Universal Health Insurance Coverage in the United States

Universal Health Insurance Coverage in the United States: 

Universal Health Insurance Coverage in the United States Brian Wells, MPH University of Florida May 18, 2004

Overview: 

Overview Today’s Health Care System Health Care Statistics Research studies Implementing a Universal System Health Care System Around the World Concluding Thoughts

“Of all the forms of inequality, injustice in health care is the most shocking and inhumane.” - Martin Luther King, Jr.: 

“Of all the forms of inequality, injustice in health care is the most shocking and inhumane.” - Martin Luther King, Jr.

Today’s Health Care System: 

Today’s Health Care System It’s not a system It is a “kaleidoscope of financing, insurance, delivery, and payment mechanisms that remain unstandardized and loosely coordinated” Major part of the system in private hands Market driven economy invites the participation of numerous private entities to serve these functions Source: Lecture, Dr. Robert Garrigues, Ph.D.

Today’s Health Care System: 

Today’s Health Care System This blend of public and private involvement in health care delivery has resulted in: A multiplicity of arrangement which enable individuals to receive health care services Numerous insurance providers using various mechanisms to insure against risk Multiple payers that make their own determinations as to what to cover and how much to pay Source: Lecture, Dr. Robert Garrigues, Ph.D.

Today’s Health Care System: 

Today’s Health Care System Types of Managed Care IPA Single Specialty, Multi-specialty HMO Staff, Group, Network PPO POS Types of reimbursement Discounted fee-for-service Capitation Source: Shortell, Stephen and Kaluzny, Arnold. Health Care Management: Organization Design and Behavior 4 th Edition

Today’s Health Care System Investor Owned v. NFP HMOs: 

Today’s Health Care System Investor Owned v. NFP HMOs Compared with not-for-profit HMOs, investor-owned plans had lower rates for 14 HEDIS quality-of-care indicators. If all women in the United States were covered in investor owned HMOs rather than non-profit plans, there would be an estimated 5925 additional deaths per year from breast cancer alone. Epo and Xigris Source: Himmelstein, D. et al. Quality of Care in Investor-Owned vs. Not-for-Profit HMOs. JAMA. 7 / 14 / 99. Vol. 282 No. 2.

Today’s Health Care System: 

Today’s Health Care System Accounts for 15.5% of GDP Approximately $1.8 trillion $6,167 per capita (2004 projected amount) Projected to reach 18.4% GDP, $3.3 trillion, and $10,709 per capita in 2013 Higher per capita expenditures than any other country Reason? High technology, number of uninsured, multiple payers, medical liability, charity care, etc. Source: Centers for Medicare and Medicaid Services - http://www.cms.hhs.gov/statistics/nhe/projections-2003/ National Center for Health Statistics - http://www.cdc.gov/nchs/

Statistics: 

Statistics

Health Insurance Coverage of the U.S. Population, 2002: 

Health Insurance Coverage of the U.S. Population, 2002 Total = 285 million Note: Data do not total 100% due to rounding. SOURCE: Urban Institute and Kaiser Commission estimates based on March 2002 Current Population Survey.

Health Insurance Coverage of Children and Nonelderly Adults, 2002: 

Health Insurance Coverage of Children and Nonelderly Adults, 2002 Total: 77.3 million Total: 173.6 million SOURCE: Kaiser Commission on Medicaid and the Uninsured (KCMU) and Urban Institute analysis of the March 2003 Current Population Survey. Children Adults under 65

Barriers to Health Care by Insurance Status, 2002: 

Barriers to Health Care by Insurance Status, 2002 Source: NPR/Kaiser Family Foundation/Kennedy School of Government Health Care Survey, May, 2002.

The Consequences of Being Uninsured: 

Research demonstrates that the uninsured: Use fewer preventive and screening services Are sicker when diagnosed Receive fewer therapeutic services Have poorer health outcomes (higher mortality and disability rates) and Have lower annual earnings because of poorer health The Consequences of Being Uninsured

Characteristics of the Uninsured, 2002: 

Characteristics of the Uninsured, 2002 Income Work Status Total = 43.3 million uninsured Age Note: Percentages may not total 100% due to rounding. SOURCE: KCMU and Urban Institute analysis of the March 2003 Current Population Survey. 1 Full-Time Worker 56% No Workers 19% Part-Time Workers 12% 2 or More Full-Time Workers 14%

The Nonelderly Uninsured by Race, 2002: 

The Nonelderly Uninsured by Race, 2002 Total = 43 Million Distribution by Race/Ethnicity Risk of Being Uninsured National Average 17.3% Note: Asian group includes Pacific Islanders; American Indian group includes Aleutian Eskimos. SOURCE: KCMU and Urban Institute analysis of the March 2003 Current Population Survey.

Health Insurance Coverage by Poverty Level, 2002: 

Health Insurance Coverage by Poverty Level, 2002 Employer Medicaid Uninsured Notes: The federal poverty level was $14,348 for a family of three in 2002. Percentages may not total 100% due to rounding. SOURCE: Urban Institute and Kaiser Commission on Medicaid and the Uninsured, analysis of the 2003 Current Population Survey. Other 285 million 52 million 54 million 51 million 128 million

Slide 17: 

Uninsured Rates Among the Nonelderly by State, 2001-2002 <13% Uninsured (19 states) 13 to <17% Uninsured (13 states & DC) > 17% Uninsured (18 states) National Average = 17% SOURCE: KCMU and Urban Institute analysis of the March Current Population Survey, 2002 and 2003, two-year pooled data.

Research Studies: 

Research Studies

Research Studies- States: 

Research Studies- States Missouri Foundation for Health Health care costs $29.4 billion annually Switch to government- run program could save $3 billion in administrative costs If state offered better benefits than 75% of Missourians now get through private health insurance , state could save additional $1.3 billion

Research Studies-States: 

Research Studies-States 1992 Report of the State Health Care Access Commission Publicly financed and publicly administered system would have saved Connecticut $2 billion in 1999 Would cover entire population, cover all necessary medical care, and provide dental coverage Mainly done through cutting administration costs and purchasing medicine in bulk AMA of Massachusetts Study Same Results as the Connecticut study, save as much as $2.7 billion in Massachusetts

Research Studies-National: 

Research Studies-National New England Journal of Medicine- Drs. Himmelstein and Woolhandler, Aug. 2003 Compared spending on health care administration in the U.S. and Canada U.S. spends $209 billion more than Canada Multiple insurers increase costs- 755 in Seattle alone

Research Studies-National: 

Research Studies-National ABC News-Washington Post Poll 8 out 10 respondents felt it was more important to provide coverage for all Americans, even if it means higher taxes 53% of insured say they worry about losing insurance because of job loss Commonwealth Fund Report 32% of uninsured workers in 2001 employed by large companies as compared to 25% in 1987 Center for Studying Health System Change Report Uninsured people’s reliance on emergency care indicates decreased access to other care, such as physicians’ offices

Research Studies-National: 

Research Studies-National Congressional Budget Office Has repeatedly found a single payer, national health care system able to cover prescriptions, catastrophic care, and offer fair wages for less than current national spending PNHP Fact Sheet More than ½ of academic physicians endorse single payer systems Most Americans favor some form of national health insurance

Implementing a Universal Health Care System: 

Implementing a Universal Health Care System

Implementing a Universal System: 

Implementing a Universal System Incremental Approach Expansion of the existing public/private, pluralistic healthcare framework of Medicare, Medicaid, SCHIP (State Children’s Health Insurance Program), HMO’s (Health Maintenance Organizations), PPO’s (Preferred Provider Organizations), and POS’s (Point of Service Plans) Single-Payer Approach Fundamental restructuring of the national/statewide healthcare system to wholly government-financed, universal, public health insurance

How do we pay for it?: 

How do we pay for it? A new study by Harvard Medical School and Public Citizen National health insurance could save at least $286 billion annually on paperwork. Funding will come from Existing government health care spending (more than $1 trillion) A phased-in tax on employers of 7.7% (almost $1 trillion)

General Accounting Office: 

General Accounting Office The GAO has said: "If the US were to shift to a system of universal coverage and a single payer, as in Canada, the savings in administrative costs (10% to private insurers) would be more than enough to offset the expense of universal coverage."

But, think about it for a second: 

But, think about it for a second Employers who provide coverage are already paying 8.5%, on average. That would raise about $920 billion. In addition to that, there's already over a trillion dollars being spent a year in local, state and federal dollars for health care. The American people are already paying for universal health care; they're just not getting it.

Health Care System Around the World: 

Health Care System Around the World

Health Care System Around the World: 

Health Care System Around the World Universal healthcare action network - http://www.uhcan.org

Health Care System in UK NHS: 

Health Care System in UK NHS Set up on 5 th July 1948 Largest organisation in Europe One of the best health services in the world as per WHO Free appointment with GP NHS Funding Mandatory salary contrib. 7% of GDP NHS Staff NHS in England - http://www .nhs.uk/england/

Health Care System in Germany: 

Health Care System in Germany Self governance, decentralization, solidarity Independent of government Sickness fund – multiple non profit insurers 90% of population covered Free appointments with GP Low waiting list

Health Care System in Japan : 

Health Care System in Japan Similar to German Primary health care/Tertiary health care Multiple insurers Mandatory enrollment Residence/employment Premiums proportional to income Low risks/high income  low premiums 7.3% of GDP – half of that in America Social factors Less violence Less drugs Life expectancy/infant mortality rate higher than in America

Health Care System in Canada: 

Health Care System in Canada Setup in 1947 Mandatory insurance Free GP – any number of opinions Funding Graduated progressive income tax Sales tax/payroll taxes Provincial health insurance Federal govt. block grants to provinces Territorial health insurance

Conclusion : 

Conclusion “…the Cubs will play the Red Sox in the World Series long before this problem (uninsured Americans) is solved”- Neil McLaughlin, Modern Healthcare Perhaps the future is not quite that grim “Their system was virtually identical to ours.”- Dr. Steffie Woolhandler referring to Canada’s system in place before national health insurance

Summary: 

Summary Today’s Health Care System Health Care Statistics Research studies Implementing a Universal System Health Care System Around the World