Healthcare Notes
Contents
Summary, Update July 20201
Trump Administration Healthcare Plan (July 2020)1
Summary2
Previous Trump Promises/Track Record3
Healthcare Costs4
Uninsured4
Single-Payer Healthcare System, Adam Gaffney4
Panel Discussion, Fox Business Network4
The Guardian, 12-11-184
Healthcare Comparisons by Country5
World Health Organization5
Reuters Health5
OECD (Organization for Economic Co-operation and Development)5
The Guardian6
Forbes6
Kaiser Family Foundation7
International Insurance7
Peter G. Peterson Foundation7
U.S. Insurance Agents9
COVID Information9
Premise9
Conspiracy Theory Special Report, CNN10
Response Information to Discussion Points10
Pandemic Preparation is Obama’s Fault10
HCQ Information10
Summary, Update July 2020
Trump Administration Healthcare Plan (July 2020)
Trump said he would sign a new Healthcare Plan by 7-31-20: “We’re signing a healthcare plan within two weeks. A full and complete healthcare plan.” Source: Donald Trump to Chris Wallace during Fox News interview on 7-17-20. [*Factual Disclaimer: he did not actually say the 31st; however, after learning of Trump’s unsurpassed cognitive test skills of counting downward by 7; I applied this technique in reverse and was able to calculate a signature date of 7-31-20.*] I read no media reports about a healthcare plan, did not hear it mentioned at all in the months leading up to the statement, nor did I hear verification from any Republican about this monumental accomplishment. They’ve done a superb job keeping this information from leaking to the public (no one does it better than them, this I can tell you). Unfortunately, no healthcare plan was signed as Trump promised. But the 31st was a Friday, so I’ll check the news on Monday and will surely be rewarded with The Good News.
Summary
• Despite being among the top world economic powers, the U.S. remains the only industrialized nation without universal health care coverage. Democrats have proposed many plans to solve the problem and provide health care for all (i.e., 0 people uninsured). Republicans have provided no plan and have implemented many strategies to block the solution (i.e., tens of millions uninsured and half the population worried about being able to pay medical bills).
• As of July 2020, U.S. per capita healthcare cost is $11,072/person, nearly 3 times the average of other developed countries (or nearly 2 times the average Organization for Economic Co-operation and Development [OECD] country). U.S. has the lowest life expectancy, highest chronic disease burden, highest obesity rate (2 times the OECD average), the highest number of hospitalizations from preventable causes, and the highest rate of avoidable deaths of the 11 OECD nations. Source: Commonwealth Fund, https://www.commonwealthfund.org/publications/issue-briefs/2020/jan/us-health-care-global-perspective-2019.
• The number of uninsured has increased since 2016 for the first time in 10 years, and was 30.1 million in 2018. This does not count underinsured, defined as those with insurance but who cannot afford adequate medical care; a 2019 Gallup poll indicated that 25% of U.S. adults said they or a family member had delayed treatment for a serious medical condition due to cost (up from 19% in 2015). Nearly half of Americans have problems paying medical bills, and a vast majority are concerned about it. This is not true in other developed countries. Source: Wikipedia.
• Coverage trends under Trump Administration (source: Wikipedia):
o Uninsured increased by 4 million from 2016 to 2018 (from 12.7% to 15.5%)
o The impact is greater under lower-income adults.
o During COVID global pandemic, an additional 5.4 million people lost health insurance from February to May 2020. That number is expected to rise.
o This adds to an estimated 84 million people who are already uninsured or underinsured.
• “The rest of the modern world has run the laboratory studies for us; now is the time for us to adopt this well proven solution.” American Medical Association Journal of Ethics 2012: https://journalofethics.ama-assn.org/article/single-payer-system-would-reduce-us-health-care-costs/2012-11.
• Costs. Source: Tax Policy Center, 2020:
o In 2019, a typical plan is $20,576 ($14,561 paid by employer, $6,015 by employee). Source: Kaiser Family Foundation.
o Sanders plan averages: employer tax $3,750/person. The benefit would disappear for joint filers with $6,000 in annual medical expenses and $175,000 or more in income. But there is a shortfall in tax revenue that is not explained.
Previous Trump Promises/Track Record
• 2016 Campaign: would immediately replace Obamacare with insurance for everybody. Much less expensive and much better.
• March 2017 promises:
o Everyone is going to be taken care of. No one will lose coverage. There will be insurance for everybody.
▪ Congressional Budget Office (CBO)-14 million will lose coverage in first year, 24 million by 2026.
o Healthcare will be a “lot less expensive” for everyone.
▪ CBO - costs go up significantly for low-middle income people. Substantially reducing premiums for young people and increasing them for older people. Costs would decrease to 10% more than current in 2026.
o No cuts to Medicaid. Nobody will be worse off financially. Get rid of state lines limitations.
• December 2017 Tax Cut eliminated ACA individual mandate, effectively eliminating much of ACA. ACA Repeal Lawsuit Would Cut Taxes for Top 0.1 Percent by an Average of $198,000. Source: Center on Budget and Policy Priorities, https://www.cbpp.org/research/health/aca-repeal-lawsuit-would-cut-taxes-for-top-01-percent-by-an-average-of-198000. “The Tax Policy Center estimates that the highest income 1 percent of households (those making about $819,000 in 2019) would receive about two-thirds of the benefit of these tax reductions, while those in the top 0.1 percent (who make $3.8 million or more) would get about 42 percent. Households making $91,000 or less would receive less than 10 percent of the benefits.” Source: Forbes, https://www.forbes.com/sites/howardgleckman/2020/05/12/by-overturning-the-aca-the-supreme-court-would-cut-taxes-substantially-for-high-income-households/#6fbdc21b2a5d.
• 3-26-19: Republicans will become the "party of healthcare" “We’re going to be involved in healthcare," he continued. "Most of it’s going to be very, very bipartisan.”
• 3-27-19: a healthcare replacement plan from Republicans would be "far better" than Obamacare if the courts agree with his administration's position that Obamacare should be thrown out.
• June 2019. In June, Trump told ABC News that he’d roll out his “phenomenal health care plan” in a couple of months, and that it would be a central part of his reelection pitch.
• 2019-2020. Trump has success lower prescription prices somewhat. Democrats have been pushing strong for that too.
• August 2019. administrator of the Centers for Medicare and Medicaid Services, Seema Verma, said officials were “actively engaged in conversations and working on things.” Earlier in August, Trump adviser Kellyanne Conway indicated an announcement might come this month.
• December 2019. Courts struck down individual mandate.
• 12-30-19. 3” Years In, No Sign of Trump’s Replacement for Obamacare”: https://apnews.com/968422ef1e16470c967bebc394fee331
Healthcare Costs
• In the 1980s, healthcare costs in the U.S. began growing much faster than in other countries.
• 1980: $1,108/person. $255.3 billion. GDP = $2.863 trillion. 8.9% of GDP. 23% uninsured.
• 1990. $2,843/person. $721.4 billion. GDP = $5.98 trillion. 12.1% of GDP. 37% uninsured.
• 1992: Uninsured 34.7 million in 1991 (X%).
• 2000: $4,855/person. $1.369 trillion. GDP = $10.285 trillion. 13.3% of GDP. 42% uninsured.
• 2008: $7,868/person. Population 304.1 million. Total cost: $2.4 trillion. 16.6% of GDP. 43% uninsured.
• 2009: $8,143/person. $2,495.4 trillion. GDP = $14.419 trillion. 17.3% of GDP. 16% uninsured.
• 2010: $8,402/person. 17.9% of GDP. 16% uninsured.
• 2016: $10,348/person. Population 323.4 million. Total cost: $3.3 trillion. 17.8% of GDP. 11% uninsured.
• As of 2017, 43% of Americans have problems paying or unable to pay medical bills (29% uninsured, 14% insured) (Kaiser Family Foundation 2019).
• Increase since 2016:
o 2016 number of uninsured was 27 million. In 2017 number uninsured rose for first time since 2010 (when it was 46 million) and is expected to keep rising due to elimination of ACA penalty (individual mandate) and anticipated increase in healthcare premiums. 2017 increase 1 million, anticipated increase 2018 is 1 million. By 2028, it will reach 35 million. Black (12%), Hispanic (17%), and American Indian (19%). population uninsured are higher than white (8%). Source: https://www.pgpf.org/analysis/2018/06/cbo-percent-of-uninsured-rose-last-year-for-the-first-time-since-2010-and-will-continue-to-climb-over-the-next-decade.
• As of July 2020, U.S. per capita healthcare cost is $11,072/person, nearly 3 times the average of other developed countries. Yay. Source: https://www.pgpf.org/chart-archive/0006_health-care-oecd.Uninsured
• Number of uninsured was steady in the non-elderly population in the mid $40 million range (17%) for many years prior to ACA. This decreased to the mid $20 million range (10%) after ACA.
Single-Payer Healthcare System, Adam Gaffney
Panel Discussion, Fox Business Network
Dr. Adam Gaffney, Physicians for a National Health Program
Very good panel discussion, 9 minute segment: https://crooksandliars.com/2019/03/fox-business-tries-and-fails-argue-against
The Guardian, 12-11-18
https://www.theguardian.com/commentisfree/2018/dec/11/universal-healthcare-could-save-america-trillions-whats-holding-us-back
• rises in utilization are likely to be modest
• at worst, these costs and savings will balance out under a Canadian-style single-payer reform
• “We found that if these features were applied in the United States, the administrative savings could offset the added costs.” GAO 1992
• even if a Medicare-for-all system only allows us to keep overall healthcare spending where it is today (as a proportion of the US economy), a quick back-of-the-envelope calculation using figures from the National Health Expenditures accounts shows that it would still save some $2tn over a decade
• new taxes will be needed to replace most of the private spending – e.g., premiums, copays, and deductibles
• To this end, the Peri analysis proposes a sensible mix of taxes, including payroll taxes paid by businesses, a sales tax on non-essentials, and a wealth tax on the richest among us. It would also treat capital gains like ordinary income.
Healthcare Comparisons by Country
World Health Organization
• Bad news: U.S. is ranked 37th out of 191 countries in the world for health system performance. (lost out to Colombia, Morocco, and Dominica)
• Good news: we beat Venezuela! (they’re 54th). We also edged out Cuba and Slovenia.
• Report: https://www.who.int/healthinfo/paper30.pdf
Reuters Health
• The U.S. spends about twice what other high-income nations do on health care but has the lowest life expectancy and the highest infant mortality rates, a new study suggests.For the study, researchers examined international data from 2013 to 2016 comparing the U.S. with 10 other high-income countries: the U.K., Canada, Germany, Australia, Japan, Sweden, France, Denmark, the Netherlands, and Switzerland.
• https://www.reuters.com/article/us-health-spending/u-s-health-spending-twice-other-countries-with-worse-results-idUSKCN1GP2YN
OECD (Organization for Economic Co-operation and Development)
*Note: this is a 2017 report prior to the ACA changes the Trump administration has been implementing. Uninsured and underinsured rates have increased as a result.
• U.S. is one of the lowest (if not the lowest) ranked OECD country for access to healthcare, using the following metrics: population coverage, consultations skipped due to cost. U.S. has the second lowest coverage rate, lower only than Greece.
• Access: the United States trails many other OECD countries in access to care indicators. Despite an increase in coverage from 85.6% in 2013, it is still not universal with only 91% of the population covered by insurance (the second lowest coverage rate after Greece). Further, 22% of Americans skipped consultations due to cost (compared to an OECD average of 9.1%).
• Despite high spending, many Americans still lack access to care:
o High cost of health care is a barrier to access for many Americans, with important shares of the population uninsured or underinsured. Indeed, 22% of the population skipped consultations and 18% did not purchase prescribed medicines due to cost in 2016. The access problem is particularly marked for poorer families, with 43% of low-income adults reporting unmet care needs because of the cost of care.
o Introduced in 2010 with major revisions coming into force in 2014, the Affordable Care Act has sought to address the issue of underinsurance and foregoing needed care and medicines. Coverage has increased, with the share of the uninsured population falling from 14.4% in 2013 to 9.1% in 2015. ACA is currently under review and the impact on coverage and costs of possible changes will depend on changes in health insurance markets.
• https://www.oecd.org/unitedstates/Health-at-a-Glance-2017-Key-Findings-UNITED-STATES.pdf
The Guardian
• Among the 35 OECD member countries, 32 have now introduced universal healthcare legislation that resembles the WHO criteria.
• Thus far, separate bills introduced in the House and the Senate were estimated to see steep increases in the number of uninsured from current levels. Under ACA, it is less than 30%; under the various House and Senate bills to repeal and replace ACA, it ranges from less than 50% to 60%.
• Go Republicans!
• https://www.theguardian.com/us-news/ng-interactive/2017/jul/25/us-healthcare-system-vs-other-countries
Forbes
• Many American conservatives oppose universal health insurance because they see it as fundamentally antithetical to a free society. But according to the Heritage Foundation, a leading conservative think tank, ten nations freer than the United States have achieved universal health coverage. It turns out that the right kind of health reform could cover more Americans while increasing economic freedom.
• Today, Heritage published its 2015 Index of Economic Freedom, an annual look at economic liberty around the world. The United States stayed put at #12, just below Ireland, Mauritius, and Denmark.
• What’s striking about the list is that of the eleven countries ahead of the U.S. in economic freedom, ten have achieved universal coverage. Many Americans on both the right on the left subscribe to the myth that the U.S. has a free-market health care system. It doesn’t. U.S. government entities spend more per-capita on health care than all but two other countries in the world.
• https://www.forbes.com/sites/theapothecary/2015/01/27/conservative-think-tank-10-countries-with-universal-health-care-are-economically-freer-than-the-u-s/#5eeab71b137e
Kaiser Family Foundation
• This slideshow compares the quality of health care in the United States to that in other wealthy and sizable countries.
• While all have seen improvements in health outcomes, the United States continues to lag behind, with higher rates of overall mortality, deaths amenable to health care, and potential years of life lost. Although the United States has lower mortality rates for breast and colorectal cancer, comparable countries continue to outperform the U.S. on a number of measures, including hospital admissions for preventable diseases; rates of medical, medication and lab errors; and cost-related access barriers to health care.
• Hospital admissions for preventable diseases are more frequent in the U.S. than in comparable countries.
• Adults in most comparable countries have quicker access to a doctor or nurse when they need care.
• Use of the emergency department in place of regular doctor visits is more common in the U.S. than in most comparable countries.
• KFF Link:
• Presentation Link: https://www.healthsystemtracker.org/chart-collection/quality-u-s-healthcare-system-compare-countries/?_sf_s=quality#item-adults-comparable-countries-quicker-access-doctor-nurse-need-care
International Insurance
• https://www.internationalinsurance.com/health/systems/
• According to a recent publication from the Commonwealth Fund, The USA is ranked last out of 11 Countries. “Among the 11 nations studied in this report – Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States—the U.S. ranks last, as it did in 2010, 2007, 2006, and 2014″ “Most troubling, the U.S. fails to achieve better health outcomes than the other countries, and as shown in the earlier editions, the U.S. is last or near last on dimensions of access, efficiency, and equity.”
• Full report: https://interactives.commonwealthfund.org/2017/july/mirror-mirror/
Peter G. Peterson Foundation
• Although the United States spends more on healthcare than other developed countries, its health outcomes are generally no better.
• https://www.pgpf.org/chart-archive/0011_health-outcomes
• U.S. is the leader of the free world, but the red dots on the charts are lonely. There are many different studies showing the same thing, this is just one set of charts (see above).
U.S. Insurance Agents
• The high cost of healthcare is probable one of the biggest things Americans complain about. An unexpected medical event can easily put a family in such a bad financial situation that they might have to file for bankruptcy. This type of situation just doesn’t happen in other places.
• In America, the elderly are typically covered by the government’s Medicare program, and low-income individuals are covered through the government’s Medicaid program. Most other people rely on their employer to provide health insurance, and some Americans buy their insurance on their own. The Affordable Care Act has helped to increase the number of people who receive health insurance, provided stipends to help pay the high premiums for those who can’t afford it, and has made it easier for those who have pre-existing conditions to get coverage. Unfortunately, millions of Americans are still uninsured, and many more are “underinsured.”
COVID Information
Premise
COVID is not the President’s fault, the response to COVID is. Information below is based on conversations with Trump supporters who feel his response is solid. My opinion is that thelack of federal response and appropriate coordination for a global pandemic, plus the continual misinformation from the administration, has caused tens of thousands of lives, if not more. And that will continue.
Conspiracy Theory Special Report, CNN
• Fareed Zakaria, 7-19-20: https://youtu.be/zv5hOiR77bg
• Doctor Fact Checks “Plandemic” documentary accusations of Fauci/CDC conspiracies re: COVID: https://youtu.be/TWpjc1QZg84Response Information to Discussion Points
Pandemic Preparation is Obama’s Fault
• Cupboards Bare Fact Check (Mostly False): https://www.politifact.com/factchecks/2020/apr/08/donald-trump/trump-said-obama-admin-left-him-bare-stockpile-wro/
• Obama left no pandemic game plan (false): https://www.politifact.com/factchecks/2020/may/14/mitch-mcconnell/evidence-counters-mcconnell-claim-obama-team-left-/HCQ Information
• MSNBC: Medical expert re: HCQ & COVID (& Fauci’schanged position on masks): https://youtu.be/dwlacQ2QUzs
• Washington Post Fact Checker re: HCQ (April): https://youtu.be/QC-h7rnZW3k
• Doctor Fact Checks Trump re: HCQ/COVID (July): https://youtu.be/flzR0DImUbk
• BBC Reality Check re: HCQ and COVID: https://www.bbc.com/news/51980731
• Group of Doctors claim HCQ cure for COVID (false): https://www.factcheck.org/2020/07/in-viral-video-doctor-falsely-touts-hydroxychloroquine-as-covid-19-cure/
• Navarro claim that HCQ reduces COVID mortality 50% (false): https://www.factcheck.org/2020/07/navarro-doesnt-give-full-picture-on-hydroxychloroquine/
• HCQ used in countries with low COVID rates (false): https://www.factcheck.org/2020/04/trumps-faulty-malaria-coronavirus-connection/
• French Study does not back HCQ as COVID cure.
o 1: https://www.cnn.com/2020/04/15/health/new-french-study-hydroxychloroquine/index.html
o 2: https://www.washingtonpost.com/politics/2020/04/13/how-false-hope-spread-about-hydroxychloroquine-its-consequences/
Contents
Summary, Update July 20201
Trump Administration Healthcare Plan (July 2020)1
Summary2
Previous Trump Promises/Track Record3
Healthcare Costs4
Uninsured4
Single-Payer Healthcare System, Adam Gaffney4
Panel Discussion, Fox Business Network4
The Guardian, 12-11-184
Healthcare Comparisons by Country5
World Health Organization5
Reuters Health5
OECD (Organization for Economic Co-operation and Development)5
The Guardian6
Forbes6
Kaiser Family Foundation7
International Insurance7
Peter G. Peterson Foundation7
U.S. Insurance Agents9
COVID Information9
Premise9
Conspiracy Theory Special Report, CNN10
Response Information to Discussion Points10
Pandemic Preparation is Obama’s Fault10
HCQ Information10
Summary, Update July 2020
Trump Administration Healthcare Plan (July 2020)
Trump said he would sign a new Healthcare Plan by 7-31-20: “We’re signing a healthcare plan within two weeks. A full and complete healthcare plan.” Source: Donald Trump to Chris Wallace during Fox News interview on 7-17-20. [*Factual Disclaimer: he did not actually say the 31st; however, after learning of Trump’s unsurpassed cognitive test skills of counting downward by 7; I applied this technique in reverse and was able to calculate a signature date of 7-31-20.*] I read no media reports about a healthcare plan, did not hear it mentioned at all in the months leading up to the statement, nor did I hear verification from any Republican about this monumental accomplishment. They’ve done a superb job keeping this information from leaking to the public (no one does it better than them, this I can tell you). Unfortunately, no healthcare plan was signed as Trump promised. But the 31st was a Friday, so I’ll check the news on Monday and will surely be rewarded with The Good News.
Summary
• Despite being among the top world economic powers, the U.S. remains the only industrialized nation without universal health care coverage. Democrats have proposed many plans to solve the problem and provide health care for all (i.e., 0 people uninsured). Republicans have provided no plan and have implemented many strategies to block the solution (i.e., tens of millions uninsured and half the population worried about being able to pay medical bills).
• As of July 2020, U.S. per capita healthcare cost is $11,072/person, nearly 3 times the average of other developed countries (or nearly 2 times the average Organization for Economic Co-operation and Development [OECD] country). U.S. has the lowest life expectancy, highest chronic disease burden, highest obesity rate (2 times the OECD average), the highest number of hospitalizations from preventable causes, and the highest rate of avoidable deaths of the 11 OECD nations. Source: Commonwealth Fund, https://www.commonwealthfund.org/publications/issue-briefs/2020/jan/us-health-care-global-perspective-2019.
• The number of uninsured has increased since 2016 for the first time in 10 years, and was 30.1 million in 2018. This does not count underinsured, defined as those with insurance but who cannot afford adequate medical care; a 2019 Gallup poll indicated that 25% of U.S. adults said they or a family member had delayed treatment for a serious medical condition due to cost (up from 19% in 2015). Nearly half of Americans have problems paying medical bills, and a vast majority are concerned about it. This is not true in other developed countries. Source: Wikipedia.
• Coverage trends under Trump Administration (source: Wikipedia):
o Uninsured increased by 4 million from 2016 to 2018 (from 12.7% to 15.5%)
o The impact is greater under lower-income adults.
o During COVID global pandemic, an additional 5.4 million people lost health insurance from February to May 2020. That number is expected to rise.
o This adds to an estimated 84 million people who are already uninsured or underinsured.
• “The rest of the modern world has run the laboratory studies for us; now is the time for us to adopt this well proven solution.” American Medical Association Journal of Ethics 2012: https://journalofethics.ama-assn.org/article/single-payer-system-would-reduce-us-health-care-costs/2012-11.
• Costs. Source: Tax Policy Center, 2020:
o In 2019, a typical plan is $20,576 ($14,561 paid by employer, $6,015 by employee). Source: Kaiser Family Foundation.
o Sanders plan averages: employer tax $3,750/person. The benefit would disappear for joint filers with $6,000 in annual medical expenses and $175,000 or more in income. But there is a shortfall in tax revenue that is not explained.
Previous Trump Promises/Track Record
• 2016 Campaign: would immediately replace Obamacare with insurance for everybody. Much less expensive and much better.
• March 2017 promises:
o Everyone is going to be taken care of. No one will lose coverage. There will be insurance for everybody.
▪ Congressional Budget Office (CBO)-14 million will lose coverage in first year, 24 million by 2026.
o Healthcare will be a “lot less expensive” for everyone.
▪ CBO - costs go up significantly for low-middle income people. Substantially reducing premiums for young people and increasing them for older people. Costs would decrease to 10% more than current in 2026.
o No cuts to Medicaid. Nobody will be worse off financially. Get rid of state lines limitations.
• December 2017 Tax Cut eliminated ACA individual mandate, effectively eliminating much of ACA. ACA Repeal Lawsuit Would Cut Taxes for Top 0.1 Percent by an Average of $198,000. Source: Center on Budget and Policy Priorities, https://www.cbpp.org/research/health/aca-repeal-lawsuit-would-cut-taxes-for-top-01-percent-by-an-average-of-198000. “The Tax Policy Center estimates that the highest income 1 percent of households (those making about $819,000 in 2019) would receive about two-thirds of the benefit of these tax reductions, while those in the top 0.1 percent (who make $3.8 million or more) would get about 42 percent. Households making $91,000 or less would receive less than 10 percent of the benefits.” Source: Forbes, https://www.forbes.com/sites/howardgleckman/2020/05/12/by-overturning-the-aca-the-supreme-court-would-cut-taxes-substantially-for-high-income-households/#6fbdc21b2a5d.
• 3-26-19: Republicans will become the "party of healthcare" “We’re going to be involved in healthcare," he continued. "Most of it’s going to be very, very bipartisan.”
• 3-27-19: a healthcare replacement plan from Republicans would be "far better" than Obamacare if the courts agree with his administration's position that Obamacare should be thrown out.
• June 2019. In June, Trump told ABC News that he’d roll out his “phenomenal health care plan” in a couple of months, and that it would be a central part of his reelection pitch.
• 2019-2020. Trump has success lower prescription prices somewhat. Democrats have been pushing strong for that too.
• August 2019. administrator of the Centers for Medicare and Medicaid Services, Seema Verma, said officials were “actively engaged in conversations and working on things.” Earlier in August, Trump adviser Kellyanne Conway indicated an announcement might come this month.
• December 2019. Courts struck down individual mandate.
• 12-30-19. 3” Years In, No Sign of Trump’s Replacement for Obamacare”: https://apnews.com/968422ef1e16470c967bebc394fee331
Healthcare Costs
• In the 1980s, healthcare costs in the U.S. began growing much faster than in other countries.
• 1980: $1,108/person. $255.3 billion. GDP = $2.863 trillion. 8.9% of GDP. 23% uninsured.
• 1990. $2,843/person. $721.4 billion. GDP = $5.98 trillion. 12.1% of GDP. 37% uninsured.
• 1992: Uninsured 34.7 million in 1991 (X%).
• 2000: $4,855/person. $1.369 trillion. GDP = $10.285 trillion. 13.3% of GDP. 42% uninsured.
• 2008: $7,868/person. Population 304.1 million. Total cost: $2.4 trillion. 16.6% of GDP. 43% uninsured.
• 2009: $8,143/person. $2,495.4 trillion. GDP = $14.419 trillion. 17.3% of GDP. 16% uninsured.
• 2010: $8,402/person. 17.9% of GDP. 16% uninsured.
• 2016: $10,348/person. Population 323.4 million. Total cost: $3.3 trillion. 17.8% of GDP. 11% uninsured.
• As of 2017, 43% of Americans have problems paying or unable to pay medical bills (29% uninsured, 14% insured) (Kaiser Family Foundation 2019).
• Increase since 2016:
o 2016 number of uninsured was 27 million. In 2017 number uninsured rose for first time since 2010 (when it was 46 million) and is expected to keep rising due to elimination of ACA penalty (individual mandate) and anticipated increase in healthcare premiums. 2017 increase 1 million, anticipated increase 2018 is 1 million. By 2028, it will reach 35 million. Black (12%), Hispanic (17%), and American Indian (19%). population uninsured are higher than white (8%). Source: https://www.pgpf.org/analysis/2018/06/cbo-percent-of-uninsured-rose-last-year-for-the-first-time-since-2010-and-will-continue-to-climb-over-the-next-decade.
• As of July 2020, U.S. per capita healthcare cost is $11,072/person, nearly 3 times the average of other developed countries. Yay. Source: https://www.pgpf.org/chart-archive/0006_health-care-oecd.Uninsured
• Number of uninsured was steady in the non-elderly population in the mid $40 million range (17%) for many years prior to ACA. This decreased to the mid $20 million range (10%) after ACA.
Single-Payer Healthcare System, Adam Gaffney
Panel Discussion, Fox Business Network
Dr. Adam Gaffney, Physicians for a National Health Program
Very good panel discussion, 9 minute segment: https://crooksandliars.com/2019/03/fox-business-tries-and-fails-argue-against
The Guardian, 12-11-18
https://www.theguardian.com/commentisfree/2018/dec/11/universal-healthcare-could-save-america-trillions-whats-holding-us-back
• rises in utilization are likely to be modest
• at worst, these costs and savings will balance out under a Canadian-style single-payer reform
• “We found that if these features were applied in the United States, the administrative savings could offset the added costs.” GAO 1992
• even if a Medicare-for-all system only allows us to keep overall healthcare spending where it is today (as a proportion of the US economy), a quick back-of-the-envelope calculation using figures from the National Health Expenditures accounts shows that it would still save some $2tn over a decade
• new taxes will be needed to replace most of the private spending – e.g., premiums, copays, and deductibles
• To this end, the Peri analysis proposes a sensible mix of taxes, including payroll taxes paid by businesses, a sales tax on non-essentials, and a wealth tax on the richest among us. It would also treat capital gains like ordinary income.
Healthcare Comparisons by Country
World Health Organization
• Bad news: U.S. is ranked 37th out of 191 countries in the world for health system performance. (lost out to Colombia, Morocco, and Dominica)
• Good news: we beat Venezuela! (they’re 54th). We also edged out Cuba and Slovenia.
• Report: https://www.who.int/healthinfo/paper30.pdf
Reuters Health
• The U.S. spends about twice what other high-income nations do on health care but has the lowest life expectancy and the highest infant mortality rates, a new study suggests.For the study, researchers examined international data from 2013 to 2016 comparing the U.S. with 10 other high-income countries: the U.K., Canada, Germany, Australia, Japan, Sweden, France, Denmark, the Netherlands, and Switzerland.
• https://www.reuters.com/article/us-health-spending/u-s-health-spending-twice-other-countries-with-worse-results-idUSKCN1GP2YN
OECD (Organization for Economic Co-operation and Development)
*Note: this is a 2017 report prior to the ACA changes the Trump administration has been implementing. Uninsured and underinsured rates have increased as a result.
• U.S. is one of the lowest (if not the lowest) ranked OECD country for access to healthcare, using the following metrics: population coverage, consultations skipped due to cost. U.S. has the second lowest coverage rate, lower only than Greece.
• Access: the United States trails many other OECD countries in access to care indicators. Despite an increase in coverage from 85.6% in 2013, it is still not universal with only 91% of the population covered by insurance (the second lowest coverage rate after Greece). Further, 22% of Americans skipped consultations due to cost (compared to an OECD average of 9.1%).
• Despite high spending, many Americans still lack access to care:
o High cost of health care is a barrier to access for many Americans, with important shares of the population uninsured or underinsured. Indeed, 22% of the population skipped consultations and 18% did not purchase prescribed medicines due to cost in 2016. The access problem is particularly marked for poorer families, with 43% of low-income adults reporting unmet care needs because of the cost of care.
o Introduced in 2010 with major revisions coming into force in 2014, the Affordable Care Act has sought to address the issue of underinsurance and foregoing needed care and medicines. Coverage has increased, with the share of the uninsured population falling from 14.4% in 2013 to 9.1% in 2015. ACA is currently under review and the impact on coverage and costs of possible changes will depend on changes in health insurance markets.
• https://www.oecd.org/unitedstates/Health-at-a-Glance-2017-Key-Findings-UNITED-STATES.pdf
The Guardian
• Among the 35 OECD member countries, 32 have now introduced universal healthcare legislation that resembles the WHO criteria.
• Thus far, separate bills introduced in the House and the Senate were estimated to see steep increases in the number of uninsured from current levels. Under ACA, it is less than 30%; under the various House and Senate bills to repeal and replace ACA, it ranges from less than 50% to 60%.
• Go Republicans!
• https://www.theguardian.com/us-news/ng-interactive/2017/jul/25/us-healthcare-system-vs-other-countries
Forbes
• Many American conservatives oppose universal health insurance because they see it as fundamentally antithetical to a free society. But according to the Heritage Foundation, a leading conservative think tank, ten nations freer than the United States have achieved universal health coverage. It turns out that the right kind of health reform could cover more Americans while increasing economic freedom.
• Today, Heritage published its 2015 Index of Economic Freedom, an annual look at economic liberty around the world. The United States stayed put at #12, just below Ireland, Mauritius, and Denmark.
• What’s striking about the list is that of the eleven countries ahead of the U.S. in economic freedom, ten have achieved universal coverage. Many Americans on both the right on the left subscribe to the myth that the U.S. has a free-market health care system. It doesn’t. U.S. government entities spend more per-capita on health care than all but two other countries in the world.
• https://www.forbes.com/sites/theapothecary/2015/01/27/conservative-think-tank-10-countries-with-universal-health-care-are-economically-freer-than-the-u-s/#5eeab71b137e
Kaiser Family Foundation
• This slideshow compares the quality of health care in the United States to that in other wealthy and sizable countries.
• While all have seen improvements in health outcomes, the United States continues to lag behind, with higher rates of overall mortality, deaths amenable to health care, and potential years of life lost. Although the United States has lower mortality rates for breast and colorectal cancer, comparable countries continue to outperform the U.S. on a number of measures, including hospital admissions for preventable diseases; rates of medical, medication and lab errors; and cost-related access barriers to health care.
• Hospital admissions for preventable diseases are more frequent in the U.S. than in comparable countries.
• Adults in most comparable countries have quicker access to a doctor or nurse when they need care.
• Use of the emergency department in place of regular doctor visits is more common in the U.S. than in most comparable countries.
• KFF Link:
• Presentation Link: https://www.healthsystemtracker.org/chart-collection/quality-u-s-healthcare-system-compare-countries/?_sf_s=quality#item-adults-comparable-countries-quicker-access-doctor-nurse-need-care
International Insurance
• https://www.internationalinsurance.com/health/systems/
• According to a recent publication from the Commonwealth Fund, The USA is ranked last out of 11 Countries. “Among the 11 nations studied in this report – Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States—the U.S. ranks last, as it did in 2010, 2007, 2006, and 2014″ “Most troubling, the U.S. fails to achieve better health outcomes than the other countries, and as shown in the earlier editions, the U.S. is last or near last on dimensions of access, efficiency, and equity.”
• Full report: https://interactives.commonwealthfund.org/2017/july/mirror-mirror/
Peter G. Peterson Foundation
• Although the United States spends more on healthcare than other developed countries, its health outcomes are generally no better.
• https://www.pgpf.org/chart-archive/0011_health-outcomes
• U.S. is the leader of the free world, but the red dots on the charts are lonely. There are many different studies showing the same thing, this is just one set of charts (see above).
U.S. Insurance Agents
• The high cost of healthcare is probable one of the biggest things Americans complain about. An unexpected medical event can easily put a family in such a bad financial situation that they might have to file for bankruptcy. This type of situation just doesn’t happen in other places.
• In America, the elderly are typically covered by the government’s Medicare program, and low-income individuals are covered through the government’s Medicaid program. Most other people rely on their employer to provide health insurance, and some Americans buy their insurance on their own. The Affordable Care Act has helped to increase the number of people who receive health insurance, provided stipends to help pay the high premiums for those who can’t afford it, and has made it easier for those who have pre-existing conditions to get coverage. Unfortunately, millions of Americans are still uninsured, and many more are “underinsured.”
COVID Information
Premise
COVID is not the President’s fault, the response to COVID is. Information below is based on conversations with Trump supporters who feel his response is solid. My opinion is that thelack of federal response and appropriate coordination for a global pandemic, plus the continual misinformation from the administration, has caused tens of thousands of lives, if not more. And that will continue.
Conspiracy Theory Special Report, CNN
• Fareed Zakaria, 7-19-20: https://youtu.be/zv5hOiR77bg
• Doctor Fact Checks “Plandemic” documentary accusations of Fauci/CDC conspiracies re: COVID: https://youtu.be/TWpjc1QZg84Response Information to Discussion Points
Pandemic Preparation is Obama’s Fault
• Cupboards Bare Fact Check (Mostly False): https://www.politifact.com/factchecks/2020/apr/08/donald-trump/trump-said-obama-admin-left-him-bare-stockpile-wro/
• Obama left no pandemic game plan (false): https://www.politifact.com/factchecks/2020/may/14/mitch-mcconnell/evidence-counters-mcconnell-claim-obama-team-left-/HCQ Information
• MSNBC: Medical expert re: HCQ & COVID (& Fauci’schanged position on masks): https://youtu.be/dwlacQ2QUzs
• Washington Post Fact Checker re: HCQ (April): https://youtu.be/QC-h7rnZW3k
• Doctor Fact Checks Trump re: HCQ/COVID (July): https://youtu.be/flzR0DImUbk
• BBC Reality Check re: HCQ and COVID: https://www.bbc.com/news/51980731
• Group of Doctors claim HCQ cure for COVID (false): https://www.factcheck.org/2020/07/in-viral-video-doctor-falsely-touts-hydroxychloroquine-as-covid-19-cure/
• Navarro claim that HCQ reduces COVID mortality 50% (false): https://www.factcheck.org/2020/07/navarro-doesnt-give-full-picture-on-hydroxychloroquine/
• HCQ used in countries with low COVID rates (false): https://www.factcheck.org/2020/04/trumps-faulty-malaria-coronavirus-connection/
• French Study does not back HCQ as COVID cure.
o 1: https://www.cnn.com/2020/04/15/health/new-french-study-hydroxychloroquine/index.html
o 2: https://www.washingtonpost.com/politics/2020/04/13/how-false-hope-spread-about-hydroxychloroquine-its-consequences/