Healthcare Costs in the USA. They do things big over here

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1

2 2 Prologue

3 Healthcare Costs in the USA They do things big over here

4 4 Spending

5 5 Spending

6 Societal Implications Medical expenses involved in 62% of all bankruptcies. Costs negate average wage increase in the past decade. Hardest hit are those who can t afford it / less secure. Federal spending on assistance programmes alone is 5% GDP and growing (military is 4.4%). Diverts money from other governmental projects (infrastructure, education). Anti-entrepreneurial. 6

7 Healthcare Outcomes US does not perform significantly better than other countries, who run much cheaper health programmes. Life expectancy: US is 35 th out of 192. Other diseases, acute and chronic: nothing special. 7

8 Possible Culprits Higher income Aging population Obesity and lifestyle Malpractice and defensive medicine Patient demands time, procedures, prescriptions Pharmaceutical companies Insurance companies Defaulting patients 8

9 Aging Population No: the USA has among the youngest populations in OECD. 9

10 10 American Lifestyle

11 11 American Lifestyle

12 Medical Liability Defensive medicine extra / more expensive procedures performed just in case. Is this a substantial contributor to the financial burden of US healthcare? Not really 12

13 Medical Liability Defensive medicine extra / more expensive procedures performed just in case. Is this a substantial contributor to the financial burden of US healthcare? Not really According to a 2010 study, the whole liability and defensive medicine system costs $55.6 billion (2.4% total spending). Law reform to limit suits have had little impact on spending (~0.1% in Texas and California) 13

14 The Story So Far We ve got pretty much nothing: can t attribute extra cost to higher income, lifestyle, demographics or over-use of hospitals. Take a slightly deeper look at the system. 14

15 The Players Doctors Hospitals People Health Insurance 15 Government Pharma

16 The Players Doctors Hospitals People Health Insurance 16 Government Pharma

17 The Players Doctors Hospitals People Health Insurance 17 Government Pharma

18 The Players Doctors Hospitals People Health Insurance 18 Government Pharma

19 The Players Doctors Hospitals People Health Insurance 19 Government Pharma

20 The Players Doctors Hospitals People Health Insurance 20 Government Pharma

21 The Players Doctors Hospitals People Health Insurance 21 Government Pharma

22 The Players Doctors Hospitals People Health Insurance 22 Government Pharma

23 The Players Doctors Hospitals People Health Insurance 23 Government Pharma

24 The Players Doctors Hospitals People Health Insurance 24 Government Pharma

25 Doctors Villains! Commission inflating costs of insurance premiums E.g. perform 25% more procedures than other countries Hospital spending per discharge,

26 Insurance Companies & Big Pharma Villains! Usual tricks: refuse to pay / insure Pharma: patents, inelastic demand IC: over-charge for generics Remember for transparency slide 26

27 Aside: Crossfire Insurance companies never pay in full hospitals overcharge Devastating for uninsured people (16% of US population) 27

28 Aside: Crossfire [The way the US system works,] people are completely dependent on their health insurance for even small medical costs. In what other industry would you do this? Would you use your car insurance to buy windshield wiper fluid or replace a burned out headlight? Would you use your homeowners insurance to replace a screen? In medicine, people are routinely billed several hundred dollars for trivial tests that shouldn t cost more than a car headlight, just because they don t have insurance, or the insurance company denied coverage for that test. Doctor David Belk 28

29 Crux: Things Cost More Everything is simply more expensive Drugs ($100 billion extra) 77% more per pill than average OECD Medical instruments Same as drugs Procedures ($500 billion extra) Hip replacement: US $40,400; Spain $7,700 Angiogram: US $900; Canada $30 Inpatient care (factor of three, per day) Medical salaries ($75 billion extra) 29

30 Why Do They Cost More? Drugs and medical instruments Advertising? >$40bn / year Early adoption: average pill 118% more expensive No centralised negotiation Medical staff 30

31 Opaque and Anticapitalist Lack of transparency not a marketplace if no-one knows in advance what anything costs! Can t shop around no competition Grocery analogy. 31

32 Opaque and Anticapitalist Any time you go to a grocery store, you expect to see all of the products being sold with their prices plainly displayed. When you go to the checkout, that's the price you expect to be charged. You also expect to be able to check the price of the same or a comparable product in competing stores so you can shop around. That's how the free market works. Imagine what it would be like if a grocery store never displayed the price of anything. And the price you're charged might be totally different from the price the next customer is charged for the same product. In fact, suppose you couldn't even pick your own groceries. A grocery list would be handed to you by a food expert and you d be billed based on your particular grocery plan. Eggs might cost you $5, the next person $10 and some poor guy who doesn t have a grocery plan would have to pay $50 for the same carton. Don't even think about shopping around. Your grocery plan follows you everywhere and determines the price you pay and, since you re only allowed to buy what s on the list, you can t even price-compare similar items (like brown eggs vs. white eggs). The only way to save money would be to go without groceries. Do you think this would make food cheaper or easier to get? Well, what s described above is pretty close to how prescription medications are sold in the US. 32

33 Conclusions Pig video. US spends far more than you d expect: for no tangible benefit Seen some places where the problem isn t, and some where it is For instance, catastrophic market failure But as expected, no clear solution Can all agree: it s messed up. 33

34 34 The End

35 35 Bad Debt

36 36 Spending Is In Care

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