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Health Insurance in America

Health Insurance in America. Michael Genuardi M.D. Massachusetts General Hospital Harvard Medical School February 26th, 2014 - Medway High School. Me?. smbc-comics.com. Financial disclosures. none. “Obamacare” to its friends... and enemies. Healthcare is a godawful mess

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Health Insurance in America

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  1. Health Insurance in America • Michael Genuardi M.D. • Massachusetts General Hospital • Harvard Medical School • February 26th, 2014 - Medway High School

  2. Me? smbc-comics.com

  3. Financial disclosures • none.“Obamacare” to its friends... and enemies

  4. Healthcare is a godawful mess • How did we get here? • The Affordable Care Act of 2010 “Obamacare” to its friends... and enemies

  5. Healthcare is a godawful mess • How did we get here? • The Affordable Care Act of 2010 “Obamacare” to its friends... and enemies

  6. Healthcare is a godawful mess • How did we get here? • The Affordable Care Act of 2010 “Obamacare” to its friends... and enemies

  7. “ Comprehensive health insurance is an idea whose time has come in America. There has long been a need to assure every American financial access to high quality health care. As medical costs go up, that need grows more pressing. Now, for the first time, we have not just the need but the will to get this job done. There is widespread support in the Congress and in the Nation for some form of comprehensive health insurance. • Surely if we have the will, 1974 should also be the year that we find the way. Surely if we have the will, 1974 should also be the year that we find the way. ” Richard Nixon

  8. 1. Healthcare is a godawful mess

  9. data: OECD

  10. data: OECD

  11. data: OECD, 2008

  12. Life Expectancy at Birth data: OECD, 2008

  13. Life Expectancy at 65 data: OECD, 2008

  14. Life Expectancy at 65 data: OECD, 2008

  15. Physicians per Capita data: OECD, 2008

  16. Physicians per Capita data: OECD, 2008

  17. Hospital Beds per Capita data: OECD, 2008

  18. Number of MRI Scans per Capita data: OECD, 2008

  19. Smoking Rate data: OECD, 2008

  20. Smoking Rate data: OECD, 2008

  21. Drinking Rate data: OECD, 2008

  22. Obesity Rate data: OECD, most recent available

  23. 2. How did we get here?

  24. The good old days?

  25. How do we pay doctors?

  26. How do we pay doctors? • Doctors (and hospitals) get paid for things they do • Office visits • Procedures • Lab tests • Radiology • “Fee for service”

  27. How did we get here? • 1929 • Baylor University Hospital enacts one of the first prepaid health insurance plans • Beneficiaries: teachers • Premium: 50¢ / month • Benefit: 21 inpatient days • Becomes Blue Cross • World War II • Henry Kaiser offers his shipyard employees pre-paid coverage, then opens it to everyone after the war • 1943Congress makes health benefits tax-free • 1966 • Johnson enacts Medicare, government-run insurance for the retired and disabled

  28. How did we get here? • 1929 • Baylor University Hospital enacts one of the first prepaid health insurance plans • Beneficiaries: teachers • Premium: 50¢ / month • Benefit: 21 inpatient days • Becomes Blue Cross • World War II • Henry Kaiser offers his shipyard employees pre-paid coverage, then opens it to everyone after the war • 1943Congress makes health benefits tax-free • 1966 • Johnson enacts Medicare, government-run insurance for the retired and disabled

  29. How did we get here? • 1929 • Baylor University Hospital enacts one of the first prepaid health insurance plans • Beneficiaries: teachers • Premium: 50¢ / month • Benefit: 21 inpatient days • Becomes Blue Cross • World War II • Henry Kaiser offers his shipyard employees pre-paid coverage, then opens it to everyone after the war • 1943Congress makes health benefits tax-free • 1966 • Johnson enacts Medicare, government-run insurance for the retired and disabled

  30. How did we get here? • 1929 • Baylor University Hospital enacts one of the first prepaid health insurance plans • Beneficiaries: teachers • Premium: 50¢ / month • Benefit: 21 inpatient days • Becomes Blue Cross • World War II • Henry Kaiser offers his shipyard employees pre-paid coverage, then opens it to everyone after the war • 1943Congress makes health benefits tax-free • 1966 • Johnson enacts Medicare, government-run insurance for the retired and disabled

  31. Who pays doctors?

  32. Who pays doctors? 30% 55% Private companies Government

  33. Who pays doctors? 30% 55% Private companies Government 15% No insurance 45,000,000 people US Census

  34. Who pays doctors? From employer Bought directly

  35. Who pays doctors? • Medicare • Americans over 65 and the disabled • Federal government run • Medicaid • (Very) poor Americans • State government run • Quality varies widely by state • Saves money by paying doctors less • Veteran’s Affairs (“The VA”) • Federal government run • For military families only • VA hospitals are government owned • VA doctors are government employees

  36. The Commonwealth Fund

  37. We ALREADY pay the same amount of tax dollars as other countries that get government-run healthcare for everyone! But we aren’t getting it! The Commonwealth Fund

  38. Rationale for Reform

  39. Rationale for Reform Sommers et al., NEJM 2012

  40. Who pays doctors? What is the best way to insure these people?

  41. Who pays doctors? Why don’t these people have insurance?

  42. Who pays doctors? Why don’t these people have insurance? • Can’t afford it • Unemployed • Not poor enough • Undocumented workers • No one will sell it to them • “Pre-existing conditions” • Don’t want it?

  43. First of all, every study has shown that Medicare has lower administrative cost than private insurance does, which is why seniors are generally pretty happy with it. And private insurers have to make a profit. Nothing wrong with that; that's what they do. And so you've got higher administrative costs, plus profit on top of that. Private Insurance is Evil? “ ” Barack Obama First presidential debate, 2012

  44. Private Insurance is Evil?

  45. Private Insurance is Evil? The Heritage Foundation

  46. Patient Protection and Affordable Care Act • New rules for insurance companies • Preventative care services • Enhancement of health care workforce • Changes to Medicare payment scheme • Cost control and revenue raising • Coverage expansion

  47. New insurance rules Preventative services Coverage expansion Try to lower cost New rules for private insurance companies • Unmarried people can stay covered from their parents’ plan until age 26 • Most money a company makes has to go to paying for medical care for its beneficiaries • Insurers can not refuse to sell insurance to someone for a “pre-existing condition”

  48. New insurance rules Preventative services Coverage expansion Try to lower cost Some pre-existing conditions (from a company’s website) BCBS of Illinois

  49. New insurance rules Preventative services Coverage expansion Try to lower cost Preventative services • Insurance now has to cover: • Annual check-ups, including shots for kids • Services to help quit smoking • Prenatal care for pregnant women • Contraceptive counseling and care • Routine cancer screening (colonoscopy, mammography, pap smears) Koh HK & Sebelius KG, NEJM 2010

  50. The main course Coverage expansion

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