1. “ The Perfect Storm” The Current Crisis State of U.S. Healthcare * * * 34th National Primary Care Nurse Practitioner Symposium * * * Vince Markovchick, MD, FAAEM Director, Emergency Medical Services Denver Health Professor of Surgery Division of Emergency Medicine University of Colorado

5. Health Insurance Costs Keep Rising Health insurance premiums are rising 2-3 times as fast as inflation and wages.

6. Administration is the Fastest Growing job in Health Care Source: Bureau of Labor Statistics and NCHS

9. B: Unemployed is probably closer to 8 or 9% now. Children have increased in coverage dramatically since this study, by about 22% due to the SCHIP program.

12. 18,314 Adult Deaths Annually Due to Uninsurance

20. National Health Spending: Per Person Source: Centers for Medicare & Medicaid Services Projected Actual Per capita expenditures

26. Obviously we have lower numbers here, simply because our life expectancy is less.

29. If you were in an insurance company CEO, who would you want to insure? Source:Agency for Healthcare Research and Quality MEPS, 1999 Percent of health Care Expenditures 1% 1% 2% 4% 6% 13% 73% 0% 0% 0%

30. Dr. Marko: This graph shows a population divided into 10ths. It shows how health care services are utilized in any one year in any population. Take even 1000 people in a population and you will find that the majority of them (80%) are healthy and use very little care. 30% of them in fact, use no care at all!. In actuality most of the services are used in any one year by a small percentage. 10% use 72 % of the health care dollars. If we add to that the 10% who use 13% of the care we find that 20% use 86% of health care services. It is worth keeping in mind that these are not the same people all the time. All of us move in and out of this group at one or many times in our lives. And when we are in that group ( birth of a baby, coronary bypass, cancer diagnosis) we expect health care services to be there waiting for us. Health care is not like other human needs. We all have the same basic needs for food. shelter, clothing etc. When you look at the population’s needs in regard to health care needs are vastly different. Because at any one time the healthy majority use very little care - 80% of the population in Vermont use only 14% of the health care dollars. On the other hand, 10% use 73% of the health care dollar. Another important point is that the most expensive services The NICU, the trauma unit, dialysis to name a few are used by a very small number of people. Dialysis is used by only 380 people per year in Vermont. Yet the infrastructure costs of sustaining these services are enormous.

31. Most of the money is spent on a few people in any one year Source:Agency for Healthcare Research and Quality MEPS, 1999 Percent of health Care Expenditures 1% 1% 2% 4% 6% 13% 73% 0% 0% 0% 20% use 86% of the care

32. Dr. Marko: Most people are not using care. 80% use around 15%. We could just look at their needs and adjust services according to the needs of the overwhelming majority. Go from $2 trillion to a mere $300 billion. Preposterous, of course, we all expect these services when we need them. Problem is, there is no health care system that guarantees adequate financing of these services.

33. If you were in an insurance company CEO, who would you want to insure? Source:Agency for Healthcare Research and Quality MEPS, 1999 Percent of health Care Expenditures 1% 1% 2% 4% 6% 13% 73% 0% 0% 0% 80% uses less than $1000 of care per year

36. Administration is the Fastest Growing job in Health Care Source: Bureau of Labor Statistics and NCHS

38. One-Third of Health Spending is Consumed by Administration 69% 31% Clinical Care Administrative Costs Source: Woolhandler, et al, New England Journal of Medicine, August 2003 & Int. Jrnl. Of Hlth. Services, 2004 ($2000 per person)

39. Dr. Marko: Does not guarantee health coverage- people get sick, especially very sick, get care, no way to pay Is complicated and creates a massive bureaucracy that consumes 31% of the health care dollar When the fixed costs of the infrastructure aren’t paid, a deficit results.

40. Non-profit organizations typically spend between 1-5% on administrative costs, as opposed to the 15-31% of private healthcare organizations.

41. Essentially, our taxes going to pay private insurance companies.

42. Yet another example of how corrupted and inefficient are the bills passed by congress. They try to “improve” the current program, resulting in more costs that essentially get wasted.

44. AMI stands for acute myocardial infarction and CHF is congestive heart failure.

53. This is EXACTLY why it would be so difficult to implement any sort of an effective NHP in the US….there are so many other factors, such as education and private businesses, etc. Because of this, the only way to really implement it would be to do it on a city or state level, because the people could vote and be represented according to their needs; changes would occur much more gradually, and corruption would be less evident.

67. I don’t really understand this slide, but maybe you will….it’s twenty years old, anyway.