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A Little Problem of Equity

Explore the disparities in healthcare spending across populations, examining key factors such as social determinants and reform proposals. Dive into how major health reform proposals address issues like individual mandates, insurance regulations, and public options.

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A Little Problem of Equity

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  1. A Little Problem of Equity Population Health Care Spending Source: Organization for Economic Cooperation and Development, 2006

  2. The Great (And Expensive) Mismatch Health System Spending $2.5 Trillion / Year Influence 10% 20% 20% 50% “Social” Determinants Sources: Centers for Disease Control and Prevention, University of California at San Francisco, Institute for the Future. Reprinted from Advances: The Robert Wood Johnson Foundation Quarterly Newsletter, 2000, Issue 1, supplement, page 1

  3. Provisions of Major Health Reform Proposals Senate HELP, Senate Finance, House Tri-Committee Common Provisions: • Individual mandate • Medicaid expansion • Premium subsidies – up to 400% FPL • Insurance regulations – renewability, guarantee issue, rating • New insurance gateway(s)

  4. Provisions of Major Health Reform Proposals (2) UnCommon Provisions: • Public insurance option – SFC = “Co-ops” • SCHIP expansion – SFC = to 250% • Employer mandate – not SFC • Primary care – SFC and House Tri = payments • Community prevention • CHCs – Senate HELP = funding to increase # CHCs and school-based clinics

  5. Where the Money Goes (Really),U.S., 2004 Source: Rough calculations based on CMS 2007 reports and estimates of administrative expenditures by UW Health Policy Analysis Program, 1990

  6. The Public Now Underwrites Most U.S. Health Spending Source: US Department of Health and Human Services, 2006; Katz estimate

  7. But the U.S. Does Have More Medical Technology MRIs / Million Population Source: Organization for Economic Cooperation and Development, 1999

  8. Health Insurance Premiums Outpace Inflation and and Workers’ Earnings

  9. The Big Squeeze: Health care spending displaces education funding 1986 2006 Source: Washington State Office of Financial Management, 2008

  10. A Confluence of Ideologies Conservative Values • Taking care of oneself and others • Preventing irresponsible free-riding • Reducing inefficiencies that burden business and entrepreneurialism Liberal Policies • Health coverage security • Mandated universal coverage • Publicly accountable budget, and uniform financing, payment, and benefits

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