The Election Issues

The New England Journal of Medicine October 16, 2008 has published explanations and views of the McCain and Obama healthcare financing reform plans. The plans are critiqued and the differences are explained.

The Kaiser Family Foundation has published a series of articles discussing the healthcare issues of the election. The articles detail the costs of the healthcare system and why we pay so much for care. These are very good background papers.

Uninsured

A paper in Health Affairs, June 2008, describes the increasing number of people that are uninsured and underinsured from 2003 to 2007. Of note is the rising number of middle class adults that find themselves uninsured. This report discusses the difficulty these people have in accessing healthcare.

A Commonwealth Fund Issue Paper, May 2008, discusses the true costs of the uninsured. The Columbia University group that authored the paper concluded that $45B was expended for the uninsured including $33B by public spending and $12B was totally uncompensated. The $12B was owed to physicians and hospitals. As more employers eliminate health insurance, the government increases its spending to partially cover the expenses, to which we all contribute through taxes.

Kaiser Family Foundation report, April 4, 2008, discussing various states' efforts to legislate universal healthcare reform.

January, 2008 position paper from the Urban Institute uses Institute of Medicine and Census Bureau data to demonstrate that 137,000 people died from 2000 to 2006 because of the lack of health insurance.

New England Journal of Medicine article discussing the use and expanded funding of community health clinics to address the needs of the uninsured, March, 2008.

Families USA report documents that children without health insurance have worse outcomes and have poor access to healthcare.

A research article in JAMA demonstrates worse outcomes for the uninsured with injuries or chronic medical conditions.

Healthcare Costs

New England Journal of Medicine, January, 2008, article discussing the resiliency of the healthcare system despite the many financial and political problems it faces.

Medicaid

Budget for 2009 Medicaid is outlined and reviewed. Spending is set to decrease by $17B.

Review article discussing the funding of the SCHIP program and the politicalization of funding healthcare for indigent children, February, 2008.

Drugs

February, 2008 update on Medicare Part D drug pricing for the 10 most prescribed drugs.

February, 2008 summary of the Medicare Part D drug program.

Families USA report on high Medicare D drug prices.

Families USA report on the drug industry outlining where pharmaceutical revenue goes within the industry. Who benefits from the high cost of drugs?

A FamiliesUSA survey published in April 2007 regarding 15 of the most commonly used medications by senior citizens found that the lowest price from the largest Part D insurers increased an average of 9.2% compared to inflation of just 2.4% from 2006 to 2007. Since taxes cover 75% of the premium for this benefit, as prices rise faster than the cost of living, taxes are likely to follow to pay for this benefit. Additionally, senior citizens pay the full price in the "doughnut hole" and they will reach that benchmark faster with higher drug prices.

Private Insurance

The California Medical Association, June, 2008, annually reports the amount of money spent on medical care as a percent of premiums. The range was from 69.4% to 97.1%. The smaller the percent, the higher the administrative costs and the higher the profits. If all carriers would have an 85% ratio, the amount spent on medical care in California would increase by $1B. Twenty-four states mandate minimal expenditures with the highest being 82%. Proposed limits of 85% in California are currently being discussed.

As reported in the AMA News, May, 2008, private health insurers have stated "We will not sacrifice profitability for membership," indicating they will not lower or keep premiums stable in order to allow people to keep their insurance. The carriers will raise premiums to maintain or increased profits despite the public's increasing inability to afford the expenses. United Health posted a profit of $1B in the first quarter of 2008.

Report from February, 2008 outlining the amount of employee compensation going to health insurance vs. wages. Though compensation is increasing, the percent going to wages is decreasing and the percent going to health insurance is increasing.

Single Payer System

An article written by Marcia Angell, MD, professor at Harvard, discusses the efforts of Massachusetts to provide universal health insurance for the state's residents. She analyzes the approach that was taken and is highly critical of the program. She proposes a different type of universal coverage. This article is a "must read" for everyone interested in expanding health coverage to as many as possible. The article details multiple concerns about a  private insurance based system.

An April 1, 2008 survey of physicians, authored by Aaron Carroll,  indicated that 59% supported a single payer system in the US compared to 49% in a 2002 survey. This article was published in the Annals of Internal Medicine. There seems to be increasing support for this type of program with the realization that the current system is leading to more uninsured people annually.

January 29, 2008 position paper from the Urban Institute makes the case that the only way we can achieve universal healthcare is through a single payer system. 

 

Physicians for a National Health Program publishes a series of articles describing the concept of a single-payer system.

Miscellaneous

April, 2008 review by the Commonwealth Fund outlines the healthcare crisis in the US and compares our expenditures and system to other countries.

Several articles have been published in the prestigious New England Journal of Medicine that are of general interest to the public that discuss the healthcare crisis in the US. They lay out different points of view as to how to solve the problem. 1, 2, 3, 4.

The 2007 Annual report from the Board of Trustees of Medicare was published in April. With 43 million people covered by Medicare, there were expenditures of $402B and income of $437B. The trustees estimate that the expenditures will exceed income in about 10 years if there is no significant change in the funding pattern of the system. Expenses will increase from the growth of the population, cost of living, higher intensity of care of the population covered. This report serves as a formal warning to Congress that significant changes are necessary to avoid the impending financial difficulties. The full report is available.