Covering the Uninsured-Searching for a Solution: Part 1 of a series

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.

There’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

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