1Universal HealthcareUniversal Healthcare• In 2004, health care spending in the United States reached $1.9 trillion, and is projected to reach $2.9 trillion in 2009• The annual premium that a health insurer charges an employer for a health plan covering a family of four averaged $10,800 in 2005. Workers contributed $2,713, or 10 percent more than they did in 2004 (3).The annual premiums for family coverage eclipsed the gross earnings for a full-time, minimum-wage worker ($10,712).Universal Healthcare• Health insurance expenses are the fastest growing cost component for employers.• The average employee contribution to company-provided health insurance has increased more than 143 percent since 2000. Average out-of-pocket costs for deductibles, co-payments for medications, and co-insurance for physician and hospital visits rose 115 percent during the same periodUniversal Healthcare• # A recent study by Harvard University researchers found that the average out-of-pocket medical debt for those who filed for bankruptcy was $12,000. The study noted that 68 percent of those who filed for bankruptcy had health insurance. In addition, the study found that 50 percent of all bankruptcy filings were partly the result of medical expenses (12). Every 30 seconds in the United States someone files for bankruptcy in the aftermath of a serious health problem.% GDP for Health Care Expenses15.2%10.1%9.9%11.0%8.0%7.9%7.3%0.0%2.0%4.0%6.0%8.0%10.0%12.0%14.0%16.0%United StatesFranceCanadaGermanyUnited KingdomJapanCubaHealth Care Expenses Per Capita$5,711$2,902$2,989$3,001$2,389$2,244$251$0$1,000$2,000$3,000$4,000$5,000$6,000United StatesFranceCanadaGermanyUnited KingdomJapanCuba2Universal Healthcare• “Universal healthcare is a system in which all residents of a geographic or political entity have their healthcare paid for, regardless of medical condition or financial status.” -Wikipedia (2006).United States Statistics• Infant Mortality– Correlates very strongly with and is the one of the best predictors of state failure– Indicator of country’s level of health or development– Rank 42ndin the world (CIA Factbook 2006)– Countries such as Japan, South Korea, Cuba, Ireland, Italy, Jersey, rank higher than the US– 6.43/1,000 (deaths/1,000 live births)Infant Mortality Rate6.434.214.694.125.083.246.2201234567United StatesFranceCanadaGermanyUnited KingdomJapanCubaLife Expectancy75767876 7679758083 8382818680505560657075808590United StatesFranceCanadaGermanyUnited KingdomJapanCubaMaleFemaleWho has healthcare?• 46.6 million Americans without health insurance (US Census Bureau, 2005)3United States Healthcare• Public Health Insurance • Medicare – Basics: A federal program that covers individuals aged 65 and over, as well as some disabled individuals. – Administration: A single-payer program administered by the government; performing the insurance function of reimbursement. – Financing: Financed by federal income taxes, a payroll tax shared by employers and employees, and individual enrollee premiums (for parts B and D). – Benefits: Medicare Part A covers hospital services, Medicare Part B covers physician services, and Medicare Part D offers a prescription drug benefit. [Medicare Part C refers to Medicare Advantage – HMO’s that administer Medicare benefits]. United States Healthcare– There are many gaps in Medicare coverage, including incomplete coverage for skilled nursing facilities, incomplete preventive care coverage, and no coverage for dental, hearing, or vision care. Because of this, the vast majority of enrollees obtain supplemental insurance. Overall, seniors pay about 22% of their income for health care costs despite their Medicare coverage.Public Health Insurance• Medicaid – A program designed for the low-income and disabled. By federal law, states must cover very poor pregnant women, children, elderly, disabled, and parents. – States have the option of expanding eligibility if they so choose. For example, states can choose to increase income eligibility levels. – Administration: The states and the District of Columbia are responsible for administering the Medicaid program; as such, there are effectively fifty-one different Medicaid programs in the country. Medicaid Cont.– Financing: Medicaid is financed jointly by the states and federal government through taxes. Every dollar that a state spends on Medicaid is matched by the federal government at least 100%. Nationwide, the federal government pays for 57% of Medicaid costs. – Benefits: Medicaid offers a comprehensive set of benefits, including prescription drugs. Despite this, many enrollees have difficulty finding providers that accept Medicaid due to its low reimbursement rate.Public Health Insurance• Other public systems – S-CHIP: The State Children’s Health Insurance Program covers children whose families make too much money to qualify for Medicaid but make too little to purchase private health insurance. – VA: Federally administered program for veterans of the military. Health care is delivered in government-owned VA hospitals and clinics. Funded by taxpayer dollars and offers extremely affordable or free care to veterans.United States Healthcare• Private Health Insurance • Employer-sponsored insurance – Basics: Employer-sponsored insurance represents the main way in which Americans receive health insurance. – Administration: Insurance plans are administered by private companies, both for-profit and non-for-profit. – Financing: Employer-sponsored insurance is financed both through employers and employees. – In 2005, the annual private employer-sponsored insurance premiums averaged $4,024 for single coverage and $10,880 for a family of four.4Private Health Insurance Cont.– Benefits: Benefits vary widely with the specific health insurance plan. Some plans cover prescription drugs, while others do not. The degree of cost-sharing varies considerably.United States Health Insurance• Private non-group– Basics: The individual market covers part of the population that is self-employed or retired. In addition, it covers some people who are unable to obtain insurance through their employer. – Administration: Plans are administered by private insurance companies. Private Non-Group Cont.– Financing: Individuals pay an insurance premium for coverage. Risk in the individual market depends only on the health status of the individual, in contrast to the group market, in which