Before I move on to the subject of Employer Sponsored Insurance or ESI, which cover a majority of citizens I wanted to put together an update on the state of the Health Care Debate.
A number of issues have become clearer over the last few months. On the one hand, the nature of the process initiated by President Obama has been a source of confusion. What I mean is that given the President Obama has chosen the path of letting Congress design the solution- within certain parameters- with some flexibility built in, the fact that there have been several bills in the various committees in the senate and the house of representatives- all works in progress, have created ample room for confusion.
Secondly, the Republicans have taken on the mantle of the protectors of the free-market system. Under this guise they have ladled up familiar free-market oriented guidelines rather than any meaty and detailed prescription for how the problem may be solved. They have also calculated quite shrewdly that causing the Democrats to lose this initiative will be extremely costly for President Obama and the Democrats. All that the so-called Republican Health Care plan contains are the familiar free-market nostrums.
Thirdly, the Democrats have- as always, become victims of their fragmented special interests. So for example, it is not entirely clear whether the objections of the "Blue Dog" Democrats are genuine- which would have implied that they would have come up with serious alternative solutions that would solve the problems, or whether the source of the objections are caused by their alignment with the insurance industry (Center for Responsible Politics: http://www.opensecrets.org/news/2009/08/health-insurers-continue-to-wo.html.)
Lastly and I think most importantly the debate has aroused the familiar tension in American politics- that between a smaller government that serves few non-egalitarian vested interests and a larger government that serves widespread vested interests. This tension has been a deeply ingrained peculiarity of the American political landscape from the founding of the Republic. It has reared its head during any debate where initiatives impacting a larger population have been at play. In more recent history this debate has been displayed during the Great Depression, then again during the formation of the Great Society in the 60's. Egalitarianism has always been a much weaker strain in American politics.
So, why the above description? It stems from the fact that I started this blog with the thought that it was the lack of information about the state of Health Care in the US that was causing the confusion. The thought that information would help clarify the terms of the debate. What has rapidly become obvious is that it is not a lack of information but the trumping by ideology of information that is at the nub of the debate. In fact, from the furious and acrimonious townhalls to the message flowing from Fox television network and from there to the unwillingness of Republicans to be tethered to the facts of the debate, it is clear that information and facts are not really the issue. What has joined the battle are two conflicting visions of America as a country.
Sunday, September 27, 2009
Monday, August 17, 2009
The Uninsured and Under Insured
I decided to tackle the uninsured and under-insured before I started describing the Employee Sponsored Insurance (ESI)- even though ESI covers the largest number of citizens. I was driven to do this because there is so much disinformation on the internet with regards to the uninsured and under-insured.
On the internet, in responses to articles on the health care debate, there is a category of readers with an explicit or implicit bias that those without health care insurance are either illegal immigrants or people who are milking the system. Without a doubt, in any system there is an opportunity for fraud and the opportunity for fraud is not limited to those who cannot afford health care- in this instance, or to the rich (see Enron and any number of Wall Street villains).
So, what is the composition of the 47 million or so without health care insurance? Of necessity this has to be a statistical investigation.
The Current Population Survey (CPS) conducted by the Census Bureau and The Bureau of Labor Statistics is most often used and cited in investigations of the uninsured. The CPS survey is conducted monthly and has a sample size of about 50,000 households.
http://www.census.gov/cps/
Another source of data is the Medical Expenditure Panel Survey (MEPS), which is conducted annually on a smaller sample population, but is focused on households, employers and medical providers. The typical number of families surveyed is around 12,000.
http://www.meps.ahrq.gov/mepsweb/about_meps/survey_back.jsp
Given that it is a statistical analysis, assumptions and conclusions around who the uninsured are, why they are uninsured along with what constitutes affordability for health insurance vary widely. I would recommend looking at conclusions from the Kaiser Family Foundation- "The Uninsured, a Primer" for a sympathetic view of the uninsured population (http://www.kff.org/uninsured/7451.cfm)
For a more hard-headed and analytical view of the uninsured read papers by Lisa Dubay et al from the John Hopkins Bloomberg School of Public Health. For example, see "The Uninsured and the affordability of Health Insurance Coverage"- http://www.healthaffairs.org/RWJ/Dubay2.pdf
Lisa Dubay uses data from the 2005 CPS and estimates that a quarter of the uninsured- approximately 11 million are eligible for public programs but are not enrolled. Another one fifth- approximately 9 million can afford health insurance but choose not to get it. The remainder need help in getting health insurance. It is ony at the end of the paper that she mentions that the individuals that she identifies can afford health insurance, may not have health insurance because their condition may make it unaffordable or unavailable.
I am sure the truth is somewhere in between. The issue is the extent to which higher projected numbers of the uninsured- implying higher program costs, may inhibit the passage of a health care insurance program.
My plan was to give a detailed description of the uninsured, however, watching the opposition to health care reform it has become obvious that this is not a battle over information. It is a battle over ideology- which no amount of data, logic or information can overcome.
For example, on the internet, you see unsubstantiated claims as to the number of illegal immigrants who would soak the citizenry in case there were a program to cover the uninsured. The various government surveys do not ask if a respondent is a legal or illegal immigrant. Hence claims around the number of illegal immigrants who would overwhelm the system are dubious at best.
The nation does need to wrestle with its conscience about the tension that exists between using the available means to control illegal immigration and providing affordable health insurance to those illegal immigrants who fall ill within our borders.
On the internet, in responses to articles on the health care debate, there is a category of readers with an explicit or implicit bias that those without health care insurance are either illegal immigrants or people who are milking the system. Without a doubt, in any system there is an opportunity for fraud and the opportunity for fraud is not limited to those who cannot afford health care- in this instance, or to the rich (see Enron and any number of Wall Street villains).
So, what is the composition of the 47 million or so without health care insurance? Of necessity this has to be a statistical investigation.
The Current Population Survey (CPS) conducted by the Census Bureau and The Bureau of Labor Statistics is most often used and cited in investigations of the uninsured. The CPS survey is conducted monthly and has a sample size of about 50,000 households.
http://www.census.gov/cps/
Another source of data is the Medical Expenditure Panel Survey (MEPS), which is conducted annually on a smaller sample population, but is focused on households, employers and medical providers. The typical number of families surveyed is around 12,000.
http://www.meps.ahrq.gov/mepsweb/about_meps/survey_back.jsp
Given that it is a statistical analysis, assumptions and conclusions around who the uninsured are, why they are uninsured along with what constitutes affordability for health insurance vary widely. I would recommend looking at conclusions from the Kaiser Family Foundation- "The Uninsured, a Primer" for a sympathetic view of the uninsured population (http://www.kff.org/uninsured/7451.cfm)
For a more hard-headed and analytical view of the uninsured read papers by Lisa Dubay et al from the John Hopkins Bloomberg School of Public Health. For example, see "The Uninsured and the affordability of Health Insurance Coverage"- http://www.healthaffairs.org/RWJ/Dubay2.pdf
Lisa Dubay uses data from the 2005 CPS and estimates that a quarter of the uninsured- approximately 11 million are eligible for public programs but are not enrolled. Another one fifth- approximately 9 million can afford health insurance but choose not to get it. The remainder need help in getting health insurance. It is ony at the end of the paper that she mentions that the individuals that she identifies can afford health insurance, may not have health insurance because their condition may make it unaffordable or unavailable.
I am sure the truth is somewhere in between. The issue is the extent to which higher projected numbers of the uninsured- implying higher program costs, may inhibit the passage of a health care insurance program.
My plan was to give a detailed description of the uninsured, however, watching the opposition to health care reform it has become obvious that this is not a battle over information. It is a battle over ideology- which no amount of data, logic or information can overcome.
For example, on the internet, you see unsubstantiated claims as to the number of illegal immigrants who would soak the citizenry in case there were a program to cover the uninsured. The various government surveys do not ask if a respondent is a legal or illegal immigrant. Hence claims around the number of illegal immigrants who would overwhelm the system are dubious at best.
The nation does need to wrestle with its conscience about the tension that exists between using the available means to control illegal immigration and providing affordable health insurance to those illegal immigrants who fall ill within our borders.
Saturday, August 15, 2009
Public and Private Healthcare- Medicaid
Medicaid is the second arm through which the Federal and State governments provide health care. Medicaid served 45 million low income citizens and nearly 14 million elderly and disabled people- a total of 59 million individuals (2005 numbers). This included nearly 9 million low income Medicare beneficiaries for whom it filled Medicare coverage gaps. In the absence of Medicaid, the covered individuals would join the ranks of the uninsured.
Of the 45 million low-income individuals 29.5 million are children. Total Medicaid expenses in 2008 are expected to be $339 billion and are expected to reach $674 billion by 2017.
The Federal government provides matching funds to State spend on Medicaid and there is no cap on this the matching funds. To be eligible for Medicaid, persons must meet certain financial criteria and also fall into a group that is category eligible. States are required to cover certain mandatory groups in order to be eligible for matching funds. The mandatory groups are:
- Pregnant women and children under the age of 6 in families where the family income is below 133% of Federal Poverty Level (FPL). FPL is $27,570 for a family of 4 in 2009.
- Children between the ages of 6-18 with family incomes below 100% of FPL
- Parents with incomes below states' July 1996 welfare eligibility levels (typically below 50% of FPL),
- Elderly and disabled individuals who receive Supplemental Security Income. SSI is given to people who typically have incomes 74% of FPL for an individual.
Families or individuals without children, no matter how poor are excluded- unless they fall into one of the categories above.
Immigrants are not eligible for Medicaid unless they have lived in the US for at least 5 years and meet the eligibility requirements (above)- except for emergency services. Undocumented immigrants are ineligible for Medicaid no matter how long they have lived in the country.
Federal Poverty levels can be viewed at: http://aspe.hhs.gov/poverty/09poverty.shtml
In general they are as follows (annual income):
- single person: $13,530
- 2 people in family: $18,210
- 3 people in family: $22,890
- 4 people in family: $27,570
etc.
For a detailed description of Medicaid, readers are encouraged to go to: http://www.kff.org/medicaid/upload/7334-03.pdf
Other than the mandatory federal coverage rules, states have a lot of leeway in terms of how they want to run Medicaid programs. For example, states can charge beneficiaries premiums, within certain bounds. Total cost sharing cannot exceed 5% of family income in any case. Cost sharing is prohibited for mandatory children.
Enrollment in HMOs is the primary delivery mechanism for Medicaid with nearly 2/3rds of beneficiaries being enrolled in HMOs. In other cases, Medicaid provides services to beneficiaries through a fee-for-service arrangement with providers. So, though Medicaid is publicly financed, health care is purchased through the private sector.
Medicaid also makes special payments to hospitals that serve a disproportionate share of low income and uninsured patients (6% of Medicaid costs).
Medicaid beneficiaries have a positive feedback on the program. Administrative costs are less than 4% of overall program costs. The elderly and disabled make up 25% of all medicaid enrollees and account for 70% of program spend. Children and adults on average cost the program $1,617 and $ 2,012 respectively (2005 numbers). The elderly and disabled account for much larger per capita costs- $11,839 and $13,524 respectively.
Medicaid's growth has also fared much better than the cost growth rates for private insurance. For example, Medicaid costs have been growing at a rate of 4% between 200 and 2006, while monthly premium increases for employee offered insurance increased at a rate of 10% during the same period.
So, overall, it would be fair to say that this government program is run pretty well- in spite of the general perception that the government cannot do anything well.
Of the 45 million low-income individuals 29.5 million are children. Total Medicaid expenses in 2008 are expected to be $339 billion and are expected to reach $674 billion by 2017.
The Federal government provides matching funds to State spend on Medicaid and there is no cap on this the matching funds. To be eligible for Medicaid, persons must meet certain financial criteria and also fall into a group that is category eligible. States are required to cover certain mandatory groups in order to be eligible for matching funds. The mandatory groups are:
- Pregnant women and children under the age of 6 in families where the family income is below 133% of Federal Poverty Level (FPL). FPL is $27,570 for a family of 4 in 2009.
- Children between the ages of 6-18 with family incomes below 100% of FPL
- Parents with incomes below states' July 1996 welfare eligibility levels (typically below 50% of FPL),
- Elderly and disabled individuals who receive Supplemental Security Income. SSI is given to people who typically have incomes 74% of FPL for an individual.
Families or individuals without children, no matter how poor are excluded- unless they fall into one of the categories above.
Immigrants are not eligible for Medicaid unless they have lived in the US for at least 5 years and meet the eligibility requirements (above)- except for emergency services. Undocumented immigrants are ineligible for Medicaid no matter how long they have lived in the country.
Federal Poverty levels can be viewed at: http://aspe.hhs.gov/poverty/09poverty.shtml
In general they are as follows (annual income):
- single person: $13,530
- 2 people in family: $18,210
- 3 people in family: $22,890
- 4 people in family: $27,570
etc.
For a detailed description of Medicaid, readers are encouraged to go to: http://www.kff.org/medicaid/upload/7334-03.pdf
Other than the mandatory federal coverage rules, states have a lot of leeway in terms of how they want to run Medicaid programs. For example, states can charge beneficiaries premiums, within certain bounds. Total cost sharing cannot exceed 5% of family income in any case. Cost sharing is prohibited for mandatory children.
Enrollment in HMOs is the primary delivery mechanism for Medicaid with nearly 2/3rds of beneficiaries being enrolled in HMOs. In other cases, Medicaid provides services to beneficiaries through a fee-for-service arrangement with providers. So, though Medicaid is publicly financed, health care is purchased through the private sector.
Medicaid also makes special payments to hospitals that serve a disproportionate share of low income and uninsured patients (6% of Medicaid costs).
Medicaid beneficiaries have a positive feedback on the program. Administrative costs are less than 4% of overall program costs. The elderly and disabled make up 25% of all medicaid enrollees and account for 70% of program spend. Children and adults on average cost the program $1,617 and $ 2,012 respectively (2005 numbers). The elderly and disabled account for much larger per capita costs- $11,839 and $13,524 respectively.
Medicaid's growth has also fared much better than the cost growth rates for private insurance. For example, Medicaid costs have been growing at a rate of 4% between 200 and 2006, while monthly premium increases for employee offered insurance increased at a rate of 10% during the same period.
So, overall, it would be fair to say that this government program is run pretty well- in spite of the general perception that the government cannot do anything well.
Wednesday, August 5, 2009
Public and Private Healthcare- Medicare
In the last blog we talked about the 5 segments of health care consumers in the US (Medicare, Medicaid, Employer Based Insurance, Private Insurance and the uninsured.) The US spent $374 million on Medicare in 2006 (about 2.3% of GDP) and it accounted for about 12% of the federal budget. Medicare provides health care for the elderly and disabled and is a popular program. Medicare is Insurance provided by the Federal Government and consists of 4 parts: Parts A, B, C & D.
1) Part A: Pays for Hospital insurance and accounts for 39% of benefit payments and is largely financed through a dedicated tax of 2.9% of earnings paid by employers and 1.45% of earnings paid by employees
2) Part B: Pays for Supplementary Medical Insurance (SMI) and accounts for 32% of the total benefits paid out. It is financed by general revenues (investments of the HI and SMI Trust Funds?) and premiums.
3) Part C: Pays for Medicare Advantage, consisting of private health care plans, and accounts for 15% of benefits payments. Part C is not financed separately.
4) Part D: Pays for prescrition drug coverage and accounts for 9% of benefit payments. It is financed from beneficiary premiums, general revenues and state payments.
Because of the age of the beneficiaries, as would be expected, older beneficiaries consume more of health care benefits than younger beneficiaries. So, 10% of beneficiaries account for two-thirds of total Medicare spending. Medical spending on for beneficiaries in their last year of life is on average 4 times greater ($22,107) than for all other beneficaries ($5,694).
To the beneficiaries, Medicare should not be supposed to be free. Medicare Part B costs beneficiaries $93.50 per month. In addition, of the $12,763 in per beneficiary costs in 2004, Medicare paid for about half, while beneficiaries had out of pocket expenses amounting to about 19%.
Since the Reagan years people have been led to believe that the government cannot do anything right. However, the popularity of Medicare as well as the fact that growth in Medicare spending has increased annually by 7.8%- 1% below that for private health insurance. It is true that private health insurance spends money on sales and marketing that Medicare does not have to. However, there is no indication that Medicare- simply because it is a Government provided service is run poorly.
From an overall health care perspective, there are problems ahead for Medicare. Firstly, it is estimated that Medicare will form 10.8% of GDP by 2082 (Office of the Actuary in the Centers for Medicare and Medicaid Services). Because these are projections based on estimates around population growth and health care consumption statistics there can be debate on the exact percentage of GDP that Medicare will form.
Secondly, there is a tsunami of baby-boomers who will be retiring and begin to participate in Medicare. Because of the constitution of the population, there will be far fewer employees to support those in retirement.
Thirdly, the same disease that ails overall health care expense increases, ails Medicare.
For all these reasons, there is a potential Medicare funding shortfall that will need to be addressed.
1) Part A: Pays for Hospital insurance and accounts for 39% of benefit payments and is largely financed through a dedicated tax of 2.9% of earnings paid by employers and 1.45% of earnings paid by employees
2) Part B: Pays for Supplementary Medical Insurance (SMI) and accounts for 32% of the total benefits paid out. It is financed by general revenues (investments of the HI and SMI Trust Funds?) and premiums.
3) Part C: Pays for Medicare Advantage, consisting of private health care plans, and accounts for 15% of benefits payments. Part C is not financed separately.
4) Part D: Pays for prescrition drug coverage and accounts for 9% of benefit payments. It is financed from beneficiary premiums, general revenues and state payments.
Because of the age of the beneficiaries, as would be expected, older beneficiaries consume more of health care benefits than younger beneficiaries. So, 10% of beneficiaries account for two-thirds of total Medicare spending. Medical spending on for beneficiaries in their last year of life is on average 4 times greater ($22,107) than for all other beneficaries ($5,694).
To the beneficiaries, Medicare should not be supposed to be free. Medicare Part B costs beneficiaries $93.50 per month. In addition, of the $12,763 in per beneficiary costs in 2004, Medicare paid for about half, while beneficiaries had out of pocket expenses amounting to about 19%.
Since the Reagan years people have been led to believe that the government cannot do anything right. However, the popularity of Medicare as well as the fact that growth in Medicare spending has increased annually by 7.8%- 1% below that for private health insurance. It is true that private health insurance spends money on sales and marketing that Medicare does not have to. However, there is no indication that Medicare- simply because it is a Government provided service is run poorly.
From an overall health care perspective, there are problems ahead for Medicare. Firstly, it is estimated that Medicare will form 10.8% of GDP by 2082 (Office of the Actuary in the Centers for Medicare and Medicaid Services). Because these are projections based on estimates around population growth and health care consumption statistics there can be debate on the exact percentage of GDP that Medicare will form.
Secondly, there is a tsunami of baby-boomers who will be retiring and begin to participate in Medicare. Because of the constitution of the population, there will be far fewer employees to support those in retirement.
Thirdly, the same disease that ails overall health care expense increases, ails Medicare.
For all these reasons, there is a potential Medicare funding shortfall that will need to be addressed.
Friday, July 31, 2009
The State of Health Care- The Basic Facts
What are the basic facts relating to our health care system? The facts listed come from a variety of respected and trusted sources (OECD, WHO, The Henry J Kaiser Foundation etc.) and readers are encouraged to read the sources for themselves. Nothing brings home the facts better and readers do not have to depend on intermediaries such as this blog or get their knowledge from second-hand comments posted in response to newspaper articles.
1) The US spent $2.1 trillion in 2006 and $2.2 trillion in 2007 on health care- overall. This expense is expected to continue its upward trend to $2.4 trillion in 2008 and $2.5 trillion in 2009. To get a sense of the rapid rate of increase in overall health care spend, we spent $28 billion in 1960, $714 billion in 1990 and $1.35 trillion in 2000.
2) In order to do a meaningful comparison of health care spend across countries, one can look at per capita spend on health care (expenditures per person) or the percentage of GDP spent on health care. As should be expected, based on the US being the richest country in the world (on a GDP basis) the US has the highest per capita spend on health care (2006- $6714) followed far behind by other developed countries. Health care spending is currently 15% of GDP and is expected to reach 19.7% of GDP by 2017 (Keehan et al, 2008.) Looking still further out in time, the Congressional Budget Office estimates that health care spend will reach 35% of GDP by 2035 and 41% of GDP by 2060. So, it is easy to understand the concern expressed by those willing to do so.
3) You would assume that because we spend the most on health care our health care outcomes should be much better than those of any other country's, right? The truth is that while on some measures the US outperforms the rest of the world, in other cases we lag the developed world. For example, new drugs and technologies are brought into the market place quicker in the US than elsewhere and the wait time for doctor's visits is only eclipsed by Germany (marginally). Outcomes for cancer are also better than almost any other country. In terms of overall measures of health and in relation to the amount of money spent on health care we lag on many countries in the developed world.
As an example, life expectancies have been increasing in all the countries in the developed world. In the US life expectancy at birth overall- as measured between 2003-05 had risen to 77.7 years from an average of 70.2 in 1960-62. Because the rate in the life expectancy of women did not rise as fast as it did for men, the US, which had a life expectancy above the OECD average, has fallen below the OECD average. Only Hungary, Slovakia, Poland and the Czech Republic do worse than us on this measure.
Similarly, when looking at life expectancy at age 65, the US falls below the OECD average for both men and women.
While, this is not an admirable ranking in itself, the result is more striking when looking at life expectancies between populations grouped according to race- white, african americans and others.
It may be argued that as the US has a higher rate of deaths caused by causes other than natural ones (accidents, homicides etc.), but even after factoring in those causes, the lower US average is not able to account for the higher health care spend.
The infant mortality rate in the US at 6.9 deaths per thousand live births is the worst after Slovakia (2004-06).
For historical, political and social reasons, the US does not provide universal health insurance to it's citizens. Of the OECD countries the other 2 are Turkey and Mexico.
4) In the US the consumers of health care fall into the following categories (Commonwealth fund):
a) Employer provided healthcare insurance for more than 160 million workers and family members
b) Medicare for 44 million old and disabled citizens (Henry J Kaiser Foundation, June 2007)
c) Medicaid serves nearly 59 million low income families and children
d) Privately purchased health insurance by about 12.8 million individuals
e) Nearly 47 million uninsured or underinsured.
In following blogs we will tackle the common myths associated with US healthcare. When I say common myths, I refer to the typical bugbears raised by those who feel that we have the best health care system in the world and any moves towards universal health care are a move towards "socialism".
1) The US spent $2.1 trillion in 2006 and $2.2 trillion in 2007 on health care- overall. This expense is expected to continue its upward trend to $2.4 trillion in 2008 and $2.5 trillion in 2009. To get a sense of the rapid rate of increase in overall health care spend, we spent $28 billion in 1960, $714 billion in 1990 and $1.35 trillion in 2000.
2) In order to do a meaningful comparison of health care spend across countries, one can look at per capita spend on health care (expenditures per person) or the percentage of GDP spent on health care. As should be expected, based on the US being the richest country in the world (on a GDP basis) the US has the highest per capita spend on health care (2006- $6714) followed far behind by other developed countries. Health care spending is currently 15% of GDP and is expected to reach 19.7% of GDP by 2017 (Keehan et al, 2008.) Looking still further out in time, the Congressional Budget Office estimates that health care spend will reach 35% of GDP by 2035 and 41% of GDP by 2060. So, it is easy to understand the concern expressed by those willing to do so.
3) You would assume that because we spend the most on health care our health care outcomes should be much better than those of any other country's, right? The truth is that while on some measures the US outperforms the rest of the world, in other cases we lag the developed world. For example, new drugs and technologies are brought into the market place quicker in the US than elsewhere and the wait time for doctor's visits is only eclipsed by Germany (marginally). Outcomes for cancer are also better than almost any other country. In terms of overall measures of health and in relation to the amount of money spent on health care we lag on many countries in the developed world.
As an example, life expectancies have been increasing in all the countries in the developed world. In the US life expectancy at birth overall- as measured between 2003-05 had risen to 77.7 years from an average of 70.2 in 1960-62. Because the rate in the life expectancy of women did not rise as fast as it did for men, the US, which had a life expectancy above the OECD average, has fallen below the OECD average. Only Hungary, Slovakia, Poland and the Czech Republic do worse than us on this measure.
Similarly, when looking at life expectancy at age 65, the US falls below the OECD average for both men and women.
While, this is not an admirable ranking in itself, the result is more striking when looking at life expectancies between populations grouped according to race- white, african americans and others.
It may be argued that as the US has a higher rate of deaths caused by causes other than natural ones (accidents, homicides etc.), but even after factoring in those causes, the lower US average is not able to account for the higher health care spend.
The infant mortality rate in the US at 6.9 deaths per thousand live births is the worst after Slovakia (2004-06).
For historical, political and social reasons, the US does not provide universal health insurance to it's citizens. Of the OECD countries the other 2 are Turkey and Mexico.
4) In the US the consumers of health care fall into the following categories (Commonwealth fund):
a) Employer provided healthcare insurance for more than 160 million workers and family members
b) Medicare for 44 million old and disabled citizens (Henry J Kaiser Foundation, June 2007)
c) Medicaid serves nearly 59 million low income families and children
d) Privately purchased health insurance by about 12.8 million individuals
e) Nearly 47 million uninsured or underinsured.
In following blogs we will tackle the common myths associated with US healthcare. When I say common myths, I refer to the typical bugbears raised by those who feel that we have the best health care system in the world and any moves towards universal health care are a move towards "socialism".
Tuesday, July 28, 2009
Introduction
I started this blog out of a deep sense of disappointment at the quality of public discourse on the Health Care Reform debate currently taking place. Articles in newspapers have described the efforts being made by the White House to convince both the Congress and the citizens, of the need for reform of the health care system in the US. Other articles have focused on the contest between Democrats and Republicans. Whilst, more recently, much has been focused on the internecine battle in various committees between Blue Dog democrats and the rest of the party. Columns have been wasted on describing the political horseplay. TV of course has been a wasteland with some exceptions.
Equally depressing have been the discussions posted in response to online newspaper articles. The responses have tended, on the one extreme, to be from liberals who are desperate to believe that some change is possible and desirable- however meager it may turn out to be. At the other extreme have been the responses of the right-wing diehards, whose common tendency has been to raise the specter and threat of socialism.
What I have found missing has been a discussion where participants honestly state the problem to be solved, their positions and the manner in which the problem may be solved. Stock positions are taken based on ideological proclivities and neither party is the better for the discussion. The media have spectacularly failed to present information that educates their readers and helps them understand the reason for the positions being taken by the players (the President, the Democrats, the Blue Dog Democrats, the Republicans, the Insurance industry and the Medical Service providers.)
In the interest of full disclosure, let me be clear- I believe that the state of health care in our country should be a matter of national shame. We spend more than any other country on health care, yet upwards of 47 million citizens are without health care. A smaller fraction are under insured. It is true that in some cases those that choose not to get health care insurance, have the means and choose not to be insured. What is more problematic is the efficiency of the health care system. We pay more for health care than other countries- by far, and have less to show for it- in terms of generally accepted measures of health and well being.
In this blog I will attempt to provide non-partisan information that readers may use to inform themselves. I hope that readers will feel free to add links to information that will move the debate forward and add to the general body of knowledge.
For starters, I am providing links that I have found useful.
1) OECD Health Data 2009- "How Does the United States Compare"
Organization for Economic Cooperation and Development (OECD)
Description- A comparison of US healthcare against other developed countries.
2) Healthcare Reform in the United States- Economics Department Working Paper #665
Organization for Economic Cooperation and Development (OECD)
Description- A discussion of issues in the US Healthcare system along with suggestions for remedies.
3) Accounting for the cost of US health care: A new look at why Americans spend more.
McKinsey Global Institute, December 2008
Description- An excellent analysis of US Healthcare cost drivers
(You will need to register, for free, at the McKinsey site in order to read the paper).
4) The Henry J. Kaiser Family Foundation
Description- Excellent source of information for all things to do with the health care system.
5) "McAllen, Texas and the high cost of health care", Atul Gawande, The New Yorker, June 1 2009.
Description- Discusses the regional cost disparities on health care costs caused by the pay for service system.
I will add other links as I find them. This is a moderated blog and the purpose is to educate us all. I also acknowledge that there may be differences in opinion, however ideology is no excuse for ignorance. So, I will delete posts that are abusive.
Equally depressing have been the discussions posted in response to online newspaper articles. The responses have tended, on the one extreme, to be from liberals who are desperate to believe that some change is possible and desirable- however meager it may turn out to be. At the other extreme have been the responses of the right-wing diehards, whose common tendency has been to raise the specter and threat of socialism.
What I have found missing has been a discussion where participants honestly state the problem to be solved, their positions and the manner in which the problem may be solved. Stock positions are taken based on ideological proclivities and neither party is the better for the discussion. The media have spectacularly failed to present information that educates their readers and helps them understand the reason for the positions being taken by the players (the President, the Democrats, the Blue Dog Democrats, the Republicans, the Insurance industry and the Medical Service providers.)
In the interest of full disclosure, let me be clear- I believe that the state of health care in our country should be a matter of national shame. We spend more than any other country on health care, yet upwards of 47 million citizens are without health care. A smaller fraction are under insured. It is true that in some cases those that choose not to get health care insurance, have the means and choose not to be insured. What is more problematic is the efficiency of the health care system. We pay more for health care than other countries- by far, and have less to show for it- in terms of generally accepted measures of health and well being.
In this blog I will attempt to provide non-partisan information that readers may use to inform themselves. I hope that readers will feel free to add links to information that will move the debate forward and add to the general body of knowledge.
For starters, I am providing links that I have found useful.
1) OECD Health Data 2009- "How Does the United States Compare"
Organization for Economic Cooperation and Development (OECD)
Description- A comparison of US healthcare against other developed countries.
2) Healthcare Reform in the United States- Economics Department Working Paper #665
Organization for Economic Cooperation and Development (OECD)
Description- A discussion of issues in the US Healthcare system along with suggestions for remedies.
3) Accounting for the cost of US health care: A new look at why Americans spend more.
McKinsey Global Institute, December 2008
Description- An excellent analysis of US Healthcare cost drivers
(You will need to register, for free, at the McKinsey site in order to read the paper).
4) The Henry J. Kaiser Family Foundation
Description- Excellent source of information for all things to do with the health care system.
5) "McAllen, Texas and the high cost of health care", Atul Gawande, The New Yorker, June 1 2009.
Description- Discusses the regional cost disparities on health care costs caused by the pay for service system.
I will add other links as I find them. This is a moderated blog and the purpose is to educate us all. I also acknowledge that there may be differences in opinion, however ideology is no excuse for ignorance. So, I will delete posts that are abusive.
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