HEALTH CARE IN THE U.S.

WHO LIVES?

WHO DIES?

WHO PAYS?

WHO GETS PAID?PLEASE INTERRUPT

“OF ALL OF THE FORMS OF INEQUALITY, INJUSTICE IN HEALTHCARE IS THE MOST SHOCKING AND INHUMANE.”

THE REVEREND MARTIN LUTHER KING , JR.

“HEALTHCARE IS AN ESSENTIAL SAFEGUARD OF HUMAN LIFE AND DIGNITY AND THERE IS AN OBLIGATION OF SOCIETY TO ENSURE THAT EVERY PERSON BE ABLE TO REALIZE THIS FUNDAMENTAL RIGHT.”

JOSEPH CARDINAL BERNADINPASTORAL LETTER ON HEALTHCARE, 10/95

COMPARE COUNTRIESU. S. IS THE ONLY OF THE 10 LARGEST INDUSTRIALIZED DEMOCRACIES (LIDs) THAT LACKS GOVERNMENT GUARANTEED HEALTHCARE & THE ONLY LID IN WHICH HEALTHCARE CAUSES BANKRUPTCY (CAUSE #1 NOW)

WORLD HEALTH ORGANIZATION (WHO) SHOWED U.S. HAS HIGHEST PER CAPITA COST (162% THE AVERAGE OF OTHER 10 LIDs: JAPAN, GERMANY, FRANCE, ITALY, U.K, CANADA, AUSTRALIA, SPAIN, AND NETHERLANDS IN 1998); IN 2003, 162%--> >200%; NOW >250%

U.S. HAS FAR THE HIGHEST ADMINISTRATIVE EXPENSES FOR AND CONTROL OF HEALTHCARE AMONG 10 LIDs

WHAT DO AMERICANS GET FOR THEIR MONEY?

WITH A > 2.5-FOLD EXCESS IN COST IN THE U.S., THERE MUST BE MUCH MORE MONEY BEING SPENT ON RESEARCH IN THE U.S. RIGHT?

WHY THE COST???(NOT QUALITY, NOT RESEARCH)ALMOST UNREGULATED CORPORATE GREED

“FIDUCIARY RESPONSIBILITY”TO STOCKHOLDERS

HUGE ADMINISTRATIVE EXCESSESPHARMACEUTICAL COMPANIESLUCRATIVE, USELESS (+) PROCEDURES

DIAGNOSTIC AND THERAPEUTICDELAY AND DENIAL - NOT JUST THE POORHALF-BAKED CARE“DEFENSIVE MEDICINE”MALPRACTIC INSURANCE (U.S.A.)MEDICAL STUDENT DEBT

WHAT DO BURGER KING AND THE HOSPITAL CORPORATION OF AMERICA (HCA) HAVE IN COMMON?

BURGER KING AND THE HOSPITAL CORPORATION OF AMERICA (HCA) WERE BOTH BOUGHT & RUN BY HEDGE FUNDS SINCE 2002

THE INSURED SHOULD BE CONCERNED FOR THEIR OWN SAFETY

EXAMPLES:LEUKEMIA AT METROBIKER ON SANIBELAETNA >200 TIMES IN 2001 (Consumer’s Union)

MERCER EXECUTIVE: COULD THINK AN INSURANCE POLICY TO BE A CADILLAC; HOWEVER, IT COULD BE A CHEVROLET, AND IT MIGHT BE A BICYCLE WHEN THE INSURED GETS SICK FIVE YEARS FROM NOW.

For-profit insurance companies:Restrict patients choices of

(a) physicians(b) hospitals

Alter therapeutic choicesPay administrators (bonuses)Increase providers’ overheadMake profits for stockholders

Increase charges for the sick

Contribute to politiciansSupport many lobbyists

NUMBER OF INSURED & EMPLOYEES IN SOME MAJOR U.S. INSURERS & CANADIAN PROVINCIAL HEALTH PLANS, 2001

EMPLOYEES/PLAN NAME INSURED EMPLOYEES 10,000 INSURED

U.S. PLANSAETNA 17,170,000 35,700 20.8ANTHEM 7,883,000 14,800 18.1CIGNA 14,300,000 44,600 31.2HUMANA 6,435,800 14,500 22.5MID ATL MED SERV 1,832,000 2,571 14.0OXFORD 1,490,600 3,400 22.8PACIFICARE 3,388,100 8,200 24.2UNITED HEALTHCARE 8,540,000 30,000 35.1WELLPOINT 10,146,945 13,900 13.7

CANADIAN PLANSSASKATCHEWAN 1,021,288 145 1.4ONTARIO 11,742,672 1,433 1.2.

SOURCE: Woolhandler, S. et al. 2003, New England Journal of Medicine 2003; 349, 768-775; data from corporate SEC filings & governments of Saskatchewan and Ontario.

WOOLHANDLER ET AL. CONCLUDED:“IN 1999...ADMINISTRATION ACCOUNTED FOR 31.0 PERCENT OF HEALTH CARE EXPENDITURES IN THE UNITED STATES...”

AARON DISPUTED WOOLHANDER’S MATHEMATICAL ANALYSIS OF THESE COMPLEX SYSTEMS. HE CONCLUDED THAT “EXCESS SPENDING ON HEALTH CARE ADMINISTRATION IN U.S.” IS 159 BILLION, NOT 209 BILLION U.S. DOLLARS.SO WHAT!SOURCE: Woolhandler, S. et al., New England Journal of Medicine 2003; 349, 768-775.

Aaron, H. J., New England Journal of Medicine 2003; 349, 801-803.

I HAVE TRIED TO OUTLINE SOME OF THE REASONS THAT WE GET SO LITTLE AT SUCH A HIGH COST IN THE U.S.

THERE ARE MANY COMPLEX ISSUES. FOR A MORE DETAILED ANALYSIS DESIGNED FOR CITIZENS, NOT SPECIALISTS, SEE THE REFERENCE SHEET THAT IS AVAILABLE HERE TONIGHT.

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