U.S. Health Care Reform: Setting the Record Straight with Scott AtlasJun 09, 2021
I'm here to talk about
reformand I decided to focus on what needs to be done and why it needs to be done and maybe some of this will get done and I'm going to show a lot of slides and a lot of data. There are a lot of graphs on the slides, so it will wake you up or put you to sleep if you're not interested, but if you pay attention, there's a ton of information here and then I'll answer questions to get you started. talk I like to use this slide which is a quote from Senator Moynihan, everyone is entitled to their own opinion, but not their own facts, and there is no area of public policy where so much misinformation has been spread and people have such strong opinions about things that don't really know the facts, so I'm going to go over a lot of facts and derive opinions from that.
There is a huge contradiction in current discussions about
careand that is that when you ask people how they rate their own healthcare experience in the United States, the overwhelming majority are and have always been very satisfied, but, interestingly and I think it is a contradiction, the same percentage of people say that the system needs a fundamental change or a complete reconstruction and I think this is an Illustration of the misinformation in the discussion when people have their own experience, they know that the United States It has, as I will show you based on data and you can read later, the best medical care in the world.
Now there is another fact that is absolutely true and that is that the US spends more on healthcare than anywhere else and that is either per person or as a percentage of GDP, the question really is what do we get for the money and this is what deduced an argument that we don't get much. World Health Organization report that came out in 2000 and is still relied upon and what is relied upon in this study was the ranking of 191 countries and as you can see here the US was ranked 37 even if we weren't spending a lot of money, that's not very good and the first thing I would do as I look at this is say, well, you know we're in the group of countries that aren't really paradigms of quality healthcare if you look at who's in the ranking.
United States and even if you look at who is at the top of the ranking, these countries are not known to have very good healthcare, so you think maybe there is something wrong with the ranking and there is something wrong with the ranking and that is that approximately two thirds of the ranking is based on equality not quality i.e. if everyone got a view that's better than if some people got an A and some people got a view the system is better if everyone got a view agree with their classification and there is Another problem and that is that this study has been completely destroyed in the academic literature by health policy experts;
In fact, this is just a sample of the peer-reviewed articles that have pointed out that not only was there a ranking based on equality, not quality, but that there was highly subjective input, assumptions were made about their relative importance when there was missing data, which came from dozens of countries, the researchers literally filled it in on what they thought would be the so-called data, this is the truth, there were huge measurement errors. that didn't make a statistically significant difference, but they were presented as a concrete ranking and many of the top contributions don't really reflect the quality of healthcare at all. what do I want to say with that?
Well, this is a very, very good example of a very crude statistic. life expectancy and you might intuitively think, hey, you know, I mean, this is an obvious reflection of the quality of health care and, in fact, our current elected officials, even those who are working on health care legislation, don't They really understand this and that is that there are a lot of things that go into life you expect to see because, first of all, not everyone dies from an illness, in fact, it turns out that many people in the United States died immediate deaths. by gunshot wound to the head or by murder, suicide or manslaughter and, in fact, Do you think right?
I mean, so do all countries, but not exactly when OECD countries are ranked. An OECD is basically the economically developed countries of the world. The United States is near the end of life expectancy if you take everything. Trade when all countries are standardized for immediate gunshot wounds to the head or immediate death from high speed car accident they simply standardize each country for the same rate the researchers did this is what happened the United States had the highest life expectancy no rational person would say that a suicide would count against the health system now health analysts don't like to talk about the OECD report, in fact, in the WHL report, in fact, the OECD, which in general terms is basically a liberal think tank, said this report is one of those things we wish you would veto, it's so flawed that it's actually been discredited and yet it's still being talked about like it's a legitimate ranking here are the facts that don't I have.
Obviously I don't have time to go over all the facts, but I wrote a book about the facts and this is a five hundred reference book that you can buy. I don't really do anything with it, so it's not like I'm not selling a book, but the facts show that we have the best benchmark healthcare system in the world. world, if you talk about health care in terms of what I'm talking about here, better survivals from cancer, survivals from other serious diseases, better access to treatment as treatment outcomes for all chronic diseases, that's access to screening for us, the best access to medicines, the best access. to accurate diagnosis, modern medical technology, the fastest access to surgeries that not only save lives but also change lives, the fastest access is special that anyone here who is sick knows that there is no one in modern healthcare , you have a serious illness that is treated by a Primary Care Physician it just doesn't work that way and I am a doctor and I know exactly how the healthcare system works in the US and that is appropriate since specialists are the only ones who have the training to understand when and how to use modern medications. diagnosis and treatment strategies we have the fastest access to specialists, but we also have and are the source of the world's leading innovations in every metric.
Here are just a few examples of cancer that rate us compared to Western European countries that are considered the best. models for healthcare we have a statistically significant better outcome, in fact, the best outcome in the world in the peer-reviewed literature on every major cancer and almost every rare cancer. What about access to treatment? We will take the most important chronic disease that exists. is high blood pressure, 53% of people in the US are receiving treatment, this is access to care if you already know you have high blood pressure and of course the New York Times pointed out that this It's not that good, but they went further.
He said this is shocking evidence of how our complicated and dysfunctional health care system cannot provide recommended care. They didn't bother to look at the rest of the countries in the study because when you look at the countries that supposedly have better healthcare. England Sweden Germany Spain Italy Canada we eclipse them in terms of access to high blood pressure treatment What about the outcome of successful healthcare? We have a statistically significant better outcome in curing high blood pressure or at least controlling high blood pressure compared to each of those countries. In fact, the OECD itself clearly said that the United States has the highest number of high blood pressure diagnoses, but also the fewest people with high levels measured due to truck use, which the data shows is called better healthcare.
What about access to screening tests? The government controlled system would at least be able to make this a non-emergency thing, just have people screened for major cancer, so when you look at the data in this case comparing the U.S. .to Canada you see that for every major cancer screening test mammography pap smear PSA colonoscopy sigmoidoscopy the US has better access to screening than the government controlled system in Canada if it is so good why would we
reformhealth care in the US? several important reasons: first, there are demographic realities, we have a markedly aging population and we harbor a large number of risk factors, particularly, but not exclusively, for obesity, which means that if we do nothing, the system will suffer. completely overwhelmed, second, public plans that are unsustainable and failing, and I'm going to explain why that's true: the Affordable Care Act, what people sometimes call Obamacare, has instituted harmful and misguided regulations that specifically have caused insurance premiums and consolidations throughout the healthcare industry, including doctors and hospitals, even insurers that has reduced competition and choice and that is always bad for consumers, wrong incentives have been implemented for decades and were duplicated by the Affordable Care Act, both economically and health-wise, and I'll go over that the Affordable Care Act expanded government.
Insurance is fine and I'm going to show you the extent to which, however, it is private insurance, not government insurance, that actually gives them broad access to care and another big reason is that the Affordable Care Act is enacting what I call a two-tier system that isolates the most vulnerable people in our society from the excellence of American health care and weighs down hundreds of billions of dollars of taxpayer money, and this is very important because I believe which is not a partisan issue, so I think there is common ground here. Two very important realities before talking about what should be done and why it should be done.
Medicaid reform number one, which is the program for the poor, depends on system-wide reforms. If you don't do it that way, you get what you need. I have in other countries like the NHS in England. I don't know how many people have been here, where there is a parallel system of private care and practically everyone who can afford it, which means, in fact, more than 80% of people who earn more than $80,000. Every year in the UK they use private insurance and care, they avoid the NHS system because it is inferior, as I will show you, and the other essential reality is specifically that it is the poor who will suffer the most if we somehow follow this inexplicable logic for healthcare payer because in reality it is only the poor who will not be able to circumvent that system, no one in this room will use that system.
I guarantee you the projected healthcare spending is fine when you look at the projections and of course the projections never come true because of that thing. what goes into the projections does change, we know that, but if you look at the projections and these are the spending projections and the black line here is the federal tax revenue, the income that the money has, notice that the government does not have money from which they take money. you, that's your money they use, we know that, I have to explain it to my kids all the time and it's about what they take, they have about 17 18 19% of GDP it's their income and if nothing changes in healthcare By 2049, all of your money, all federal dollars will be absorbed by Medicare, Medicaid and Social Security, there will be zero money left for any national defense program for anything else, so we know that's unsustainable now, right? what was the focus of the Affordable Care Act and this?
It's really very important, I think understanding it focused on increasing the number of people with insurance and did it by centralizing government authority over health care and did it by adding a series of regulations and mandates that I'm not going to follow. All of this except mandates on regulations for individuals and businesses on private insurance regulations that directly and indirectly affected health care payments and approximately 21 new taxes totaling more than half a billion dollars over the decade, here's how did and what he did with what he spent. Affordable Care Act money was spent about $2 trillion over a decade and half of that $1 trillion rounded up here is spent subsidizing private insurance through the Obamacare exchanges and about $1 trillion is spent in expanding Medicaid.
Is it working now? It's not really debatable anymore, but I'll show you some of the claims here. It is working well? The percentage of people who are uninsured definitely decreased. No doubt about it. Now itdid by greatly expanding the number of people with Medicaid. sixty to eighty-four percent depending on what you read and I said, 60 here of the people who are newly insured under Obamacare are insured through Medicaid, did it reduce health care expenses? Well, there's a headline here in the Washington Post from one of President Obama's advisors. success story of health care law slowing medical costs and then you look at the numbers and this is health care spending over time, this is the US and since the implementation or since the initial signing of the law there was a plateau or a slight decline in the way this is an illustration of Washington's speech, they think that a decrease in the growth rate is a decrease, okay, there is a nuance but a very important difference, but In any case we will tell you that there is a stagnation here. health care spending the problem is that there is stagnation in every country in the world in health care spending, now you have to be totally convinced of the success of Obamacare to think that Obamacare caused health care spending to slow down in all countries countries around the world and in fact, the OECD itself that generated the data said that the reason healthcare spending slowed down was because of the economic crisis of 2008.
We have evidence that that is true in countries as well. When you look at what happens after the recessions described here in blue, every time there has been an economic recession historically in the United States there is a slowdown in the rate of health spending in the country and when the recession has recovered as it progresses. Now the rate of increase in healthcare spending is fine, we know that, no it's not working, why do I say that? Well, because health insurance premiums have skyrocketed, millions of people, in fact, ten times the initial projections will have been kicked out of their chosen insurance plan there.
There are a dwindling number of doctors and hospitals that even accept Obamacare insurance, as we read. I expect that in the news every day there will be a significant loss of insurance options for those who rely on Obamacare exchanges. We are spending a billion dollars to expand. Medicaid and it is a failed program and there has been a very harmful side effect, the so-called unintended consequence, which is a consolidation because the regulations of doctors' offices and hospitals, which actually increase prices, are harmful to consumers. The problem is that there is a huge disconnect on health care reform and this is not a question of one party or the other, both parties do not seem to understand that politicians are focused on making health insurance more affordable as if that were the main goal and they do it in the Obama health care model by subsidizing consumers and putting the regulations direct cash to buy insurance and in the Republican models that have been presented they have done it through what are called refundable tax credits, which are basically effective.
Well, the problem is that insurance premiums are secondary, that is not the main thing. Insurance premiums reflect the cost of healthcare primarily and the regulatory environment, in fact a rough estimate can be given that around 80% of an insurance plan is due to the cost of healthcare. Since the Obamacare law went into effect, the increase in premiums is overwhelmingly due to the new regulatory environment the main goal of health reform should be to reduce health care costs, everything else follows and for everything else I'm talking about access to care insurance premiums and even the cost of government insurance programs if the cost of healthcare were lower. everything else becomes easier and more available the key here is the fine print without harming the quality of access or innovation we know in pate in countries with centralized single payer healthcare there is one and only one way to restrict costs of health care: limiting health care is why there are really inordinate delays in care, people die while waiting for care, they have worse health care outcomes than we do, and in fact the solution is our summary below, no We want to reveal the punchline here is that the solution to failure.
Single payer healthcare systems take taxpayer money and pay for private healthcare and sometimes even in neighboring countries this is not understood by the people who advocate for single payer healthcare here how can we reduce the cost of health care as prices go down? in every other good or service in the United States, the same reason why that super computer in your pocket that you call a phone costs hundreds of dollars, not twenty thousand dollars, and that is to instill competent and correct incentives, these are the steps and this is in the Wall Street Journal article that I wrote a week ago that you can read about, I talked a little bit about this on TV this morning on Stuart Varney, who is my favorite TV guy, if anyone See, shows the key steps to reduce drug prices. health care incentivizes people to care about the price of health care no one cares about the price of health care no one here really asks I bet you hardly know what the price of something is because our model is that insurance is designed to minimize out of pocket payment if someone else is paying why would you even ask about the price?
In fact, we use healthcare without knowing the price. It's the only good or service you've ever really used without knowing what the prices are and then you find out weeks later. After what it costs, the second point is to increase the supply of health care and stimulate competition for the people who have the power to control patients' money and the third is to reform the tax code to eliminate the harmful and counterproductive incentives that exist. have applied. there for years, how do we judge what will happen or at least what President Trump is thinking about what he wants to do by the point he has made?
That's how I judge it because nothing really significant was done, except today, like being happy to answer questions about appointing Tom Price as HHS secretary, who is actually very good at his health care knowledge, has designed a proposal for health care reform that is somewhat similar in many ways to what I designed and he is a very articulate person, unfortunately he is gone. Seema Verma is the head of Medicare and Medicaid Services at CMS, she is very good, she was the brain behind some of their state reforms for Medicaid that coincided again with the things that I proposed, which is changing Medicaid to an insurance model private instead of a separate parallel. system that doctors don't accept and the third person is the director of the FDA, who is a friend of mine and a colleague in some of the campaigns we worked on together, and he is very good, Scot Gottlieb, who understands very important problems at the FDA with the approval of drugs that I think will be important and will change the way that at least improve access to drugs and reduce costs.
This is what I think the main goals of President Trump's health care reforms are to roll back the regulations and taxes of the Affordable Care Act and, in fact, some of that was done. By today's executive order, which you can read about or will read about, is in every station, health savings accounts will be significantly expanded, there will be tax reform, and if passed, judging by what they proposed, it will include something called refundable tax credits and despite the fact that, in my opinion, it is a bad idea to do that, for many reasons, giving money to voters is irresistible to a politician and so it will be done.
Medicare will not be affected for all of you who are on Medicare or almost eligible for Medicare I can guarantee that nothing will change with Medicare, although it is essential that it change, they will not. Medicaid will be transformed and the way I think they are going to do it is What they have already proposed is to try to delegate power to the states because, in theory and then in practice, it is a state program, although you have to keep in mind that Medicaid, the program for the poor, is paid for approximately sixty percent by the federal government. government even though it is called a state program and then innovation in healthcare will be facilitated with some deregulation and incentives because that is what the current president likes.
Now the first example is this is the Affordable Care Act and it's a pretty big law as you can see in the image here and we know that President Trump talks a lot about deregulation and this is an example of the literal size of the proposal. House of Representatives; there will be a significant simplification of regulations in any healthcare reform that has done this. It's my plan and you can read about it if you want. It's free on Hoover's website and will restore quality healthcare. I'm going to go over very quickly what needs to be done first.
Expand affordable private insurance. We know that more than five million Americans. They have already lost the private insurance they chose due to Obamacare's regulatory requirements, and ten million Americans will eventually be forced to abandon it as these years pass. That's a problem, why is it a problem? Because government insurance has been expanded much more than it existed in the past. population before him compared to the expansion of private insurance and this is a problem at least for big reasons, the number one doctors do not accept the government programs that they are expanding. These are data from 2008, we are a third of the doctors and we are already primary care doctors. didn't accept new Medicaid patients, you can expand an insurance program all you want, you can slap someone on the forehead and say they're insured, but if you can't give me health care, that's really a travesty and an unconscionable one of my words. favorites to celebrate. that kind of thing as an achievement when it's not really affordable for healthcare, there's another problem with people switching to government insurance and that is that there's a massive cost shift to private insurance.
This is the underpayment of government insurance per year compared to previous private insurance. -obama care and here it is post Obamacare there is a dramatic increase in underpayment by government insurance compared to private insurance, that cost change is significant in fact, a family of four using private insurance in the numbers 2008 I was already paying almost $2,000 extra because of that cost shift because you have to realize that government insurance pays less than the cost of care, okay, so if you want to eliminate private insurance and make it unaffordable, you would put every time more people on government insurance because that underpays private insurance, but Democrats when they proposed the Affordable Care Act said we're not using a government insurance model, we're putting private insurance on the exchanges and this is a so-called republican idea and that smart health insurance exchanges are actually a good idea where they work. when private companies get together and create insurance plans that actually work to give people choices and people spend less money when they want, but then there was this part, the Affordable Care Act added a huge amount of regulations to any insurance that it was considered approved to be on the exchange, that's fine and that regulatory environment not only made insurance expensive but also caused insurers to now see it withdraw from the market because they are not going to sell a product in which they obviously lose money and when If you look closely at the insurance that people even buy, there are a variety of doctors and hospitals that are significantly less than before.
Here is some data. Here are private health insurance premiums after the first full year of full implementation of Obamacare exchange rules. average American county, premiums went up 49 percent, okay, this is what happened in the first four years, individuals, families, premiums skyrocketed at the same time deductibles went up. Everyone here probably understands that deductibles are the amount you pay until your insurance kicks in if deductibles are higher generally premiums are lower, but here we had the worst: premiums exploded and deductibles exploded, in fact, the Affordable Care Act specifically hurt high deductible plans in some ways, that's my data on the rate of premium increases depending on what type of health care plan now I said Affordable Care Act insurance It has reduced access to doctors and hospitals and that is true, the year before full implementation, the third end of individual health plans here was what is called narrow or ultra narrow.
Networks of doctors who accepted the insurancethe first year they have now doubled. 70% of the Affordable Care Act exchange plans had what's called a narrow or ultra-narrow network, and as a concrete example, let's look at cancer care. This is one of the jewels of American healthcare. The system is fine, it turns out that 13 out of 19 of the major cancer hospitals in the United States do not accept the Obamacare insurance exchange, so you think you will be treated at Sloan-Kettering, MD Anderson or Stanford, no, You have insurance, but it doesn't cover where you think it covers This goes beyond doctor networks that accept Obamacare insurance 42 percent fewer oncologists than if you purchased private insurance outside of Obamacare 42 percent fewer cardiologists one-third fewer psychiatrists and healthcare providers primary care 24% fewer hospitals that's what we mean by narrow network, insurance options have continued to decline.
In 2015, only 7% of counties had one insurer available in their exchange and two-thirds had three or more insurance options. In 2017, just two years later, with the Obamacare regulations, look at the change here almost 40% now actually for next year it's not even on the chart we will only have one insurance plan possible one insurance provider in your county the The key to reducing insurance premiums is to reduce regulations and create incentives to seek value. What to do? I mean high deductibles are very important to lowering the price of meth. CAIR is not for everyone, it is not a panacea, but if you pay directly, you care about what you pay, this does not even need to be discussed, it really is like that.
It's true and everything we do and high deductibles actually restore the true purpose of health insurance. Health insurance in any insurance is to reduce the risk of large and unforeseen financial losses. It is not the subsidy that is not purchased in homeowners insurance to pay for the light bulbs. is not the purpose of insurance, there are other ways to give people money for small, routine expenses, but that is not the purpose of insurance and when all insurance is required to be inflated with those types of mandatory coverages, all Insurance becomes very expensive, plus that type of insurance model instills harmful incentives because everything is paid for, you don't care what it costs and you actually use more healthcare when you don't even need it.
We know that plans with high deductibles reduce spending. It is a fact. This is not an opinion. There are studies on this, it decreases spending by about 15% per year and it doesn't hurt patients because people think about what they are doing. By doing this, there is nothing wrong with that, there is nothing that is free, so what you should know to at least look for value. One-third of the savings for people using high-deductible plans are due to lower cost per utilization; In other words, they are buying and are actually Americans. they want lower cost insurance they want higher deductibles it is the fastest growing type of insurance in recent years, I heard we had a representative government now this is a very fundamental economic principle, we are in the building of the economy here so When people have choices and are consciously spending their own money, they make value-based decisions.
Okay, this is obvious, but it needs to be clarified somehow. The second reform is to liberalize and expand health savings accounts too. Because? Because L savings accounts, which are tax-sheltered accounts that can be used to reduce health care expenses, the cost of health care why do I say that because they are proven to be another 15% beyond high deductible plans, Additionally, people with health savings accounts use wellness programs more frequently because they are interested in saving the money, they have a motivation to use wellness programs and these are validated wellness programs that improve health at based on health savings account data is a bit esoteric, but this is a better tax proposition than having a health care deduction because even though they did it, the contribution to health savings accounts is deductible .
It does something else, it encourages saving money, it makes you price conscious and Americans want HSAs. There are a
recordnumber of people putting money into HSAs. I talked about lowering the price of health care. Is it even practical? I mean, if you have chest pain. pain and an ambulance, is not the option to seek care, okay, we know that, but we also know that only five to six percent of health care expenses are emergency. Five to six percent, in fact, about sixty percent of the health care expenses of people under 65 years of age. They are elective outpatient things that you can buy.
I guarantee you that if Stanford and UCSF published their MRI prices and made them visible because people were demanding it because we are spending their own money, there would be competition and prices would go down. What's wrong with the people? those who actually use the most healthcare the top 1% of people spend 25% of the money on healthcare aren't these people because they spend so much more than a health savings account? They spend $100,000 a year on average, but the thing is, the top one percent, forty-five percent of their spending is outpatient, so now they're going to look at the prices.
Three instill appropriate incentives in the tax code. We know that the tax code as it stands is not where there is an unlimited exclusion of your employer. Providing health benefits is one of the biggest mistakes in the tax code because it incentivizes people to spend more money on health care. It makes your healthcare dollar more valuable than any other dollar and people don't realize it, but you know if we clamp down. at that time or that income exclusion people say "well, then I would lose all the money" well, not really because most people may not realize it, but their employer's benefits are taken away, salaries are placed on them to take home that no one gives them. you extra money your take home pay is lower when your benefits are higher overall now I'm not going to go into this in detail but I just want to make point number one here, why wouldn't you want refundable tax credits like the Republicans propose that This is the main reason because giving people money to pay for the wrong kind of insurance, which means inflated comprehensive insurance that minimizes concern about the cost of care, if you prop that up by giving them money, you're out. promoting the wrong incentives is not only the 250 or 300 billion dollars a year that are charged, what that tax exemption costs the government to modernize Medicare, that is why I say that it is urgent not only that the population over 65 years of age increase dramatically in the next 25 years, but let's look at the population over 85 years old yellow here this is what is called the elderly now it is a great thing that we are living longer, but as everyone knows, it is not about complete health, older people are using more health care, this is the data on what you use in health care versus your age is not free when there are people who live longer, that has a disadvantage in terms of cost, so we could look at even a disease, Alzheimer's, which is probably the most public health problem in the world.
I think it's reasonable to say that the projections are that by 2050, in the United States alone we will spend more than a trillion dollars if nothing changes with Alzheimer's and that It is a problem not only for individuals, it is a problem for the government, because a huge amount is through Medicare because people with Alzheimer's are generally over 65 years old; in fact, dementia and cognitive decline with Alzheimer's are already more costly to society in the US then the total cost of heart disease and cancer combined with just that disease and this is this aging population this is really something that is almost scary really the other problem with Medicare people say oh Medicare is great but there is another reality and the reality is this when Medicare When Medicare started, it was paid for by the working population and there were four point six workers per Medicare user, like this It's how it's financed.
What has happened over the years seems about half as unsustainable, even if Medicare was a good Medicare hospitalization fund, so to speak, it is projected to be completely bankrupt in about 15 years, less than 15 years. There really is another problem with Medicare. People think it's so good and the problem is that doctors are already starting to not accept Medicare patients. Twenty percent of primary care physicians in 2008 did not accept new ones. Now more than half of Medicare patients are not accepting new Medicare patients and we have this bolus of seniors entering the Medicare eligible population. One thing is that Medicare is very good at denying claims if you look at this data here.
Medicare, not private insurance denials, is close. or at the top of the chart every year, not these private insurers who deny claims, not to mention sixty billion dollars a year in fraud, waste and abuse, but we have people who say Medicare for all, by the way, about 80 % of people with Medicare realize that this is not the case. so good that they buy private insurance to supplement there are very few people who only have Medicare, traditional Medicare insurance five they change Medicaid so that these people have the same access to care as everyone else and that means that through private insurance this It's Medicaid expansion.
In general, under Obama's care, essentially all adults say and believe what children are disabled. I gave you some data from 2008 that about a third of primary care doctors did not accept Medicaid when you look at this from the top 15 metropolitan areas, about 45% of doctors did not accept new Medicaid patients in 2009 2013 54% of doctors did not accept new Medicaid patients in 2013. This is even more compelling to me. This is a study I dug up that was published by the government's Department of Health and Human Services. itself was their study these are the doctors who accept Medicaid who signed the contract to accept Medicaid but when you try to get an appointment with them 56 percent of primary care doctors and 45% of specialists who said they accept Medicaid do not accept Medicaid, you can imagine how few doctors now actually accept new Medicaid patients.
Expand that everything you want will be worthless. The other thing we know about Medicaid and the idea of expanding Medicaid is that in the study, the single randomized study takes up half of it. uninsured people half of them get Medicaid make them get nothing and stay uninsured what is the impact Medicaid failed to improve physical health at all beyond not having insurance what is the purpose of the health care system if not is to improve health in addition when We look closely at the medical literature that I made and look at the best magazines in the world that handle cancer surgery.
American Journal of Cardiology, they all show the same thing people on Medicaid do worse than people on private insurance even if you control for the same disease and everything else is fine, how do I know these are the articles? well, what about Medicaid purchases? I say we should change it to the same type of program we want to have for everyone else, well, 60% of Medicaid spending. they're elective outpatient care Medicaid reform is already happening before this administration and a lot of it was based on Seema verma moving toward private insurance models, even HSAs that require a co-pay and you say, well, what?
How can you say you should have a co-pay? You are poor, well, we are in time for a dollar because it turns out that even when people have a dollar that they have to pay, they think about using something, this is very important, there have been two important reforms that have at least been attempted will be submitted and not I'm going to go into details. I just want to go over some facts because everyone has heard of the CBO and everyone read the same things I read. I'm sure NPR said oh, the Republican Party. the health home will leave 23 million more uninsured citing the CBO, let's look at the CBO first, the CBO is a group of economists who make projections for the government and bill themselves as non-partisan, okay, by the way, nonpartisan is not synonymous with nonpartisan, nonpartisan if you look it up and I have a slide here, but I think I pulled it out nonpartisan means not affiliated with a party, okay, the accuracy of the CBO projections, let's see what They said about Obamacare coverage, we're talking about the Obamacare exchanges. in 2013 they made predictions about how many millions of us will be covered and then I'm comparing it here with what actually happened on the date.
This is what happened, in fact, in 2017 they were almost triple the actual effect of their projections. notoriously inaccurate, that is point number one and it must be recognized that they know it and that is why they revised theirprojections, so here's an example of how many people will have Obama care insurance each year. They made the projection in March 2016 as their millions and then they came out. a new set of projections in January 2017 and you can see that there is tremendous variation, in fact there is about a third less now than the health care proposals that came out of the Republicans earlier this year, months after the projection January, so you'd think that's fine, the CBO.
They are going to compare what they project from the Republican plans with their reference projections on Vivalma's attention. That's the purpose of the comparison in their baseline projection at that time was January 2017, but no, they didn't, they went back to March. 2016, you might say, well, that's convenient because there's almost a 50% increase since January 2007 in the number of people who are claimed to be insured under current law. Well, that should at least attract attention and, indeed, it did. of the representatives wrote a letter saying: well, why did they do that? Why wouldn't they compare their latest projections on Obama's attention just because they're worse and they said we haven't had time?
Well, look when they wrote that. letter nine months after their projections showing that Obama's care wasn't going to cover as many people, but they went back to the previous iteration of their own projection. I don't know if I'm articulating that well enough, but that's for me. It's really a shame now there's another thing that happened and that is the projections on Medicaid spending by the Republican proposals the program for the poor this is the amount of money three hundred and ninety three billion dollars spent this year on Medicaid that it's a fact, it's not a projection the CBO projections came out in the New York Times they said the Senate health care bill includes deep cuts to Medicaid and Chuck Schumer, the Senate minority leader, said the Republican proposal cuts Medicaid in quotes the way this bill cuts Medicaid health care is heartless this is the CBO's own projection of Medicaid spending does anyone think this amounts to a deep and cruel cut?
This curve is going up, not down, in case anyone noticed that the CBO said a false basis for Medicaid coverage, in addition to what I said first. They assumed for the current law that all states have expanded Medicaid even though only thirty-one states did so, but they stated in their projection, to compare the Republican plan with Obamacare, that all states have expanded and that 80% of everyone who is eligible in every state is enrolled even though this is simply not the case, they further stated that millions of people will not enroll in the GOP Medicaid program because just because they might think they are subject to sanctions even though they are not.
They are, I mean that you really have to be careful with what you read, that's the point. Reform Six strategically improves the supply of medical care and encourages innovation. I think there are many ways to do this, it's very important if people are going to buy healthcare if they want it. Having options requires having enough supplies, and one way to do that is to increase the capacity of nurse practitioners and physician assistants to provide very simple care. Another thing to keep in mind is that the medical field itself has placed harmful restrictive restrictions on a number of trained specialists, including residents, and that's a bad thing that I'm going to quickly discuss here, why not cap the prices of the medicines?
There are a couple of things I want to cover because when you limit the price of a good, it is a historical fact that your supply of that good is restricted and, in fact, that happens with drugs; We know that, in fact, it happens as a body of literature shows price control. Strongly delay the launch of new drugs. Significantly decrease the early launch of new drugs. Substantially reduce the RMD of new drugs in development and, indeed, the calculations. indicate that the financial benefit of new drugs far outweighs the savings from capping prices, so I think it's best to be careful what you ask for if you believe drug prices should be maintained.
The way to work with medications is to really increase competition. When we see this curve, when a generic is introduced, the price goes down slightly, when even a second generic drug is introduced, the price of a drug goes down. % I mean, it's pretty remarkable what price competition does. I'm going to go over here quickly because I want to get to the final section. Kennedy said that the great enemy of the truth is often not lies but myth and Bernie Sanders. in his campaign and now shamefully says that the United States remains the only major country on Earth that does not guarantee health care to all people, the only long-term solution is a single-payer national health care system, this is what he says, separate of a possum, okay, we have There are artistic people in the audience who understand that this is surrealism, but this means that this is not a pipe.
Why isn't it a pipe? Because it is an image of a pipe. Health insurance is not medical care. I've already explained it in our current system, okay? and we know it's not by looking at the countries that have horrendous healthcare and guarantee in their constitution free healthcare for all of this is 1936 USS our Constitution free healthcare for all I've been to Moscow I've been to your cities I've seen your medical care, that is anecdotal, but I want to say that it is not even remotely the level of the United States, this is Venezuela as a Constitution, they guarantee that medical care is a right and it has to be without contributions, we have a single payer system, It's the VA and the VA is a disgrace and everyone knows it.
I have worked in a VA. Everyone knows the data about excessive waits for care. People die while waiting. What is the solution even here? The solution is to allow veterans to receive care in private hospitals. that is the solution we are the only country in the world that is moving towards the single payer system the countries that have a single payer system not only are they not moving more towards the single payer system the solution to their failures is to take the money of taxpayers and pay for private health Single-payer systems are worse according to the data.
This is not a statement. If anyone is interested, they could look me up. I wrote an article about ten days ago on CNN about the data on single payer. There are a lot of hyperlinks there. Single-payer systems have massive wait lists and dangerous delays in medical appointments—life-threatening delays in treatment, even for urgent cancer care. Well, nineteen percent of people in the UK NHS system who are referred for urgent cancer treatment, quote, nineteen percent wait more than two. months to receive their first treatment Twenty per cent of people needing brain tumor surgery in the UK Twenty per cent wait more than four months to see a neurosurgeon after making the diagnosis.
These pesos are never, literally, ever found in the United States. payment systems have delayed availability of important medications, worse availability of screening tests, and last but not least, worse outcomes across all serious diseases. Sweden and the other countries are privatizing after decades of single-payer care Sweden has privatized all of its pharmacies, they are privatizing some of their long-term care facilities and are doing more, and although a family of four pays more than twenty thousand dollars per year in taxes and Sweden through its national system six hundred thousand Swedes also with private insurance, the same deal with the rest of the European countries systems in our single-payer system and England.
I'm not going to quote the statistics because I already have, but I note that the NHS recently paid more than $8 billion for private care. This is a very fun quote. Dive deeper into Google's UK spin-off. says that the NHS in 2017 still retains the dubious title of being the world's largest buyer of fax machines, that's there to come, okay, the last two slides, expectations in healthcare, this is data from a survey that I haven't shown it to anyone. We did a study of seven countries, six countries. every seven I don't know why there are six flags here the importance of the election we are not British okay we are not people who live in Sweden or Canada why do I say that?
Well, you ask people what they want, how important things like choice are, even if you ignored the economic things I've shown you how important the ability to choose which doctors will perform medical procedures on you. These are extremely, very important British citizens, someone important, not very important, important, not at all important, this is the United States, okay? We are concerned about access to the latest trucks, this is the United States, these are statistically significant differences, there is a shift to the left, we think things are extremely important, access to the latest medical technology, this is the United States , compared to Britain, what about the waiting times?
Let's assume that these are exactly the The way I phrased the question here is a quote. Let's say you need non-emergency heart surgery to prevent a serious heart condition. What is the maximum wait time in the US? 52% of people say they will, it is only acceptable to wait less than or equal to a week. The British, 70% of people say yes, no problem, a month or more, okay, what about cataract surgery because I couldn't drive or live independently until the surgery okay, sixty three percent, nearly two-thirds of Americans said only a week, while acceptable Britons, 70 percent say yes, a month or more, a diagnostic MRI for an underlying condition that is not an emergency but yes serious. 73% of Americans said they are only willing to wait less than or equal to a week RIT Sixty percent of people say a month or more for heart surgery, but while waiting for surgery you may have a heart attack or die nearly 90 percent of Americans said it was okay, just a week is acceptable.
The British said 25 percent a month or more, okay, we're not British. We hear that last point all the time, and I showed it: Roughly 80% of Americans think the system needs fundamental change or a complete rebuild. Nobody shows you the rest of that study because here are the other countries. In that study, almost the same percentage of people, not exactly but pretty close, say their system needs a fundamental change or a complete rebuild to take home messages that I think are very important for reforming Medicaid, which is a hot topic. in literature these days. In terms of the news, the success of Medicaid reform depends on the baseline of the entire system, we want an integrated system, the poor want the same health care as everyone else, to me there is no ethical justification for them to have any kind of bad system that we would never want. thinking that you did something great because you're spending five to seven billion dollars a year on that system, it's not free, second of all, the poor are going to suffer the most if we somehow move towards a single payer system because only they will not be able to bypass that system.
The last slide is from Milton Friedman, who had his office down the hall from mine when he was at Hoover. One of the big mistakes is judging policies and programs by intentions and not by their results. Okay thank you very much. a lot
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