A Little Problem of Equity Health Care SpendingPopulation Source: Organization for Economic Cooperation and Development, 2006

MEDICAL CARE GENETICS ENVIRONMENT HEALTH BEHAVIORS MEDICAL CARE 88% OTHER 8% HEALTH BEHAVIORS 4% 10% 20% 50% The Great (And Expensive) Mismatch Sources: Centers for Disease Control and Prevention, University of California at San Francisco, Institute for the Future. Reprinted from Advances: The Robert Wood Johnson Foundation Quarterly Newsletter, 2000, Issue 1, supplement, page 1 “Social” Determinants Influence Health System Spending $2.5 Trillion / Year

Provisions of Major Health Reform Proposals Senate HELP, Senate Finance, House Tri-Committee Common Provisions:  Individual mandate  Medicaid expansion  Premium subsidies – up to 400% FPL  Insurance regulations – renewability, guarantee issue, rating  New insurance gateway(s)

Provisions of Major Health Reform Proposals (2) UnCommon Provisions:  Public insurance option – SFC = “Co-ops”  SCHIP expansion – SFC = to 250%  Employer mandate – not SFC  Primary care – SFC and House Tri = payments  Community prevention  CHCs – Senate HELP = funding to increase # CHCs and school-based clinics

Where the Money Goes (Really), U.S., 2004 Source: Rough calculations based on CMS 2007 reports and estimates of administrative expenditures by UW Health Policy Analysis Program, 1990

The Public Now Underwrites Most U.S. Health Spending Source: US Department of Health and Human Services, 2006; Katz estimate

But the U.S. Does Have More Medical Technology Source: Organization for Economic Cooperation and Development, 1999 MRIs / Million Population

Health Insurance Premiums Outpace Inflation and and Workers’ Earnings

The Big Squeeze: Health care spending displaces education funding Source: Washington State Office of Financial Management, 2008

A Confluence of Ideologies Conservative Values  Taking care of oneself and others  Preventing irresponsible free-riding  Reducing inefficiencies that burden business and entrepreneurialism Liberal Policies  Health coverage security  Mandated universal coverage  Publicly accountable budget, and uniform financing, payment, and benefits