Medicare for All
Mythbusters
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What We’ll Cover
In This Training :
Group Agreements :
Introductions
Introductions
Introductions
Health:
It’s more than just healthcare!
HEALTHCARE
POVERTY
RACISM
INEQUALITY
HOUSING
ENVIRONMENT
“America has the BEST healthcare system in the world!”
George W. Bush
(and almost every other American politician)
Myth #1: We’re #1
US Health Outcomes:
A Global Outlier
*Source: World Health Organization, Life Expectancy at Birth (Years), Accessed: 11/14/2022
Lowest Life Expectancy
*Source: World Health Organization, Healthy life expectancy (HALE) at birth (years), Accessed: 11/14/2022
Fewest “Healthy” Years of Life
*Source: World Health Organization, Infant mortality rate (per 1000 live births), Accessed: 11/14/2022
Highest Infant Mortality in Developed World
*Source: World Health Organization, Maternal mortality ratio (per 100 000 live births), Accessed: 11/14/2022
Highest Maternal Mortality in Developed World
U.S. Health Insurance Coverage:
A Global Outlier
*Source: OECD, Health At a Glance 2021, Access to care: eligibility for core services, Accessed: 11/14/2022
Health Insurance Coverage (6 countries)
*Source: U.S. Census Bureau, American Community Surveys (ACS), “Table HIC-4_ACS. Health Insurance Coverage Status and Type of Coverage by State--All Persons: 2008 to 2021”, Accessed: 11/14/2022
U.S. Health Insurance Coverage Over Time
*Source: U.S. Census Bureau, American Community Surveys (ACS), “Table HIC-9_ACS. Population Without Health Insurance Coverage by Race and Hispanic Origin: 2008 to 2021”, Accessed: 11/14/2022
Large Inequities in Coverage Remain
ACA subsidies & Medicaid expansion
US Access to Care:
A Global Outlier
*Source: OECD, Health At a Glance 2021, Access to care: eligibility for core services, Accessed: 11/14/2022
Cost-Related Problem Accessing Care
*Source: Medical Expenditure Panel Survey (MEPS) Insurance Component (IC), Data Tools. Accessed: 11/14/2022
Insured Workers with Deductibles
*Source: Medical Expenditure Panel Survey (MEPS) Insurance Component (IC), Data Tools. Accessed: 11/14/2022
Average Deductible for Insured Workers
*Source: Commonwealth Fund, “U.S. Health Insurance Coverage in 2020: A Looming Crisis in Affordability.” Accessed: 11/14/2022
“Underinsured”
Similar Impact to No Insurance
US Healthcare Costs:
Yet another Global Outlier!
*Source: OECD (2022), Health spending (indicator). doi: 10.1787/8643de7e-en. Accessed: 11/14/2022
U.S. Healthcare Spending Per Person:
Off the Charts!
$12,318
$5,905
$5,387
$4,666
State Budgets
RISING HEALTHCARE COSTS
Employer Budgets
Household Budgets
*Source: Massachusetts Budget & Policy Center, Budget Browser, Funding History. Accessed: 11/14/2022
Healthcare Costs Squeeze State Budgets: MA
2001
2021
*Source: Kaiser Family Foundation, “2022 Employer Health Benefits Survey.” Accessed: 11/14/2022
Healthcare Costs Squeeze Businesses & Employers
*Source: Kaiser Family Foundation, “2022 Employer Health Benefits Survey.” Accessed: 11/14/2022
Employers Squeeze Employees
with Higher Premium Contributions
*Source: Kaiser Family Foundation, “2022 Employer Health Benefits Survey.” Accessed: 11/14/2022
Employers Limit Premium Increases
by Increasing Deductibles, Cost Sharing for Workers
*Source: Commonwealth Fund, Small-Business Owners’ Views on Health Coverage and Costs, Sept. 2019. Accessed: 11/14/2022
Top Challenge for Small Business Owners:
*Source: Commonwealth Fund, Small-Business Owners’ Views on Health Coverage and Costs, Sept. 2019. Accessed: 11/14/2022
How Small Business Owners Have Responded:
*Source: Katherine Baicker & Amitabh Chandra, “The Labor Market Effects of Rising Health Insurance Premiums,” NBER Working Paper No. 11160, February 2005. Accessed: 11/14/2022
Every 10% increase in employer health premiums is passed onto workers with:
Two thirds of a premium increase is paid for with wages.
The remaining third comes from a reduction in benefits.
*Source: Congressional Research Service, “Real Wage Trends, 1979 to 2019,” Dec. 28, 2020. Accessed: 11/14/2022
Real Wages Frozen or FALLEN Since 1979
Medical expenses contributed to 58.5% of bankruptcies
*Source: Himmelstein et al. Medical Bankruptcy: Still Common Despite the Affordable Care Act. Am J Public Health. 2019 Mar;109(3):431-433. Accessed: 11/14/2022
1 in 4 Adults with health care debt owe more than $5,000. 1 in 5 with any amount of debt said they don’t expect to ever pay it off.
*Source: Levey. 100 Million People in America Are Saddled With Health Care Debt, KHN/KFF News . Accessed: 02/08/2023
23% of mortgage foreclosures due to medical bills
*Source: Robertson et al. Get Sick, Get Out: The Medical Causes of Home Mortgage Foreclosures (August 18, 2008). Health Matrix: Journal of Law-Medicine, Vol. 18, No. 65, 2008. Accessed: 11/14/2022
The $4.1 Trillion Question:
Why are U.S. healthcare costs so HIGH?
What are some explanations (correct or incorrect) you’ve heard why healthcare costs are higher here than in other countries?
Inadequate Prevention
Behavioral factors
Racial and ethnic makeup of the U.S.
Aging population
End of life care
Chronic Illnesses
Overuse of technology (e.g. MRIs, CT scans, etc)
Use more prescription drugs
Fee-for-service: overuse of tests and procedures
Common Explanations for High Healthcare Costs
Lower cost transparency
More third party insurance payers
More physician visits
More ER and hospitals visits
More Medical Malpractice lawsuits
Worse electronic health records
Higher cost of drugs
Higher cost of medical devices
Too much hospital bargaining power
More profits
More administration/paperwork
Higher physician/nurse pay
Inadequate Prevention
Behavioral factors
Racial and Ethnic Makeup of the U.S.
Aging population
End of life care
Chronic Illnesses
Three Narratives About Healthcare Costs
Higher cost of drugs
Higher cost of medical devices
Too much hospital bargaining power
More profits
More administration/paperwork
Higher physician/nurse pay
Health of the Population
Over-Utilization of Healthcare
Higher Cost of Healthcare
Overuse of technology (e.g. MRIs, CT scans, etc)
Use more prescription drugs
Fee-for-service: overuse of tests and procedures
Lower cost transparency
More third party insurance payers
More physician visits
More ER and hospitals visits
More Medical Malpractice lawsuits
Worse electronic health records
WHODUNNIT? Assign % Blame to Each Category!
Health of the Population
Over-Utilization of Healthcare
Higher Cost of Healthcare
Myth: We’re too sick, fat, & lazy
“The financial feasibility of Medicare for All is already questionable. Unless Americans start taking care of themselves, the outsized costs may be too much for our outsized nation.”
Christopher Dale
Writer, Democratic Socialist,
& Medicare for All Supporter(!)
*Source: McKinsey Global Institute, “Accounting for the cost of US health care: A new look at why Americans spend more,” December 1, 2008. Accessed: 11/14/2022
Health of the Population: Health Condition Prevalence
*Source: McKinsey Global Institute, “Accounting for the cost of US health care: A new look at why Americans spend more,” December 1, 2008. Accessed: 11/14/2022
Health of the Population: Health Condition COSTS
*Source: McKinsey Global Institute, “Accounting for the cost of US health care: A new look at why Americans spend more,” December 1, 2008. Accessed: 11/14/2022
Health of the Population: INNOCENT
Disease prevalence
=
$57 to $70 billion savings
Myth: We use too much healthcare!
“Any healthcare reform will have to confront the biggest single reason costs keep rising: The American people keep buying more and more healthcare. [...]
If a treatment can save our lives or increase quality of life, we want it. Therefore, in the long run, the only way to spend less on healthcare is to consume less healthcare. Someone, sometime, has to say no.”
Michael Tanner
Senior Fellow, Cato Institute
Over-Utilization
of Healthcare?
A Kernel of Truth
*Source: Anderson et al. “It's the prices, stupid: why the United States is so different from other countries.” Health Affairs. 2003 May-Jun;22(3):89-105. Accessed: 11/14/2022
Over-Utilization of Healthcare: INNOCENT
*Source: OECD (2019), Health at a Glance 2019: OECD Indicators, OECD Publishing, Paris. Accessed: 11/14/2022
Physician Visits per Person per Year
*Source: OECD (2019), Health at a Glance 2019: OECD Indicators, OECD Publishing, Paris. Accessed: 11/14/2022
Hospital Admissions per 1,000 people
*Source: OECD (2019), Health at a Glance 2019: OECD Indicators, OECD Publishing, Paris. Accessed: 11/14/2022
Average Length of Hospital Stay (days)
Myth #4: Immigrants ARE STEALING OUR healthcare!
“Over 130 legislators in this chamber have endorsed legislation that would bankrupt our nation by providing free taxpayer-funded health care to millions of illegal aliens, forcing taxpayers to subsidize free care for anyone in the world who unlawfully crosses our borders.”
Donald J. Trump
OK, But why Are U.S. healthcare costs
ACTUALLY so high?
Single-Payer
Multi-Payer
Universal Healthcare Fund
Hospital
Doctor
Drugs
Devices
Public
Insurer
Private
Insurer
Private
Insurer
Private
Insurer
Private
Insurer
Hospital
Doctor
Pharma
Devices
Follow the Dollars: Insurance Overhead Costs
Canada
United States
2.8% ($146 / person)
*Source: Himmelstein et al. “Health Care Administrative Costs in the United States and Canada, 2017.” Annals of Internal Medicine, Jan 2020, 21;172(2)
7.9% ($844 / person)
97.2%
92.1%
Follow the Dollars: Insurance Overhead Costs
Canada
United States
97.2%
92.1%
Profits
Marketing
Advertising
Broker fees
Lobbying
Exec. salaries
Care denials
*Source: Himmelstein et al. “Health Care Administrative Costs in the United States and Canada, 2017.” Annals of Internal Medicine, Jan 2020, 21;172(2)
2.8% ($146 / person)
7.9% ($844 / person)
Follow the Dollars: Hospital Overhead Costs
United States
Canada
13.1%
26.6%
*Source: Himmelstein et al. “Health Care Administrative Costs in the United States and Canada, 2017.” Annals of Internal Medicine, Jan 2020, 21;172(2)
86.9%
73.4%
($196 / person)
($933 / person)
Follow the Dollars: Physician Overhead Costs
Canada
United States
*Source: Himmelstein et al. “Health Care Administrative Costs in the United States and Canada, 2017.” Annals of Internal Medicine, Jan 2020, 21;172(2)
10.8%
21.8%
89.2%
78.2%
($87 / person)
($465 / person)
Follow the Dollars: TOTAL Administrative Costs
Canada
United States
*Source: Himmelstein et al. “Health Care Administrative Costs in the United States and Canada, 2017.” Annals of Internal Medicine, Jan 2020, 21;172(2)
17.0%
34.2%
83.0%
65.8%
($551 / person)
($2,497 /
person)
*Source: Gabriel Levitt, “How much cheaper is medicine in Canada?” October 11, 2018. Accessed: 11/14/2022
Follow the Dollars: Brand Name Drug Costs
*Source: Political Economy Research Institute, “Economic Analysis of Medicare for All, November 2018. Accessed: 11/14/2022
Passing Medicare for All in the U.S.:
Universal Healthcare for LESS Money!
Current spending | | $3.24 trillion |
Administrative savings | -9.0% | |
Drug price savings | -5.9% | |
Uniform hospital rates | -2.8% | |
Reduced fraud/waste | -1.5% | |
Increased utilization | +12.0% | |
Spending under M4A | | $2.93 trillion |
Myth #5: We can’t win
“Single-payer just isn’t a political possibility starting from here. It’s just a distraction from the real issues.”
Paul Krugman
New York Times Columnist