HEALTH CARE POLICY Introduction Why health care policy

HEALTH CARE POLICY

Introduction • Why health care policy matters • The problem in (sort of) 3 charts

Health in America • US vs. the world • Emphasis on elderly • Health care vs. health

The U. S. Health Care System • Complexity of system

The U. S. Health Care System • Fee for Service • Managed Care • Government subsidized care

Problems with the U. S. System: Cost • High relative cost

Problems with the U. S. System: Cost • Fee-for-service system • Technology • Market Failure • Aging public • Medical culture • Prescription Drugs • Administrative costs • It’s the prices, stupid • What it is not

Retail Price Indexes for Basket of In-Patent Pharmaceuticals, 2010 21 US is set at 100 Price level Note: Calculations weighted relative to U. S. consumption patterns. U. S. retail prices were discounted from manufacturer prices according to the rebates obtained by the Medicaid program. Source: P. Kanavos, A. Ferrario, S. Vandoros et al. , "Higher U. S. Branded Drug Prices and Spending Compared to Other Countries May Stem Partly from Quick Uptake of New Drugs, " Health Affairs, April 2013 32(4): 753– 61. THE COMMONWEALTH FUND

Diagnostic Imaging Prices, 2013 Dollars ($US) MRI Dollars ($US) Notes: US refers to the commercial average. MRI refers to magnetic resonance imaging; CT refers to computed tomography. Source: International Federation of Health Plans, 2013 Comparative Price Report. CT Scan (abdomen) 22

Total Hospital and Physician Costs, 2013 Dollars ($US) Appendectomy Bypass Surgery Dollars ($US) Notes: US refers to the commercial average. Appendectomy prices reflect a blend of inpatient and outpatient prices based on relative utilization in each setting. Source: International Federation of Health Plans, 2013 Comparative Price Report. 23

Spending on Health Insurance Administration per Capita, 2012 Adjusted for Differences in Cost of Living Dollars ($US) * 2011. Source: OECD Health Data 2014.

Spending per Hospital Discharge, 2012 Adjusted for Differences in Cost of Living Dollars ($US) * 2011. ** 2010. Source: OECD Health Data 2014. 25

Spending per Hospital Discharge, 2012 Adjusted for Differences in Cost of Living Dollars ($US) * 2011. ** 2010. Source: OECD Health Data 2014. 26

Problems with the U. S. System: Access • Inadequate Access • Why so many uninsured? • Maldistribution of resources • Employer-based issues • Rationing

Rationing the wait

Problems with the U. S. System: Quality • Quality in cross-national perspective

Problems with the U. S. System: Quality • Lack of Access • Focus on sickness instead of health • Overspecialization

Contemporary Policy • Medicare • Medicaid • ACA

Affordable Care Act/ “Obama. Care” • Goals • Basics/Three-legged stool • What it’s not • Early Assessment • “Repeal and Replace” and ACA under President Trump

Further reform? • The long-term cost problem • Lessons from abroad • Policy Options • Single-payer • “Medicare for all”? • “Gradual” single payer/Other public options • Employer-based reforms • Expanded individual market reforms • So, what happens?

Reforms/International Lessons • Single Payer Plan • Employer Mandates • Socialized Medicine • Individual Mandates • Future of Health Care Reform?