Movie Footnotes


  1. “MCS faced with double digit increases every year in health care cost increases” and “The premiums in total for health care cost has actually doubled over the past 10 years”
    -From MCS Files – Employee share in 2004 was $75.66 for Aetna in 2014 it is now $413.01 for Highmark Blue Shield. In 2004 the monthly premium for Aetna was $710 and is now $1,529.66 for Highmark Blue Shield as of 2014.
  2. “A Worker making minimum wage for an entire year is not making enough to pay for a health care benefit”
    “10 Dollars an hour for every hour they work”
    -Health insurance equals $18K cost for medical insurance is $9 per hour --- 2,000/18K = $9 *
  3. “For an average family of 4 this years number is $23,000 dollars that’s what a typical family insured that way costs” -(
    In 2015 the average annual family insurance cost is $24,671
  4. “Insurance companies are able to older employees up to 3x as much as they would a younger employee”
    - The HHS report provides some details for premiums by age group, showing that a typical 60-year-old individual will pay almost 60 percent more than a typical 27-year-old for the second-lowest cost silver plan. But, again, these figures don’t include out of pocket expenses. costs of claims also increase with the age of the insured, as shown in Figure 2. The average costs of claims rise every 10 years for men from age 45 on and for women from age 35
  5. “Of 1 million bankruptcies in the U.S over 60 percent are because of medical related issues, and the majority amount of those people have health insurance”-In 2013 1.7 Americans lived in households experiencing bankruptcies due to health care. 64 million Americans struggled to pay medical bills in 2014 - commonwealth fund of those 64 million Americans 59 percent were insured for the entire year - 36 percent or 66 million Americans reported delayed care due to costs
    A study by the American journal of medicine in 2007 62.1 percent of all bankruptcies have medical cause. Most medical debtors are well educated and middle class citizens and ¾ of them had health insurance.
    The share of bankruptcies attributable to medical problems rose by 50 percent between 2001 and 2007
  6. 1,973 American households file for bankruptcy every day - - 62% of bankruptices are medical related. There are 1.2 million total bankruptcies a year.
    - in 2005 1 out of 55 households filed for bankruptcies –
    - Businesses are 3 percent of bankruptcies –
    - in 2011 1,400,000 bankruptcies
    - in 2005 medical bills were 46% of bankruptcies –
    - in 2014 937k bankruptcy fillings and less than 3% were from businesses – U.S Bankruptcy Court- “Business and Non Business Cases Commenced Case Load Stats U.S Bankruptcy”
  7. Richard conversation about Premium Shares, and how an employee could end up paying an additional 6,000+ if one or two family members got sick.
    - Additional information from Kasier Employer Health Benefit Survey for data on Premiums
    - In 2014 the average contributions for employees are $1,081 for single and $4,823 for family.
    - Family contribution has increased 81% since 2004
    - PPO is the most common health plan 54% of insured people had it in 2014
    - In 2009 the average deductible was $829 in 2014 it was $1,217
    - 73% of workers have co-pays for primary care physicians and 72% for specialty care
    - Average co-pay for in-network is $24 for primary and $36 for specialty
    - Average Coinsurance = 18% for primary and 19% for specialty
    - 62% of covered works are in drug prescription plans with 3 or more tiers
    - 15% of plans pay fill cost of prescriptions once the deductible is met
    - 17% are in plans with the same cost sharing for all prescription drugs.
    - The Typical American family is not prepared for a major financial shock) only has 21 days of income readily accessible – CNN Financial report * (we both have this on file) from the same report *Middle Class income families make between $36-60K the lowest income households earn less than $20,300. 60% of Americans have the same amount of wealth as they did in 1989. From the PEW Research center 46 percent of Americans are considered Middle Class (
  8. “health care costs are going up 2 percent above the inflation rate and 2 to 2 ½ percent the projected growth of the GDP”
    Inflation -
    Healthcare cost growth refers to the rate at which the national spending is increasing. In 2013, this was 3.6 percent. That’s the lowest rate of increase since 1960 when the government started keeping track of these things – but it’s still more than double the 1.5 percent rate of inflation that we saw in the broader US economy in 2013.
    GDP - The U.S. Commerce Department's Bureau of Economic Analysis in its advance estimate (PDF) for second-quarter gross domestic product showed healthcare spending climbed 4.9% compared to the second quarter a year ago. The overall economy grew at a 2.3% rate in the quarter.
    Information is from this article:
    Which uses this information
  9. Additionally from the CMS
    - Health spending is projected to be 19.9 percent of GDP by 2022.
    - Health spending is projected to grow at an average rate of 5.8 percent from 2012-2022, 1.0 percentage point faster than expected average annual growth in the Gross DomesticProduct (GDP).
  10. “Health costs have gone up to 3 trillion dollars”
    NHE grew 3.6% to $2.9 trillion in 2013, or $9,255 per person, and accounted for 17.4% of Gross Domestic Product (GDP).
  11. We’ve gone from 7 percent of the economy back in 1971 being health care to 18 percent today” And “When the rest of the world is spending less than 10 percent of their economies and getting health care to all of their citizens” is currently 17.6 percent of the GDP, compared to an average of 9.2% of the OECD countries
    Spending per person in the U.S is $8,745 compared to an average of $3,355 for OECD countries
  12. Chuck, Philadelphia school discussion
    change teachers to school staff - June 7, 2013 -- The Philadelphia School District announced Friday is it laying off 3,783 people across entire range of district employees, from senior administrators to support staff.Class Size growth - School officials previously said they might have to lay off 1,300 employees, swell class sizes to 40 or more, ax school police officers, and further cut services to students.At least one of those doomsday scenarios would not come to pass, the superintendent said Wednesday."I'm saying definitively, I'm not going to put 40 children in a class," he told reporters, "because they're not going to be safe."
  13. “If an ICU stay costs 30K a day, we are shelling out 30K a day, that’s half a police officer a day”
    - ICU - Mean intensive care unit cost and length of stay were 31,574 +/- 42,570 dollars and 14.4 days +/- 15.8 for patients requiring mechanical ventilation and 12,931 +/- 20,569 dollars and 8.5 days +/- 10.5 for those not requiring mechanical ventilation
  14. Fall of the Blues source
  15. “The U.S has one of the shortest lengths of stays in hospitals per country”
  16. “We go to the doctor about 4.2 times a year the Japanese go 13 times”
  17. Nurse discussion about billing and complexity file:///C:/Users/HP%20ENVY%2015/Downloads/FinalPaperworkReport.pdf
  18. US physicians spend 84k a year just to interact with the private health insurance industry
    - We estimated physician practices in Ontario spent $22,205 per physician per year interacting with Canada’s single-payer agency—just 27 percent of the $82,975 per physician per year spent in the United States. US nursing staff, including medical assistants, spent 20.6 hours per physician per week interacting with health plans—nearly ten times that of their Ontario counterparts. If US physicians had administrative costs similar to those of Ontario physicians, the total savings would be approximately $27.6 billion per year.
  19. Taiwan’s spends 1.5-1.6% of its total budget on administration
    I’m getting 1.7 here “Another critically important factor is the NHIA’s powerful information technology (IT)-driven administrative system, which provides high administrative efficiency at low cost. In 2014 the administrative budget for the NHI was 1.07 percent of total NHI expenditure”
  20. Rationing DiscussionData from the CDC Summary Health Statistics for the U.S Population: National Health Interview Survey, 2012
    - About 25.9 million persons (8%) delayed seeking medical care in the last year due to cost and 19.2 million (6%) did not receive needed care due to the cost of care
    - Adults aged 18-44 and 45-64 were more likely than older adults and not children to delay seeking or not receive medical care due to cost.
    - Persons in the lowest income group were about 10 times as likely as person in the highest income group to not receive needed medical care due to cost and more than 6 times as likely to delay seeking medical care.
    - Persons under age 65 who were uninsured were about 3x as likely as persons who had Medicaid and other insurance to delay seeking or not receive needed medical care due to cost.
    - Persons who were in fair or poor health were about three or four times as likely as persons who were in excellent or very good health to delay seeking or not receive needed medical care due to cost
    - Among persons under age 65, those with Medicaid (9%) were more likely than those who had private insurance (4%) and those who were uninsured (4%) to have stayed overnight in the hospital once in the past year.
  21. “84,000 lives could be saved yearly if the U.S lowered its preventable death rate”
  22. Berwick waste study “Eliminating Waste in U.S Healthcare”
  23. Healthcare waste- Dartmouth 30% Excess Medicare spending According to the Dartmouth Institute for Health Policy and Clinical Practice, 30 percent of all Medicare clinical care spending is unnecessary or harmful and could be avoided without worsening health outcomes.
    $690 billion Waste in health care A September 2012 Institute of Medicine report estimated that $690 billion was wasted in US health care annually, not including fraud.
    The Institute of Medicine breaks those numbers down, they also have us at a $765 billion total in waste
    another source
  24. “MRI’s cost $12,000 when in fact it could really cost them $300 to provide”
    - Charges for a single MRI scan vary widely across the country for reasons beyond startup costs. According to the recently released Medicare data, MRIs charges are as little as $474 or as high as $13,259, depending on where you go. (Another recent study of medical claims by Change Healthcare found that in-network prices for certain MRIs can run from $511 to $2,815.) Article also notes the national average is $2,600
  25. Hospital prices and variation

Provider Savings footnotes:

For provider savings we added all providers together and looked at the Himmelstein study which showed that 26 percent of total expenditures was wasted in excess administration, which is the highest In comparison to other countries hospitals.

  1. U.S. far out in front again - in hospital administrative wasteA Comparison Of Hospital Administrative Costs In Eight Nations: US Costs Exceed All Others By Far. By David U. Himmelstein, Miraya Jun, Reinhard Busse, Karine Chevreul, Alexander Geissler, Patrick Jeurissen, Sarah Thomson, Marie-Amelie Vinet and Steffie Woolhandler.
    Health Affairs, September 2014 of hospital administrative costs across eight nations: Canada, England, Scotland, Wales, France, Germany, the Netherlands, and the United States. We found that administrative costs accounted for 25.3 percent of total US hospital expenditures—a percentage that is increasing. Next highest were the Netherlands (19.8 percent) and England (15.5 percent), both of which are transitioning to market-oriented payment systems. Scotland and Canada, whose single-payer systems pay hospitals global operating budgets, with separate grants for capital, had the lowest administrative costs. Costs were intermediate in France and Germany (which bill per patient but pay separately for capital projects) and in Wales. Reducing US per capita spending for hospital administration to Scottish or Canadian levels would have saved more than $150 billion in 2011.

    Bureaucracy consumes one-quarter of US hospitals’ budgets, twice as much as in other nations: Health Affairs study

    A study of hospital administrative costs in eight nations published today in the September issue of Health Affairs finds that hospital bureaucracy consumed 25.3 percent of hospital budgets in the U.S. in 2011, far more than in other nations.

    Hospital administrative spending totaled $667 per capita in the U.S., vs. $158 in Canada, $164 in Scotland, $211 in Wales, $225 in England and $325 in the Netherlands.

    Administrative costs were lowest (about 12 percent) in Scotland and Canada, whose single-payer systems fund hospitals through global, lump-sum budgets, much as a fire department is funded in the U.S.

    The article attributes the high administrative costs in the U.S. to two factors: (1) the complexity of billing a multiplicity of insurers with varying payment rates, rules and documentation requirements; and (2) the entrepreneurial imperative for hospitals to amass profits (or, for nonprofit hospitals, surpluses) in order to fund the modernization and upgrades essential to survival.

    “We’re squandering $150 billion each year on hospital bureaucracy,” said lead author Dr. David Himmelstein, a professor at the CUNY/Hunter College School of Public Health and lecturer at Harvard Medical School. “And $300 billion more is wasted each year on insurance companies’ overhead and the paperwork they inflict on doctors.”

    He added: “Only a single-payer reform can squeeze out the bureaucratic waste and use the money to give patients the care they need. Instead, we’re layering on more bureaucracy in insurance exchanges and ‘accountable care organizations”

    He added: “Only a single-payer reform can squeeze out the bureaucratic waste and use the money to give patients the care they need. Instead, we’re layering on more bureaucracy in insurance exchanges and ‘accountable care organizations.’

    Dr. Steffie Woolhandler, senior author of the study, said: “For three decades our policy makers have pushed market-oriented strategies that have turned health care into a business. As a result, Americans now have the world’s costliest health care, and our life expectancy is years shorter than in most other wealthy nations. It’s time to admit that, when it comes to caring for sick people, markets don’t work.”

  2. Physician Practices in the U.S. Spend Nearly $83,000 Annually Per Physician on Administrative Costs, Nearly Four Times as Much as Canadian Practices Spend practices in the U.S. spend significant amounts of time and labor interacting with multiple health plans on claims and billing, obtaining prior authorization for patient services, and dealing with pharmaceutical formularies. The physician and staff time spent on these interactions is estimated to cost at least $82,975 per physician annually in the U.S., compared with $22,205 in Ontario, Canada, according to a study published in the July issue of Health Affairs. The study was partially supported by The Commonwealth FundThe amount spent on these activities by practices in the U.S was nearly four times that spent by their counterparts in Ontario interacting with Canada's single-payer system, according to estimates by lead author Dante Morra of the Department of Medicine at the University of Toronto and colleagues, based on surveys of physicians and administrators. If U.S. physician practices had administrative costs similar to those in Ontario, the total savings for U.S. health spending would be about $27.6 billion per year.

    The authors note that per capita health spending in the U.S. is 87 percent higher than in Canada—$7,290 vs. $3,895 annually—saying that "many factors contribute to the high cost of health care in the United States, but there is broad consensus that administrative costs are high and could be reduced

    Additional findings from the study, "U.S. Physician Practices Spend Nearly Four Times as Much Money Interacting with Health Plans and Payers than Do Their Canadian Counterparts":

    U.S. physicians spend 3.4 hours per week interacting with health plans, significantly more than the 2.2 hours per week Ontario physicians spend interacting with the Canadian single payer plan. Most of the difference comes from one hour per week that U.S. physicians spend obtaining prior authorizations.

    Nurses and medical assistants spend 20.6 hours per physician per week on administrative tasks related to health plans, nearly 10 times the time spent by Canadian practices. More than 13 of these hours per week are spent obtaining prior authorization for medical services that physicians believe are needed by patients.

    U.S. clerical staff spend 53.1 hours per physician per week on administrative tasks related to insurance, compared to 15.9 hours in Ontario. Most of the difference comes from the time U.S. clerical staff spend on billing (45.5 hours) and obtaining prior authorizations (6.3 hours)

    Senior administrators of physician practices in the U.S. spend much more time per physician than their Canadian counterparts on overseeing claims and billing tasks: 163.2 hours a year in the U.S. compared to 24.6 hours a year in Ontario.

    Physician practices spent very little time submitting quality data to health plans in either the United States or Ontario.


Pharmacy footnotes:

  1. From Bloomberg business:“U.S Drug Spending Increases most in 13 years to 373.9 Billion”“Last year’s $43 billion growth in spending on medicines was the highest ever,” said Murray Aitken, executive director the IMS Institute for Healthcare Informatics, which issued the report. The institute is part of IMS Health Holdings Inc., a data company that tracks prescription drug use.

    Much of the increase came from treatments for hepatitis C, cancer, diabetes and multiple sclerosis after U.S. regulators approved more new drugs than any year since 2001. In total, spending on prescription drugs rose 13.1 percent in 2014, according to the report.

    11.7 million Americans gained health coverage under the Patient Protection and Affordable Care Act, they weren’t a major driver of the spending growth, Aitken said. The main contributors were new and expensive specialty treatments, which include medicine for viral diseases, cancer and auto-immune disorders such as rheumatoid arthritis.

    Drugmakers introduced four new products for hepatitis C, a liver virus that’s infected about 3 million people in the U.S. The drugs are among the most expensive treatments ever, with Gilead Sciences Inc.’s Harvoni listing at more than $1,000 a pill. In total, the U.S. spent $12.3 billion on the treatments, according to the report.

  1. Prescription drug spending jumps 13% to record $374 billion in 2014From LA Times: influx of millions of people newly insured under the Affordable Care Act was less of a factor than expected — about $1 billion of the spending growth, it said.

    The bulk of that was from people seeking breakthrough treatments for hepatitis C — a cure that came with a wallop at the cash register. A 12-week treatment of Gilead Sciences Inc.'s breakthrough hepatitis C drug Sovaldi could cost more than $80,000 per patient.

    Gilead's drugs Sovaldi and Harvoni drove nearly 10 times as many people to start treatment for hepatitis C last year than in 2013, the report said. Sovaldi, in its first full year on the market, became the top-selling drug in the United States, the report said.

  1. Why do Americans spend so much on pharmaceuticals? United States spends almost $1,000 per person per year on pharmaceuticals. That’s around 40 percent more than the next highest spender, Canada, and more than twice as much as than countries like France and Germany spend.Prices in the U.S. for brand-name patented drugs are 50 to 60 percent higher than in France and twice as high as in the United Kingdom or Australia.
  1. More Proof That American Health Care Prices Are Sky-High
  • A prescription for Nexium, a popular remedy for acid reflux disease and other stomach ailments, costs $215 on average in the U.S., which is more than 3.5 times the cost in Switzerland, the second-most-expensive nation for Nexium prescriptions, and almost 10 times more than what Dutch people pay.
  1. Sales of Sovaldi, New Gilead Hepatitis C Drug, Soar to $10.3 Billion
  • Gilead Sciences sold $10.3 billion of it’s new hepatitis C drug Sovaldi in 2014.
  • Its success with hepatitis C more than doubled Gilead’s overall revenues to $24.9 billion in 2014, compared to $11.2 billion a year earlier. Net income after certain adjustments was $13.3 billion, or $8.09 per diluted share, compared to $3.5 billion, or $2.04 per diluted share for 2013.
  • In the fourth quarter alone, revenue was $7.3 billion, compared to $3.1 billion for the fourth quarter of 2013. Net income, after adjustments, was $3.9 billion, or $2.43 per diluted share, compared to $930 million, or 55 cents per diluted share, a year earlier.
  • In addition Gilead has stuck a deal with Indiana manufacturers to create a generic version of the pill which will cut the drugs price by 99% for poor countries. For example in the U.S Sovaldi costs 1,000 a pill or $84,000 for the recommended 12 week treatment, in India it is likely to be sold for less than $1,800 for a 24 week treatment. Gilead plans to introduce the drug in India for about $10 a pill. 1 percent of the price in the U.S -






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