One of the
pleasures of travelling is to read local news. I read an in depth article
titled “How will Oregon fill the Medicaid gap?”
It gives an insight into the US Health Care Industry. Medicaid is the
insurance scheme for the poor. Medicare is the insurance scheme for those over
65. In Oregon as a result of the Affordable Care Act 436,000 extra people were
able to receive health care insurance. “It gave free or subsidized health care
coverage to nearly half a million Oregonians. It also drove insurance companies
out of business, led to painful insurance rate hikes, generated windfall
profits for hospitals and undoubtedly saved lives”. The uninsured numbers
dropped from 16% to 5% (about 280,000) Oregonians. Oregon has a population of about 4 Million (a
bit less than British Columbia at 4.6 Million). Every state negotiates
different deals with the Federal Government.
In Oregon those who do not qualify for Medicaid (the cut off is $16,394
annual salary for an individual) are required to buy insurance otherwise they
get fined. Two 55 year olds with no pre-existing health conditions saw their
premiums rise to $1,472 per month, with a deductible of $7,150 per year.
“That’s more than double what we pay on our mortgage”. The Oregon Health and Science University now
employs 16,000 staff compared with 12,000 before the Affordable Care Act
(Obamacare) came into being. There is a lot of uncertainty as to what the Trump
Administration and the Congress will do with Obamacare, whether it will result
in more uninsured and whether the State will have to pick up more of the costs
that until now have been provided by the Federal Government. In Canada we do not have to be concerned
about those uninsured but there is a continuing tug of war between the Federal
Government and the Provinces as to how much each will pay. Presently the
Federal Government will only agree on increases if new monies are provided for
Home Care and Mental Health rather than for hospitals and doctors.
“In 2015, total health expenditure in
Canada is expected to reach $219.1 billion, or $6,105 per person. It is
anticipated that, overall, health spending will represent 10.9% of
Canada's gross domestic product (GDP).”
“U.S. health care spending grew 5.3
percent in 2014, reaching $3.0 trillion or $9,523 per person. As a share of
the nation's Gross Domestic Product, health spending accounted for 17.5
percent.”
From the World
Bank – the following are % of GDP spent on health care on selected countries to
compare. Argentina 4.5, Austria 9.4, Cuba 11.1, France 11.5, Japan 10.2,
Netherlands 10.9, New Zealand 11.0, Sweden 11.9, UK 9.1.
What really needs
to be compared are Health Outcomes – such as average life expectancy, infant
mortality, maternal mortality etc but also responsiveness (timeliness of access
to care). The US and the Oregonian article spent most of the time commenting on
costs but not on outcomes. That could be another commentary piece!