Kao-Ping ChuaKao-Ping ChuaJack Rutledge Fellow, 2005-2006Jack Rutledge Fellow, 2005-2006

American Medical Student AssociationAmerican Medical Student Association

The Case for Universal Healthcare

What is Universal Health Care?What is Universal Health Care?

What is Universal Health Care?What is Universal Health Care?

““No American should lack access to health careNo American should lack access to health carebecause he or she lacks the ability to pay for itbecause he or she lacks the ability to pay for itwhen needed, and no American should sufferwhen needed, and no American should suffer

serious financial distress or personal bankruptcyserious financial distress or personal bankruptcyas a result of unpaid medical bills.” as a result of unpaid medical bills.”

Uwe Reinhardt, Princeton health economistUwe Reinhardt, Princeton health economist

Countries with Universal Health CareCountries with Universal Health Care

… (South Africa)

Industrialized countries without universal health care?

only one …

Weighing the ArgumentsWeighing the Arguments

Moral

Economic

Cultural

Moral

Economic

Cultural

The moral argument for UHCThe moral argument for UHC

The Central Moral QuestionThe Central Moral Question

Is it wrong to deny people healthcare based Is it wrong to deny people healthcare based on the ability to pay? on the ability to pay?

Increases in Health Insurance Premiums Compared to Other Indicators, 1999-2004

0%

2%

4%

6%

8%

10%

12%

14%

16%

1998 1999 2000 2001 2002 2003 2004 2005

Health Insurance Premiums Inflation Average Weekly EarningsSource: KFF/HRET Survey of Employer-Sponsored Health Benefits: 1999 – 2004

5 TIMES!

How Many Uninsured?

45,000,000 Americans

Annual deaths by cause, age 25-64Annual deaths by cause, age 25-64

18000

17500

19000

14100

19700

0 5000 10000 15000 20000 25000

Uninsurance

Diabetes

Stroke

HIV/AIDS

Homicide

The uninsured receive poor The uninsured receive poor medical caremedical care

Inability to fill prescriptionInability to fill prescriptionLack of regular healthcare provider or Lack of regular healthcare provider or institutioninstitutionPoor care of chronic diseasePoor care of chronic diseaseThe “unhappy triad” of uninsuranceThe “unhappy triad” of uninsurance– Receive less preventive careReceive less preventive care– Diagnosed at more advanced disease stagesDiagnosed at more advanced disease stages– Once diagnosed, receive less therapeutic Once diagnosed, receive less therapeutic

carecare

Real-life examplesReal-life examples

Statistics don’t tell the full storyStatistics don’t tell the full story

Uninsured childUninsured child

Uninsurance can affect ANYONEUninsurance can affect ANYONEHi, My name is ______, and I am extremely interested in participating in Hi, My name is ______, and I am extremely interested in participating in

whatever small way I can to effect Healthcare Reform in Indiana.  My whatever small way I can to effect Healthcare Reform in Indiana.  My husband is a [very sick patient], and we were informed last husband is a [very sick patient], and we were informed last Wednesday that Anthem Blue Cross of Indiana is going to terminate Wednesday that Anthem Blue Cross of Indiana is going to terminate his employer's group insurance coverage…[unfortunately], he cannot his employer's group insurance coverage…[unfortunately], he cannot qualify for individual coverage due to his health. 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 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 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 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 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 try to get insurance so we can try to hang on to the home where we raised our children.  raised our children. 

It is a living nightmare that I know is shared by millions of other 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.Hoosiers.  Please let me know what I can do to help with this initiative.

The Central Moral QuestionThe Central Moral Question

Is it wrong to deny people healthcare based Is it wrong to deny people healthcare based on the ability to pay? on the ability to pay?

The economic argument for UHCThe economic argument for UHC

The central economic questionThe central economic question

Will we save money by achieving Will we save money by achieving universal health care?universal health care?

A 3 part questionA 3 part question

How much would it cost to cover How much would it cost to cover everyone?everyone?

How much does it cost to NOT cover How much does it cost to NOT cover everyone?everyone?

Do the costs of UHC outweigh the Do the costs of UHC outweigh the benefits?benefits?

How much would it cost to How much would it cost to cover everyone?cover everyone?

The cost of universal

healthcare tothe government

Additionalhealthcare that would be usedby uninsured if

they had insurance

Covering out-of-pocket costs for the

uninsured

Reimbursingproviders for

uncompensated care

Depends ongenerosity ofbenefits

Depends ongenerosity ofbenefits

$34-69 billionper year

How much would it cost to How much would it cost to cover everyone? (Reinhardt, 2003)cover everyone? (Reinhardt, 2003)

Assume $100 billion cost to government in Assume $100 billion cost to government in the first year of a UHC programthe first year of a UHC programAssume increase of per capita health Assume increase of per capita health spending by 10%/yearspending by 10%/year

Total cost: $1.6 trillion over 10 years, Total cost: $1.6 trillion over 10 years, or aboutor about $160 billion per year$160 billion per year

Questions to askQuestions to ask

How much would it cost to cover How much would it cost to cover everyone?everyone?

How much does it cost to NOT cover How much does it cost to NOT cover everyone?everyone?

Do the costs of UHC outweigh the Do the costs of UHC outweigh the benefits?benefits?

How much does it cost NOT to How much does it cost NOT to cover everyone? cover everyone?

IOM: $65-$130 billion in lost productivity IOM: $65-$130 billion in lost productivity per yearper year

How much does it cost NOT to How much does it cost NOT to cover everyone? cover everyone?

““Job lock” (3.8 million jobs)Job lock” (3.8 million jobs)

Less preventive/chronic disease care Less preventive/chronic disease care costlycostly

High rate of medical bankruptcyHigh rate of medical bankruptcy

Unnecessary use of the ERUnnecessary use of the ER

How much does it cost NOT to How much does it cost NOT to cover everyone? cover everyone?

Costs of keeping current employer-based Costs of keeping current employer-based system: system: – Loss of global competitivenessLoss of global competitiveness– Strain on businessesStrain on businesses

Questions to askQuestions to ask

How much would it cost to cover How much would it cost to cover everyone?everyone?

How much does it cost to NOT cover How much does it cost to NOT cover everyone?everyone?

Do the costs of UHC outweigh the Do the costs of UHC outweigh the benefits?benefits?

Do the costs of UHC outweigh Do the costs of UHC outweigh the benefits? the benefits?

$160 billion per year

Lost productivity

Loss of entrepreneurship

Less preventive care

Unnecessary use of ER

Less global competitiveness*

Strain on business*

UHC coupled with cost controls UHC coupled with cost controls would save money would save money

Scenario 1: employer mandateScenario 2: expansion of public insurance programsScenario 3: creation of new programs for the uninsuredScenario 4: single-payer system

"The issue of universal coverage is not amatter 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 UHCThe cultural argument for UHC

The central cultural questionThe central cultural question

Is universal health care consistent with Is universal health care consistent with American values?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 valuesUHC and American values

Do we believe in:Do we believe in:Equality and equal Equality and equal opportunity?opportunity?

UHC and American valuesUHC and American values

Do we believe in:Do we believe in:Life, liberty, and the Life, liberty, and the pursuit of happiness?pursuit of happiness?

UHC and American valuesUHC and American values

Do we believe in:Do we believe in:Getting good value for Getting good value for our money?our money?

US Spending on Health Care, 2002US Spending on Health Care, 2002

$- $1,000 $2,000 $3,000 $4,000 $5,000

U. S.

Switzerland

Germany

Canada

France

Japan

U. K.

$ Per Capita Public Private

Total health care costs comprise 14% of GDP!

Source: OECD Health Data 2002, Health Affairs 2002 21:88-99

$1.7 trillion$1.7 trillion

Best Health Care in the world? Best Health Care in the world? (WHO Rankings 2000)(WHO Rankings 2000)

Source: World Health Organization, Health Systems: Improving Performance, 2000

1. France2. Italy3. San Marino4. Andorra5. Malta6. Singapore7. Spain8. Oman9. Austria10. Japan

16. Luxembourg17. Netherlands18. United Kingdom19. Ireland20. Switzerland

11. Norway12. Portugal13. Monaco14. Greece15. Iceland

21. Belgium22. Colombia23. Sweden24. Cyprus25. Germany26. Saudi Arabia27. United Arab Emirates28. Israel29. Morocco30. Canada

31. Finland32. Australia33. Chile34. Denmark35. Dominica36. Costa Rica37. United States of America38. Slovenia39. Cuba40. Brunei Darussalam

Infant Mortality, 2000Infant Mortality, 2000Deaths/100,000 BirthsDeaths/100,000 Births

0

1

2

3

4

5

6

7

8

U. S. Canada Australia France I taly Germany Sweden

Source: OECD, 2003

Life Expectancy, 2000Life Expectancy, 2000

7575.5

7676.5

7777.5

7878.5

7979.5

80

U. S. Germany U.K. France I taly Canada Sweden

Year

s

Source: OECD Health Data 2003

The 3 Big QuestionsThe 3 Big Questions

Is it wrong to deny people healthcare Is it wrong to deny people healthcare based on the ability to pay? based on the ability to pay?

Will we save money by Will we save money by achieving universal health care?achieving universal health care?

Is universal health care consistent with Is universal health care consistent with American values?American values?

Benefits for providersBenefits 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?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 thoughtsParting thoughts

““The Americans will The Americans will always do the right always do the right thing…after they’ve thing…after they’ve exhausted all the exhausted all the

alternatives.”alternatives.”

- Winston Churchill- Winston Churchill