Increases in Health Insurance Premiums Compared with Other Indicators,

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1 Sustainable Health Care The Alliance for Natural Health (ANH) defines sustainable healthcare as "A complex system of interacting approaches to the restoration, management and optimization of human health that has an ecological base, that is environmentally, economically and socially viable indefinitely, that functions harmoniously both with the human body and the non-human environment, and which does not result in unfair or disproportionate impacts on any significant contributory element of the healthcare system. U.S. Healthcare system is not economically or socially sustainable: only wealthy industrialized nation that does not guarantee access to healthcare for all of its citizens More than 15% of Americans (46 million) are completely uninsured, many of them children Contrary to popular opinion, most of the uninsured come from working families, with only 19% coming from families with no workers Lack of health insurance increases medical risks and is associated with a higher death rate; a recent study estimated that in the U.S. in 25 roughly 45, deaths of Americans between the ages of 18 and 64 were associated with lack of health insurance Americans currently pay far more for health care, in total and per capita, than any other country in the world see next figure..

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3 ACCESS: AFFORDABLE CARE Percent Increases in Health Insurance Premiums Compared with Other Indicators, Health insurance premiums Workers earnings Overall inflation 5.3* 8.2* 1.9* 13.9^ 12.9* 11.2* 9.2* 7.7* 6.1*.8 *Estimate is statistically different from the previous year shown at p<.5. ^Estimate is statistically different from the previous year shown at p<.1. Note: Data on premium increases reflect the cost of health insurance premiums for a family of four. Historical estimates of workers earnings have been updated to reflect new industry classifications (NAICS). Data: G. Claxton, J. Gabel et al., "Health Benefits in 27: Premium Increases Fall To An Eight-Year Low, While Offer Rates And Enrollment Remain Stable," Health Affairs, September/October 27 26(5): Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 27, and Commonwealth Fund analysis of National Health Expenditures data.

4 EFFICIENCY International Comparison of Spending on Health, Average spending on health per capita ($US PPP*) Total expenditures on health as percent of GDP $7, United States Germany Canada $6, France Australia United Kingdom $5, $4, $3, $2, $1, $ United States Germany Canada France Australia United Kingdom * PPP=Purchasing Power Parity. Data: OECD Health Data 27, Version 1/27. 4

5 ACCESS: PARTICIPATION EXHIBIT 16 Access Problems Because of Costs Percent of adults who had any of three access problems* in past year because of costs United States NETH UK CAN GER NZ AUS International Comparison * Did not get medical care because of cost of doctor s visit, skipped medical test, treatment, or follow-up because of cost, or did not fill Rx or skipped doses because of cost. AUS=Australia; CAN=Canada; GER=Germany; NETH=Netherlands; NZ=New Zealand; UK=United Kingdom. Data: 25 and 27 Commonwealth Fund International Health Policy Survey.

6 HEALTHY LIVES Infant Mortality Rate Infant deaths per 1, live births National Average and State Distribution International Comparison, 24 U.S. average Bottom 1% states Top 1% states ^ ^ Denotes baseline year. Data: National and state National Vital Statistics System, Linked Birth and Infant Death Data (AHRQ 23, 24, 25, 26, 27a); international comparison OECD Health Data 27, Version 1/27.

7 HEALTHY LIVES Mortality Amenable to Health Care Deaths per 1, population* /98 22/ * Countries age-standardized death rates before age 75; including ischemic heart disease, diabetes, stroke, and bacterial infections. See report Appendix B for list of all conditions considered amenable to health care in the analysis. Data: E. Nolte and C. M. McKee, London School of Hygiene and Tropical Medicine analysis of World Health Organization mortality files (Nolte and McKee 28).

8 HEALTHY LIVES Healthy Life Expectancy at Age 6, 22 Developed by the World Health Organization, healthy life expectancy is based on life expectancy adjusted for time spent in poor health due to disease and/or injury Years 3 Women Men Note: Indicator was not updated due to lack of data. Baseline figures are presented. Data: The World Health Report 23 (WHO 23, Annex Table 4).

9 HEALTHY LIVES Working-Age Adults with Health Limits on Activities or Work Percent of adults (ages 18 64) limited in any activities because of physical, mental, or emotional problems 4 National Average and State Distribution By Age Group U.S. Average Top 1% States Bottom 1% States Age Age 3 49 Age 5 64 Data: D. Belloff, Rutgers Center for State Health Policy analysis of Behavioral Risk Factor Surveillance System. 9

10 ACCESS: PARTICIPATION Percent of Children Ages 17 Uninsured by State WA OR ID NV UT CA AZ AK MT WY CO NM ND MN WI SD IA NE IL KS MO OK AR MS TX LA IN MI TN AL OH KY WV GA SC PA VA NC FL VT NH NY NJ ME MA RI CT DE MD DC WA OR ID NV UT CA AZ AK MT WY CO NM ND MN WI SD IA NE IL KS MO OK AR MS TX LA IN MI TN AL OH KY WV GA SC PA VA NC FL VT NH NY ME MA RI CT NJ DE MD DC HI 16% or more 1% 15.9% HI 7% 9.9% Less than 7% Data: Two-year averages , updated with 27 Current Population Survey correction, and from the Census Bureau s March 2, 21 and 26, 27 CPS.

11 ACCESS: PARTICIPATION Population Under Age 65 Without Health Insurance Percent uninsured Millions uninsured Adults Children under All under 65 Children under 18 Adults Data: Analysis of Current Population Survey, March supplements. Updated data from March 27 Current Population Survey.

12 Solutions Spend less on prescription medicines and expensive machines for diagnostic tests. Spend more on promoting exercise and healthy eating. Lower insurance costs through tort reform Use online rating of hospitals and doctors: provides a strong incentive for doctors and hospitals to provide quality care Think about health care in a more holistic way. Health care does not involve only doctors and nurses, prescribing drugs and performing operations; it is also providing healthy food, preventive medicine, opportunities for exercise, and health education. All of these components should be part of an integrated system. Sustainable healthcare should emphasize preventive medicine and rely less on drugs and questionable medical procedures. Preventive medicine is more effective than both, without side effects or harmful effects on the environment. Health care should be viewed as an investment in human capital, which is a component of social capital. In an age of limited capital, we need to make data-driven decisions that are cost-effective, that maximize social capital without depleting economic capital. Only then can we hope to achieve a sustainable health care system.

13 Objections: Mandatory Health Insurance Republicans for decades have been advocating a mandate requiring individuals to buy health insurance. They viewed it as a free-market solution. Most experts agree some kind of requirement is needed in a reformed system because health insurance doesn t work if people put off joining the risk pool until they get sick. Now that insurance companies can t deny coverage for preexisting conditions (something everyone supported), it s essential that everyone be forced to have coverage. Only when the Democrats adopted the idea beginning last September did Republicans change their minds and start fighting against it. I give Obama credit for trying to include Republicans in the debate, and adopting some of their ideas, but Republicans were determined to be obstructionists. Mitt Romney and now Senator Scott Brown supported the health insurance mandate that now exists in Massachusetts, but months later Romney opposes the national version: Republican Bill Frist (former Senate majority leader) said he supports the president's efforts to reduce the number of uninsured people. "From a justice, fairness and equity standpoint, I'm very proud of this administration and that America has addressed this," Frist said. " +says+legal+fight+over+health+care+won+t+succeed

14 Other Objections Potential shortage of primary care physicians Expanded coverage was delayed until 214 so that the pool of primary care providers could prepare. The bill saves money by expanding the use of preventive care, which costs less than reactive medicine. The bill also did not ignore the anticipated shortage of primary care physicians: it includes money to induce doctors to practice primary care in areas where there are shortages, and for expanded community health centers that will pick up some of the slack. The article also seems to suggest that patients now and in the new bill will continue to pay co-pays except for important preventive care measures : imary_care But all Americans already have guaranteed health care. Emergency rooms are required to treat the sick. But wouldn t it be cheaper to provide access to preventive medical care? Shifting healthcare administration from private companies to the government will increase costs because government is less efficient. See the next slide. But don t patients in countries with socialized health care have to wait forever to see a doctor? See slide after.

15 Exhibit 4. Insurance Administrative Costs as a Percent of Total Private and Public Insured Spending on Health Services and Supplies, 27 Percent Private admin. expenses as % of privately insured personal health spending Public admin. expenses as % of publicly insured personal health spending Public admin. expenses as % of publicly insured personal health spending, excluding Medicare Part D Part D admin. expenses as % of drug spending Private drug plan admin. expenses as % of drug spending Medicare Advantage private drug plan admin. expenses as % of drug spending Source: Authors calculations from M. Hartman, A. Martin, P. McDonnell et al., National Health Spending in 27: Slower Drug Spending Contributes to Lowest Rate of Overall Growth Since 1998, Health Affairs, Jan./Feb (1):

16 QUALITY: PATIENT-CENTERED, TIMELY CARE EXHIBIT 16 Waiting Time to See Doctor When Sick or Need Medical Attention, Among Sicker Adults Percent of adults who could get an appointment on the same or next day United States NZ NETH GER AUS UK CAN International Comparison AUS=Australia; CAN=Canada; GER=Germany; NETH=Netherlands; NZ=New Zealand; UK=United Kingdom. Data: 25 and 27 Commonwealth Fund International Health Policy Survey.