U.S. Health Care System Why is healthcare so controversial in the US?

Do you agree or disagree? 1.Quality, affordable healthcare is basic right that should be guaranteed to all Americans 2.In general, healthcare in the US is very expensive for most people. 3.The reason why healthcare is so expensive for Americans is because insurance and drug companies are more interested in profit than providing care

Do you agree or disagree? 4.Employers with over 50 employees should be required to provide healthcare to their employees as a benefit of employment. 5.All Americans should be required to have at least major medical insurance, (much like the requirement for car insurance) or they should pay a penalty. 6.Insurance companies should be able to drop individuals with “pre-existing” conditions (such as diabetes, cancer, or even obesity)

Do you have a healthcare experience?  Turn to a neighbor and tell them a story about your experience with the healthcare industry – good or bad.

THE FACTS Healthcare in the US

Coverage  Most people (about 53%) in the US get healthcare through private insurance, usually through their employer  About 32% of people get healthcare through a government program  Medicare  Medicaid  That leaves about 15% that are without any insurance

Profile of the uninsured  About 50 million people  Usually under age 65 (19-25 have the highest rates of no insurance)  Usually have incomes less than $25K  Usually have jobs, but are not full-time  9.4% of the uninsured are children  Tend to live in urban areas

The healthcare dollar

HOW DOES THE US COMPARE TO THE REST OF THE WORLD? World Map World Map

Questions to consider:  What country spends the most public dollars on health care? Private dollars?  What % of GDP is spent on health care?  What is the per capita rate?  How long do people live?  How many babies die at birth?  Do these numbers tell us anything about how healthy we are as a nation?

Financing Public versus Private Spending, 2003 Source: OECD Health Data 2005 public private

Total Spending on Health Care, 2005 Source: OECD Health Data 2007 International perspective

Health Care Spending per Capita, 2005 Source: OECD Health Data 2007 International perspective

Health status and outcomes Life Expectancy at Birth, Source: OECD Health Data 2007

Health status and outcomes Infant Mortality, Source: OECD Health Data 2007

Coverage Health Insurance Coverage of the Non-elderly Population, 2003 Source: Kaiser Commission on Medicaid and the Uninsured (KCMU) and Urban Institute analysis of the March 2004 Current Population Survey

Financing Where the Health Care Dollar Came From, 2003 Source: Centers for Medicare & Medicaid Services, Office of the Actuary, National Health Statistics Group

Financing Where the Health Care Dollar Went, 2003 Source: Centers for Medicare & Medicaid Services, Office of the Actuary, National Health Statistics Group

Employer-sponsored insurance  Offered by employers as part of benefits package  Run by private insurance companies (for-profit and non-profit)  Employer pays bulk of premium; employee pays remainder  Erosion of employer-sponsored insurance in recent years

Individual insurance  Purchased directly by people who do not get coverage through their employers  Non-group (individual) plans  Premiums based on individual health risk  Very expensive

Medicare  Covers elderly (ages 65 and older) and non- elderly with disabilities  Administered by the federal government  Paid for by:  Federal income taxes  Payroll taxes  Out-of-pocket payments by enrollees

Medicaid  Covers certain low-income individuals; not every low- income person is covered!  Administered by state governments  Benefits are fairly comprehensive, but many providers won’t take care of Medicaid patients

Profile of the uninsured  47.0 million Americans  81% from working families  52-59% from low-income families (200% FPL)  80% are adults  50% are ethnic minorities  79% are American citizens Source: Kaiser Commission on Medicaid and the Uninsured Source: US Census Bureau

Other public insurance programs  Veterans Health Administration  Indian Health Service

Financing Individuals/Businesses Government Health Service Providers PrivateInsurers premiums taxes direct/out-of-pocket payments Medicare, Medicaid, SCHIP, VA, IHS payments to providers public employees’ premiums subsidies

Financing Individuals/Businesses Government Health Service Providers PrivateInsurers premiums taxes direct/out-of-pocket payments Medicare, Medicaid, SCHIP, VA, IHS payments to providers public employees’ premiums subsidies

Financing Individuals/Businesses Government Health Service Providers PrivateInsurers premiums taxes direct/out-of-pocket payments Medicare, Medicaid, SCHIP, VA, IHS payments to providers public employees’ premiums subsidies

Financing Individuals/Businesses Government Health Service Providers PrivateInsurers premiums taxes direct/out-of-pocket payments Medicare, Medicaid, SCHIP, VA, IHS payments to providers public employees’ premiums subsidies

Financing Individuals/Businesses Government Health Service Providers PrivateInsurers premiums taxes direct/out-of-pocket payments Medicare, Medicaid, SCHIP, VA, IHS payments to providers public employees’ premiums subsidies

HOW DOES THE US COMPARE?

The patchwork employer- sponsored VAMedicare individual employer- sponsored IHS Medicaid SCHIP Medicare VAMedicare employer- sponsored Medicaid

THE HEALTHCARE REFORM ACT What has changed and why?

PPACA (OBAMACARE) Patient Protection Affordable Care Act

Provisions of the Law  Will cost $940 billion over 10 years  Incomes above $250K will pay additional 3.8% tax on investment income  Tanning tax  Expands Medicare and Medicaid  By 2014, insurance companies can no longer deny people for pre-existing conditions (already in place for kids)  Young adults can stay on parents’ insurance until age 26

 All people must have insurance by 2014 or face a $695 fine  This piece has been challenged in court and the Supreme Court decided recently that the provision is constitutional  Illegal immigrants will not be allowed to buy insurance, even if they pay with their own money  Employers (over 50 employees) will be fined if they do not offer an insurance plan to employees

THE CASE AGAINST PPACA

Violates Liberty  It’s unconstitutional  No where else does has the federal government regulated one’s right buy something (commerce clause)  It’s unenforceable  It would take a mass audit of citizens to know if they were participating or not  Even if it was, the incentive is to avoid the purchase

Affects Jobs, Wages and Prices  If employers are forced to offer a health insurance plan, they will hire fewer people for lower wages to keep costs down  Higher labor costs are passed down to customers through higher prices for goods/services  $2500 per Cadillac is to insure an auto worker

Federalism  PPACA undermines the ability of the states to have programs that best fit their citizens

There is no “right” to healthcare  Rights do not pose an obligation on others (funding healthcare)  Universal access to healthcare would force an obligation by those who can pay onto those who cannot

“Free” is a myth  Politicians cannot create wealth, they can only redistribute it  When prices are artificially low, the demand will skyrocket and shortages will result  The government can force prices down, but not costs. That will force doctors, drug companies and hospitals out of business

SO WHERE IS IT THE BEST? Was Michael Moore telling the truth?

Canada  1 in 6 have trouble getting routine care  Wait times are long  4 weeks for a CT scan/ultrasound  8 weeks for an MRI  1 in 9 Canadian doctors have left to practice in the US  Costs are rising

France  High cost: 10% of household income for healthcare  The system is in debt  Doctors are not paid well  Hiring is impeded because of high costs to the employers

USACanadaFrance Universal Healthcare? NoYes Vacation Time2 weeks? (No government set minimum) 3 Weeks6 weeks/35 hour work week Maternity Leave6 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/yearFree TaxesLow (22%) Take home: $39,000 Medium (26%) Take home: $37,000 High (46%) Take home: $27,000 Unemployment Rate9.5%8.5%11% Prison Rate (per 100,000 people)