health care reform in half an hour-detailed
DESCRIPTION
Here is a fuller version of the 'Health Care Reform in Half an Hour' presentation.TRANSCRIPT
Health Care Reform in the United States
WILLIAM M. SAGE, MD, JDTHE UNIVERSITY OF TEXAS AT AUSTIN
APRIL 2012
America’s Health Care Cost Problem
Approximately $3.5 trillion aggregate annual cost
Spending over $8,000 per capitaPremium for family coverage=$12,106 in
2007 Rising much faster than wages A year's salary at minimum wage= $12,168
More than half is publicly funded, amounting to a substantial part of government spending
International Spending on Health:1980–2006
$0
$1,000
$2,000
$3,000
$4,000
$5,000
$6,000
$7,000United StatesGermanyCanadaNetherlandsFranceAustraliaUnited Kingdom
Data: OECD Health Data 2008, June 2008 version.
Average spending on health per capita ($US PPP*)
* PPP = Purchasing Power Parity.
THE COMMONWEALTH
FUND
THE COMMONWEALTH
FUND
Publication: R. E. Leu, F. F. H. Rutten, W. Brouwer et al., The Swiss and Dutch Health Insurance Systems: Universal Coverage and Regulated Competitive Insurance Markets, The Commonwealth Fund, January 2009
What is a potential solution to U.S. federal health care spending?
1. Preventing any growth in pension spending (social security)
2. Eliminating politicians’ pet projects (“pork” or “earmarks”)
3. Cutting back all discretionary federal spending
4. Renting out the U.S. military to other countries
What is a potential solution to U.S. federal health care spending?
1. Preventing any growth in pension spending (social security)
2. Eliminating politicians’ pet projects (“pork” or “earmarks”)
3. Cutting back all discretionary federal spending
4. Renting out the U.S. military to other countries
Federal Budget Trends
Health and State Budgets
Components of total state spending, fiscal 2006
Medicaid, 21.5%Elementary/secondary education, 21.4% (largest until ‘03)Higher education, 10.4% (2nd largest until 1990)Transportation, 8.1%Corrections, 3.4 %Public assistance, 1.8%All other expenditures, 33.4%
Source: NGA/NASBO Dec. 2007 Survey
America’s Health Care Access Problem
47 million Americans (15%) did not have health insurance in 2006
Institute of Medicine estimates that 18,000 Americans die every year from lack of care
There are large racial, ethnic, and socioeconomic disparities in diagnosis, treatment, and medical outcomes
Number of Nonelderly Uninsured Americans,1994 – 2006
40.6 41.743.1 43.9
42.1 40.943.3 43.0
44.446.545.544.7
40.0 39.6
44.80
25
50
Previous Method 1999 Revised Method 2004 Revised Method
* The Census Bureau periodically revises its CPS methods, which means data before and after the revision are not comparable. Comparison across years can be made between 1994 and 1999, 1999 through 2004, and 2004 though 2006.SOURCE: Kaiser Commission on Medicaid and the Uninsured/Urban Institute analysis of March 2007 CPS.
‘94 ‘95 ‘96 ‘97 ‘98
'99*
‘00 ‘01 ‘03‘02
’04* ‘05
39.8
‘06
Patient Protection and Affordable Care Act of 2010
Title I: “Quality, Affordable Care for All Americans” Insurability reforms
Title II: “Role of Public Programs” Affordability reforms
Title III: “Improving the Quality and Efficiency of Health Care” Delivery system reforms
Title IV: “Prevention of Chronic Disease and Improving Public Health” Health reforms
Title V: “Health Care Workforce” Education reforms
Uninsured Nonelderly vs. All Nonelderly,by Family Poverty Level, 2006
36%17%
29%
17%
19%
16%
16% 49%
Uninsured All Nonelderly
46.5 Million 260.0 Million
Under 100%
100% - 199%
200% - 299%
300% +
NOTES: The Federal Poverty Level for a family of four in 2006 was $20,614 (according to the U.S. Census Bureau’s poverty threshold). Family size and total family income are grouped by insurance eligibility. Data may not total 100% due to rounding. SOURCE: Kaiser Commission on Medicaid and the Uninsured/Urban Institute analysis of March 2007 CPS.
Uninsured Rates Among Nonelderly by State, 2005-2006
<13% Uninsured (13 states)13 to 17% Uninsured (18 states & DC)National Average = 18%
SOURCE: Kaiser Commission on Medicaid and the Uninsured and Urban Institute analysis of the March Current Population Survey, 2006 and 2007, two-year pooled data.
AZ
WA
WY
ID
UT
OR
NV
CA
MT
HI
AK
AR
MS
LA
MN
ND
CO
IA
WISD
MOKS
TN
NMOK
TX
AL
MI
ILOH
IN
KYNC
PA
VAWV
SC
GA
FL
ME
NY
NH
MA
VT
NJ
DE
MD
RI
DC
CT
≥18% Uninsured (19 states)
NE
Patient Protection and Affordable Care Act of 2010
Title I: “Quality, Affordable Care for All Americans” Insurability reforms
Title II: “Role of Public Programs” Affordability reforms
Title III: “Improving the Quality and Efficiency of Health Care” Delivery system reforms
Title IV: “Prevention of Chronic Disease and Improving Public Health” Health reforms
Title V: “Health Care Workforce” Education reforms
America’s Health Care Value Problem
Fragmented, variable, poor quality health care delivery Lack of preventive care Poor adherence to clinical “best practices” Frequent medical errors
Mediocre population health Life expectancy at birth ranks 40th in the world Epidemic obesity and associated chronic disease
burden (diabetes, cardiovascular disease) 25% of Americans are obese 45% of Americans have a chronic disease
Lack of Insurance Undermines Preventive and Chronic Care
5046
53
32
0
20
40
60
80
100
Total Uninsuredall year
Uninsuredpart year
Insured allyear
Receipt of Recommended Screening
and Preventive Care,* 2005
Percent of adults
81
41
63
21
0
20
40
60
80
100
Diabetes under control** High blood pressureunder control***
Insured Uninsured
Chronic Disease Under Control: Diabetes and Hypertension,
1999–2004
* Recommended care includes: blood pressure, cholesterol, Pap, mammogram, fecal occult blood test or sigmoidoscopy/colonoscopy, and flu shot within a specific time frame given age and sex. ** Refers to diabetic adults whose HbA1c is <9.0 *** Refers to hypertensive adults whose blood pressure is <140/90 mmHg.
Percent of adults
Poor Coordination: Nearly Half Report Failures to Coordinate Care
Percent U.S. adults reported in past two years:
Source: Commonwealth Fund Survey of Public Views of the U.S. Health Care System, 2008.
No one contacted you about test results, or you had to call
repeatedly to get results
Test results/medical records were not available at the time of
appointment
Your primary care doctor did not receive a report back from a
specialist
Any of the above
25
21
19
15
13
47
0 20 40 60
Doctors failed to provide important medical information to other
doctors or nurses you think should have it
Your specialist did not receive basic medical information from
your primary care doctor
Patient Protection and Affordable Care Act of 2010
Title I: “Quality, Affordable Care for All Americans” Insurability reforms
Title II: “Role of Public Programs” Affordability reforms
Title III: “Improving the Quality and Efficiency of Health Care” Delivery system reforms
Title IV: “Prevention of Chronic Disease and Improving Public Health” Health reforms
Title V: “Health Care Workforce” Education reforms
The problem
“The American public cannot have it both ways. They must
decide what is more important – money and time–
or comprehensive, appropriate care.”
A Kentucky physician opposing
retail medical clinics
Patient Protection and Affordable Care Act of 2010
Title I: “Quality, Affordable Care for All Americans” Insurability reforms
Title II: “Role of Public Programs” Affordability reforms
Title III: “Improving the Quality and Efficiency of Health Care” Delivery system reforms
Title IV: “Prevention of Chronic Disease and Improving Public Health” Health reforms
Title V: “Health Care Workforce” Education reforms
Obesity Trends* Among U.S. AdultsBRFSS, 1985
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14%
Obesity Trends* Among U.S. AdultsBRFSS, 1986
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14%
Obesity Trends* Among U.S. AdultsBRFSS, 1987
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14%
Obesity Trends* Among U.S. AdultsBRFSS, 1988
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14%
Obesity Trends* Among U.S. AdultsBRFSS, 1989
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14%
Obesity Trends* Among U.S. AdultsBRFSS, 1990
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14%
Obesity Trends* Among U.S. AdultsBRFSS, 1991
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19%
Obesity Trends* Among U.S. AdultsBRFSS, 1992
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19%
Obesity Trends* Among U.S. AdultsBRFSS, 1993
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19%
Obesity Trends* Among U.S. AdultsBRFSS, 1994
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19%
Obesity Trends* Among U.S. AdultsBRFSS, 1995
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19%
Obesity Trends* Among U.S. AdultsBRFSS, 1996
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19%
Obesity Trends* Among U.S. AdultsBRFSS, 1997
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% ≥20%
Obesity Trends* Among U.S. AdultsBRFSS, 1998
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% ≥20%
Obesity Trends* Among U.S. AdultsBRFSS, 1999
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% ≥20%
Obesity Trends* Among U.S. AdultsBRFSS, 2000
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% ≥20%
Obesity Trends* Among U.S. AdultsBRFSS, 2001
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
Obesity Trends* Among U.S. AdultsBRFSS, 2002
No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
Obesity Trends* Among U.S. AdultsBRFSS, 2003
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
Obesity Trends* Among U.S. AdultsBRFSS, 2004
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
Obesity Trends* Among U.S. AdultsBRFSS, 2005
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
Obesity Trends* Among U.S. AdultsBRFSS, 2006
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
Obesity Trends* Among U.S. AdultsBRFSS, 2007
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
Patient Protection and Affordable Care Act of 2010
Title I: “Quality, Affordable Care for All Americans” Insurability reforms
Title II: “Role of Public Programs” Affordability reforms
Title III: “Improving the Quality and Efficiency of Health Care” Delivery system reforms
Title IV: “Prevention of Chronic Disease and Improving Public Health” Health reforms
Title V: “Health Care Workforce” Education reforms
