Health Care in the 2008 Election Elise Gould, Ph.D. October 20 th, 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

Access: The Crisis of the Uninsured 45 million Non-elderly uninsured in 2007 (17.1%) (CPS) Duration of Uninsurance, (SIPP)

Costs: Unsustainable Growth KFF/HRET Employer Benefits Survey, 2007 Premium increase (+115%) Workers earnings (+29%) Overall inflation (+24%) Nearly 50% of GDP by 2062 (CBO)

Value: International Comparison OECD Health Data, 2005 US spends 15.5% of GDP $7,439 per person (OECD)

Quality: Stark National Inequalities Black White Infant Mortality by Race, 2004Life Expectancy at 60 by Income, 2001 Top 50% Bottom 50% CDC Linked DataWaldron, 2007

Two Visions for Reform in 2008 Barack Obama Build on current employer- sponsored system Strengthen public system by building large insurance pools Give tax credits to self- employed, near-poor, and small businesses to help purchase coverage John McCain Radically change current system Replace current tax subsidies for employer- based 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 Employer- provided IndividualPublic Employer- provided National Exchange Public Uninsured Obama PlanMcCain Plan Tax Policy Center Analysis 20 million Lose their employer- sponsored 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 employer- provided 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 Obama: $1.6 Billion McCain: $1.3 Billion Total 10-Year Cost of Plan 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