Transcript Will We Ever Have Healthcare for Everyone?

Healthcare for Everyone?
Like the rest of the civilized world
Rob Stone MD
Director, Hoosiers for a Commonsense Health Plan
Director, Palliative Care, IU Health Bloomington
Assistant Clinical Professor of Medicine, IUSM
DISCLOSURES
Dr. Rob Stone has no relevant financial
relationships with commercial interests.
Slides can be downloaded at:
HCHP.info/Presentations
Countries with Universal Healthcare
What Are We Paying For?
 An incredibly complex system
 Thousands of plans
 Armies of people to:
-deny coverage and payments
- collect payments
- determine eligibility
What Do We Get For Our Money?
 The most expensive
health care in the
world
 The best health
care in the world?
WHO Global Health Rankings

At the top: France is #1

US ranks 37th, between Costa
Rica and Slovenia
Tobacco Smokers
OECD, 2004 (2002 Data, U.K is 2001)
Why spend so much
AND get so little?
Reason # 1: Our profitdriven insurance system
AND
As long as millions are
left out, everyone will
suffer
Health Insecurity Indiana
• 800,000 to 900,000
Hoosiers uninsured
• Hoosier bankruptcy filings
because of medical bills:
> 27,000 annually
US Census Dept, “Income, Poverty, and
Health Insurance Coverage” Sept 2012
Himmelstein et al, American Journal
of Medicine, August 2009
Is the ACA Going in the Right Direction?
Affordable Care Act
• Original projection: 30-35 million
newly covered
• Half thru Health Insurance Exchanges
(Mandate)
• Half thru Medicaid expansion
• Supreme Court Decision Summer 2012
Two Very Different Public Programs
Medicare
Pre-paid health insurance
Medicaid
The only safety net
Who
• Age >65, dialysis, disability
Who
• Low-income people with
additional eligibility criteria
How
• 100% federally funded, the
same in every state
How
• 60% federal, 40% state
funded
Medicaid 101
What
•Established in 1965 with Medicare
•Administered by states within broad federal parameters
Who
•73% Caucasian, 19% African American, 5% Hispanic
•Largest numbers covered – children
•Largest expense – care of frail elderly, esp in nursing homes
Indiana Medicaid 2014
400% ($95,400)
300% ($71,550)
250%
200%
200% ($47,700)
Premium
100% ($23,850)
FPL
0
No
Premium
Children
19%
Pregnant
Y-axis is % of Federal Poverty Level;
Example of a family of four
Parents
HIP
Childless Adults
ACA as Planned
400% ($95,400)
300% ($71,550)
Sliding scale premium subsidies:
100% - 400% of poverty level
200% ($47,700)
100% ($23,850)
100-138% poverty: patient’s choice
Medicaid in all states: up to 138% of poverty
0
Y-axis is % of Federal Poverty Level;
Example of a family of four
Medicaid Expansion Would
Help People We All Rely On
Hoosier Medicaid Expansion
• Estimated 350 – 450 thousand
lives covered, ~ half the
uninsured
• Largest increase in coverage in
>50 years
• $11.50 a day versus $30,000 a
year eligibility
Medicaid Expansion –
Good for All of Us
• Traditional Medicaid 60/40 Federal/State
• ACA Medicaid 100% tapering to 90%
Federal
• Cost to Indiana taxpayers: $50-150 million
• Federal subsidy: $1.7 billion a year
A Deal Too Good to Refuse
• HIP cigarette taxes - $121 million
• High risk pool - $48 million
• Savings from prisons and jails
“I’m just here for the dental.”
A Deal Too Good to Refuse
•
•
•
•
•
•
HIP cigarette taxes - $121 million
High risk pool - $48 million
Savings from prisons and jails
Hospitals avoid $345 M/year unpaid care
30,000 new jobs
>$100 million new tax revenues
Indiana Hospital Association Report 2/11/13
Indiana Is Being Taxed
For a Program We’re Turning Down
100%
Federal
responsibility
for cost of
expansion
population
75%
Our federal tax dollars are
paying for Medicaid but IN is
50%
not getting the benefits
25%
0%
2014
2016
2018
2020
2022
2024
Losing $5 Million a Day
Michigan Chamber Applauds Passage
of Medicaid Reform Legislation
“Make no mistake, the Michigan Chamber
remains strongly opposed to Obamacare,”
said Jim Holcomb, Senior Vice President for
the Michigan Chamber. “However,
our Board of Directors believes Medicaid
reform makes sense for our state and the
business community.”
June 13, 2013
Governor
Pence has
called
Medicaid a
“broken
program”
Is Medicaid worse than no
insurance at all?
Oregon: Expand Medicaid,
Increase ER Usage by 40%
5
Annual
emergency room
visits per person
4
3
A 40% relative increase means
one extra visit per person
every four years
2
1
0
0.68
0.95
No Medicaid
Medicaid
Taubman, S. Science Magazine. Jan 2, 2014.
Medicaid Expansion Is About
Life and Death In Indiana
Better women’s health
• 5,893 more mammograms
• 14,246 more Pap smears
Better treatment of chronic diseases
• 14,225 more diabetics receiving medications
• 23,971 less adults with depression
Fewer preventable deaths
• Between 240 and 758 preventable deaths avoided
• Consistent with the “Culture of Life”
Annual data for Indiana from Dickman S, Himmelstein D, McCormick D, and
Woolhandler S. Opting out of Medicaid Expansion: The Health and Financial
Impacts. Health Affairs Blog. January 30, 2014
International Timeline of Universal Healthcare
Germany
Switzerland
New Zealand
France
United Kingdom
Sweden
USA
Japan
Canada
Australia
Italy
Spain
Taiwan
1883
1911
1938
1945
1946
1947
1947*
1961
1966
1974
1978
1986
1995
*President Truman proposed but failed to pass National Health Insurance
Why
Health Care for All Young and Old,
Rich and Poor?
What Can We Do?
✔Educate Ourselves
✔Find Our Voices
✔Join In
PNHP.org