Kao-Ping Chua Jack Rutledge Fellow, American Medical Student Association The Case for Universal Healthcare

What is Universal Health Care?

“No American should lack access to health care because he or she lacks the ability to pay for it when needed, and no American should suffer serious financial distress or personal bankruptcy as a result of unpaid medical bills.” Uwe Reinhardt, Princeton health economist

Countries with Universal Health Care … (South Africa) Industrialized countries without universal health care? only one …

Weighing the Arguments Moral Economic Cultural Moral Economic Cultural

The moral argument for UHC

The Central Moral Question Is it wrong to deny people healthcare based on the ability to pay?

Source: KFF/HRET Survey of Employer-Sponsored Health Benefits: 1999 – TIMES!

How Many Uninsured? 45,000,000 Americans

Annual deaths by cause, age 25-64

The uninsured receive poor medical care Inability to fill prescription Lack of regular healthcare provider or institution Poor care of chronic disease The “unhappy triad” of uninsurance –Receive less preventive care –Diagnosed at more advanced disease stages –Once diagnosed, receive less therapeutic care

Real-life examples Statistics don’t tell the full story

Uninsured child

Uninsurance can affect ANYONE Hi, My name is ______, and I am extremely interested in participating in whatever small way I can to effect Healthcare Reform in Indiana. My husband is a [very sick patient], and we were informed last Wednesday that Anthem Blue Cross of Indiana is going to terminate his employer's group insurance coverage…[unfortunately], he cannot 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 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 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 raised our children. 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 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 try to get insurance so we can try to hang on to the home where we raised our children. 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.

The Central Moral Question Is it wrong to deny people healthcare based on the ability to pay?

The economic argument for UHC

The central economic question Will we save money by achieving universal health care?

A 3 part question How much would it cost to cover everyone? How much does it cost to NOT cover everyone? Do the costs of UHC outweigh the benefits?

How much would it cost to cover everyone? Depends on generosity of benefits Depends on generosity of benefits $34-69 billion per year

How much would it cost to cover everyone? (Reinhardt, 2003) Assume $100 billion cost to government in the first year of a UHC program Assume increase of per capita health spending by 10%/year Total cost: $1.6 trillion over 10 years, or about $160 billion per year

Questions to ask How much would it cost to cover everyone? How much does it cost to NOT cover everyone? Do the costs of UHC outweigh the benefits?

How much does it cost NOT to cover everyone? IOM: $65-$130 billion in lost productivity per year

How much does it cost NOT to cover everyone? “Job lock” (3.8 million jobs) Less preventive/chronic disease care  costly High rate of medical bankruptcy Unnecessary use of the ER

How much does it cost NOT to cover everyone? Costs of keeping current employer-based system: –Loss of global competitiveness –Strain on businesses

Questions to ask How much would it cost to cover everyone? How much does it cost to NOT cover everyone? Do the costs of UHC outweigh 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 would save money Scenario 1: employer mandate Scenario 2: expansion of public insurance programs Scenario 3: creation of new programs for the uninsured Scenario 4: single-payer system

"The issue of universal coverage is not a matter 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 UHC

The central cultural question Is universal health care consistent with 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 values Do we believe in: Equality and equal opportunity?

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

UHC and American values Do we believe in: Getting good value for our money?

US Spending on Health Care, 2002 Total health care costs comprise 14% of GDP! Source: OECD Health Data 2002, Health Affairs :88-99 $1.7 trillion

Best Health Care in the world? (WHO Rankings 2000) Source: World Health Organization, Health Systems: Improving Performance, France 2. Italy 3. San Marino 4. Andorra 5. Malta 6. Singapore 7. Spain 8. Oman 9. Austria 10. Japan 16. Luxembourg 17. Netherlands 18. United Kingdom 19. Ireland 20. Switzerland 11. Norway 12. Portugal 13. Monaco 14. Greece 15. Iceland 21. Belgium 22. Colombia 23. Sweden 24. Cyprus 25. Germany 26. Saudi Arabia 27. United Arab Emirates 28. Israel 29. Morocco 30. Canada 31. Finland 32. Australia 33. Chile 34. Denmark 35. Dominica 36. Costa Rica 37. United States of America 38. Slovenia 39. Cuba 40. Brunei Darussalam

Infant Mortality, 2000 Deaths/100,000 Births Source: OECD, 2003

Life Expectancy, 2000 Source: OECD Health Data 2003

The 3 Big Questions Is it wrong to deny people healthcare based on the ability to pay? Will we save money by achieving universal health care? Is universal health care consistent with American values?

Benefits 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? Educate yourself and question your assumptions: Get involved in a state or national campaign: JOIN AMSA!

Parting thoughts “The Americans will always do the right thing…after they’ve exhausted all the alternatives.” - Winston Churchill