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Health Care in the 2008 Election Elise Gould, Ph.D. October 20th, 2008 Columbia University Medical Center What Must (Good) Health Reform Accomplish? • Access – Cover the uninsured – Ensure minimal disruption of current coverage – Ensure minimum benefits and coverage of certain conditions • Cost – Affordable premiums and cost-sharing – Risk pooling – Efficiencies of scale • Quality – – – – Encourage research and best practice-driven medicine Oversight and regulation for consumer protection Reduce disparities Efficient and effective chronic care management % of Under 65 Population Uninsured between 2001-2003 Access: The Crisis of the Uninsured 40% 45 million Non-elderly uninsured in 2007 (17.1%) 36% 35% (CPS) 30% 26% 25% 20% 17% 15% 9% 10% 4% 5% 0% At any time More than 4 months More than a year More than 2 years Duration of Uninsurance, 2001-2003 (SIPP) 3 years Costs: Unsustainable Growth Nearly 50% of GDP by 2062 (CBO) Premium increase (+115%) Workers earnings (+29%) Overall inflation (+24%) KFF/HRET Employer Benefits Survey, 2007 OECD Health Data, 2005 Sweden Japan Finland Norway France Infant Mortality Across Countries (2005) Belgium 8 7 6 5 4 3 2 1 0 Greece Germany Ireland Spain Austria Switzerland Denmark Italy Netherlands Australia United Kingdom New Zealand Canada United States Infant Deaths per 1,000 Live Births Value: International Comparison US spends 15.5% of GDP $7,439 per person (OECD) Quality: Stark National Inequalities Infant Mortality by Race, 2004 Black White CDC Linked Data Life Expectancy at 60 by Income, 2001 Top 50% Bottom 50% Waldron, 2007 Two Visions for Reform in 2008 Barack Obama •Build on current employersponsored system •Strengthen public system by building large insurance pools •Give tax credits to selfemployed, near-poor, and small businesses to help purchase coverage John McCain •Radically change current system •Replace current tax subsidies for employerbased insurance with tax credits •Replace employer-based coverage with a national deregulated individual insurance market Obama: More Coverage Tax Policy Center Analysis Obama: Keep the Coverage You Have Obama Plan McCain Plan National Exchange Employerprovided Individual Public Employerprovided Uninsured Tax Policy Center Analysis Public 20 million Lose their employersponsored insurance McCain: On Your Own in the Individual Market • The individual market offers lower benefits at greater financial risk • The individual market is less efficient than employer-sponsored group insurance • Administrative costs 2.5-4x higher than large employer pools • McCain has proposed removing the current system of state-based protections, making the already insufficient individual market only riskier McCain Plan’s Effects on New York • 1,605,030 individuals, or 15.5% of those currently covered, would lose their employerprovided insurance (1 in 7) • New York residents would also lose important protections, such as – Minimum medical loss prevention – Pure community rating – Mandated coverage of ambulance services, cancer chemotherapy, and cervical cancer screening Obama Plan: More Bang for Your Buck Total 10-Year Cost of Plan Obama: $1.6 Billion McCain: $1.3 Billion Tax Policy Center Analysis Quality: Changes to Medical Practice • Four key provisions: – Evidence-based medicine – Health information technology – Chronic disease management – Medical Home • Only Obama’s plan can effectively reach both public and private sectors – Less fragmentation; more oversight Conclusion • Moral and economic imperative for reform • Most effective method of lowering costs and improving quality is by covering everyone – access, cost, and quality are complementary goals not competing ones www.epi.org