A Little Problem of Equity

Rest of the

World 61%

United States 39%

Rest of the World

95%

United States

5%

Health Care SpendingPopulation

Source: Organization for Economic Cooperation and Development, 2006

MEDICAL CARE  

GENETICS

ENVIRONMENT

HEALTHBEHAVIORS

MEDICAL CARE

88%

OTHER 8%

HEALTH BEHAVIORS 4%

10%

20%

20%

50%

The Great (And Expensive) Mismatch

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

“S

ocia

l”

Dete

rmin

an

ts

InfluenceHealth System Spending

$2.5 Trillion / Year

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)

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

Where the Money Goes (Really),U.S., 2004

Hospital21%

Rx + Products

9%

Investment7%

Gov Public Health

3%

NH/ HH6%

Prof Services

19%All Admin36%

Source: Rough calculations based on CMS 2007 reports and estimates of administrative expenditures by UW Health Policy Analysis Program, 1990

The Public Now Underwrites Most U.S. Health Spending

Source: US Department of Health and Human Services, 2006; Katz estimate

79% 21%

60% 40%

57% 43%

46% 44% 10%

0% 20% 40% 60% 80% 100%

1960

1980

2000

2004Private

Public

Taxsubsidy

But the U.S. Does Have More Medical Technology

0250

500750

10001250

15001750

20002250

25002750

30003250

35003750

4000

Australia

Canada

Japan

Spain

UK

US

1995

1990

Source: Organization for Economic Cooperation and Development, 1999

MRIs / Million Population

Health Insurance Premiums Outpace Inflation and and Workers’ Earnings

119%

34%

29%

0%

20%

40%

60%

80%

100%

120%

140%

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

Health Insurance Premiums

Workers' Earnings

Overall Inflation

The Big Squeeze: Health care spending displaces education funding

Health Care and All Other

38.4%

Public Schools

45.7%

Higher Ed

15.8%

Health Care and All Other

49.9%

Public Schools

39.5%

Higher Ed

10.6%

1986 2006

Source: Washington State Office of Financial Management, 2008

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