Issue brief: Health care
The Electoral Issue:
Health care is expensive and getting more so, squeezing private enterprise and driving up the deficit. Millions of Americans are uninsured which leads to bankruptcies and anxiety.
The Challenge:
How to lower costs and expand coverage without a drop in quality.
Problems:
Cost
The share of the economy devoted to health care increased from 7.2 percent in 1970 to 17.9 percent in 2009 and 2010. Costs are projected to rise to 25 percent of GDP in 2025. This amount was 48 percent higher than in the next highest spending country (Switzerland), and about 90 percent higher than in many other countries that we would consider global competitors. Despite the rate of spending, Americans do not have appreciably better health outcomes than people in other developed nations.
The two main drivers of cost are improvements in technology and the uninsured. A systemic driver of high costs is America's fee-for-service healthcare system, in which providers are compensated for each procedure, not for the outcome of care. This system provides providers an incentive to pad their bills by performing as many services as possible, while providing no incentive for patients to decline unnecessary procedures. The rising cost of health care is the number one cause of increased deficits. (See CBS Policy entry on the budget.)
The high cost of care and inefficiency is a drag on business productivity because those dollars cannot be spent on investment and employees. Health care benefits, at 12 percent, are the most expensive benefit paid by employers. "That kind of a cost, compared with the rest of the world, is like a tapeworm eating at our economic body," Warren Buffet told the Associated Press in 2010.
Coverage
Among the 34 OECD countries, only Mexico, Turkey, and the United States do not have universal health care coverage. Almost 50 million Americans did not have health insurance in 2010 - 16.3 percent of the population. The percentage of uninsured individuals varies greatly on a state-by-state basis -- Texas has the highest proportion of uninsured residents, at 24.6 percent. Massachusetts has the lowest, at 5.6 percent. Generally, states in the Northeast, Midwest, and Pacific Northwest have a greater share of insured residents than states in the South and Southwest.
The biggest gaps in coverage were seen among foreign-born non-citizens, low-income families, and young adults between 19 and 25. The healthcare costs incurred by those without insurance are eventually shifted to those with insurance in the form of higher premiums. A 2008 study from Families USA, an advocacy group that supports coverage expansion, determined that the average family pays $1017 per year in higher premiums to help cover the cost of the uninsured.
A majority of Americans (55.3 percent in 2010) receive medical insurance through their employers, but this number has been eroding as rising costs lead companies to determine that providing coverage is too expensive. In 2000, 64.1 percent of Americans had employer-provided health coverage. The decline in employer-provided coverage has been especially pronounced among businesses with fewer than 10 employees.
If you are not covered by your employer, insurance is expensive or unavailable. Only five percent of nonelderly Americans receive coverage on the individual market. Many uninsured Americans are only one medical diagnosis away from bankruptcy.
In 2009, a study by the American Journal of Medicine reported that medical debt was the number one reason behind bankruptcy filings in the U.S., accounting for 62 percent of personal bankruptcies. Even those with health insurance can find their coverage dangerously lacking: the New York Times reported in 2009 that approximately three quarters of people pushed into bankruptcy by medical bills were actually insured when their medical problems began.
Health Care Entitlements (Medicare, Medicaid, and CHIP)
Obama, Romney explain visions for Medicare
Federal health care programs, including Medicare, Medicaid, and the Childrens' Health Insurance Program (CHIP), comprised 21 percent of the 2011 federal budget, totaling $769 billion dollars. Nearly two thirds of this amount went to Medicare, the health-insurance program that covers approximately 48 million disabled and elderly Americans. The remainder went to Medicaid and CHIP which provide health care to 60 million low-income children and families and are co-funded by states.
These costs are projected to rise dramatically in coming years as the weak economy increases enrollees and the population ages particularly increasing Medicare costs.
According to Congressional Budget Office projections, spending on Medicare and Medicaid, which equaled 5.5 percent of gross domestic product in 2009, is predicted to rise to 6.6 percent by 2020 and could conceivably reach 10 percent by 2035, consuming more than half of all federal tax revenues. And the spending growth may be larger than meets the eye. The Medicare Sustainable Growth Rate, dubbed the "doc fix", was created in 1997 to curb medical spending by setting payment targets for physicians administering to Medicare patients. The measure has required yearly reductions in physician payments since 2002, but Congress has blocked the reduction every year. Abandoning the doc fix by freezing physician payments between 2012 through 2020, according to the Simpson-Bowles deficit commission report, would cause an additional $267 billion in Medicare spending.
Primary Care Shortage
The need for more primary care doctors
America has a growing shortage of primary care physicians who can help curb medical costs by addressing problems before they require the expensive intervention of a specialist.
The American Association of Medical Colleges has forecast a shortage of 124,000 physicians by 2020, with 37 percent of that shortage in primary care. America currently has approximately 100,000 primary care doctors, and the American Academy of Family Physicians projects that we will need 139,531 in 10 years. At the current rate, American medical schools are graduating only half the necessary number needed to meet this demand.The shortfall is expected to be even more dramatic after 16 to 32 million additional Americans enter the insurance market due to the Affordable Care Act despite provisions in the act meant to encourage more doctors to choose primary medicine.
Due to the high cost of a medical degree, many graduating physicians choose the more-lucrative path of a specialist instead of a general practitioner. Between 2002 and 2007, the number of medical school students seeking to practice family medicine declined by more than 25 percent. In 2008, the Journal of the American Medical Association reported that only 2 percent of medical school students in their final year were considering a career in general internal medicine.
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Humana based in Louisville, KY. They have 11.5 million medical members and over 25,400 employees. Their revenues exceed 25.3 billion dollars in expense of vulnerable American taxpayers. Humana generated $36.8 billion in revenue for 2011, up 9.6% from $33.5 billion in 2010, and has a market capitalization of more than $14 billion.
Then there is the 'granddaddy' of the private health insurance industry's impact of physician private practices - a system of codification and nomenclature required when submitting claims that leave doctors having to employ far too many people to manage the insurance billing system and punishes doctors for dealing with a variety of patient problems in one visit. Indeed, a physician who refuses to discuss or treat two different patient complaints in one visit, thereby requiring the patient to return for another session to discuss the problems separately, will likely be paid twice as much by the patient because the insurance company refuses to pay.
Romney (per Ryan's Budget) will jerk your Medicate, no doubt about it. Health costs spiraling out of control. Merchants of Sickness making out like bandits (Reason Medical Care stocks are best investment in Wall St. and greedy health providers, insurance, and pharmacompanies hate Obamacare). US Health most expensive, but only 37th best (or worst) in the world. Paralyzed politicians don't do anything about it as they enjoy excellent health plans in Congress. Government (it's its job) has to step in to save the country' Health from collapse. The outcry vs Universal Care apes outcries in Canada, UK, Germany and other countries where Universal Care's established. Romney Care (Medicare vouchers and Medicaid Block Grants to states) will produce 72 million uninsured by 2030 (per Family USA) and treble costs to pay for the uninsured. Illegal aliens (McCain Immigration bill was killed by Repubs) plus 72 million uninsured are going to cost trillions to all taxpayers. Merchants of Sickness spending millions to brainwash the Average Joe against Obamacare. Per Kaiser Family Foundation, Romneycare would add more out of pocket expense nationwide to seniors, $200/mo in Florida (AP 10/16/12). NEED YOUR VOTES SUCKERS.
The public option would have saved average people like you and me THOUSANDS a year!
YOUR beloved republican'ts had you believing it was socialism and socialism is BAD! Then they high-fived the health insurance companies and collected their big donations!
You are being used. The republican party has proven through its actions that they only work for the big money. And that's not you.
Here is why: First of all lets look at diabetes as an example. Diabetes is of 'epidemic' proportion in this country(1 out of 5 people have it), it's the number one cause of blindness, Renal disease,Heart Failure(CHF) and top reason for re-admits in hospitals. The cost of the medications are high as well. If more people had access to healthcare,this one disease alone, which cost billions of dollars and an average of 3,000 more in a diabetics out-of- pocket expenses, would reduce costs tremendously. People will be able to be diagnosed before it gets out of control, and in many cases avoided, as we can now tell who will be most at 'risk' for this disease!Insurance companies will no longer dictate who lives and who dies.
Having access to health care =preventive care=lower medical costs=less hospitalizations=less unnecessary deaths=less sickness= quality of life=trillions of $dollars$ in savings over time.= less debt.
It stops insurance companies from cancelling coverage if your sick. Your young people can stay on parents coverage till age 26. There will be no 'Donut' hole for the Part 'D' medication that Seniors get stuck in,they will pay less for their medications.. Furthermore it will create-'State' based market places so people can shop for better rates,which is a lot different than shopping around in a corrupt & 'expensive' 'private' market. Even Upper Middle Class find it hard to keep their insurance these days, so how are the Middle Class or single parent supposed to afford it? Mitt Romney has no solutions. Just as he wants to Eliminate FEMA & leave it up to the states he is wrong! Tell New Jersey that FEMA Should not be there, or Federal money to help the out of this disaster. There are some things the states just cant handle alone. The biggest lie is that you must give up your current insurance and go on Obama care. That is a flat out 'lie' by the GOP! You are not forced to give up your own insurance should you choose to keep it! Funny the GOP always has something to say other than the truth!!
Ukraine has better access to medical care than America. Who says doctors should get fabulously wealthy? They have priced themselves out of a job. Our insurance system is atrocious and built in the best interest of insurance companies thanks to the lobbies of those who are no more than criminals.
You think you have insurance? Perhaps your life will go like mine. You work for years contributing hundreds of thousands of dollars to your medical plan. As soon as you get sick, you're out of work and out of insurance. If you cost the insurance company significant money, they have a talk with your employer just before you're fired. We have the most ridiculously administered health care system in the world.
I think tort reform would have a more significant effect than the article stated. Doing away with responsibility for gross negligence would be a mistake. However, we can hardly afford new vaccines. If 100 people out of a million die from polio, one would think a vaccine that reduces it to only 5 would be a good thing. However, the vaccine costs us 10 times more in the end because it's all the doctor's fault that the 5 died which means millions in damages. Stupid.
Tell you what? I can't tell the difference between Romney the Obstructionist/Bribed Politician and Romney the guy with a sensible secret plan. Until this clown comes out with something more than arm-waving and motherhood, I'll go with the tangibles we already have in ObamaCare.
Texan Landowners take a rare stand against Big Oil:
http://www.salon.com/2012/10/17/texas_landowners_take_a_rare_stand_against_big_oil/singleton/
Some of my American friends have protested that they wouldn't accept not having the freedom to not have their health care provided by the government - assuming wrongly that this the only option. However, the UK also has a thriving private health care market that allows you to pay for nice-to-haves like private rooms, or getting your hernia repaired tomorrow instead of waiting 2 months. You can pay on the nose, or buy private medical insurance.
Another thing: drugs cannot be advertised on TV in the UK the way they are here. I believe that many Americans are driven to hypochondria by all the drug ads that tell you to talk to your doctor to find out whether you have some fake illness that they just invented to sell you a drug for. (ADHD? When I was a kid, bad behaviour got us sent to the principal's office - and we all grew up OK!) The less spent on advertising drugs, the lower the price can be, as well as reducing demand due to hypochondria.
(Reason Medical Care stocks are best investment in Wall St. and greedy health providers, insurance, and pharmacompanies are against Obamacare). US Health most expensive, but only 37th in the world. Paralyzed politicians don't do anything about it as they enjoy excellent health plans in Congress. Government (it's its job) has to step in to save the country' Health from collapse. The outcry vs Universal Care is carbon copy of outcries in Canada, UK, Germany and other countries where Universal Care is established. Romney Care (Medicare vouchers and Medicaid Block Grants to states) will produce 72 million uninsured by 2030 (per Family USA) and treble costs to pay for the uninsured. Illegal aliens (McCain Immigration bill was killed by Repubs), plus 72 million uninsured are going to cost trillions to all taxpayers. Merchants of Sickness spending millions to brainwash the Average Joe against Obamacare.
Canada is both 1/10th our GDP and population, they live a little longer only pay 10% of GDP with 1% for administration and they cover everyone. We spend 16% of GDP soon to be 20% because of this lousy health care bill. We do not cover everyone, do not live as long and we spend 6% for administration. If we paid for Canada's health care in exchange for them managing our heath care we would only spend 11% of GDP and everyone in both countries would be covered. The savings would balance the budget, pay down the deficit and make Social Security good thru about 2100. Canada wins because their health care is paid for and they will hire Canadians to manage our health care. We win because our health care is almost half price. This gets us around the health care lobby and our lousy Congress. People can still buy more insurance just in case, all though I can not understand why. The health care bill was 2400 pages and mine is not a page. KEN KRIEGER CAPE CORAL, FLORIDA 239-283 7385 PS The amount we are spending is double what the European Union spends. In other words if we paid for Europe's health in return for them managing ours, the 600 million people here and in Europe would have health care.