Health Care in the
2008 Election
Elise Gould, Ph.D.
October 20th, 2008
Columbia University Medical Center
What Must (Good) Health Reform
Accomplish?
• Access
– Cover the uninsured
– Ensure minimal disruption of current coverage
– Ensure minimum benefits and coverage of certain conditions
• Cost
– Affordable premiums and cost-sharing
– Risk pooling
– Efficiencies of scale
• Quality
–
–
–
–
Encourage research and best practice-driven medicine
Oversight and regulation for consumer protection
Reduce disparities
Efficient and effective chronic care management
% of Under 65 Population Uninsured
between 2001-2003
Access: The Crisis of the Uninsured
40%
45 million
Non-elderly uninsured
in 2007 (17.1%)
36%
35%
(CPS)
30%
26%
25%
20%
17%
15%
9%
10%
4%
5%
0%
At any time
More than 4
months
More than a
year
More than 2
years
Duration of Uninsurance, 2001-2003 (SIPP)
3 years
Costs: Unsustainable Growth
Nearly 50% of
GDP by 2062
(CBO)
Premium increase
(+115%)
Workers earnings
(+29%)
Overall inflation
(+24%)
KFF/HRET Employer Benefits Survey, 2007
OECD Health Data, 2005
Sweden
Japan
Finland
Norway
France
Infant Mortality Across Countries (2005)
Belgium
8
7
6
5
4
3
2
1
0
Greece
Germany
Ireland
Spain
Austria
Switzerland
Denmark
Italy
Netherlands
Australia
United Kingdom
New Zealand
Canada
United States
Infant Deaths per 1,000 Live Births
Value: International Comparison
US spends
15.5% of GDP
$7,439 per person
(OECD)
Quality: Stark National Inequalities
Infant Mortality by Race, 2004
Black
White
CDC Linked Data
Life Expectancy at 60 by Income, 2001
Top 50%
Bottom 50%
Waldron, 2007
Two Visions for Reform in 2008
Barack Obama
•Build on current employersponsored system
•Strengthen public system
by building large insurance
pools
•Give tax credits to selfemployed, near-poor, and
small businesses to help
purchase coverage
John McCain
•Radically change current
system
•Replace current tax
subsidies for employerbased insurance with tax
credits
•Replace employer-based
coverage with a national
deregulated individual
insurance market
Obama: More Coverage
Tax Policy Center Analysis
Obama: Keep the Coverage You Have
Obama Plan
McCain Plan
National
Exchange
Employerprovided
Individual
Public
Employerprovided
Uninsured
Tax Policy Center Analysis
Public
20 million
Lose their employersponsored insurance
McCain: On Your Own in the Individual
Market
• The individual market offers lower benefits at
greater financial risk
• The individual market is less efficient than
employer-sponsored group insurance
• Administrative costs 2.5-4x higher than large employer
pools
• McCain has proposed removing the current system
of state-based protections, making the already
insufficient individual market only riskier
McCain Plan’s Effects on New York
• 1,605,030 individuals, or 15.5% of those
currently covered, would lose their employerprovided insurance (1 in 7)
• New York residents would also lose important
protections, such as
– Minimum medical loss prevention
– Pure community rating
– Mandated coverage of ambulance services, cancer
chemotherapy, and cervical cancer screening
Obama Plan: More Bang for Your Buck
Total 10-Year Cost of Plan
Obama: $1.6 Billion
McCain: $1.3 Billion
Tax Policy Center Analysis
Quality: Changes to Medical Practice
• Four key provisions:
– Evidence-based medicine
– Health information technology
– Chronic disease management
– Medical Home
• Only Obama’s plan can effectively reach both
public and private sectors
– Less fragmentation; more oversight
Conclusion
• Moral and economic imperative for reform
• Most effective method of lowering costs and
improving quality is by covering everyone
– access, cost, and quality are complementary goals
not competing ones
www.epi.org