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HEALTHCARE

U.S. Healthcare Problems

U.S. lags behind developed countries on a number of metrics in regards to healthcare, especially in terms of cost-efficiency and effectiveness

OECD data
- U.S. spends a lot more government money on healthcare per capita than developed countries that have more successful healthcare systems
- Note: a version of the data said that voluntary healthcare spending in the U.S. was disproportionately high, but that version is outdated. Even then, voluntary healthcare spending in the US is on the high end compared to other OECD countries.
Sawyer, Cox 18
- U.S. has spent more than other developed countries when it comes to healthcare, and that gap has widened over time
Gagnon 08
- Finds that in the USA, “pharmaceutical companies spend almost twice as much on promotion as they do on R&D. These numbers clearly show how promotion predominates over R&D in the pharmaceutical industry, contrary to the industry’s claim.”
- 2002 study with similar results
- Rather outdated by this point, unfortunately
- This is opposed to a 2018 study on Canadian pharmaceutical companies which found mixed/opposite results
Moses et al. 13
- In real terms, healthcare costs have tripled from 1980-2011, and most price increases (91%) were due to professional services, drugs and devices, and administrative costs - not demand for services or aging of the population
- Government funding of healthcare has increased by 11% from 1980 to 2011, yet US healthcare still lags behind other comparable countries on multiple metrics, such as life expectancy at birth and survival with many diseases
WIP: Epipens
- https://www.businessinsider.com/epipen-cost-increase-healthcare-insurance-2016-8
- Epipen price has increased 6-fold since 2007: https://www.businessinsider.com/how-much-price-of-mylans-epipen-has-increased-2016-8
- Epipen price surge hasn’t hurt demand, showing that people legitimately need epipens in order to survive and that need doesn’t change from a change in the supply of epipens: https://www.reuters.com/article/us-health-epipen-costs-idUSKBN16Y24O
45% of respondents said cost was a factor in them avoiding healthcare. Indicating that expanding access is necessary, but not sufficient in resolving https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6125037/
Cost-containment strategies (reducing costs by lowering physician-to-patient closeness, generic medications, and pushing more costs to customers) have highly unfavorable outcomes in health care.
- screws over vulnerable kids: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1508766/
- Enhances racial and ethnic inequalities: https://www.ncbi.nlm.nih.gov/books/NBK220345/
Cost-containment strategies for ACA are ineffective https://ldi.upenn.edu/brief/effects-aca-health-care-cost-containment
Despite spending more for healthcare, US citizens use less healthcare than comparable countries, indicating that higher prices for health goods and services account for differences in spending https://www.healthaffairs.org/doi/full/10.1377/hlthaff.22.3.89
US consistently performs worse than comparable countries https://www.kff.org/slideshow/how-does-the-quality-of-the-u-s-healthcare-system-compare-to-other-countries/
High pharmaceutical drug spending in US does not contribute to innovation https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2866602/
Prices are higher regardless of utilization rates https://www.healthsystemtracker.org/chart-collection/how-do-healthcare-prices-and-use-in-the-u-s-compare-to-other-countries/#item-the-u-s-leads-most-comparable-countries-in-mri-availability-and-use_2018
US healthcare outcomes very poor compared to other countries https://www.healthsystemtracker.org/chart-collection/quality-u-s-healthcare-system-compare-countries/#item-start
https://www.reuters.com/article/us-usa-healthcare-deaths-idUSBRE85J15720120620 10s of thousands die every year from lack of insurance in US
Prescription drugs prices accounted for the biggest increases in spending, particularly brand names https://www.healthaffairs.org/do/10.1377/hblog20180208.27999/full/
Health insurance companies made higher profits during covid due to lower expenditures and utilization from people losing their health insurance https://www.kff.org/private-insurance/issue-brief/health-insurer-financial-performance-through-september-2020/ https://jamanetwork.com/channels/health-forum/fullarticle/2770148
42% of cancer patients lose their life savings in two years, 38% deplete life assets, and 65% of cancer patients enter medical debt https://www.amjmed.com/article/S0002-9343(18)30509-6/fulltext
50% of polled Americans fear medical bankrupcy https://news.gallup.com/poll/317948/fear-bankruptcy-due-major-health-event.aspx

U.S. Medicare for All

Universal health care could save money if properly implemented

Cai et al. 20
- META ANALYSIS: 91% of peer reviewed journals say that Medicare-For-All would save money in both the short-run and the long-run
- Found and compared cost analyses of 22 single-payer plans for the US or individual states
- “The largest source of savings was simplified payment administration (median 8.8%), and the best predictors of net savings were the magnitude of utilization increase, and savings on administration and drug costs”
Pollin et al. 18
- An assessment of a possible M4A plan in the U.S.
- As of right now, 35% of Americans are uninsured or underinsured on their current healthcare plans
- “Medicare for All could reduce total health care spending in the U.S. by nearly 10 percent, to $2.93 trillion, while creating stable access to good care for all U.S. residents.”
- This assessment had largely positive reviews from multiple experts in the field**
WIP
- https://www.acpjournals.org/doi/full/10.7326/M17-0302
- A recent Lancet article suggests that M4A would lead to a 13% savings in national health expenditure (equivalent to about $450 billion annually)
  - The same study estimates that on a yearly basis, 68,000 lives and 1.73 MILLION life-years will be saved, relative to our system.
- The Annals of Internal Medicine (one of the most widely cited and influential specialty medical journals in the world) document that a single-payer system would reduce healthcare administration costs by $500 billion annually
Medicare has better health outcomes (articles and research list, too lazy to pull individual sources rn):
Medicare beneficiaries are more satisfied than private insurance https://www.healthaffairs.org/doi/10.1377/hlthaff.W2.311
Giant CBO analysis done recently finds that Medicare For All would save at minimum 300 billion dollars in national health expenditures. https://www.cbo.gov/system/files/2020-12/56811-Single-Payer.pdf
Medicaid expansion is being denied in states w/ more unhealthy people https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4902718/
ACA is critical in ensuring a third of the citizens in republican dominated states https://www.kff.org/health-reform/press-release/analysis-examines-the-affordable-care-acts-impact-on-nearly-all-americans/
Sixty-one percent of enrollees who had used their insurance to get care said they would not have been able to afford or access it prior to enrolling. Doctor availability and appointment wait times are similar to those reported by insured Americans overall. Majorities with marketplace or Medicaid coverage continue to be satisfied with their insurance. https://pubmed.ncbi.nlm.nih.gov/27224966/

General Universal Healthcare Benefits

Kirros et al. 20
- Study into health system and infant mortality in Sub Saharan Africa
- ‘Both public and external health care spending showed a significant negative association with infant and neonatal mortality. However, private health expenditure was not significantly associated with either infant or neonatal mortality.’
Public sector healthcare is no more cost-efficient, accountable, or medical effectiveness. Public healthcare has an issue of timeliness and hospitality, while private healthcare frequently violated medical standards of practice and had poorer patient outcomes https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3378609/
Single payer has superior equity with no difference in quality. Universal healthcare coverage is ‘the most powerful concept that public health has to offer’. https://www.sciencedirect.com/science/article/abs/pii/S0033350618302312
Public sector research produces the most innovative drugs. Public sector research funds base research for all drugs and is indirectly involved in the production of half of all drug research https://www.healthaffairs.org/doi/10.1377/hlthaff.2009.0917
Canada healthcare administration costs lower than US https://pubmed.ncbi.nlm.nih.gov/15088673/
ACA is critical in ensuring a third of republican dominated states https://www.kff.org/health-reform/press-release/analysis-examines-the-affordable-care-acts-impact-on-nearly-all-americans/
Primary care, enhanced physician-to-patient relationships, and preventative care increase quality and cost-effectiveness of healthcare https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5296930/
Industry Life Cycle - Final stage of industry maturity is consolidation
- There is persistent vertical and horizontal consolidation of hospitals and providers in the US healthcare industry, significantly reducing the benefits derived from markets. https://www.kff.org/health-costs/issue-brief/what-we-know-about-provider-consolidation/
- If the tendency towards consolidation/monopolization is likely to occur regardless, it should be utilized for the most social good (akin to regional monopolies like utility companies, particularly telecommunication companies) Vertical integration potentially poggers (assuming we can use it for social good) https://journals.lww.com/hcmrjournal/Abstract/2019/04000/A_systematic_review_of_vertical_integration_and.8.aspx
- Ie healthcare is an inelastic good, the only elasticity when it comes to price shopping are providers. How can we utilize intra-market elasticity when there is no market?
Wait times are not likely to drastically increase under a single payer system