International Health Care Systems

1. International Health Care Systems Claudia Chaufan, MD, PhD Physicians for a National Health Program-California California Health Professional Student Alliance, October 14, 2012

2. Medical Bankruptcies • What is the first cause of personal bankruptcy in the US? • How many people go bankrupt annually in the US even when they have health insurance?

3. In medical bankruptcies…we are leaders! • First cause of personal bankruptcy is medical • In 2007, 62% of personal bankruptcies were medical • Increase of ~50% from 2001 • Most debtors well educated, homeowners, middle class occupation • 75% had health insurance at time of filing The American Journal of Medicine, 2009

4. International model:Social insurance / National Systems • Everybody in, nobody out! (true universality) • Always a function of income, receive medical care according to need • Unified benefits package of “medically necessary services” • Everybody in large pools (spread risk widely) • Profit banned from sale of insurance for medically necessary services “buyers” “sellers” Patients Public or private Mutual funds (non profit) Germany, France, Japan Financing Single payer Canada, Taiwan, UK

5. Groups divided by actuarial risk/income • Pay according to plan • Services according to plan • Profit ok for medically necessary services US health care before March 2010 $$$$$$$$ Private insurers Employer Market 55% $$$$ Employed, health coverage Young, healthy, secure jobs (?)c Private insurers Individual Market $$ Self-employed $$$ Working (near) poor Unemployed • Public insurers • ~30% • Medicare • Medicaid • Private Medicare • /Medicaid • SCHIP Elderly (poor and non-poor) Disabled Renal Failure Out of pocket $$$$$$$ (Near) poor kids Black hole (uninsured) ~15%

6. Groups divided by actuarial risk/income • Pay according to plan • Services according to plan • Profit ok for medically necessary services US health care after March 2010 • TAXPAYER EXPANSIONS OF PUBLIC • HEALTH CARE (MEDICAID) • TAXPAYER FUNDED SUBSIDIES • (PROMISED) GUARANTEED ISSUE • MANDATE TO PURCHASE COMMERCIAL INSURANCE • COST CUTTING MEASURES (EMR, P4P, CUT ‘WASTE’, ETC) • REGULATIONS / REGULATIONS / REGULATIONS EXCHANGES IND.MARKET $$ $$$$$$$$ Private insurers Employer Market 55% $$$$ Employed, health coverage Young, healthy, secure jobs (?)c Self-employed $$$ Working poor Unemployed • Public insurers • ~30% • Medicare • Medicaid • Private Medicare • /Medicaid • SCHIP Elderly (poor and non-poor) Disabled Renal Failure Out of pocket $$$$$$$ (Near) poor kids Uninsured circa 2019, 26 million? (7%)

7. Groups divided by actuarial risk/income • Pay according to plan • Services according to plan • Profit ok for medically necessary services US health care after March 2010 Public option 2% (6 million) ? EXCHANGES IND.MARKET $$ $$$$$$$$ Private insurers Employer Market 55% • TAXPAYER EXPANSIONS OF PUBLIC • HEALTH CARE (MEDICAID) • TAXPAYER FUNDED SUBSIDIES • (PROMISED) GUARANTEED ISSUE • MANDATE TO PURCHASE COMMERCIAL INSURANCE • COST CUTTING MEASURES (EMR, P4P, CUT ‘WASTE’, ETC) • REGULATIONS / REGULATIONS / REGULATIONS $$$$ Employed, health coverage Young, healthy, secure jobs (?)c Self-employed $$$ Working poor Unemployed • Public insurers • ~30% • Medicare • Medicaid • Private Medicare • /Medicaid • SCHIP Elderly (poor and non-poor) Disabled Renal Failure Out of pocket $$$$$$$ (Near) poor kids Black hole (uninsured) ~15%