2. Standard Disclaimer: I hardly have any idea about what I might say today, so of course my employer and the sponsors are not liable for what comes out of my mouth.
5. Do we have a health care crisis? We have a financing of health care crisis.
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10. National Compensation Measures as a Share of GDP, NIPA 1960-2006 Private Group Health Insurance 56.4% of GDP 56.3% of GDP Other Fringe Benefits and Payroll Taxes 3.8% 6.7% 0.6% 4.1% Wages 51.8% 45.6% 2006 Source: Kaiser Family Foundation analysis of data from the U.S. Department of Commerce, Bureau of Economic Analysis, National Income and Product Accounts, 1960-2006, Tables 1.1.5, 2.1, 6.11B, 6.11C, & 6.11D, 2008.
http://www.flickr.com/photos/52421717@N00/5477782480/sizes/o/in/photostream/This had at its heart two issues, the provision of public health benefits and the financing of them..medicaid is squeezing the budget, and the health benefits of public employees squeezing the employer.
I’m not convinced we have a health care crisis, but I do believe the way we finance health care has led and is leading to a crisis. The Madison protests are the first bit of evidence, followed by the over the debt ceiling. We finance health care 50% through taxes, about 50% privately of which 65% (30%) is employer based insurance, 25% out of pocket, 15% philanthropy.
CBO projections
CBO projections
Source: C. Eugene Steuerle and Stephanie Rennane The Urban Institute Benefits $35,000 $132,000 $343,000 $530,000 Taxes $0 $7,800 $55,000 $84,000 Present value inflation adjusted.
We might not be able to reduce expenditures, but we can improve outcomes.
http://www.flickr.com/photos/childofwar/3341613458/sizes/z/in/photostream/Curing cancer doesn’t do anything for longevity. Adds to health expenditures. Cure heart disease and you increase longevity, but you will die of something so we will not lower expenditures.
http://www.flickr.com/photos/childofwar/3341613458/sizes/z/in/photostream/Curing cancer doesn’t do anything for longevity. Adds to health expenditures. Cure heart disease and you increase longevity, but you will die of something so we will not lower expenditures.
http://www.flickr.com/photos/childofwar/3341613458/sizes/z/in/photostream/Curing heart disease adds longevity, but doesn’t necessarily reduce expenditures because diabetes and cancer are around the corner. Cure heart disease and you increase longevity, but you will die of something so we will not lower expenditures.
Easy decision ex-post, more difficult ex-ante.
http://modeledbehavior.com/2011/02/19/overtreatment-in-america-this-time-patients-killing-themselves/CONCLUSIONS: Faced with hypothetical cancer diagnoses, many people say they would pursue treatment even if doing so would increase their chance of death. This tendency toward active treatment is notably stronger when the treatment offered is surgery instead of medication. Our study suggests that few people can imagine standing by and doing nothing after being diagnosed with cancer, and it should serve to remind clinicians that, for many patients, the best treatment alternative may not only depend on the medical outcomes they can expect to experience but also on whether those outcomes are achieved actively or passively.http://modeledbehavior.com/2011/04/23/the-us-health-care-system-is-the-most-efficient-in-the-world/Studies were selected by conducting database searches in Medline and Healthstar to identify papers published since 1995 in peer-review journals pertaining to consumer report cards on health care. The evidence indicates that consumer report cards do not make a difference in decision making, improvement of quality, or competition.
http://www.scottwinship.com/1/post/2009/7/that-veterinarian-services-vs-health-spending-chart.htmlAccording to Andrew Biggs http://blog.american.com/?p=2991This again highlights that the real issue with healthcare may not be the rate of growth but the level of health spending—and the fact that so much of it seems to be wasteful. This distinction is important because it shapes our policy priorities. The level of spending has different causes than the rate of growth of spending, among them our healthcare system’s structural incentives to overspend. Rather than attempting merely to temper cost growth, plans that remove incentives for overspending, improve consumer choice, or pay doctors based on quality rather than quantity of service could reduce the overall level of spending.--However I disagree. While it might be true half of all healthcare spending is wasteful, we only figure that out – for the most part – ex-post.
There are cost controls, but they have been weakened (excise tax on cadillac plans). Independent Payment Advisory board. Accountable Care Organizations.
