Transcript The Case for Universal Healthcare Kao-Ping Chua Jack Rutledge Fellow, 2005-2006 American Medical Student Association.

The Case for Universal
Healthcare
Kao-Ping Chua
Jack Rutledge Fellow, 2005-2006
American Medical Student Association
What is Universal Health Care?
What is Universal Health Care?
“No American should lack access to health care
because he or she lacks the ability to pay for it
when needed, and no American should suffer
serious financial distress or personal bankruptcy
as a result of unpaid medical bills.”
Uwe Reinhardt, Princeton health economist
Countries with Universal Health Care
…
(South Africa)
Industrialized countries without universal health care?
only one …
Weighing the Arguments
Moral
Moral
Economic
Economic
Cultural
Cultural
The moral argument for UHC
The Central Moral Question
Is it wrong to deny people healthcare based
on the ability to pay?
Increases in Health Insurance Premiums
Compared to Other Indicators, 1999-2004
16%
14%
12%
10%
8%
5 TIMES!
6%
4%
2%
0%
1998
1999
2000
2001
Health Insurance Premiums
2002
Inflation
2003
2004
2005
Average Weekly Earnings
Source: KFF/HRET Survey of Employer-Sponsored Health Benefits: 1999 – 2004
How Many Uninsured?
45,000,000
Americans
Annual deaths by cause, age 25-64
Homicide
19700
HIV/AIDS
14100
Stroke
19000
Diabetes
17500
Uninsurance
18000
0
5000
10000
15000
20000
25000
The uninsured receive poor
medical care
Inability to fill prescription
Lack of regular healthcare provider or
institution
Poor care of chronic disease
The “unhappy triad” of uninsurance
– Receive less preventive care
– Diagnosed at more advanced disease stages
– Once diagnosed, receive less therapeutic
care
Real-life examples
Statistics don’t tell the full story
Uninsured child
Uninsurance can affect ANYONE
Hi, My name is ______, and I am extremely interested in participating in
whatever small way I can to effect Healthcare Reform in Indiana. My
husband is a [very sick patient], and we were informed last
Wednesday that Anthem Blue Cross of Indiana is going to terminate
his employer's group insurance coverage…[unfortunately], he cannot
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
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
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
raised our children.
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.
The Central Moral Question
Is it wrong to deny people healthcare based
on the ability to pay?
The economic argument for UHC
The central economic question
Will we save money by achieving
universal health care?
A 3 part question
How much would it cost to cover
everyone?
How much does it cost to NOT cover
everyone?
Do the costs of UHC outweigh the
benefits?
How much would it cost to
cover everyone?
The cost
of universal
healthcare to
the government
Additional
healthcare that
would be used
by uninsured if
they had insurance
$34-69 billion
per year
Covering out-ofpocket costs for the
uninsured
Depends on
generosity of
benefits
Reimbursing
providers for
uncompensated care
Depends on
generosity of
benefits
How much would it cost to
cover everyone? (Reinhardt, 2003)
Assume $100 billion cost to government in
the first year of a UHC program
Assume increase of per capita health
spending by 10%/year
Total cost: $1.6 trillion over 10 years,
or about $160 billion per year
Questions to ask
How much would it cost to cover
everyone?
How much does it cost to NOT cover
everyone?
Do the costs of UHC outweigh the
benefits?
How much does it cost NOT to
cover everyone?
IOM: $65-$130 billion in lost productivity
per year
How much does it cost NOT to
cover everyone?
“Job lock” (3.8 million jobs)
Less preventive/chronic disease care 
costly
High rate of medical bankruptcy
Unnecessary use of the ER
How much does it cost NOT to
cover everyone?
Costs of keeping current employer-based
system:
– Loss of global competitiveness
– Strain on businesses
Questions to ask
How much would it cost to cover
everyone?
How much does it cost to NOT cover
everyone?
Do the costs of UHC outweigh the
benefits?
Do the costs of UHC outweigh
the benefits?
Lost productivity
Loss of entrepreneurship
$160
billion per
year
Less preventive care
Unnecessary use of ER
Less global competitiveness*
Strain on business*
UHC coupled with cost controls
would save money
Scenario 1: employer mandate
Scenario 2: expansion of public insurance programs
Scenario 3: creation of new programs for the uninsured
Scenario 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 UHC
The central cultural question
Is universal health care consistent with
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 values
Do we believe in:
Equality and equal
opportunity?
UHC and American values
Do we believe in:
Life, liberty, and the
pursuit of happiness?
UHC and American values
Do we believe in:
Getting good value for
our money?
US Spending on Health Care, 2002
U. K.
Japan
France
Total health care
costs comprise
14% of GDP!
Canada
Germany
Switzerland
$1.7 trillion
U. S.
$-
$1,000
$ Per Capita
$2,000
Public
$3,000
Private
Source: OECD Health Data 2002, Health Affairs 2002 21:88-99
$4,000
$5,000
Best Health Care in the world?
(WHO Rankings 2000)
1. France
2. Italy
3. San Marino
4. Andorra
5. Malta
6. Singapore
7. Spain
8. Oman
9. Austria
10. Japan
11. Norway
12. Portugal
13. Monaco
14. Greece
15. Iceland
16. Luxembourg
17. Netherlands
18. United Kingdom
19. Ireland
20. Switzerland
21. Belgium
22. Colombia
23. Sweden
24. Cyprus
25. Germany
26. Saudi Arabia
27. United Arab Emirates
28. Israel
29. Morocco
30. Canada
31. Finland
32. Australia
33. Chile
34. Denmark
35. Dominica
36. Costa Rica
37. United States of America
38. Slovenia
39. Cuba
40. Brunei Darussalam
Source: World Health Organization, Health Systems: Improving Performance, 2000
Infant Mortality, 2000
Deaths/100,000 Births
8
7
6
5
4
3
2
1
0
U. S.
Canada
Source: OECD, 2003
Australia
France
Italy
Germany
Sweden
Life Expectancy, 2000
80
79.5
79
Years
78.5
78
77.5
77
76.5
76
75.5
75
U. S.
Germany
Source: OECD Health Data 2003
U.K.
France
Italy
Canada
Sweden
The 3 Big Questions
Is it wrong to deny people healthcare
based on the ability to pay?
Will we save money by
achieving universal health care?
Is universal health care consistent with
American values?
Benefits 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?
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 thoughts
“The Americans will
always do the right
thing…after they’ve
exhausted all the
alternatives.”
- Winston Churchill