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Explore the challenges and disparities in the American healthcare system, from financial suffering to racial inequalities. Learn about the impact of for-profit entities and proposed reforms. Discover the complexities of insurance models and the Massachusetts healthcare reform experiment.
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PHYSICIANS FOR A NATIONAL HEALTH PROGRAM 29 EAST MADISONSUITE 602CHICAGO, IL 60602TEL: (312) 782-6006WWW.PNHP.ORG
Variation in Medicare Spending: Some Regions Already Spend at Canadian Level
Half of Americans Live Where Population Is Too Low for Competition A town’s only hospital will not compete with itself Source: NEJM 1993;328:148
Medicare HMOs:A Cautionary Tale About Competition Between Public and Private Plans (AKA Public Plan Option)
Despite Medicare’s Lower Overhead, Enrollment of Medicare Patients in Private Plans Has Grown
For-Profit Hospitals’ Death Rates are 2% Higher Source: CMAJ 2002;166:1399
For-Profit Hospitals Cost 19% More Source: CMAJ 2004;170:1817
For-Profit Dialysis Clinics’ Death Rates are 9% Higher Source: JAMA 2002;288:2449
High Deductible Insurance:Except for the Healthy and Wealthy, It’s Unwise
Proposed by Richard Nixon in 1971 to block Edward Kennedy’s NHI proposal “Mandate” Model for Reform
Government uses its coercive power to make people buy private insurance. “Mandate” Model for Reform
“Mandate” Model for Reform • Expanded Medicaid-like program • Free for poor • Subsidies for low income • Buy-in without subsidy for others • Employer Mandate +/- Individuals • Managed Care / Care Management
“Mandate” Model - Problems • Absent cost controls, expanded coverage unaffordable • Computers, care management, prevention not shown to cut costs • Adds administrative complexity and cost; retains wasteful private insurers • Impeccable political logic, economic nonsense
Massachusetts: Required Coverage(Income > $31k) • Premium: $4,800 Annually (56 year old) • $2000 deductible • 20% co-insurance AFTER deductible is reached