kao-ping chua jack rutledge fellow, 2005-2006 american medical student association the case for...
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Kao-Ping ChuaKao-Ping ChuaJack Rutledge Fellow, 2005-2006Jack Rutledge Fellow, 2005-2006
American Medical Student AssociationAmerican Medical Student Association
The Case for Universal Healthcare
What is Universal Health Care?What is Universal Health Care?
What is Universal Health Care?What is Universal Health Care?
““No American should lack access to health careNo American should lack access to health care
because he or she lacks the ability to pay for itbecause he or she lacks the ability to pay for it
when needed, and no American should sufferwhen needed, and no American should suffer
serious financial distress or personal bankruptcyserious financial distress or personal bankruptcy
as a result of unpaid medical bills.” as a result of unpaid medical bills.”
Uwe Reinhardt, Princeton health economistUwe Reinhardt, Princeton health economist
Countries with Universal Health CareCountries with Universal Health Care
… (South Africa)
Industrialized countries without universal health care?
only one …
Weighing the ArgumentsWeighing the Arguments
Moral
Economic
Cultural
Moral
Economic
Cultural
The moral argument for UHCThe moral argument for UHC
The Central Moral QuestionThe Central Moral Question
Is it wrong to deny people healthcare based Is it wrong to deny people healthcare based on the ability to pay? on the ability to pay?
Increases in Health Insurance Premiums Compared to Other Indicators, 1999-2004
0%
2%
4%
6%
8%
10%
12%
14%
16%
1998 1999 2000 2001 2002 2003 2004 2005
Health Insurance Premiums Inflation Average Weekly EarningsSource: KFF/HRET Survey of Employer-Sponsored Health Benefits: 1999 – 2004
5 TIMES!
How Many Uninsured?
45,000,000 Americans
Annual deaths by cause, age 25-64Annual deaths by cause, age 25-64
18000
17500
19000
14100
19700
0 5000 10000 15000 20000 25000
Uninsurance
Diabetes
Stroke
HIV/AIDS
Homicide
The uninsured receive poor The uninsured receive poor medical caremedical care
Inability to fill prescriptionInability to fill prescriptionLack of regular healthcare provider or Lack of regular healthcare provider or institutioninstitutionPoor care of chronic diseasePoor care of chronic diseaseThe “unhappy triad” of uninsuranceThe “unhappy triad” of uninsurance– Receive less preventive careReceive less preventive care– Diagnosed at more advanced disease stagesDiagnosed at more advanced disease stages– Once diagnosed, receive less therapeutic Once diagnosed, receive less therapeutic
carecare
Real-life examplesReal-life examples
Statistics don’t tell the full storyStatistics don’t tell the full story
Uninsured childUninsured child
Uninsurance can affect ANYONEUninsurance can affect ANYONE
Hi, My name is ______, and I am extremely interested in participating in Hi, My name is ______, and I am extremely interested in participating in whatever small way I can to effect Healthcare Reform in Indiana. My whatever small way I can to effect Healthcare Reform in Indiana. My husband is a [very sick patient], and we were informed last husband is a [very sick patient], and we were informed last Wednesday that Anthem Blue Cross of Indiana is going to terminate Wednesday that Anthem Blue Cross of Indiana is going to terminate his employer's group insurance coverage…[unfortunately], he cannot his employer's group insurance coverage…[unfortunately], he cannot qualify for individual coverage due to his health. qualify for individual coverage due to his health.
So we are between a rock and a hard place and I am being forced to close So we are between a rock and a hard place and I am being forced to close my daycare business which I have ran for 23 years in order to try to my daycare business which I have ran for 23 years in order to try to find a job with benefits so we can have insurance. My husband is also find a job with benefits so we can have insurance. My husband is also looking for a new job in the middle of this health crisis so he too can looking for a new job in the middle of this health crisis so he too can try to get insurance so we can try to hang on to the home where we try to get insurance so we can try to hang on to the home where we raised our children. raised our children.
It is a living nightmare that I know is shared by millions of other It is a living nightmare that I know is shared by millions of other Hoosiers. Please let me know what I can do to help with this initiative.Hoosiers. Please let me know what I can do to help with this initiative.
The Central Moral QuestionThe Central Moral Question
Is it wrong to deny people healthcare based Is it wrong to deny people healthcare based on the ability to pay? on the ability to pay?
The economic argument for UHCThe economic argument for UHC
The central economic questionThe central economic question
Will we save money by achieving Will we save money by achieving universal health care?universal health care?
A 3 part questionA 3 part question
How much would it cost to cover How much would it cost to cover everyone?everyone?
How much does it cost to NOT cover How much does it cost to NOT cover everyone?everyone?
Do the costs of UHC outweigh the Do the costs of UHC outweigh the benefits?benefits?
How much would it cost to How much would it cost to cover everyone?cover everyone?
The cost of universal
healthcare tothe government
Additionalhealthcare that would be usedby uninsured if
they had insurance
Covering out-of-pocket costs for the
uninsured
Reimbursingproviders for
uncompensated care
Depends ongenerosity ofbenefits
Depends ongenerosity ofbenefits
$34-69 billionper year
How much would it cost to How much would it cost to cover everyone? (Reinhardt, 2003)cover everyone? (Reinhardt, 2003)
Assume $100 billion cost to government in Assume $100 billion cost to government in the first year of a UHC programthe first year of a UHC program
Assume increase of per capita health Assume increase of per capita health spending by 10%/yearspending by 10%/year
Total cost: $1.6 trillion over 10 years, Total cost: $1.6 trillion over 10 years,
or aboutor about $160 billion per year$160 billion per year
Questions to askQuestions to ask
How much would it cost to cover How much would it cost to cover everyone?everyone?
How much does it cost to NOT cover How much does it cost to NOT cover everyone?everyone?
Do the costs of UHC outweigh the Do the costs of UHC outweigh the benefits?benefits?
How much does it cost NOT to How much does it cost NOT to cover everyone? cover everyone?
IOM: $65-$130 billion in lost productivity IOM: $65-$130 billion in lost productivity per yearper year
How much does it cost NOT to How much does it cost NOT to cover everyone? cover everyone?
““Job lock” (3.8 million jobs)Job lock” (3.8 million jobs)
Less preventive/chronic disease care Less preventive/chronic disease care costlycostly
High rate of medical bankruptcyHigh rate of medical bankruptcy
Unnecessary use of the ERUnnecessary use of the ER
How much does it cost NOT to How much does it cost NOT to cover everyone? cover everyone?
Costs of keeping current employer-based Costs of keeping current employer-based system: system: – Loss of global competitivenessLoss of global competitiveness– Strain on businessesStrain on businesses
Questions to askQuestions to ask
How much would it cost to cover How much would it cost to cover everyone?everyone?
How much does it cost to NOT cover How much does it cost to NOT cover everyone?everyone?
Do the costs of UHC outweigh the Do the costs of UHC outweigh the benefits?benefits?
Do the costs of UHC outweigh Do the costs of UHC outweigh the benefits? the benefits?
$160 billion per year
Lost productivity
Loss of entrepreneurship
Less preventive care
Unnecessary use of ER
Less global competitiveness*
Strain on business*
UHC coupled with cost controls UHC coupled with cost controls would save money would save money
Scenario 1: employer mandateScenario 2: expansion of public insurance programsScenario 3: creation of new programs for the uninsuredScenario 4: single-payer system
"The issue of universal coverage is not a
matter of economics. Little more than 1% of
GDP assigned to health could cover all.
It is a matter of soul."
- Uwe Reinhardt
The cultural argument for UHCThe cultural argument for UHC
The central cultural questionThe central cultural question
Is universal health care consistent with Is universal health care consistent with American values?American values?
What does the American Dream mean to you? (The Feldman Group, 2005)
What are the main threats to the American Dream? (The Feldman Group, 2005)
UHC and American valuesUHC and American values
Do we believe in:Do we believe in:
Equality and equal Equality and equal opportunity?opportunity?
UHC and American valuesUHC and American values
Do we believe in:Do we believe in:
Life, liberty, and the Life, liberty, and the pursuit of happiness?pursuit of happiness?
UHC and American valuesUHC and American values
Do we believe in:Do we believe in:
Getting good value for Getting good value for our money?our money?
US Spending on Health Care, 2002US Spending on Health Care, 2002
$- $1,000 $2,000 $3,000 $4,000 $5,000
U. S.
Switzerland
Germany
Canada
France
Japan
U. K.
$ Per Capita Public Private
Total health care costs comprise 14% of GDP!
Source: OECD Health Data 2002, Health Affairs 2002 21:88-99
$1.7 trillion$1.7 trillion
Best Health Care in the world? Best Health Care in the world? (WHO Rankings 2000)(WHO Rankings 2000)
Source: World Health Organization, Health Systems: Improving Performance, 2000
1. France2. Italy3. San Marino4. Andorra5. Malta6. Singapore7. Spain8. Oman9. Austria10. Japan
16. Luxembourg17. Netherlands18. United Kingdom19. Ireland20. Switzerland
11. Norway12. Portugal13. Monaco14. Greece15. Iceland
21. Belgium22. Colombia23. Sweden24. Cyprus25. Germany26. Saudi Arabia27. United Arab Emirates28. Israel29. Morocco30. Canada
31. Finland32. Australia33. Chile34. Denmark35. Dominica36. Costa Rica37. United States of America38. Slovenia39. Cuba40. Brunei Darussalam
Infant Mortality, 2000Infant Mortality, 2000Deaths/100,000 BirthsDeaths/100,000 Births
0
1
2
3
4
5
6
7
8
U. S. Canada Australia France I taly Germany Sweden
Source: OECD, 2003
Life Expectancy, 2000Life Expectancy, 2000
75
75.5
76
76.5
77
77.5
78
78.5
79
79.5
80
U. S. Germany U.K. France I taly Canada Sweden
Years
Source: OECD Health Data 2003
The 3 Big QuestionsThe 3 Big Questions
Is it wrong to deny people healthcare Is it wrong to deny people healthcare
based on the ability to pay? based on the ability to pay?
Will we save money by Will we save money by
achieving universal health care?achieving universal health care?
Is universal health care consistent with Is universal health care consistent with
American values?American values?
Benefits for providersBenefits for providers
UHC will…
Allow you to more successfully treat patients
Allow you to be your patient’s doctor, not their financial counselor/social worker.
Allow you to base your decisions on medical care on best practices, not on your patient’s ability to pay
How can you get involved?How can you get involved?Educate yourself and question your assumptions: http://www.amsa.org/uhc
Get involved in a state or national campaign:http://www.amsa.org/uhc
JOIN AMSA!
Parting thoughtsParting thoughts
““The Americans will The Americans will always do the right always do the right thing…after they’ve thing…after they’ve exhausted all the exhausted all the
alternatives.”alternatives.”
- Winston Churchill- Winston Churchill