“Improved Medicare For All” for Beginners (Part A)

How is Health Care Currently Financed?

Employer Sponsored Insurance (ESI)

How is Health Care Currently Financed? Employer Sponsored Insurance (ESI) Individual Market

How is Health Care Currently Financed? Employer Sponsored Insurance (ESI) Individual Market VA Health

How is Health Care Currently Financed? Employer Sponsored Insurance (ESI) Individual Market VA Health Medicare

How is Health Care Currently Financed? Employer Sponsored Insurance (ESI) Individual Market VA Health Medicare Medi-Cal (Medicaid)

How is Health Care Currently Financed? Employer Sponsored Insurance (ESI) Individual Market VA Health Medicare Medi-Cal (Medicaid) Out-of-pocket

What Are the Results?

How Do We Compare? Maternal Mortality Life Expectancy Infant Mortality Source: OECD 2011

How Do We Compare?

The Secret Life of the Health Care Dollar $

Private Insurance Takes Its Cut $ 20% Overhead (5% Profit)

Delivery Side Takes Its Hit $ 10% Overhead

Clinical Waste Weighs In $ 20% Lost

The End Result? $ 50% Left for Actual Health Care

The Single-Payer Health Care Dollar $ 5% Overhead (or less)

The Patient Protection and Affordable Care Act (ACA)

Impact of ACA on: The Uninsured # of uninsured reduced from 46 million today to ~26 million in 2019 (most likely even higher due to SCOTUS decision). Safety net hospital funding through Medicare cut by $36 billion through Community health centers receive extra $1 billion annually

Impact of ACA on: The Underinsured If you like your current coverage you can keep it. If you don’t like your current job-based coverage, you HAVE to keep it. Policies required to cover at least 60% of expected health costs – e.g. $2,000 deductible + 20% co-insurance for next $15,000 of care.

Impact of ACA on: Medical Bankruptcy No change for 75% of medical bankruptcy filers who have insurance. Up to 50% reduction among the 25% of the medically bankruptcy who were uninsured in 2007 but will gain coverage under reform. Maximum expected reduction in medical bankruptcies = 12.5%.

Impact of ACA on: Health Care Costs - 1 Expanded Medicaid - $434 billion (maybe) Subsidies for private coverage - $358 billion Small employer tax credits - $37 billion Temporary high risk pools, subsidy for retirees <65, etc – ~$10 billion All figures reflect spending through 2019

Impact of ACA on: Health Care Costs – 2 (savings) Decreased Medicare Advantage/HMO overpayment - $136 billion Decreased Medicare (DSH) payment to safety net hospitals - $36 billion Decreased Medicare fee-for-service payments to doctors/hospitals - $196 billion Other Medicare/Medicaid cuts - $87 billion All figures reflect spending through 2019

Impact of ACA on: Cost Control Provisions Insurance exchanges Health information technology Comparative effectiveness research Fraud and abuse prosecution/recovery Alternatives to F-F-S (experiments) Coverage of preventive services Tax on “Cadillac” coverage Malpractice reform (experiments) Medicare advisory board

Health Reform Bill: Proven Cost Control Provisions

Impact of ACA on: Administrative Costs IRS cost to enforce mandate - $5-10 bil Running insurance exchanges - ~4% of premiums (based on Massachusetts) Insurance overhead - ~13% of new premium revenues = $42 billion Cap on insurance overhead - ???? Standardized claim forms - ????

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