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Charity is no substitute
for justice withheld.
St. Augustine
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U.S. Health System is Too Costly
• We spend twice as much as other advanced countries
• Medical bills leading to personal bankruptcy
• Employee insurance costs threaten global competitiveness
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Health Care Spending per Capita in 2004
$2,083$2,249
$2,546$2,571
$2,876$3,005$3,041$3,159$3,165
$6,102
$0
$1,000
$2,000
$3,000
$4,000
$5,000
$6,000
$7,000
United
States
Canada France Netherlands Germany Australia OECD
Median
United
Kingdom
J apan New
Zealandaa
Source: The Commonwealth Fund, calculated from OECD Health Data 2006.a2003
a
Adjusted for Differences in Cost of Living
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Americans Pay Twice: First, through our TAXES -
Americans, including the uninsured, paid ~$1.2 TRILLION in 2009 in government subsidies to:–insurance companies–HMOs–hospital chains–drug companies–the health industry.
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Public Spending on Health Care per Capita in 2004*
Total Public spending Divided by Total National Population
Adjusted for Differences in the cost of Living
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Americans Pay Twice:A Second time, as PATIENTS -
Unlike taxpayers in other advanced nations, Americans then have to pay a second time for their health care. Americans spent $1.3 TRILLION in 2009, on top of what they paid in taxes, for;– care not covered by insurance– private insurance premiums– deductibles – co-payments– other direct payments.
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Health Care Expenditure per Capita by Source of Funding in 2004
$803
$472 $313$582 $396 $389
$359
$2,572
$483 $342 $354
$2727$2,210 $2,475
$1,894$2,350
$1,940 $2,176 $1,917 $1,832 $1,611
$239
$238
$148$906
$444
$113$28$370
$0
$1,000
$2,000
$3,000
$4,000
$5,000
$6,000
$7,000
United
States
Canada France Netherlands Germany Australia United
Kingdom
OECD
Median
J apan New
Zealand
Private Spending
Out-of-Pocket Spending
Public Spending
a b
a2003b2002 (Out-of-Pocket)
aa
Source: The Commonwealth Fund, calculated from OECD Health Data 2006.
Adjusted for Differences in Cost of Living
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U.S. Health System is of Poor Quality
• Despite high quality of doctors and other health professionals, fragmentation of U.S. systems limits their ability to provide good care.
• Up to 98,000 patient deaths annually due to system failures. (Institute of Medicine, 2000)
• 18,000 preventable deaths each year among those who are uninsured, due to the inability to access effective, timely care. (Institute of Medicine, 2003)
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U.S. Health System is UNJUST
• 47 million Americans, most in working families whose taxes subsidize the health care system, have no insurance.
• At least that many more are underinsured. They have insurance, but it doesn’t begin to cover their needs.
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U.S. Health System is UNJUST The system perpetuates sharp racial disparities
in health:
– An African-American newborn has twice the chance of a white baby of dying before her first birthday.
– Across the age spectrum, minority Americans have less access to needed health care.
– Minority Americans live sicker and die younger.
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U.S. Health System is UNJUST
ALL Americans pay more
and get less than people
in other advanced nations.
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The Status Quo is Unsustainable
• The Centers for Medicare and Medicaid Services (CMS) projects that the cost of Medicaid will double by 2019.
• Health care inflation threatens the solvency of the Medicare trust funds.
• Medical inflation, if not addressed, makes it all but impossible to reduce the national debt.
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Every system is perfectly designed to achieve exactly the results it gets.
Dr. Donald Berwick
Founder, Institute for Healthcare Improvement
Administrator, Centers for Medicare & Medicaid Svcs.
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A Century of Bipartisan Effort
These problems are a century old, as are efforts to address them:
That any sane nation, having observed that you could provide for the supply of bread by giving bakers a pecuniary interest in baking for you, should go on to give a surgeon a pecuniary interest in cutting off your leg, is enough to make one despair of political humanity,”
George Bernard Shaw’s Preface to
“Doctor’s Dilemma” (1906).
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A Century of Bipartisan Effort
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Lessons of the past century:•Real changes only occur when there is strong presidential leadership and control of Congress by the President’s party.•The parties’ rhetoric has been ideologically polarized, but they have often pursued similar policies in efforts to control cost and address gaps in coverage
A Century of Bipartisan Effort
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The Massachusetts Story
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ACA is MA Plan +
• Same three legged stool – although subsidize up to 400% of poverty
• But also adds financing– Reductions in Medicare overpayments– Tax on wealthiest families
• And takes on cost control– Five innovative strategies provide a key first
step towards tackling the cost problem
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What Will ACA Do? Coverage
• 32 million more Americans (CBO)
• 15,000 persons each year will avoid death due to lack of insurance
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Coverage for Those with Pre-Existing
Conditions
A Consumer-Friendly Marketplace
Coverage Regardless of Workplace
Limits on Out-of-Pocket Costs
Subsidies for Middle-Income Families
Accountability for Insurer Spending
Protections against Losing Coverage
Affordable Care Act- The Basics
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Tax Credits for Small Businesses
Addresses Health Disparities
Coverage for Young Adults
Coverage for Low-Income Families
Help for American Indians and Alaska Natives
Help for Seniors and People with Disabilities
Help for People Who Need Long-Term Services
Investment in Preventive Care
The basics. Part 2
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Coverage for Those with Pre-Existing Conditions
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AConsumer-
FriendlyMarketplace
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Coverage Regardless
Of YourWorkplace
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Limits onOut-of-PocketCosts
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Subsidies forMiddle-Income
Families
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AccountabilityFor InsurerSpending
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ProtectionAgainst Losing
Coverage
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Tax CreditsFor Small
Businesses
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Addresses Health
Disparities
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CoverageFor Young
Adults
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Coverage forLow-Income
Families
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Help for Seniors andPeople withDisabilities
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Repeal Undoes it All
• Poorer health, more deaths • Unfair, expensive insurance market that leads to
economic instability and medical bankruptcy• A less efficient job market where individuals lack
the freedom to change jobs• Continued free-riding by those who pass billions
of dollars in care costs onto the insured• A massive decline in private insurance coverage• Huge and unsustainable increases in budget
deficits reaching the trillions of dollars over coming decades
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This is our best hope for our community
• There is no proposal now on the table that covers even 10% as many persons as ACA
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For more information:
• On America’s health care system and how it measures up:– www.commonwealthfund.org– www.kff.org
- Atul Gawande, “The Hot Spotters:Can we lower medical costs by giving the neediest patients better care? The New Yorker, 1-24-11 http://www.newyorker.com/reporting/2011/01/24/110124fa_fact_gawande?currentPage=all
Talk to the public about health reform, look to the Herndon Alliance to learn which messages work and don’t work:
http://herndonalliance.org/table/resources/
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• "For me, an area of moral clarity is: you're in front of someone who's suffering and you have the tools at your disposal to alleviate that suffering or even ehttp://www.facebook.com/tnjustice?v=box_3&ref=nfradicate it, and you act. "
-Paul Farmer, founder of Partners in Health and 2009 recipient of the Dietrich Bonheoffer award.
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Gordon [email protected]
Michele [email protected]
www.tnjustice.org615-255-0331
http://www.facebook.com/tnjustice?v=box_3&ref=nf
