Maine Medical Association says U.S. healthcare system needs an overhaul
The 4,000-member organization is the fifth state medical association to pass a resolution calling for universal health care insurance coverage.
The health policy statement – in favor of universal care – shows that the group recognizes the need to put patients’ and caregivers’ interests first.
The Maine Medical Association is to be commended for its newly developed health policy statement, unveiled recently at its annual meeting in Portland (“Maine Medical Association says U.S. health care system needs an overhaul,” Sept. 13). It is the most detailed and comprehensive health policy statement issued by any state medical society in the U.S. It recommended fundamental reform of our existing complicated, fragmented and balkanized system by replacing it with a new comprehensive, simplified and adequately funded national or statewide system, covering all Mainers.
The MMA statement is the product of a nearly two-year effort by a 20-member ad hoc committee. It has been vetted by the MMA Board of Directors and is strongly supported by the recent meeting of the general membership of the association.
I understand that not all of my fellow members of the MMA are enthusiastic about this statement and its proposal for a major overhaul of the health care system – fearing it could disrupt their current business models. But that’s really the whole point of reform. They need to adapt their business model to the needs of patients and caregivers.
Sometimes, fundamental change is necessary to serve the public interest. Such change may require disruption and adaptation. In such times, we must follow our oath as physicians to “put the patient first” and “first do no harm” (including economic harm) ahead of all other considerations. That is the best way to continue to earn the high level of status and public trust we enjoy as physicians.
Medicare for all is the best way to achieve those goals.
Dr. Philip Caper
Portland
The Maine Idea: Hospitals are also part of the health care dilemma
by Douglas Rooks - Maine Press Herald - September 14, 2023
I used to think the gold standard for American health care reform would be a “universal” or “single-payer” system similar to Canada’s, where everyone is covered, there are no bills to consumers and government directs spending to providers.
Canada’s system is called Medicare. It started when our Medicare did, in 1965, and became nationwide by the early 1990s.
For the U.S., this would involve getting private Advantage plans out of Medicare and having the government offer similar plans directly, which — despite industry nonsense — it could easily do. There’s nothing magical about private insurance.
It would also require a much tighter rein on the joint federal-state Medicaid programs, which Republican governors have outrageously abused to deny fully-funded care to an expanded group of poor people while imposing onerous work requirements.
That would still leave some Americans uninsured. Filling the gap might require more generous subsidies, and a return of the penalty for not buying insurance that a Republican Congress zeroed out in a vain attempt to persuade the Supreme Court to strike down the Affordable Care Act.
But it could be done. Massachusetts has achieved virtually universal coverage through a more robust version of the Dirigo Health program enacted under Maine Gov. John Baldacci (2003-2011) and repealed by his successor. The nation could, too.
Yet I’ve begun to wonder whether even this would be enough to solve the problem of sky-high costs.
After all, other countries, including Germany and Switzerland, have private insurance — though much more tightly regulated — and manage universal coverage with reasonable costs.
What makes the U.S. truly unique is its remarkably low proportion of public hospitals. And hospitals are the gatekeepers for health care spending, driving insurance rates and even drug prices, the more familiar villains, based on enormous market power — and their ability to bill states and the federal government.
We often think the big distinction is between for-profit and nonprofit hospitals, and for-profits do try to shed unprofitable patients and avoid unprofitable procedures.
Yet nonprofits are hardly blameless. Following the ACA debate, one remarkable investigative report identified a nonprofit in West Texas as collecting the highest Medicare reimbursements of any hospital in the country.
There was seemingly nothing unusual about the hospital, and confronted with the facts, the administrator at first denied it could be, then finally admitted the reporter was correct.
Another report’s depressing conclusion was that the reason our health care costs are so high is they’re already high and keep going up every year.
That’s because our programs, with few exceptions, bill solely for medical procedures and not for keeping Americans well — what one might naively presume to be the goal of having a health care system.
Maine, for instance, is still mostly nonprofit. Yet don’t imagine these are still the “charitable” community organizations their property tax breaks are based on.
Just ask nurses at Maine Med in Portland, who succeeded in forming a union only on the third try, over two generations, with hospital management using anti-union techniques even Starbucks CEO Howard Schultz might admire.
In Farmington, Franklin Memorial Hospital tried a different approach. Starting in the 1980s, it offered wellness programs and revised its mission so thoroughly that, within a decade, there were measurable increases in community health.
Small rural hospitals were once championed in Congress by the likes of Maine Sen. Olympia Snowe, but support has ebbed, and Franklin, like most small hospitals, was eventually faced with the business imperative that market share is everything.
In 2014, it sold out to MaineHealth, Maine Med’s parent. Slowly but surely, and without more than token news attention, almost all the once-independent community hospitals in Maine have been acquired by MaineHealth or Northern Light (previously Eastern Maine).
Central Maine Med in Lewiston made a disastrous attempt to compete and nearly foundered after unwisely acquiring Parkview in Brunswick. Then Mid Coast — a merger of Brunswick and Bath — picked up Parkview and choked, then sold to — you guessed it — MaineHealth.
The only successful community merger came in Augusta and Waterville, where MaineGeneral built Maine’s only new hospital in decades on a North Augusta campus.
We’ve ended up with only two large hospital chains; Maine Health is dominant. Its board meetings are private, and the state requires only minimal disclosure.
There’s one truly public hospital in Maine — city-owned Cary Medical Center in Caribou. Worth a news story, don’t you think?
In the end, we must finish the project begun by the ACA to achieve universal coverage.
Yet we’ll never reduce costs satisfactorily until we start applying scrutiny — a lot of scrutiny — to the way hospitals operate.
Editor's Note -
The following clipping did not copy well to this blog. I urge those interested in seeing the original article to click of the link at the end of the clipping.
How Much Does the US Spend on Healthcare?
Updated on
The U.S. Health Care System is one of the most sophisticated medical systems in the world. It is also by far the most expensive healthcare system in the world and has serious difficulties delivering affordable care to those who most need it.
US healthcare is a major source of controversy and a leading cause of debt and financial stress. To understand those problems a little better, let’s take a closer look at US healthcare spending.
Key Takeaways
- The United States spent $4.1 trillion on healthcare in total in 2020, an increase of $500 million over the previous year.
- The US spends around $12,530 a year per person on healthcare.
- Canada spends $6,413 less per person each year than the US.
- People 55 and older account for 30% of the population but 56% of healthcare spending.
- Women spend $1770 more on healthcare per year than men do on average.
- On average, Americans spend $1,059 a year on prescription drugs alone.
- Insured individuals paid $7,739 on average for a single policy in 2021.
- The amount of medical debt in the US is estimated to be anywhere from $88 billion to $195 billion.
- 63% of people said they had to cut back on food and basic necessities to stay on top of their medical bills.
In 2020 the U.S spent a total of $4.1 trillion on health care, a $305 billion increase over 2019. The increase was largely driven by the COVID-19 Pandemic.[1]
For perspective, that’s about 19% of the US Gross Domestic Product (GDP) and more than 5 times the annual defense budget.
| Year | National Health Expenditures |
|---|---|
| 2016 | $3.3 trillion |
| 2017 | $3.4 trillion |
| 2018 | $3.6 trillion |
| 2019 | $3.7 trillion |
| 2020 | $4.1 trillion |
Average Cost of Healthcare per Person
The US spends around $12,530 a year per person on healthcare, the highest average cost of healthcare in the world. That figure is up from $10,242 in 2016.
To put the numbers in perspective, Canada spends $6,413 less per person than the US.[1]
| Year | Average Amount Spent on Health Care |
|---|---|
| 2016 | $10,242 |
| 2017 | $10,611 |
| 2018 | $11,040 |
| 2019 | $11,462 |
| 2020 | $12,530 |
How Much Does the US Spend on Healthcare Compared to Other Countries
The U.S.spends an average of $12,318 per person on healthcare every year. Germany falls a distant second with an average of $7,383 per person per year.[2]
Healthcare Spending by State, Age, and Gender
Per Capita Healthcare Spending by State
We were unable to determine the exact per capita healthcare expenditures per state. This is why we calculated the average healthcare spending per capita by state using the data on total personal healthcare spending. *Rolling drums* New York has the highest per-capita healthcare expenditure, with $14,007.[3]
Healthcare Spending by Age
The chart below shows the most recent data (2014) broken down by type sources of funding (private health insurance, Medicare, Medicaid, out-of-pocket, and all other payers and programs).
Statistics show that the 5-17 age group spends the least on healthcare, with an average of only $1,921 a year. The highest healthcare spending ($11,316) has been recorded for the age group 65+, which is expected: as we grow older, we require more care.[4]
| Age | 0-18 | 19-44 | 46-64 | 65+ |
|---|---|---|---|---|
| Medicare | $51,867 | 11,043 | 11,600 | 9,885 |
| Medicaid | $3,536 | 7,037 | 11,360 | 38,681 |
| Private | $2,245 | 3,297 | 7,339 | 5,804 |
| Out of Pocket | $382 | 571 | 1,236 | 8,381 |
| Other Payers and Programs | $683 | 841 | 1,404 | 3,907 |
Healthcare Spending by Gender
Data from 2014
Women spend on average $1770 more on healthcare than men, which could be due to the fact that women tend to go for regular checkups a lot more often than men. Women also have unique medical expenses, from giving birth to birth control and preventive care services.[4]
MaleFemale| Age | Male | Female |
|---|---|---|
| Medicare | $10,763 | $11,169 |
| Medicaid | $6,882 | $6,692 |
| Private | $4,047 | $5,025 |
| Out of Pocket | $891 | $1,186 |
| Other Payers and Programs | $1,029 | $1,035 |
Where Does the Money Come From? Where Does It Go?
How Is Healthcare Financed
Most healthcare in the US is financed by private insurance companies, government programs like Medicare and Medicaid, and out-or-pocket expenses carried directly by the patient. Here’s how the balance gaming those payers has evolved. [5]
| Year | Medicare | Medicaid | Private Health Insurance | Out of pocket |
|---|---|---|---|---|
| 2000 | $225 billion | $200 billion | $441 billion | $194 billion |
| 2001 | $248 billion | $224 billion | $483 billion | $201 billion |
| 2002 | $265 billion | $248 billion | $537 billion | $219 billion |
| 2003 | $283 billion | $269 billion | $589 billion | $235 billion |
| 2004 | $311 billion | $291 billion | $626 billion | $248 billion |
| 2005 | $340 billion | $309 billion | $671 billion | $264 billion |
| 2006 | $404 billion | $307 billion | $705 billion | $278 billion |
| 2007 | $433 billion | $326 billion | $748 billion | $294 billion |
| 2008 | $467 billion | $344 billion | $769 billion | $300 billion |
| 2009 | $499 billion | $375 billion | $795 billion | $297 billion |
| 2010 | $520 billion | $397 billion | $820 billion | $301 billion |
| 2011 | $545 billion | $407 billion | $851 billion | $310 billion |
| 2012 | $568 billion | $423 billion | $878 billion | $323 billion |
| 2013 | $589 billion | $445 billion | $879 billion | $331 billion |
| 2014 | $618 billion | $498 billion | $922 billion | $340 billion |
| 2015 | $648 billion | $543 billion | $976 billion | $353 billion |
| 2016 | $676 billion | $565 billion | $1,030 billion | $366 billion |
| 2017 | $705 billion | $579 billion | $1,079 billion | $373 billion |
| 2018 | $749 billion | $596 billion | $1,131 billion | $387 billion |
| 2019 | $801 billion | $614 billion | $1,166 billion | $404 billion |
| 2020 | $830 billion | $671 billion | $1,151 billion | $389 billion |
Who Pays For Healthcare?
A study by AMA shows that 27.9% of costs related to health care in 2020 were covered by private health insurance and 20.1% by Medicare.[6]✓
✓ Trusted source
AMA
The
American Medical Association brings together more than 190 state and
specialty medical societies as well as other important stakeholders.
| Source of Funds | Amount |
|---|---|
| Private health insurance | $1,151.4 million |
| Medicare | $829.5 million |
| Medicaid | $671.2 million |
| Other health insurance programs | $157.2 million |
| Government public health activity | $223.7 million |
| Other federal programs | $193.9 million |
| Other third party payers and programs | $315.8 million |
| Investment | $192.7 million |
| Out-of-pocket | $388.6 million |
Healthcare Spending By Type of Expenditure
Data show that people spend the most on physicians and clinical services, with $2,459 per person in 2020. This means an increase of $801 over the last ten years. Prescription drugs come second as the most expensive with $1,059 spent per capita in 2020.[1]
Cost Of Health Insurance
The net cost of health insurance has increased from $64 billion in 2000 to $259 billion in 2018. That’s a $194 billion increase over those 18 years. To put those numbers in perspective, Chile’s GDP is $252 billion.[7]
The average cost of insurance for single coverage grew from $6,435 in 2016 to $7,739 in 2021, with the cost of family coverage growing from $18,142 to $22,221.[7]
Who Pays for Employer-Provided Private Health Insurance?
The cost of employer-provided private health insurance is typically shared between the employer and the employee. The employer pays a portion of the cost as part of the employee’s compensation package. Here’s how the balance between employer and employee contributions breaks down.
Medical Debt Statistics
How Much Medical Debt Is There in the US?
The total amount of medical debt in the United States falls into the $88 billion (according to CFPB) to $195
billion range. Although this is a rather “generous” range, it is
challenging to get an accurate figure, as many people use credit cards,
loans, or other forms of financing to cover their medical costs.[8]✓
✓ Trusted source
CFPB
The Consumer Financial Protection Bureau is a United States federal organization in charge of financial consumer protection.
How Much Medical Debt Does the Average American Have?
Healthcare debt is a problem many Americans deal with, some of them finding themselves under challenging circumstances because of it, while others manage to stay on top of their bills. Wyoming has the highest average health care debt of all states, with $1,611, while Alaska comes second with $1,363. You might be wondering, why is health care debt so high in Alaska? Well, that’s because medical services cost a lot more than they cost in other states, considering accessibility to all medical services and procedures, costs of transportation for all medical supplies, and other factors.[9]
How Do People Tackle Medical Debt?
Health care services are quite costly in the U.S., and not all of the cost is covered by insurance. Many Americans, even those with insurance, fall into debt because of their high hospital bills.
A survey designed to reveal how Americans manage medical debt found that 63% of the people surveyed said they had to cut back on food and basic necessities to stay on top of their bills, while 48% used up all of their savings to pay off the debt. Unfortunately, some have been put in situations where they filed for bankruptcy, asked for charity aid, or lost their home.[9
No comments:
Post a Comment