Obamacare, Trump Care or no care? The debate about who pays to keep America healthy rages on with no end in sight. It might even become a huge talking point in the next presidential election, as some are pushing for Medicare-for-all coverage. Confused? I know I am. Here is the first of a series of summaries about US health care.

1. US Health Care 101
Zeena Nackerdien

2. Overview
US public and private healthcare spending is estimated to rise to one-fifth of the
national economy in the next eight years. This major driver of increased government
spending will be used to manage the country’s health, including common public health
concerns listed by the Centers for Disease Control and Prevention i.e., alcohol-related
harms, nutrition, healthcare-associated infections, heart disease and stroke,
prescription drug overdose, teen pregnancies, tobacco use, physical activity and
obesity.
One article stated that, in 2008 and 2009, 5% of Americans were responsible for ~50%
of US healthcare expenses. Another article pinpointed diabetes as the most expensive
condition to manage nationwide ($101 billion in 2013), followed by ischemic heart
diseases ($88 billion in 2013).

3. Understanding the problem
History
Employer-sponsored plans
took off during World
War II. The 1960 Kerr-
Mills and subsequent
Johnson-sponsored
Medicaid and Medicare
programs placed insurance
within reach of
marginalized groups e.g,
the poor.
Status quo (18 – 64 y)
Almost two-thirds of
Americans have private
insurance, 20% of people
have public coverage, and
12.4% reported being
uninsured in 2016. Caring
for aging baby boomers
will likely contribute to
this socioeconomic
challenge.
Return on investment
Health outcomes are
similar and, in some cases
worse, than in other
countries. Unnecessary
and overpriced services
are among the reasons
cited for an estimated
$765 billion in wasteful
expenses.

4. Understanding the market

5. Target audience
Currently, individuals without co-
insurances pay about $8,000 per year
for policies and out-of-pocket costs.
Older patients usually require more
health care. Over the next two
decades, the number of Americans
aged 65 and older will increase by
73%. These baby boomers will also
likely be switching from commercial
plans to Medicare. Young millennials
(18 – 24) pay monthly premiums
ranging from $180 to $426.

6. Market trends
Trend 1
Cost containment by employers will likely
focus on work site health promotion programs to
the right people, evaluating drug costs, and
focusing on provider arrangements to tackle costs
Client Implications:
The strength of an employer’s benefits
package is an advantage in a
competitive work landscape , as is a
robust wellness program; however, this
has to be balanced against employee
engagement.
Trend 2
Health insurers will continue to look for
ways to automate processes, consider
alternate treatments, explore value-based
purchasing with pharmaceutical companies,
and other process to reduce costs.
Client Implications:
A cost shift to the consumer, and adoption
of technology will have to be balanced
against the extent to which patients
who disproportionately use health care
will adopt these practices.