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U.S. Health Care SystemU.S. Health Care System
Why is healthcare so controversial in the US?Why is healthcare so controversial in the US?
Do you agree or Do you agree or disagree?disagree?1.1. Quality, affordable healthcare is basic Quality, affordable healthcare is basic
right that should be guaranteed to all right that should be guaranteed to all AmericansAmericans
2.2. In general, healthcare in the US is very In general, healthcare in the US is very expensive for most people. expensive for most people.
3.3. The reason why healthcare is so The reason why healthcare is so expensive for Americans is because expensive for Americans is because insurance and drug companies are more insurance and drug companies are more interested in profit than providing careinterested in profit than providing care
Do you agree or Do you agree or disagree?disagree?
4.4. Employers with over 50 employees should be Employers with over 50 employees should be required to provide healthcare to their employees required to provide healthcare to their employees as a benefit of employment.as a benefit of employment.
5.5. All Americans should be required to have at least All Americans should be required to have at least major medical insurance, (much like the major medical insurance, (much like the requirement for car insurance) or they should pay requirement for car insurance) or they should pay a penalty. a penalty.
6.6. Insurance companies should be able to drop Insurance companies should be able to drop individuals with “pre-existing” conditions (such as individuals with “pre-existing” conditions (such as diabetes, cancer, or even obesity)diabetes, cancer, or even obesity)
Do you have a healthcare Do you have a healthcare experience?experience? Turn to a neighbor and tell them a story Turn to a neighbor and tell them a story
about your experience with the healthcare about your experience with the healthcare industry – good or bad.industry – good or bad.
THE FACTSTHE FACTSHealthcare in the USHealthcare in the US
CoverageCoverage
Most people (about 53%) in the US get Most people (about 53%) in the US get healthcare through private insurance, healthcare through private insurance, usually through their employerusually through their employer
About 32% of people get healthcare About 32% of people get healthcare through a government programthrough a government program MedicareMedicare MedicaidMedicaid
That leaves about 15% that are without any That leaves about 15% that are without any insuranceinsurance
Profile of the uninsuredProfile of the uninsured
About 50 million peopleAbout 50 million people Usually under age 65 (19-25 have the Usually under age 65 (19-25 have the
highest rates of no insurance)highest rates of no insurance) Usually have incomes less than $25KUsually have incomes less than $25K Usually have jobs, but are not full-timeUsually have jobs, but are not full-time 9.4% of the uninsured are children9.4% of the uninsured are children Tend to live in urban areasTend to live in urban areas
The healthcare dollarThe healthcare dollar
HOW DOES THE US COMPARE HOW DOES THE US COMPARE TO THE REST OF THE TO THE REST OF THE WORLD?WORLD?
World Map
Questions to consider:Questions to consider:
What country spends the most public What country spends the most public dollars on health care? Private dollars?dollars on health care? Private dollars?
What % of GDP is spent on health care?What % of GDP is spent on health care? What is the per capita rate?What is the per capita rate?
How long do people live?How long do people live? How many babies die at birth?How many babies die at birth? Do these numbers tell us anything about Do these numbers tell us anything about
how healthy we are as a nation?how healthy we are as a nation?
FinancinFinancingg
Public versus Private Spending, 2003Public versus Private Spending, 2003
Source: OECD Health Data 2005
44.4
58.5
78.2 76.369.9 67.5
81.5 83.3
55.6
41.5
21.8 23.730.1 32.5
18.5 16.7
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
UnitedStates
Switzerland Germany France Canada Australia Japan UnitedKingdom
% o
f Hea
lth S
pen
din
g
publicpublic
privateprivate
15.3
11.610.7
11.1
9.8 9.5
8 8.3
0
2
4
6
8
10
12
14
16
18
UnitedStates
Switzerland Germany France Canada Australia Japan UnitedKingdom
% G
DP
Total Spending on Health Care, 2005Total Spending on Health Care, 2005
Source: OECD Health Data 2007
International International perspective perspective
Health Care Spending per Capita, 2005Health Care Spending per Capita, 2005
Source: OECD Health Data 2007
$6,401
$4,177
$3,287 $3,374 $3,326$3,128
$2,358$2,724
0
1000
2000
3000
4000
5000
6000
7000
UnitedStates
Switzerland Germany France Canada Australia Japan UnitedKingdom
Spe
ndin
g pe
r C
apit
a, U
SD
International International perspective perspective
Health status and Health status and outcomes outcomes
Life Expectancy at Birth, 2004-5Life Expectancy at Birth, 2004-5
Source: OECD Health Data 2007
77.8
81.3
79
80.3 80.2
80.9
82
79
75
76
77
78
79
80
81
82
83
UnitedStates
Switzerland Germany France Canada Australia Japan UnitedKingdom
Yea
rs
Health status and Health status and outcomes outcomes
Infant Mortality, 2004-5Infant Mortality, 2004-5
Source: OECD Health Data 2007
6.8
4.23.9
3.6
5.35
2.8
5.1
0
1
2
3
4
5
6
7
8
UnitedStates
Switzerland Germany France Canada Australia Japan UnitedKingdom
Dea
ths
per
1,00
0 li
ve b
irth
s
CoverageCoverage
Employer-sponsored
62%Private Non-
group5%
Medicaid/ Other Public
15%
Uninsured18%
Health Insurance Coverage of the Health Insurance Coverage of the Non-elderly Population, 2003Non-elderly Population, 2003
Source: Kaiser Commission on Medicaid and the Uninsured (KCMU) and Urban Institute analysis of the March 2004 Current Population Survey
FinancinFinancing g
Other Public12%
Other Private5%
Private Insurance
36%
Out-of-pocket14%
Medicare17%
Medicaid and SCHIP16%
Where the Health Care Dollar Came From, 2003Where the Health Care Dollar Came From, 2003
Source: Centers for Medicare & Medicaid Services, Office of the Actuary, National Health Statistics Group
FinancinFinancing g
Physician and Clinical Services
22%
Nursing Home Care7%
Prescription Drugs11%
Program Administration and Net Cost
7% Other Spending
23%
Hospital Care30%
Where the Health Care Dollar Went, 2003Where the Health Care Dollar Went, 2003
Source: Centers for Medicare & Medicaid Services, Office of the Actuary, National Health Statistics Group
Employer-sponsored Employer-sponsored insuranceinsurance
Offered by employers as part of benefits Offered by employers as part of benefits packagepackage
Run by private insurance companies (for-profit Run by private insurance companies (for-profit and non-profit)and non-profit)
Employer pays bulk of premium; employee pays Employer pays bulk of premium; employee pays remainderremainder
Erosion of employer-sponsored insurance in Erosion of employer-sponsored insurance in recent yearsrecent years
Individual insuranceIndividual insurance
Purchased directly by people who do not get Purchased directly by people who do not get coverage through their employerscoverage through their employers
Non-group (individual) plansNon-group (individual) plans Premiums based on individual health riskPremiums based on individual health risk
Very expensiveVery expensive
MedicareMedicare
Covers elderly (ages 65 and older) and non-Covers elderly (ages 65 and older) and non-elderly with disabilitieselderly with disabilities
Administered by the federal government Administered by the federal government Paid for by:Paid for by:
Federal income taxesFederal income taxes Payroll taxesPayroll taxes Out-of-pocket payments by enrolleesOut-of-pocket payments by enrollees
MedicaidMedicaid
Covers certain low-income individuals; not every low-Covers certain low-income individuals; not every low-income person is covered!income person is covered!
Administered by state governmentsAdministered by state governments
Benefits are fairly comprehensive, but many providers Benefits are fairly comprehensive, but many providers won’t take care of Medicaid patientswon’t take care of Medicaid patients
Profile of the uninsuredProfile of the uninsured
47.0 million Americans47.0 million Americans 81% from working families81% from working families 52-59% from low-income families (200% 52-59% from low-income families (200%
FPL)FPL) 80% are adults80% are adults 50% are ethnic minorities50% are ethnic minorities 79% are American citizens79% are American citizens
Source: Kaiser Commission on Medicaid and the Uninsured
Source: US Census Bureau
Other public insurance Other public insurance programsprograms
Veterans Health AdministrationVeterans Health Administration Indian Health ServiceIndian Health Service
FinancinFinancing g
Individuals/Individuals/BusinessesBusinesses
GovernmentGovernment
Health Service Health Service ProvidersProviders
Private Private InsurersInsurers
premiumspremiums
taxestaxes
direct/out-of-pocket paymentsdirect/out-of-pocket payments
Medicare, Medicare, Medicaid, SCHIP, Medicaid, SCHIP,
VA, IHSVA, IHS
payments to payments to providersproviders
public public employees’ employees’ premiumspremiums
subsidiessubsidies
FinancinFinancing g
Individuals/Individuals/BusinessesBusinesses
GovernmentGovernment
Health Service Health Service ProvidersProviders
Private Private InsurersInsurers
premiums
taxes
direct/out-of-pocket payments
Medicare, Medicare, Medicaid, SCHIP, Medicaid, SCHIP,
VA, IHSVA, IHS
payments to payments to providersproviders
public public employees’ employees’ premiumspremiums
subsidiessubsidies
FinancinFinancing g
Individuals/Individuals/BusinessesBusinesses
GovernmentGovernment
Health Service Health Service ProvidersProviders
Private Private InsurersInsurers
premiumspremiums
taxestaxes
direct/out-of-pocket paymentsdirect/out-of-pocket payments
Medicare, Medicaid, SCHIP,
VA, IHS
payments to payments to providersproviders
public employees’ premiums
subsidies
FinancinFinancing g
Individuals/Individuals/BusinessesBusinesses
GovernmentGovernment
Health Service Health Service ProvidersProviders
Private Private InsurersInsurers
premiumspremiums
taxestaxes
direct/out-of-pocket paymentsdirect/out-of-pocket payments
Medicare, Medicare, Medicaid, SCHIP, Medicaid, SCHIP,
VA, IHSVA, IHS
payments to providers
public public employees’ employees’ premiumspremiums
subsidiessubsidies
FinancinFinancing g
Individuals/Individuals/BusinessesBusinesses
GovernmentGovernment
Health Service Health Service ProvidersProviders
Private Private InsurersInsurers
premiumspremiums
taxestaxes
direct/out-of-pocket paymentsdirect/out-of-pocket payments
Medicare, Medicare, Medicaid, SCHIP, Medicaid, SCHIP,
VA, IHSVA, IHS
payments to providers
public public employees’ employees’ premiumspremiums
subsidiessubsidies
HOW DOES THE US HOW DOES THE US COMPARE?COMPARE?
The The patchwork patchwork
employer-sponsored
employer-sponsored
employer-sponsored
employer-sponsored
employer-sponsored
VAMedicareindividual
employer-sponsored
IHSMedicaid
Medicaid
Medicaid
SCHIP
Medicare
Medicare
Medicare
VA
Medicareemployer-sponsoredMedicaid
THE HEALTHCARE REFORM THE HEALTHCARE REFORM ACTACT
What has changed and why?What has changed and why?
PPACA PPACA (OBAMACARE)(OBAMACARE)
Patient Protection Affordable Care ActPatient Protection Affordable Care Act
Provisions of the LawProvisions of the Law Will cost $940 billion over 10 yearsWill cost $940 billion over 10 years
Incomes above $250K will pay additional 3.8% Incomes above $250K will pay additional 3.8% tax on investment incometax on investment income
Tanning taxTanning tax
Expands Medicare and MedicaidExpands Medicare and Medicaid By 2014, insurance companies can no By 2014, insurance companies can no
longer deny people for pre-existing longer deny people for pre-existing conditions (already in place for kids)conditions (already in place for kids)
Young adults can stay on parents’ insurance Young adults can stay on parents’ insurance until age 26until age 26
All people must have insurance by 2014 or face All people must have insurance by 2014 or face a $695 finea $695 fine This piece has been challenged in court and This piece has been challenged in court and
the Supreme Court decided recently that the the Supreme Court decided recently that the provision is constitutionalprovision is constitutional
Illegal immigrants will not be allowed to buy Illegal immigrants will not be allowed to buy insurance, even if they pay with their own moneyinsurance, even if they pay with their own money
Employers (over 50 employees) will be fined if Employers (over 50 employees) will be fined if they do not offer an insurance plan to employeesthey do not offer an insurance plan to employees
THE CASE AGAINST PPACATHE CASE AGAINST PPACA
Violates LibertyViolates Liberty It’s unconstitutional It’s unconstitutional
No where else does has the federal government No where else does has the federal government regulated one’s right buy something (commerce regulated one’s right buy something (commerce clause)clause)
It’s unenforceable It’s unenforceable It would take a mass audit of citizens to know if It would take a mass audit of citizens to know if
they were participating or notthey were participating or not Even if it was, the incentive is to avoid the Even if it was, the incentive is to avoid the
purchasepurchase
Affects Jobs, Wages and Affects Jobs, Wages and PricesPrices If employers are forced to offer a health If employers are forced to offer a health
insurance plan, they will hire fewer people insurance plan, they will hire fewer people for lower wages to keep costs downfor lower wages to keep costs down
Higher labor costs are passed down to Higher labor costs are passed down to customers through higher prices for customers through higher prices for goods/servicesgoods/services $2500 per Cadillac is to insure an auto worker$2500 per Cadillac is to insure an auto worker
FederalismFederalism
PPACA undermines the ability of the PPACA undermines the ability of the states to have programs that best fit their states to have programs that best fit their citizens citizens
There is no “right” to There is no “right” to healthcarehealthcare
Rights do not pose an obligation on Rights do not pose an obligation on others (funding healthcare)others (funding healthcare)
Universal access to healthcare would Universal access to healthcare would force an obligation by those who can pay force an obligation by those who can pay onto those who cannotonto those who cannot
““Free” is a mythFree” is a myth
Politicians cannot create wealth, they can Politicians cannot create wealth, they can only redistribute itonly redistribute it
When prices are artificially low, the demand When prices are artificially low, the demand will skyrocket and shortages will resultwill skyrocket and shortages will result
The government can force prices down, but The government can force prices down, but not costs. That will force doctors, drug not costs. That will force doctors, drug companies and hospitals out of businesscompanies and hospitals out of business
SO WHERE IS IT THE SO WHERE IS IT THE BEST?BEST?
Was Michael Moore telling the truth?Was Michael Moore telling the truth?
CanadaCanada
1 in 6 have trouble getting routine care1 in 6 have trouble getting routine care Wait times are long Wait times are long
4 weeks for a CT scan/ultrasound 4 weeks for a CT scan/ultrasound 8 weeks for an MRI8 weeks for an MRI
1 in 9 Canadian doctors have left to 1 in 9 Canadian doctors have left to practice in the USpractice in the US
Costs are risingCosts are rising
FranceFrance
High cost: 10% of household income for High cost: 10% of household income for healthcarehealthcare
The system is in debtThe system is in debt Doctors are not paid wellDoctors are not paid well Hiring is impeded because of high costs Hiring is impeded because of high costs
to the employersto the employers
USA Canada France
Universal Healthcare?
No Yes Yes
Vacation Time 2 weeks? (No government set
minimum)
3 Weeks 6 weeks/35 hour work week
Maternity Leave 6 weeks unpaid (FMLA)
1 year at 55% of salary
4-6 months; 16 weeks at 100% salary
Daycare $9000/year $6000/year $2000/year
College $12,000/year $8000/year Free
Taxes Low (22%)Take home: $39,000
Medium (26%)Take home: $37,000
High (46%)Take home: $27,000
Unemployment Rate 9.5% 8.5% 11%
Prison Rate(per 100,000 people)
756 116 96