The US Healthcare System (There’s a hole in the bucket!) John C. Nelson, MD, MPH

Cost of Healthcare Healthcare is the most rapidly growing sector of the US economy. Nearly 15% of the GDP. Not only are costs skyrocketing, but the rate of rise is even faster. Over $2 trillion per year in US. $6,820 per capita.

Access to Healthcare US is the only industrialized nation not to have universal access to healthcare. Measurably poorer outcomes in several categories. Comparisons may not be fair, but are highly political and motivate discussion.

Cost of Healthcare Some factors are beyond the control of the healthcare system. Number of people. Increasing age of the population. New diseases. New modalities. Litigation.

Access to Healthcare Lack of health insurance is in itself a risk factor. Uninsured have poorer outcomes. Uninsured have increased mortality rates. Insured patient with AMI. Uninsured patient with AMI. Uninsured patient more likely to die.

Access to Healthcare Lack of insurance leads to other issues. Little or no prenatal care. Later entry into care if available. Increased risk of premature birth. Overall poorer outcomes for the neonate. Also, more costly.

Access to Healthcare IOM Report “As many as 18,000 Americans die annually from diseases that can be prevented or treated but are not because of lack of access to health insurance.” And this is the United States of America! Shameful.

Cost of Healthcare To cover the 47 million uninsured will cost (depending on the method chosen) between $200 and $500 billion extra dollars per year over what we are now spending on healthcare coverage in the United States. Can we afford this?

Cost of Healthcare What is the cost of not covering 47 million of our fellow Americans? That exact question was asked by the Institute of Medicine in a 2002 report. The answer is staggering!

Cost of Healthcare Depends on assumptions made. Actual cost of care received. Cost of wages not earned. Cost of taxes not paid. Cost of goods and services that were not purchased.

Cost of Healthcare IOM estimate of costs of not covering the 47 million uninsured: Up to $3.2 trillion per year!! ($200 to $500 billion per year to pay for insurance for all.)

Cost of Healthcare You ain’t seen nothin’ yet! The human genome. Multiple therapeutic uses. Specific anti cancer drugs tailor made to the tumor and even to the patient. May be able to predict disease. But at what cost?

Scourges of our Society Obesity. Sexually transmitted diseases (STDs.) Teenage pregnancy. Violence. Suicide. Accidents. Alcohol abuse. Tobacco use.

Overall Costs $1.17 trillion of the nearly $2 trillion bill for healthcare is for diseases over which we can exert some control. Over half of what we spend is unnecessary! Common denominator: an element of choice or behavior in every example.

Scourges of Society Over half of the entire cost of healthcare in the United States for one year are actually preventable!

Scourges of Society What is common among all of these conditions? All are behaviorally related. All include an element of choice. All are preventable.

Reasons to Cover All It’s the right thing to do. Public health argument. Costs overall.

Method of Coverage Single payer, government run healthcare for all. Will not work for 3 reasons: Medicare. Medicaid. Tricare.

Method of Coverage Private sector. Team with public sector. Change in tax law will cover 85% of those currently uninsured. Need some creative thinking.

Medicaid Recently served on federal Medicaid Commission. Goal was to make recommendations to improve current Medicaid program. Frustrating experience. Opportunity lost.

Medicaid 60% of Medicaid money is spent on long term care, much of which is used by those for whom Medicaid was never intended. This takes away scarce resources for those who most need them. Benefit package needs to be carefully analyzed and down-sized.

Medicaid Three obvious recommendations. Re-think the long term care obligation of Medicaid. Reduce the number of eligibility classes to two: in or out. Propose an evidence-based benefits package.

What Can We Do Now? Continue the excellent, caring, and compassionate service that you are currently rendering to patients. Improve the overall program. Analyze all that is currently being done and apply an evidence-base to it. Who knows where this may lead?

Globus Relief We take surplus medical goods and equipment and send them around the world for humanitarian use. We also recognize there are domestic needs. We are willing to partner with local groups who could use our help.

Globus Relief Located at: 1775 West 1500 South, Salt Lake City Phone: 801/ Contact: Ashley Robinson