Republicans for Single-Payer
Universal Healthcare with Informed Choice

Reforming Healthcare – Why Bother?

How  does our existing healthcare system perform?

·         It’s not universal health care.  15% uninsured, 50% underinsured, and hundreds of plan variations.

·         Almost everyone is one unexpected, unpredictable catastrophic event away from disaster.

·         Consumers lack free choice of providers and coverage as long as employers select plans.

·         Consumers must abide by the guidelines of 3^rd party payers, often limited to provider panels.

·         Consumers and providers lack accurate cost data on alternative healthcare options.

·         Aside from Medicare and costly individual plans, healthcare is linked to employers.

·         Businesses entail huge costs of selecting insurance plans and managing them, and costs are rising.

·         Healthcare is subject to excessive political and 3rd party payer guidelines and regulation.

How is our current healthcare system funded?

·         Over 50% of our current healthcare expenses are funded by government revenues.

·         15% of Americans are uninsured and pay out-of-pocket or apply for Medicaid when sick.

·         56% of personal bankruptcies are due to medical expenses, with consequences to providers/creditors.

·         Bad Debts, or uncompensated charges, are mostly paid by the rest of us through higher premiums.

·         Adverse selection results in cost-shifting by carving out risk pools and excluding high-risk conditions.

·         Overall healthcare expense is 16% of GDP, projected to exceed 20% by 2020.

·         Administrative expense in the US exceeds 30% due to redundant and wasteful process.

·         Businesses are forced to reduce benefits and shift costs to employees, due to rising costs.

What is the current process for handling claims and payments?

·         Providers have hundreds of 3^rd party payers to bill, resulting in high administrative costs.

·         Claims are submitted to 3^rd party payers with payments often delayed for months.

·         Providers negotiate “contractual adjustments” with 3^rd party payers so actual charges are unknown.

·         Uninsured patients are charged “list price”, far in excess of 3^rd party rates.

·         Claims are often covered by multiple policies, resulting in conflicts and excessive payment delays.

·         Endless debate and litigation to determine medical liability adds to costs and additional complexities.

What is the level of quality of our current healthcare system?

·         Healthcare data is fragmented into thousands of inaccessible databases, many proprietary.

·         National databases are based on samples and produce “snapshots”, often delayed by years.

·         Providers maintain their own medical records, with multiple duplications, usually on paper.

·         Financial incentives favor specialists, resulting in excessive, high-cost treatments and risks.

·         Incentives to become specialists result in shortages of primary, family practice MDs.

·         Payment system encourages over 30% redundancy of service, outside of best practices.

·         Patients receive less than 50% of recommended care, according to best practice guidelines.

·         Providers fail to follow evidence-based guidelines to inform clinical decision-making.

·         Quality data is not available to consumers to facilitate informed, value-conscious decisions.

·         Communities lack data to facilitate effective and economic health services to residents.

·         Providers’ credentials and practice profile data is not accessible to the public.

·         Public Health is compromised by lack of timely access to integrated data repositories.

·         Key performance indicators (eg Healthy People 2010, JCAHO Oryx) are not widely used.

·         According to WHO and OECD, the US is far from the healthiest country in the world.

·         Health disparities persist for many dis-advantaged minorities, resulting in high costs to society.

The six aims of a healthcare delivery system, as described by the Institute of Medicine (IOM) in Crossing the Quality Chasm, are not being addressed.  Our system should be:

·         Safe — avoiding injuries to patients from the care that is intended to help them.

·         Effective — providing essential and appropriate services while avoiding underuse.

·         Patient-Centered — respectful and responsive to patient preferences, needs, and values.

·         Timely — reducing waits and sometimes harmful delays for everyone involved.

·         Efficient — creating a value-conscious collaboration and avoiding waste or overuse.

·         Equitable — providing care in a consistent quality regardless of ethnicity, gender etc.

More info:  www.pnhp.org     www.nchc.org     www.healthcareforallcolorado.org    www.r4sp.com