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The US Healthcare System

The US Healthcare System. (There’s a hole in the bucket!) John C. Nelson, MD, MPH. Cost of Healthcare. Healthcare is the most rapidly growing sector of the US economy. Nearly 15% of the GDP. Not only are costs skyrocketing, but the rate of rise is even faster.

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The US Healthcare System

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  1. The US Healthcare System • (There’s a hole in the bucket!) • John C. Nelson, MD, MPH

  2. Cost of Healthcare • Healthcare is the most rapidly growing sector of the US economy. • Nearly 15% of the GDP. • Not only are costs skyrocketing, but the rate of rise is even faster. • Over $2 trillion per year in US. • $6,820 per capita.

  3. Access to Healthcare • US is the only industrialized nation not to have universal access to healthcare. • Measurably poorer outcomes in several categories. • Comparisons may not be fair, but are highly political and motivate discussion.

  4. Cost of Healthcare • Some factors are beyond the control of the healthcare system. • Number of people. • Increasing age of the population. • New diseases. • New modalities. • Litigation.

  5. Access to Healthcare • Lack of health insurance is in itself a risk factor. • Uninsured have poorer outcomes. • Uninsured have increased mortality rates. • Insured patient with AMI. • Uninsured patient with AMI. • Uninsured patient more likely to die.

  6. Access to Healthcare • Lack of insurance leads to other issues. • Little or no prenatal care. • Later entry into care if available. • Increased risk of premature birth. • Overall poorer outcomes for the neonate. • Also, more costly.

  7. Access to Healthcare • IOM Report 2002. • “As many as 18,000 Americans die annually from diseases that can be prevented or treated but are not because of lack of access to health insurance.” • And this is the United States of America! • Shameful.

  8. Cost of Healthcare • To cover the 47 million uninsured will cost (depending on the method chosen) between $200 and $500 billion extra dollars per year over what we are now spending on healthcare coverage in the United States. • Can we afford this?

  9. Cost of Healthcare • What is the cost of not covering 47 million of our fellow Americans? • That exact question was asked by the Institute of Medicine in a 2002 report. • The answer is staggering!

  10. Cost of Healthcare • Depends on assumptions made. • Actual cost of care received. • Cost of wages not earned. • Cost of taxes not paid. • Cost of goods and services that were not purchased.

  11. Cost of Healthcare • IOM estimate of costs of not covering the 47 million uninsured: • Up to $3.2 trillion per year!! • ($200 to $500 billion per year to pay for insurance for all.)

  12. Cost of Healthcare • You ain’t seen nothin’ yet! • The human genome. • Multiple therapeutic uses. • Specific anti cancer drugs tailor made to the tumor and even to the patient. • May be able to predict disease. • But at what cost?

  13. Scourges of our Society • Obesity. • Sexually transmitted diseases (STDs.) • Teenage pregnancy. • Violence. • Suicide. • Accidents. • Alcohol abuse. • Tobacco use.

  14. Overall Costs • $1.17 trillion of the nearly $2 trillion bill for healthcare is for diseases over which we can exert some control. • Over half of what we spend is unnecessary! • Common denominator: an element of choice or behavior in every example.

  15. Scourges of Society • Over half of the entire cost of healthcare in the United States for one year are actually preventable!

  16. Scourges of Society • What is common among all of these conditions? • All are behaviorally related. • All include an element of choice. • All are preventable.

  17. Reasons to Cover All • It’s the right thing to do. • Public health argument. • Costs overall.

  18. Method of Coverage • Single payer, government run healthcare for all. • Will not work for 3 reasons: • Medicare. • Medicaid. • Tricare.

  19. Method of Coverage • Private sector. • Team with public sector. • Change in tax law will cover 85% of those currently uninsured. • Need some creative thinking.

  20. Medicaid • Recently served on federal Medicaid Commission. • Goal was to make recommendations to improve current Medicaid program. • Frustrating experience. • Opportunity lost.

  21. Medicaid • 60% of Medicaid money is spent on long term care, much of which is used by those for whom Medicaid was never intended. • This takes away scarce resources for those who most need them. • Benefit package needs to be carefully analyzed and down-sized.

  22. Medicaid • Three obvious recommendations. • Re-think the long term care obligation of Medicaid. • Reduce the number of eligibility classes to two: in or out. • Propose an evidence-based benefits package.

  23. What Can We Do Now? • Continue the excellent, caring, and compassionate service that you are currently rendering to patients. • Improve the overall program. • Analyze all that is currently being done and apply an evidence-base to it. • Who knows where this may lead?

  24. Globus Relief • We take surplus medical goods and equipment and send them around the world for humanitarian use. • We also recognize there are domestic needs. • We are willing to partner with local groups who could use our help.

  25. Globus Relief • Located at: • 1775 West 1500 South, Salt Lake City • Phone: • 801/977-0444 • Contact: Ashley Robinson

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