Is health care a human right? According to US law via ratified UN treaties, it is.

1. Why is there a health care debate? Marilyn J. Ray, M.D., M.P.H. Fort Hays State University November 3, 2009 mray@fhsu.edu

2. Health Care – a Human Right UN Charter – 1948 Ratified by the U.S. Senate on July 28, 1945 (64 years ago) Article 55 of the UN Charter states: The UN shall promote higher standards of living, full employment, and conditions of economic and social progress and development . . . as well as universal respect for, and observance of, human rights and fundamental freedoms for all without distinction as to race, sex, language or religion.

4. Enumerates for each nation that signed

5. Rights of individuals

6. Duties of every nation

7. All levels of U.S. Government are expected to enforce rights guaranteed by the Charter

12. Why is there a health care debate? Cost

14. 17% of national economy... and growing

15. $1 trillion increase in health care spending over the last decadehttp://www.rwjf.org/pr/product.jsp?id=44888

16. We Spend More on Health Care than Any Other Country http://www.chcf.org/documents/insurance/HealthCareCosts08.pdf

17. Drivers of Spending Growth http://www.chcf.org/documents/insurance/HealthCareCosts08.pdf

18. Why is there a health care debate?

19. What quality? US Ranks 50th in Life Expectancy 2009 CIA World Factbook https://www.cia.gov/library/publications/the-world-factbook/rankorder/2102rank.html

20. Quality In 2005, the US ranked 30th in infant mortality MacDorman MF, Mathews TJ. Behind international rankings of infant mortality: How the United States compares with Europe. NCHS data brief, no 23. Hyattsville, MD: National Center for Health Statistics. 2009.

21. Quality Hi IMR in US due to high % of preterm births MacDorman MF, Mathews TJ. Behind international rankings of infant mortality: How the United States compares with Europe. NCHS data brief, no 23. Hyattsville, MD: National Center for Health Statistics. 2009.

23. 1 in 3 Americans are obese or overweight

24. Nearly 25 million Americans have been diagnosed with diabetes

25. Nearly 2,400 Americans die from heart disease every day

26. 1 in 2 Americans will be diagnosed with cancer in their lifetime

27. Nearly 1 in 10 children have asthmahttp://www.rwjf.org/pr/product.jsp?id=44888

28. Why is there a health care debate?

29. Robert Wood Johnson Foundation Commission to Build a Healthier America Higher Income, Longer Life Adult life expectancy* increases with increasing income. Men and women in the highest income group can expect to life at least six and a half years longer than poor men and women. Life expectancy at Age 25 Life Expectancy at Age 25 *This chart describes the number of years that adults in different income groups can expect to live beyond age 25. For example, a 25-year-old woman whose family income is at or below 100 percent of the Federal Poverty Level (FPL) can expect to live 51.5 more years and reach an age of 76.5 years. http://www.rwjf.org/pr/product.jsp?id=44888

30. Robert Wood Johnson Foundation Commission to Build a Healthier America More Education, Longer Life For both men and women, more education often means longer life. College graduates can expect to live at least five years longer than individuals who have not finished high school. Life expectancy at Age 25 Life Expectancy at Age 25 http://www.rwjf.org/pr/product.jsp?id=44888

31. Robert Wood Johnson Foundation Commission to Build a Healthier America Health Varies by Income and Across Racial or Ethnic Groups Percent in Poor/Fair Health Lower income generally means worse health. Racial or ethnic differences health status are also evident: Poor or fair health is much more common among black and Hispanic adults than among white adults. %of Adults, ages >=25 years, with Poor/Fair Health* FAMILY INCOME(% of Federal Poverty Level) RACIAL OR ETHNIC GROUP *Age-adjusted http://www.rwjf.org/pr/product.jsp?id=44888

32. Robert Wood Johnson Foundation Commission to Build a Healthier America Across America, Differences in How Long and How Well We Live http://www.rwjf.org/pr/product.jsp?id=44888

33. Robert Wood Johnson Foundation Commission to Build a Healthier America A Short Difference to Large Disparities in Health http://www.rwjf.org/pr/product.jsp?id=44888

35. Non-Hispanic white adults fare better than any other racial or ethnic group.Comparing these rates against the national benchmark for adult health status reveals that, at every education level and in every racial or ethnic group, adults in this country are not as healthy as they could be. Percent in Less than Very Good Health http://www.rwjf.org/pr/product.jsp?id=44888

36. Why is there a health care debate?

38. 7 million Americans will lose health insurance between 2008 and 2010 due to recession alone, not due to job loss

39. Urban Institute estimates that under a worse case scenario, 66 million Americans will be uninsured by 2019 (only 10 years from now)

40. Nearly 90 million people (~ 1/3 of the population under 65) spent a portion of either 2007 or 2008 without health insuranceSource: http://www.nchc.org/facts/coverage.shtml

42. 1.1 million part-time workers lost health insurance in 2008

43. >8/10 uninsured come from working familiesSource: http://www.nchc.org/facts/coverage.shtml

45. Comparatively, diabetes causes ~ 17,500 deaths/year

46. Less preventive care

47. Diagnosis at later stage of disease

48. Receive less therapeutic care

49. Higher mortality rate

50. Uninsured 1.6 x more likely to die of cancer within 5 years of dx

51. Upfront payment required more and more

52. ER stabilizes but does not manage comprehensively

53. High impact of medical debt

54. Forgo medical care

56. “Public Option” Plus + Lower cost to insured Coverage to the currently uninsured More hospital payment for current uninsured Minus - Probably lower pay to hospitals A problem only if too many join the plan Possible shift of costs to private payers Dobson A, DaVanzo JE, El-Gamil AM, Berger G. How a New ‘Public Plan’ Could Affect Hospitals’ Finances and Private Insurance Premiums. Health Affairs, November/December 2009; 28(6): w 1013 – w1024

57. Figure 1 Physician Support for Coverage Expansion Options Robert Wood Johnson Foundation at http://www.rwjf.org/pr/product.jsp?id=48453

58. Figure 2 Support for Allowing Adults Ages 55 to 64 to Buy into the Current Medicare Program Differences were not statistically significant (p=0.08). Robert Wood Johnson Foundation at http://www.rwjf.org/pr/product.jsp?id=48453

59. Massachusetts 2006 Reform Sustains employer-sponsored insurance Employers keep coverage Employers do not cut back benefits Access to employer coverage has increased Scope and quality of insurance has increased Premiums and out-of-pocket costs more of an issue for employees in small firms Long SK, Stockley K. Massachusetts Health Reform: Employer Coverage From Employees’ Perspective. Health Affairs, November/December 2009; 28 (6): w1079-w1087

60. Mount Auburn Hospital, Cambridge, Massachusetts Global payments negotiated for the year Bonuses paid according to quality benchmarks Including patient satisfaction measures Hospital assumes some risk Primary care physicians in charge Hip fracture costs $40,000 - $50,000 Preventing hip fracture costs $1000 Case managers – home visits Promotes consultation Bebinger M. Mission Not Yet Accomplished? Massachusetts Contemplates Major Moves on Cost Containment. Health Affairs, September/October 2009; 28(5): 1373-1381