The Shame Of American The Shame Of American Health CareHealth Care

Why We Don’t Get What We Paid For Why We Don’t Get What We Paid For And How to Fix ItAnd How to Fix It

The Problem Is Simply This:

The U.S. has a third rate health care system that costs more than any in the world.

We Rank 37th In Overall Health Care Performance

World Health Organization report. 2000.

Of course if you can pay, you can get the world’s finest health care here in America. We're talking about care for everyday people.

Yes, in the whole world.Yes, in the whole world. Some examples: Some examples:

$0$1,000$2,000$3,000$4,000$5,000$6,000$7,000

Au

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Can

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Denm

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Fra

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Germ

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J apan

Spain

Sw

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Engla

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USA

Health Spending per cap. OECD Report, 2006. Data, 2004.

A major reason is that A major reason is that private for profit health private for profit health insurance companies play insurance companies play a far larger role in our a far larger role in our system than in any other.system than in any other.

A major reason is that A major reason is that private for profit health private for profit health insurance companies play insurance companies play a far larger role in our a far larger role in our system than in any other.system than in any other.

Health Care Expenditure per CapitaHealth Care Expenditure per Capitaby Source of Funding in 2004by Source of Funding in 2004

Adjusted for Differences in Cost of LivingAdjusted for Differences in Cost of Living Not counting state and local health benefitsNot counting state and local health benefits

$803

$472 $313$582 $396 $389

$359

$2,572

$483 $342$354

$1,611$1,832$1,917$2,176$1,940$2,350

$1,894$2,475

$2,210$2727

$238

$239$370 $28

$113

$444

$906 $148

$0

$1,000

$2,000

$3,000

$4,000

$5,000

$6,000

$7,000

Public Spending Out-of-Pocket Spending Private Spending

a b

A2003 b2002 (Out-of-Pocket)

aa

$6,102

$3,165 $3,158 $3,038 $3,005 $2,876 $2,546

$2,461 $2,249 $2,083

J. Cylus and G. F. Anderson, Multinational Comparisons of Health Systems Data, 2006 (New York: The Commonwealth Fund, Apr. 2007).

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Public Spending

Out of Pocket

Private (Insurance)

Private for-profit Private for-profit health insurance is health insurance is wasteful, inefficient wasteful, inefficient and parasitic.and parasitic.

Private for-profit Private for-profit health insurance is health insurance is wasteful, inefficient wasteful, inefficient and parasitic.and parasitic.

par·a·sitesomething dependent on something else for existence or support without making a useful or adequate return

par·a·sitesomething dependent on something else for existence or support without making a useful or adequate return

PNC Financial Services PNC Financial Services surveyed 200 hospital and surveyed 200 hospital and

insurance executives:insurance executives:

• 96% of all claims must be submitted more than once

• 1 in 5 claims are delayed or denied

• Insurance companies go back to hospitals at least twice for each claim.

The Duke University Hospital has 900 beds and employs

900 billing clerks.

Professor Uwe Reinhardt, Trustee. From PNHP

Profits of the top 12 health insurance and managed care companies, 2006

$13 Billion

You have to deny a lot of claims to make that kind of money

Medicare and other Medicare and other public systems around public systems around the world have far lower the world have far lower administrative costs administrative costs than private for-profit than private for-profit insurance companies.insurance companies.

Medicare and other Medicare and other public systems around public systems around the world have far lower the world have far lower administrative costs administrative costs than private for-profit than private for-profit insurance companies.insurance companies.

Compare Wellpoint, the Compare Wellpoint, the largest US health largest US health insurance company to the insurance company to the Ontario health system. Ontario health system.

Comparable in size but Comparable in size but look at the difference in look at the difference in employeesemployees

Wellpoint and OntarioWellpoint and Ontario

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5,000

10,000

15,000

WellPointInsurance

OntarioPlan

0

2

4

6

8

10

12

WellpointInsurance

OntarioPlan

Million Members EmployeesWoolhandler et al NEJM 2003

Cost of Health Care Administration

USA: 31% of all health care expenditures

Canada: 16%

New England Journal Of Medicine 8/21/2003.Steffie Woolhandler MD, MPH Terry Camphell MHADavid Himmelstein MD.

The Problem Is Private The Problem Is Private Health InsuranceHealth Insurance

Private insurance only Private insurance only works if most of the people works if most of the people who buy it never use it.who buy it never use it.

For example, 80% of the For example, 80% of the people who buy life people who buy life insurance let it lapse insurance let it lapse without collecting.without collecting.

But, everyone needs But, everyone needs health care health care

With what we are already spending, we can have a single payer system far better than Canada’s.

But how will we pay for it?

$6,102

$3,165

$3,158

USA

Canad

a

Fran

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We have already paid for it twice over!

Per capita health care spending

The Polls Show The Polls Show There Is SupportThere Is Support

Associated Press/Yahoo PollAssociated Press/Yahoo PollDec. 14Dec. 14thth 2007 2007

65 percent of Americans support extending Medicare to everyone.

54 percent are willing to identify themselves as single-payer supporters. 

MEDICARE FOR ALLMEDICARE FOR ALL

H.R. 676H.R. 676