Medicare: a Single Payer system in

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Medicare a Single Payer system in crisis?A
Comparison to other U.S. Health Insurance Systems

• Oliver Fein, M.D.
• Chair, New York Metro Chapter
• Physicians for a National Health Program
• Professor of Clinical Medicine and Health Policy
• Associate Dean (Affiliations)
• Weill Cornell Medical College
• (ofein_at_med.cornell.edu)
•  
• Workshop
• PNHP National Meeting
• New Orleans, LA
• November 15, 2014
•  

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DISCLOSURES

• Dr. Oliver Fein has no relevant financial
  relationships with commercial interests
• Dr. Oliver Fein is Chair of the NY-Metro Chapter
  and past President of Physicians for a National
  Health Program (PNHP), a non-profit educational
  and advocacy organization. He receives no
  financial compensation from PNHP.

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PRESENTATION OUTLINE

• Macroeconomics of Health Care
• Medicare in Comparison to other
• U.S. Health Insurance Programs
•  
• 3. Comparing Traditional Medicare
• to Medicare Advantage

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(No Transcript)
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NATIONAL HEALTH CARE EXPENDITURES Billions
of dollars ( total for year)
Category 1960 2012
Personal Health Care 23.3 (85) 2,360.4 (84)
Public Health Activities 0.4 (1) 75.0 (3)
Research and Construction 2.6 (10) 160.0 (6)
Other 1.2 (4) 198.0 (7)
TOTAL NHE 27.5 (100) 2,793.4 (100)
Per Capita NHE 147 8, 915
NHE as percent of GDP 5.2 17.2
Data for 2012 from Health Affairs January,
20143367-77
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PERSONAL HEALTH CARE EXPENDITURES Billions of
dollars ( total for year)
Category 1960 2012
Hospital care 9.2 (39) 882.3 (37)
Physician services 5.4 (23) 565.0 (24)
Dental 2.0 (9) 110.9 (5)
Other professional services 0.4 (2) 76.4 (3)
Prescription drugs 2.7 (12) 263.3 (12)
Other medical products 2.3 (9) 95.0 (4)
Nursing home and home health 0.9 (4) 367.5 (15)
Other 0.4 (2) 0 (0)
Total Personal Health Care 23.3 (100) 2,360.4 (100)
Data for 2012 from Health Affairs January,
20143367-77
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WHO PAYS FOR HEALTH CARE?1
Category Billions of Dollars of Total
NHE (minus investments - 160B) 2,633.4 (100)
Private Funds 882.1 (34)
Private health insurance 553.9 (12)
Out of pocket payments 328.2 (13)
Public Funds 1,751.4 (66)
Medicare 572.5 (22)
Medicaid 421.2 (16)
Other Federal 103.8 (4)
Other Federal and State 290.8 (11)
Public Employee health benefits 167.6 (6)
Tax Subsidies 195.5 (7)
Tax-Financed ( per capita) 5,590 Tax-Financed ( per capita) 5,590 Tax-Financed ( per capita) 5,590
Data for 2012 from Health Affairs January,
2014, using the methodology described in Health
Affairs 20022188-98 Includes VA, DOD,
CHIP Includes IHS, federal public health,
Workers Comp., SAMSA, School health, etc. 1
Woolhandler S, Himmelstein, DU. Paying for
National Health Insuranceand Not Getting It.
Health Affairs. 20022188-98
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CONCLUSION 1

• We are more than half way to a government
  financed health care system!

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US Public Spending for Health ExceedsTotal
Spending in Other Nations
8,950
2011 healthcare spending per capita
Data are for 2011 Sources OECD 2013 Health
Affairs 2002 21(4)88
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COMPARISON OF US HEALTH INSURANCE PROGRAMS
  Medicare Medicaid Private HI Employer-based Private HI Exchange-based
Number enrolled          
Eligibility        
Means-based        
Comprehensive Coverage 1. Benefits        
2. Deductibles (annual)        
3. Co-payments
Actuarial Value        
Type of Financing          
Progressiveness of Financing        
Administrative Costs        
Type of MD Payment        
Network Narrowness        
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2014 Federal Poverty GuidelinesFederally
facilitated marketplaces will use the 2014
guidelines to determine eligibility for Medicaid
and CHIP (this is effective February 10, 2014).
 Household Size  100  133  150 200 250  300 400
 1 11,670 15,521 17,505 23,340 29,175 35,010 46,680
 2 15,730  20,921 23,595   31,460 39,325 47,190 62,920
 3 19,790  26,321 29,685   39,580 49,475 59,370 79,160
 4 23,850  31,721 35,775   47,700 59,625 71,550 95,400
 5 27,910  37,120 41,865   55,820 69,775 83,730 111,640
 6 31,970  42,520 47,955   63,940 79,925 95,910 127,880
 7 36,030  47,920 54,045   72,060 90,075 108,090 144,120
 8 40,090  53,320 60,135   80,180 100,225 120,270 160,360
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Subsidization of Cost Sharing Amounts (for
copayments and deductibles) will be made for
parties or below 250 of poverty (currently less
than 28,725 for a single adults and 58,875 for
a family of four). It is not clear how any
provider will be in a position to know any
members cost share obligations at the time of
service.
TABLE 4 HOSPITAL COST SHARE AMOUNTS
Metal Product Deductible Inpatient Cost Share Outpatient Cost Share ED Cost Share Max Annual Out of Pocket
Platinum 0 500 100 100 2,000
Gold 600 1,000 100 150 4,000
Silver Full Pay FPL 200 - 250 FPL 150 - 200 FPL 100 - 150 2,000 1,750 250 0 1,500 1,500 250 100 100 100 75 25 150 150 75 50 5,500 4,000 2,000 1,000
Bronze 3,000 50 50 50 6,350
Catastrophic 6,400 100 100 100 6,400
Catastrophic policies cover 3 primary care
visits per year at no cost. Catastrophic policies
also cover the free preventive benefits
(https//www.healthcare.gov/what-are-my-preventive
-care-benefits/)
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TABLE 4A PHYSICIAN SERVICES COST SHARE AMOUNTS
Metal Product Primary Care MD Specialist MD Surgeon MD
Platinum 15 35 100
Gold 25 40 100
Silver Full Pay FPL 200 - 250 FPL 150 - 200 FPL 100 - 150 30 30 15 10 50 50 35 20 100 100 75 25
Bronze 50 50 50
Catastrophic 100 100 100
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CONCLUSION 2

• U.S. Health Insurance system
• is very complex

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COMPARISON

• Traditional Medicare
•  
• Medicare Advantage

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CONTACTS AND REFERENCES

• PNHP National www.pnhp.org
• PNHP-NY Metro www.pnhpnymetro.org
• Bodenheimer TS, Grumbach K. Understanding Health
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• OBrien ME, Livingston M (editors). 10 Excellent
  Reasons for National Health Care. New Press
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• Potter W. Deadly Spin An Insurance Company
  Insider Speaks Out on How Corporate PR Is Killing
  Health Care and Deceiving Americans. Bloomsbury
  (2010)
• Geyman, J. Health Care Wars How Market Ideology
  and Corporate Power are Killing Americans.
  Copernicus Healthcare, Friday Harbor, Washington
  (2012)
• Himmelstein, DU, et. al. A Comparison of Hospital
  Administrative Costs in Eight Nations US Costs
  Exceed All Others by Far. Health Aff (2014)
  331586-1594.