The Sunday Oregonian

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!