Facilitator: Our focus in this gathering will be the cultural idea that more health care is better health care.

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1 Handout #1: Conversation Goals and Process Facilitator: The goal of this gathering is to stimulate public conversation about what ordinary people can do to change the culture of excess in health care which leads to too many unnecessary and expensive tests, medications, and procedures. The process was developed by Baby Boomers for Balanced Health Care, a citizen action group with a mission to change the cultural belief that more health care is better health care. Let s go around the group with each of us reading a sentence. You can take a pass on reading too if you like. Facilitator: Our focus in this gathering will be the cultural idea that more health care is better health care. Group member 1: We will begin by reading some background material together to set the stage for our conversation. Group member 2: Then we will share our thoughts about the sources of the more is better cultural idea. Group member 3: After that, there will be time for anyone who would like to share a personal or family story of too much health care. Group member 4: We ll end with a conversation about what we can do individually and together about this problem. Facilitator: My role will be to pose the questions, make sure everyone gets a chance to talk, and keep track of time. I ll share my own thoughts as well. Keep in mind that I am not here as an expert on health care. Baby Boomers for Balanced Health Care has asked us to pass on learnings and ideas from our discussion. Does anyone have a question at this point about the goal and focus for our gathering?

2 Handout #2: Background Information about Health Care Overuse and Overspending 1. U.S. health care spending is out of control and becoming unsustainable. In 2013 we spent $2.9 trillion (17% of the nation s total output), which is expected to rise to $5.2 trillion in 2023 (19% of output). Unchecked, health care spending will squeeze out funding for all other sectors of society. 2. We are not getting more for all this extra spending. On many key health indicators such as life expectancy and infant mortality, we fall behind other developed nations that spend far less per capita. 3. Overuse in health care is a big contributor to overspending. We get too many unnecessary tests, medications, and procedures. The Institute of Medicine estimates that we spend $210 billion per year in unnecessary services. Examples: antibiotic treatment for viral illnesses, annual EKGs for people without symptoms, diagnostic imaging for low back pain in the absence of danger signs, routine prostate cancer screening, and futile technological care for people who are dying. 4. Unnecessary medical services also cause harm. Harms to patients include medication side effects, complications from unwarranted procedures, false positive tests that lead to more tests and procedures, and suffering from invasive procedures at the end of life. 5. The economic sources of overuse in health care are well-documented. They include greater profits for expensive technologies and medications, a payment system of incentives for providers to do more, and a widespread lack of understanding of what services cost in everyday practice. 6. Cultural sources of overuse are largely unaddressed. There is a widely shared cultural idea that more health care is better health care. Sources: Choosing Wisely: Centers for Medicare and Medicaid Services (2014); Institute of Medicine (2012); Organization for Economic Cooperation and Development (2014); Robert Wood Johnson Foundation (2008, 203/5/153/5/1513); Consumer Reports (2014);

3 Handout #3: Outline And Key Discussion Questions Cultural Sources Of The More Is Better Idea Discussion Question: Assuming you agree that medical overuse is a problem and that the more is better cultural belief is a contributor, what do you think are the sources of this belief? Why do so many of us assume that we are getting better care when it s newer, more expensive, and involves more things being done to us? Personal Stories Of Too Much Health Care Discussion Questions: Part One: Does anyone have a story about a personal or family experience with too much health care, and how it affected you or a loved one? Part Two: Does anyone have a story of how you have resisted the pull towards overuse of health care? It might be a small example or a large one. WHAT WE CAN DO INDIVIDUALLY? WHAT CAN WE DO TOGETHER?

4 5 QUESTIONS to Ask Your Doctor Before You Get Any Test, Treatment, or Procedure Do I really need this test or procedure? Medical tests help you and your doctor or other health care provider decide how to treat a problem. And medical procedures help to actually treat it. What are the risks? Will there be side effects? What are the chances of getting results that aren t accurate? Could that lead to more testing or another procedure? Are there simpler, safer options? Sometimes all you need to do is make lifestyle changes, such as eating healthier foods or exercising more. What happens if I don t do anything? Ask if your condition might get worse or better if you don t have the test or procedure right away. How much does it cost? Ask if there are less-expensive tests, treatments or procedures, what your insurance may cover, and about generic drugs instead of brand-name drugs. Use the 5 questions to talk to your doctor about which tests, treatments, and procedures you need and which you don t need. Some medical tests, treatments, and procedures provide little benefit. And in some cases, they may even cause harm. Talk to your doctor to make sure you end up with the right amount of care not too much and not too little. FOR MORE INFORMATION Use your smartphone to access all of the lists of tests and procedures for you and your physicians to question as part of the Choosing Wisely campaign.

5 Handout #5: About Baby Boomers for Balanced Health Care Baby Boomers for Balanced Health Care is a group of citizen Baby Boomers who believe that health care spending is out of control and will bankrupt our country unless we all take responsibility for changing how we do health care. Our focus is changing the cultural belief that more health care is better health care. In today s health care system, there are too many tests, procedures, and services that don t help and can harm. We are overdosing on health care. In addition to harming individuals, medical overuse deprives our country of resources for other priorities like education, transportation, research, community safety, and human services. We are calling for a new mindset that values balanced health care Goldilocks health care not too much, not too little, but just right. Why citizen groups are necessary: Provider groups and health care organizations are often dismissed as wanting to reduce necessary care in order to increase profits. Without new cultural norms, reform efforts will lead to backlash. Why a Baby Boomers group? We are a generation who came of age in abundance, witnessed medical miracles like the polio vaccine and heart transplants, and came to believe that more is always better in many areas of life, including health care. We were wrong. Now that we are elders, we want to lead a cultural conversation about restoring balance in health care: smarter health care, not more health care. Baby Boomers for Balanced Health Care is Citizen Health Care initiative sponsored by the Citizen Professional Center at the University of Minnesota. Its website, with bios on its members, is The group is currently holding public conversations and developing organizational allies, like the Choosing Wisely campaign and Consumer Reports (ConsumerHealthChoices.org/Choosing) to help amplify its message.