1. What’s Driving
Health Care Costs?
Universal, Affordable Care for
Massachusetts
http://masscare.org

2. U.S. Spends Almost Double Next
Highest Spending Country

3. Common Explanations for
High Health Care Costs
• Inadequate Prevention • Fee-for-service: overuse of tests and
• Behavioral factors procedures
– High obesity rate • Lower cost transparency
– High smoking rate • More third party insurance payers
– High levels of drinking • More physician visits
• Racial and Ethnic Makeup of the U.S. • More ER and hospitals visits
• Aging population • More Medical Malpractice lawsuits
• End of life care • Worse electronic health records
• Chronic Illnesses • Higher Cost of drugs
– High cancer rates • Higher cost of medical devices
– High diabetes rates • Too much hospital bargaining power
– High heart disease rates • More profits
• Overuse of technology (e.g. MRIs, CT • More administration/paperwork
scans, etc) • Higher physician/nurse pay
• Use more prescription drugs

4. Common Explanations for
High Health Care Costs
• Inadequate Prevention • Fee-for-service: overuse of tests and
• Behavioral factors procedures
– High obesity rate • Lower cost transparency
– High smoking rate • More third party insurance payers
– High levels of drinking • More physician visits
• Racial and Ethnic Makeup of the U.S. • More ER and hospitals visits
• Aging population • More Medical Malpractice lawsuits
• End of life care • Worse electronic health records
• Chronic Illnesses • Higher Cost of drugs
– High cancer rates • Higher cost of medical devices
– High diabetes rates • Too much hospital bargaining power
– High heart disease rates • More profits
• Overuse of technology (e.g. MRIs, CT • More administration/paperwork
scans, etc) • Higher physician/nurse pay
• Use more prescription drugs

5. Common Explanations for
High Health Care Costs
• Inadequate Prevention • Fee-for-service: overuse of tests and
• Behavioral factors procedures
– High obesity rate • Lower cost transparency
– High smoking rate • More third party insurance payers
– High levels of drinking • More physician visits
• Racial and Ethnic Makeup of the U.S. • More ER and hospitals visits
• Aging population • More Medical Malpractice lawsuits
• End of life care • Worse electronic health records
• Chronic Illnesses • Higher Cost of drugs
– High cancer rates • Higher cost of medical devices
– High diabetes rates • Too much hospital bargaining power
– High heart disease rates • More profits
• Overuse of technology (e.g. MRIs, CT • More administration/paperwork
scans, etc) • Higher physician/nurse pay
• Use more prescription drugs

6. Common Explanations for
High Health Care Costs
• Inadequate Prevention • Fee-for-service: overuse of tests and
• Behavioral factors procedures
– High obesity rate • Lower cost transparency
– High smoking rate • More third party insurance payers
– High levels of drinking • More physician visits
• Racial and Ethnic Makeup of the U.S. • More ER and hospitals visits
• Aging population • More Medical Malpractice lawsuits
• End of life care • Worse electronic health records
• Chronic Illnesses • Higher cost of drugs
– High cancer rates • Higher cost of medical devices
– High diabetes rates • Too much hospital bargaining power
– High heart disease rates • More profits
• Overuse of technology (e.g. MRIs, CT • More administration/paperwork
scans, etc) • Higher physician/nurse pay
• Use more prescription drugs

7. Disease Prevalence:
U.S. vs. Peer Countries
Other 97%
Back problems 91%
Osteoarthritis/joint disorders 86%
Diabetes melitus 122%
Hypertension 77%
COPD, asthma 67%
Mental disorders 98%
Cancer 105%
Trauma-related disorders 106%
Heart conditions 95%
0% 20% 40% 60% 80% 100% 120% 140%

8. Disease Prevalence:
U.S. vs. Peer Countries
Other 97%
Back problems 91%
Osteoarthritis/joint disorders 86%
Disease
Diabetes melitus 122% prevalence
Hypertension 77% =
$57 to $70
COPD, asthma 67%
billion savings
Mental disorders 98%
Cancer 105%
Trauma-related disorders 106%
Heart conditions 95%
0% 20% 40% 60% 80% 100% 120% 140%

10. Physician Visits Per Capita, 2009
14 13.2
12
10
8.2
8
6.9
6.5
6 5.5 5.7
5
4.6 4.3 4
4
2.7 2.9
2
0

11. Hospital Stays per 1,000
population, 2009
300
263
250 237
200
170 177
162 166 168
150 142 138
131
117
100 84
50
0

12. Average Length of Hospital Stay in
Days, 2009
9
8 7.7 7.5 7.5
7
6.8
5.9 5.9
6
5.4 5.6
5.2
5 4.6 4.5
4
3
2
1
0

13. Nations With Universal
Health Care Coverage

14. How Universal Health
Care Is Paid For
Fixed Payroll Tax Negotiated Budget
Government Health Care
You Fund Providers

15. How U.S. Health Care
Is Paid For
Medicaid
Taxes Medicare
Separate contracts
Blue Cross
Premiums Tufts Medical Insurance
You Out-of-Pocket Costs
Health Care
Providers

16. Insurance Administration Costs
OECD Data, 2010

17. Hospital Administration Costs
OECD, 2010

18. Aortic Aneurysm Repair Costs
Brox. et. al. Arch Internal Medicine, 2003

19. U.S. Pays Higher Prices for
the Same Drugs
mt.gov.com, 2010