TO
DOCTORS, TO BE ABLE TO GET PRESCRIPTIONS FILLED, AND THINGS DONE FOR THEM. AND SO THESE PROGRAMS REFLECT THE BEST OF
OUR NATIONAL CHARACTER, ABOUT HOW WE FEEL, ABOUT THE MOST VULNERABLE AND ANY ONE OF US
OR ANY ONE OF THOSE WE LOVE COULD BE THE NEXT SERIOUSLY DISABLED PERSON. AND IT SAYS A LOT ABOUT THE MORAL FIBER OF
THE AMERICAN CHARACTER THAT WE WANT THESE PROGRAMS TO BE THERE FOR THEM AND THEY DO
MAKE THEIR LIVES SO MUCH MORE FULL, HEALTHY, AND DIGNIFIED.>>THANK YOU. SO QUICKLY DIANE, TALK A LITTLE BIT ABOUT
THE IMPACT OF THESE PROGRAMS, OF LOW INCOME ADULTS AND CHILDREN.>>WELL CLEARLY TODAY ONE IN THREE AMERICAN
CHILDREN DEPEND ON THE MEDICAID PROGRAM OR ITS COMPANIONSHIP FOR THEIR HEALTH INSURANCE
COVERAGE. FOR THEIR HEALTH INSURANCE COVERAGE AS JASON
NOTED GIVING CHILDREN THE ABILITY TO GET EARLY CARE, TO HAVE A HEALTHY START IN LIFE IS REFLECTED
THROUGH LIFETIME EARNINGS THROUGH THE ABILITY TO CONTRIBUTE TO SOCIETY. WE TALKED TO FAMILIES AND ASKED THEM IF THEY
WERE ELIGIBLE FOR MEDICAID OR IF THEIR CHILDREN WERE WOULD THEY ENROLL AND 80% SAID YES, WE’D
TAKE THE OPTION. SO WHILE THE PROGRAM OFTEN HAS A NEGATIVE
OPINION IN MANY OF THE POLICYMAKERS’ VIEWS, IT IS A FUNDAMENTALLY IMPORTANT AND CRITICAL
PROGRAM TO THE POPULATION THAT IT SERVES. PEOPLE NEED THOSE SERVICES. THEY GET THE KIND OF EARLY, AS YOU SAW IN
THE VIDEO, EARLY SCREENING THAT ENABLES THEM TO GET TREATMENT AND NOT TO END UP UNINSURED
AND SICK AND IN OUR HOSPITALS, WHERE THEIR LIFE IS SHORTENED BY THE FACT THAT THEY DIDN’T
GET CARE. SO IT’S BEEN JUST AN INCREDIBLE CONTRIBUTION
TO FAMILIES. WHEN I WORKED HERE AT THE VERY BEGINNING OF
HCFA, BARELY ANY CHILDREN AND ALMOST NO ADULTS WERE COVERED BY THE MEDICAID PROGRAM BECAUSE
IT WAS SO TIED TO THE WELFARE SYSTEM. IT HAS BEEN OUR GREAT CONTRIBUTION, ESPECIALLY NOW
WITH THE AFFORDABLE CARE ACT, TO BREAK THAT TIE AND TO SAY IF YOU ARE LOW INCOME AND NEEDY
AND NEED HEALTH INSURANCE COVERAGE, MEDICAID WILL BE THERE FOR YOU AND I HOPE IN ALL STATES
IT WILL BE THERE FOR YOU BUT IT’S NOT QUITE THERE YET.>>I THINK IN THE LAST TEN MINUTES YOU ALL
CAPTURED PROBABLY THE BEST END TO END 360 VIEW OF THESE PROGRAMS AND WHAT THEY MEAN. AND WITH THAT GROUNDING, WE WILL GO A COUPLE
MORE ROUNDS AND MAYBE A LITTLE BIT RAPID FIRE TO HELP THE AUDIENCE FOCUS ON THE FUTURE AND
UNDERSTAND THE MOST IMPORTANT THINGS IN THE PROGRAMS FOR THE NEXT 50 YEARS. SO I AM LOOKING
FOR CHALLENGES. I AM LOOKING FOR OPPORTUNITIES. SO NANCY, BEGINNING WITH YOU. THE FACE OF THE CONSUMER IS CHANGING VERY
RAPIDLY. MUCH MORE DIVERSE, MANY MORE LANGUAGES, MORE
CHRONIC CONDITIONS, OLDER, BUT ALSO MORE DEMANDING. TEN MILLION TIMES A DAY PEOPLE ARE ACCESSING
THE SYSTEM.^ WE GET 750,000 PAGE VIEWS ON THE MEDICARE.GOV WEBSITE AS AN EXAMPLE. 70,000
CALLS TO 1-800-MEDICARE STARS, DATA INFORMATION. HOW BEST TO MEET THE CONSUMER CHALLENGE AHEAD?>>WELL, I THINK YOU’VE DESCRIBED IT AND IT’S
ONLY GOING TO GROW. I THINK THE IMPORTANT STEPS YOU ALL HAVE TAKEN
FOR TRANSPARENCY AND INFORMATION ARE THE OBLIGATION THEN ON THE CONSUMERS IS TO BE ABLE TO BE
ABLE TO UNDERSTAND IT AND NAVIGATE THROUGH THE SYSTEM. AND I THINK THAT IS THE SINGLE BIGGEST CHALLENGE
IN THIS PERIOD OF CHANGE. IF THERE IS A DIZZYING ARRAY OF ACRONYMS. THE HEALTHCARE SYSTEM AND DELIVERY SYSTEM
IS CHANGING RAPIDLY AND BEING ABLE TO, ON THE PART OF YOUR ORGANIZATION AND ALL OF OURS,
TO HELP PEOPLE UNDERSTAND HOW TO MOVE THROUGH THE SYSTEM IS GOING TO BE A VERY, VERY BIG
CHALLENGE. AND AS YOU POINT OUT, NEEDING TO DO IT IN
VARIOUS LANGUAGES AND WITH DIFFERENT PEOPLE HELPING.>>SO STEVE LET’S TALK ABOUT QUALITY IN OUR
PAYMENT SYSTEMS A LITTLE BIT. I HEAR FREQUENTLY HOW IT’S IMPOSSIBLE TO BE
ABLE TO RUN QUALITY CARE AND PARTICULARLY TO DIFFICULT TO TREAT POPULATIONS OF LOW SOCIOECONOMIC
STATUS. NOW I SIT HERE AND AS THE SECRETARY SAID I WANT TO REWARD THE INSTITUTION
IN THE COMMUNITY THAT’S PROVIDE THE HIGHEST QUALITY. HOW DO WE DO ALL THAT WITHOUT BREAKING THE
SYSTEM? CAN THE PROVIDER COMMUNITY, THE DELIVERY SYSTEM
COMMUNITY GET THERE?>>SO ABSOLUTELY. I BELIEVE THAT THE ENTIRE SYSTEM CAN MOVE
AWAY FROM FEE FOR SERVICE AND TOWARDS VALUE BASED PURCHASING. THE INCENTIVES IN MY MIND CREATE OVERUSE,
ARE NOT IN LINE WITH QUALITY AND ARE EXPENSIVE. I RECOGNIZE THAT IT TAKES TIME AND YOU NEED
TO GEAR UP, TO MOVE IN THAT DIRECTION. AT MONTIFIORE WE’VE BEEN MOVING IN THAT DIRECTION
FOR OVER 20 YEARS. AND PRESENTLY OF THE MILLION PATIENTS THAT
WE TAKE CARE OF,FOR ALL OR MOST OF THEIR CARE, APPROACHING 500,000 ARE EITHER IN FULL RISK
TRANSFER OR IN A VALUE BASED PURCHASING, INCLUDING THE PIONEER ACO. AND REPEATEDLY WE’VE PROVEN
THAT THAT IS A BETTER WAY TO LOWER THE EXPENSE, RAISE THE QUALITY, AND INCREASE PATIENT SATISFACTION
BECAUSE WE CAN WRAP OUR ARMS AROUND PATIENTS, ESPECIALLY MEDICARE AND MEDICARE PATIENTS,
WHICH AT TIMES HAVE DIFFICULTY NAVIGATING THE SYSTEM. AND PROVIDING THE GAPS THAT EXIST
IN THE PRESENT SYSTEM. SO I THINK IT’S TOTALLY DOABLE, AND I APPLAUD
CMS AND I APPLAUD NEW YORK STATE IN ENCOURAGING US ALL TO MOVE IN THAT AREA.>>SISTER CAROL, AS YOU SAID THESE PROGRAMS
DON’T LIVE IN A CONSTANT WORLD. NEW CHALLENGES COME AT US EVERY DAY AND I
WILL THROW A FEW OUT THERE. NEW ADVANCES IN HIGH PRICE MEDICATIONS IN
TECHNOLOGY, MULTIPLE CHRONIC CONDITIONS, THENEEDS OF THE CAREGIVERS WHO ARE IN SANDWICH GENERATIONS
TREMENDOUS AMOUNT OF CHANGE. YOU DON’T HAVE TO REACT TO ALL OF THOSE
THINGS BUT HOW SHOULD WE REACT AND HOW DO WE KEEP THE PROGRAM VIBRANT AND REACTIVE TO
CONTINUE TO MEET THE NEEDS OF ALL THIS CHANGE?>>I WOULD SAY YOU ARE THE RECIPIENTS OF HUGE
AMOUNTS OF DATA. YOU CAN USE THAT DATA INCREDIBLY WELL AND
I KNOW THAT THERE ARE MANY INITIATIVES GOING ON IN THAT ARENA. YOU ALSO HAVE BEEN ABLE TO GET TO THE LOWEST
ADMINISTRATIVE COST IN SERVING PATIENTS. AND THAT’S NO SMALL TRICK. PARTICULARLY GIVEN THE POPULATION YOU SERVE
SO CAPITALIZE ON THAT, EXPAND IT. I WOULD ALSO SAY YOU HAVE NOW LEARNED WAYS
TO EVALUATE. SO AS NEW DRUGS, AS NEW TREATMENTS, AS NEW
TECHNOLOGY COMES ON, USE YOUR HISTORY TO EVALUATE WHETHER THEY WOULD BE HELPFUL OR NOT. AND ALSO, WHAT THEY ARE WORTH. WHAT THE PRICE IS WORTH IN THAT. I WOULD ALSO SAY TO YOU, AS SOMEBODY WHO HAS
WORKED A LONG, LONG TIME WITH THE ELDERLY, PARTICULARLY, REMEMBER THE KIND OF PATIENT
YOU ARE SERVING. BE CAREFUL NOT TO FALL FOR THINGS THAT SEEM
TO BE A NEW WRINKLE THAT WOULD BE SO HELPFUL. ONE OF THE THINGS THAT I AM PARTICULARLY CONCERNED
ABOUT IS HAVING PATIENTS RECHOOSE EVERY YEAR WHAT PLAN THEY WANT TO GET, GETTING A VOUCHER
INSTEAD OF HAVING THE SECURITY OF THE QUALITY OF PLAN YOU LAID OUT FOR THEM AND THE ABILITY
YOU HAVE TO EXPLAIN IT TO THEM TO HAVE THEM PUT AT THE MERCY OF MANY, MANY MARKETERS. YOU KNOW THE PEOPLE YOU SERVE, AND YOU KNOW
WHAT THEY NEED. SPEAK UP.>>THANK YOU. OKAY, JASON. SO I UNDERSTAND FROM OUR ACTUARIES THAT THE
NUMBER OF SENIORS IN THIS COUNTRY WILL DOUBLE BY 2030. AND THAT MEDICARE SPENDING DOUBLES ON A PER
CAPITA BASIS FOR A 70 YEAR OLD TO A 96 YEAR OLD. SO IN THE SCHEME OF LOOKING AT THE FUTURE
AND THE FEDERAL BUDGET, HOW DO WE THINK ABOUT THESE PROGRAMS? HOW DO WE THINK ABOUT THE DIMINISHING NUMBER
OF TAXPAYERS AND RAPIDLY EXPANDING AND AGING SET OF PEOPLE WE NEED TO SERVE?>>THE BRIEF ANSWER TO THAT IS THAT WE THINK
ABOUT IT QUITE DIFFERENTLY THAN WE DID JUST A FEW YEARS AGO. JUST A FEW YEARS AGO, THE PROJECTION WAS FOR
A QUITE LARGE FEDERAL DEFICIT OVER THE NEXT 75 YEARS. THE LATEST CBO ESTIMATE IS THAT WE DO HAVE
DEBT RISING GRADUALLY AS A SHARE OF THE . GDP OVER THE NEXT 75 YEARS. WHICH WE DON’T
LIKE TO SEE, WE’D LIKE TO SEE IF FLAT OR COME DOWN. BUT ONLY GRADUALLY. AND ONLY A SMALL WHAT ECONOMISTS CALL FISCAL
GAP, A MEASURE OF THE DEFICIT OVER THAT PERIOD OF TIME. AND THE REASON THAT THE FISCAL GAP IS CONSIDERABLY
MORE MODEST THAN WHAT WE THOUGHT IT WAS GOING TO BE A FEW YEARS AGO IS THAT THE MEDICARE
PROJECTIONS HAVE CHANGED SO DRAMATICALLY. WE ARE EXPECTING EVERYTHING YOU JUST SAID,
BUT MEDICARE IN RECENT YEARS HAS LED TO THE OVERALL SLOWDOWN IN THE GROWTH OF HEALTH COSTS. AND WE EXPECT SOME OF THAT TO CONTINUE GOING
FORWARD. PARTLY THAT’S THANKS TO THE AFFORDABLE CARE
ACT AND THE SET OF REFORMS THAT THAT PUT IN PLACE. AND PARTLY IT’S JUST A SET OF CHANGES THAT
ARE REALLY EXCITING GOING ON IN THE HEALTH SYSTEM. SO I THINK THE MOST IMPORTANT QUESTION
FOR US IS FOR THAT REMAINING PORTION OF THE CHALLENGE WHAT TO DO? AND WHAT I WOULD PROPOSE IS AND THE FOCUS
OF THE ADMINISTRATION HAS BEEN TO THINK ABOUT NATIONAL HEALTH EXPENDITURES AS A WHOLE. DON’T
THINK ABOUT, YOU CAN COST SHIFT ALL YOU WANT AND YOU CAN COST SHIFT TO SENIORS AND SOLVE ALL
OUR FISCAL PROBLEMS THAT WAY. THE MATHEMATICS OF THAT MIGHT ADD UP BUT THE
MORALITY DOESN’T AND I DON’T THINK THE ECONOMICS DOES EITHER. WHEN YOU’RE LOWERING OVERALL HEALTH SPENDING,
YOU CAN EXTEND THE SOLVENCY OF MEDICARE REDUCE THE DEFICIT, REDUCE PREMIUMS, HELP SENIORS,
DO ALL OF THOSE THINGS AT THE SAME TIME. SO THAT’S WHY ACOs, AS YOU WERE TALKING ABOUT,
THE TYPES OF THINGS THE INNOVATION CENTER IS DOING WITH BUNDLED CARE, ET CETERA, ALL
OF THAT IS THE RIGHT WAY TO THINK ABOUT THAT REMAINING CHALLENGE. BUT LET’S NOT EXAGGERATE THAT REMAINING CHALLENGE
EITHER.>>SO DIANE, JASON MAKES A CASE THAT WE ARE
GOING TO NEED TO HAVE A RAPIDLY, MORE PRODUCTIVE HEALTHCARE SYSTEM. IN OTHER WORDS, WE’RE GOING TO NEED TO BE
ABLE TO CAKE CARE OF OUR PEOPLE, TREAT THEM BETTER, AND THERE IS CLEARLY INNOVATION AT
THE HEART THAT HAVE, WHETHER THAT’S MOVING PEOPLE INTO LOWER COST CARE SETTINGS, MOVING
TIE FOCUS ON PREVENTION, OR OHTER INNOVATIONS TO MAKE THE HEALTH SYSTEM MORE PRODUCTIVE. THAT’S THE IMPERATIVE. HOW DO WE DO THIS? HOW DO WE ADVANCE THE SYSTEM THIS WAY?>>I THINK WE’RE BEGINNING TO ADVANCE THE
SYSTEM WITH ALL OF THE EFFORTS BOTH ON THE MEDICARE AND MEDICAID SIDE TO LOOK AT HOW
TO MORE EFFECTIVELY PAY FOR CARE BUT ESPECIALLY MORE EFFECTIVELY TO DELIVER IT TO POPULATIONS
TO KEEP THEM IN THE COMMUNITY LONGER SO WE DON’T END UP WITH A HIGH INSTITUTIONAL RATE
TO REDUCE SOME OF THE CHURNING BETWEEN GOING IN AND OUT OF INSTITUTIONS BUT ESPECIALLY
TO MAKE THE CARE ORIENTED TO WHAT THE PEOPLE NEED AND TO HELP COORDINATE IT SO THAT THEY
KNOW WHERE TO GO AND WHAT TO GET. AND WE’RE SEEING A REAL INVESTMENT IN UPFRONT
PRIMARY CARE AND CARE COORDINATION. I THINK WE MAY NEED TO RETURN TO SOME OF OUR
OLD HOME VISITOR PROGRAMS AND OTHER WAYS TO REALLY SEE PEOPLE IN THE SETTING WHERE THEY
ARE SO THAT WE CAN ASSESS THEIR NEEDS. I THINK WE NEED TO LOOK MORE BROADLY BEYOND
HEALTH AT HOW NUTRITION IS AND WHEN YOU LOOK AT THE LOWER INCOME POPULATION, IT’S OFTEN
A PROBLEM CREATED BY OTHER FACTORS THAN THE HEALTH NEEDS THAT CREATE A HEALTH NEED AND
WE REALLY NEED TO BEGIN TO LOOK AT ALL THE SOCIAL DETERMINANTS AND HOW TO GET TO PEOPLE’S
ABILITY TO LIVE HEALTHIER LIVES IN ADDITION TO PAYING FOR IT. BUT I THINK THE OTHER GAP WE HAVE TO LOOK
AT IS WHAT ARE WE GOING TO DO ABOUT THE NEED FOR LONG TERM CARE AS WE HAVE THE SILVER POPULATION
GROWING? BECAUSE MEDICAID CANNOT BE THE SOLE SOURCE
OF HELPING PEOPLE WHO NEED HELP AT HOME AND KEEPING PEOPLE OUT OF INSTITUTIONS WHEN THEY
WANT TO REMAIN IN THE COMMUNITY. AND THAT REMAINS THE BIG UNSOLVED ISSUE OF
THE NEXT 50 YEARS, I THINK, AND I THINK IT HAS TO BE SOLVED BEFORE 50 YEARS IS UP.>>OKAY. SO WE HAVE TIME FOR ONE VERY RAPID FINAL ROUND
AND I AM GOING TO GO IN THIS DIRECTION. AND I’M GOING TO ASK YOU A SIMPLE QUESTION. GIVE HHS A PIECE OF ADVICE FOR HOW WE MUST
SUCCESSFULLY PLAN IN THE NEXT 50 YEARS. JASON?>>YOU JUST HAVE SUCH A GREAT PLATFORM AND
THE PRIVATE SECTOR REALLY CAN FOLLOW YOUR LEAD. SO TAKE ADVANTAGE OF THAT. WHICH IS WHAT YOU ARE DOING. BUT WHEN YOU DO DEMONSTRATIONS, WHEN YOU DO
INNOVATION WHEN YOU FIGURE THINGS OUT AND THE PATHS LIKE DRGS, LIKE ACOS, THAT CAN REALLY
LEAD THE HEALTH SYSTEM AS A WHOLE AND THAT’S A GREAT THING TO TAKE ADVANTAGE OF.>>THANK YOU. DIANE?>>KEEP RECOGNIZING THAT YOU’RE AN INNOVATOR
AND LEADER IN TERMS OF TAKING CARE OF SOME OF THE MOST VULNERABLE IN OUR SOCIETY AND
ALWAYS KEEP THE PEOPLE THAT THESE PROGRAMS SERVE IN MIND AS THE FIRST PRIORITY.>>THANK YOU. NANCY?
I’D SAY KEEP PEOPLE AT THE CENTER, AND WE’VE TALKED ABOUT LONG TERM CARE. WE’RE RECOGNIZING AND WE BELIEVE ALL ORGANIZATIONS
NEED TO BE THE IMPORTANT ROLE OF FAMILY CAREGIVERS. IT’S NOT JUST ABOUT HELPING WITH MEALS. THEY ARE ALSO PROVIDING MEDICAL SERVICES SO
THE KIND OF FAMILY CAREGIVERS THE NEW PROVIDER GROUP IN HEALTHCARE AND EIGHT OUT OF TEN PEOPLE
WANT TO STAY IN THEIR HOMES. THE HOME IS BECOMING A NEW HEALTHCARE ORGANIZATION.
I WAS READING YOU CAN GO TO 50 MILLION SESSIONS IN WASHINGTON, D.C. ABOUT TELEMEDICINE.^ A
SURVEY CAME OUT LAST WEEK. 41% OF AMERICANS DON’T KNOW WHAT TELEMEDICINE
IS AND THAT TO ME UNDER SCORES THE CHALLENGE.>>BIG OPPORTUNITY. STEVEN?
YOU HAVE HUGE LEVERAGE, AND YOU HAVE THE BULLY PULPIT. SO I WOULD SAY CONTINUE TO MOVE HEALTHCARE
AT WRITL ARGE FOR VALUE BASED PURCHASING AND STAY AWAY FROM VOUCHERS. I’D CONSIDER OVER TIME LOWERING THE AGE, NOT
RAISING THE AGE AND I WOULD DO IT BECAUSE IT’S ECONOMIC. IT WOULD SAVE MONEY. I WOULD BEGIN TO USE YOUR INFLUENCE MORE AND
MORE TO STANDARDIZED MEDICAID ACROSS THE COUNTRY AND I EMBRACE THAT YOU WANT TO ENCOURAGE THE
STATES THAT ARE NOT IN IT. AND I BELIEVE THAT IS AN ISSUE THAT IS A THREAT
TO ALL OF THIS IS THE OTHER HUGE DETERMINANTS OF HEALTH, WHICH WAS MENTIONED HERE, WHICH
ARE SOCIAL, WHICH WE NEED TO RECOGNIZE THAT IN EUROPE WHERE THE GDP, THE PERCENTAGE OF
GDP SPENT ON HEALTHCARE IS WAY LOWER. BUT THE OUTCOMES ARE HIGHER JUST BECAUSE THAT
GAP IS FILLED BY SOCIAL SERVICES MORE THAN JUST SOCIAL SECURITY. SO WE NEED TO WORK IN ALL THOSE DIRECTIONS
IN A FINAL PIECE OF ADVICE IS YOUR INFLUENCE ON THE PHARMACEUTICAL COMPANIES COULD BE GIGANTIC.
THERE ARE TWO TROUBLING TRENDS JUST TO MAKE MENTION OF THEM. THERE IS A MERGER GOING ON NOW AROUND GENERICS
THAT MAY RAISE THE PRICE OF GENERICS. AND IN ADDITION TO THAT, THEY’RE A NUMBER
OF VERY IMPORTANT BREAKTHROUGHS WITH PHARMACEUTICALS THAT CAN MAKE ADIFFERENCE BETWEEN LIFE AND
DEATH AND THE PRICE IS TOO HIGH. DON’T BE SHY. [APPLAUSE]>>SISTER CAROL?>>THANK YOU. I WOULD AGREE WITH EVERYTHING THAT HAS BEEN
SAID. SO THAT’S ALREADY A BIG MENU. BUT I WOULD SAY TO YOU JUST BY WAY OF ENCOURAGEMENT
TO DO THESE THINGS IS YOU HAVE ENORMOUS AMOUNTS OF DATA. YOU KNOW WHAT WORKS. YOU KNOW WHAT DOESN’T WORK. YOU KNOW WHAT’S A WASTE. YOU KNOW WHERE THERE IS FRAUD, USE IT. REMEMBER ALWAYS YOU REPRESENT THE CONSCIENCE
OF THIS COUNTRY TO ITS PEOPLE. AND YOU KNOW THESE PEOPLE BEST. YOU KNOW THEIR NEEDS BEST. AND YOU HAVE BEEN FILLING THEM BEST. DO NOT BE DISTRACTED BY THE DETRACTORS WHO,
FOR POLITICAL PURPOSES, WANT TO TRASH ANYTHING THAT GOES ON IN ANY OF THE SAFETY NET SYSTEMS
OR OUR MEDICARE SYSTEM FOR POLITICAL PURPOSES. IGNORE IT. YOU KNOW HOW WELL YOU’RE SERVING PEOPLE AND
YOU KNOW WHAT WOULD SERVE THEM BETTER. GO FOR IT.>>WELL, I CAN’T THINK OF A BETTER NOTE TO
FINISH ON. THANK YOU. [APPLAUSE] THANKS AGAIN TO THAT GREAT PANEL. SO AS WE CLOSE, THIS ANNIVERSARY CELEBRATION
IS ABOUT LOT OF THINGS. AT ITS HEART, IT’S BEST TOLD IN THE STORIES
THAT INSPIRE THIS LEGISLATION 50 YEARS AGO AND INSPIRE TO US TAKE ON THE NEXT SET OF
CHALLENGES THAT SECRETARY BURWELL AND OUR PANEL CLEARLY LAID OUT. AND PLEASE I HOPE YOU HAVE TIME TO TAKE A
LOOK AT SOME OF THOSE STORIES THAT ARE AT THE BACK OF THE ROOM. WHEN I’M ON THE ROAD, I LIKE TO STOP IN PLACES
WHERE OUR BENEFICIARIES RECEIVE CARE AND TRY TO GET A PERSONAL SENSE OF THE QUALITY OF
THE CARE THEY RECEIVE, AS WELL AS THE NEEDS AND CONCERNS OF THE PEOPLE THAT ARE SERVING
OUR BENEFICIARIES. I RECENTLY VISITED A FACILITY IN SAN FRANCISCO
CALLED ON LOK. IF YOU DON’T KNOW IT, IT’S PART OF A VERY
IMPORTANT PROGRAM CALLED THE ALL INCLUSIVE CARE FOR THE ELDERLY LET ME TELL YOU A LITTLE
BIT ABOUT IT. 90% OF THE PATIENTS ARE DUALY ELIGIBLE. THE VAST MAJORITY SPEAK A LANGUAGE OTHER THAN
ENGLISH. THE TYPICAL PERSON CARED FOR IS 83, AND HAS
THE 19 MEDICAL DIAGNOSES, 59% HAVE ALZHEIMER’S OR DEMENTIA. NOW, THE STAFF AT ON LOK WAS CARING, THEY
INTERACT SEAMLESSLY WITH FAMILY CAREGIVERS. THE KITCHEN PREPARES A DIVERSE SET OF ETHNIC
MEALS, AND VANS COME IN FROM ALL OVER THE CITY BRINGING PEOPLE IN THEIR FROM THEIR HOMES
FOR THE DAY TO AN ARRAY OF ACTIVITIES. PLACES LIKE ON LOK REALLY IMPRESS ME. BY ALSO, WHEN I VISIT THEM, FEEL LIKE I’M
SEEING VERY MUCH INTO OUR FUTURE. ALREADY ONE QUARTER OF OUR BENEFICIARIES ARE
OVER 80. AND THE SENIOR POPULATION THAT WE TALKED ABOUT,
AS JASON MENTIONED, WILL DOUBLE IN THE NEXT 5O YEARS. I’M SORRY 15 YEARS. ONE FIVE. SHOULD THAT SCARE US? ACTUALLY, AT HHS, THIS INSPIRES US. WE ARE BUILDING THE TOOLS NOW TO KEEP THE
PROMISE TO THE NEXT 50 YEARS OF BENEFICIARIES. PRECISION MEDICINE.^ A SIGNIFICANT COMMITMENT
TO PREVENTION, INITIATED WITH THE AFFORDABLE CARE ACT HOME AND COMMUNITYB ASED AND LONG
TERM SUPPORT SERVICES AND ACCESS TO DATA AND TOOLS FOR BETTER DECISION MAKING AND A MORE
INTEGRATED, COORDINATE ADD APPROACH TO CARE. IN MEETING PATIENTS IN THE SETTINGS WHERE
THEY ARE MOST COMFORTABLE, THEIR HOMES. I KNOW I SPEAK, FOR MY COLLEAGUES AT HHS,
I SAY WHAT A PRIVILEGE IT IS TO WORK WITH ALL OF YOU TO IMPROVE CARE IN OUR COMMUNITIES
EVERY DAY AND WE ARE VERY EXCITED FOR THE WORK AHEAD. THANK YOU FOR JOINING US TODAY. [APPLAUSE]

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