Physicians have different solutions to this complex problem. Tennessee’s Dr. Thompson said that universal access should be state-based. The federal government can’t do it. Tennesseeans have diabetes and obesity from poor diet and lack of exercise that create massive problems. For example, I trach 300-pound 10-year olds. Wyoming must have different problems. Oregon’s Dr. Richardson said, For health care reform to be truly effective requires a national scope. This requires multiple elements to work together. If everyone has to buy it and everybody’s covered, universal coverage could work.
Explore This Issue
April 2007There’s no easy answer.
Federal Entitlements
Medicare
- 42 million beneficiaries
- $325 billion spent in 2005, 13% of federal budget; expected to grow to $444 billion in 2010
- 12% of beneficiaries consume 69% of budget
- 12% enrolled in managed care plans
- 51% of beneficiaries have incomes below 200% of federal poverty line (FPL)
Medicaid
- 54 million beneficiaries
- Two-thirds of beneficiaries are in low-wage working families
- The federal government pays 57% of Medicaid’s $288 billion budget; states pay the balance
- Average spending per child $1410, per senior $10,147
- Medicaid pays for 17% of hospital care, 17% of physician income, 50% of home care
Veterans Administration
- 26 million beneficiaries
- 9% uninsured, many of them homeless
- 14,000 in mental hospitals
- Seven priority classes for services
- Increase of 66% in outpatient services since 1999, as VA intentionally shifted from IP to OP services
Federal Employee Health Benefits Plan (FEHBP)
- 8 million beneficiaries
- Wide selection of plans-FFS, PPO, POS, HMO (all with gatekeeper)
- Managed competition-plans are rated by premium costs, provider quality, service, cost/benefit
- Federal government pays 72% of the average premium
©2007 The Triological Society