The document discusses the history and current state of healthcare in the United States. It notes that healthcare costs have been rising much faster than inflation, taking up a growing share of the economy. The U.S. ranks lower than most developed countries in measures of healthcare system performance. It argues that a national healthcare system is needed to control costs and promote rational markets, and that the for-profit healthcare system has created problems and must be reformed or replaced. A three-tier system that provides basic care for all while allowing private insurance is proposed as a civilized American approach.

1. THE PAST, PRESENT, AND FUTURE OF HEALTHCARE IN AMERICA Jamie A. Koufman, M.D., F.A.C.S., Director, Voice Institute of New York www.voiceinstituteofnewyork.com

2. ALTERNATIVE TITLE FOR THIS PRESENTATION FIX HEALTHCARE AND HEAL THE NATION

6. WHO* WORLD HEALTH RANKINGS 1 France 2 Italy 3 San Marino 4 Andorra 5 Malta 6 Singapore 7 Spain 8 Oman 9 Austria 10 Japan 11 Norway 12 Portugal 13 Monaco 14 Greece 15 Iceland 16 Luxembourg 17 Netherlands 18 U.K. 19 Ireland 20 Switzerland 21 Belgium 22Colombia 23 Sweden 24 Cyprus 25 Germany 26 Saudi Arabia 27 U.A.E. 28 Israel 29 Morocco 30 Canada 31 Finland 32 Australia 33 Chile 34 Denmark 35 Dominica 36 Costa Rica 37 U.S.A. * World Health Organization (2000)

7. TWO CONFLICTING REALITIES Americans believe that healthcare is a right and rationing unacceptable -- U.S. consumers don’t act like consumers Nationalized healthcare, “socialized medicine,” is the best (only) alternative to stabilize cost & promote competition

8. Capitalism cannot solve the healthcare crisis. Healthcare is not a commodity any more than police and fire services; and it should have never been treated as such. - Koyaanisqatsi

18. GROSS NATIONAL PRODUCT (GNP) AND TOTAL HEALTHCARE EXPENSES (HCE) († Trillions of dollars; β Billions of dollars) Year GNP † HCE β %GNP 1960 $0.5 $27 6% 1970 1.0 75 8% 1980 2.8 256 9% 1990 5.8 724 12% 2000 9.9 1,400 14% 2010 14.0 2,500 17% Of the wealth created since 1980, a hugely disproportionate share has gone to the wealthiest 5% of the population

22. FEDERAL BUDGET 2010

23. IT’S A WHALE OF AN INDUSTRY! $2,500,000,000,000 AND GROWING HEALTHCARE Surprise! The American people are in the boat

28. TWO CONFLICTING REALITIES Americans believe that healthcare is a right and rationing unacceptable - U.S. consumers don’t act like consumers Nationalized healthcare, “socialized medicine,” is the best (only) alternative to stabilize cost & promote competition

29. ARE THERE ANY PLAUSIBLE AND AFFORDABLE SOLUTIONS? IF WE CAN FIX HEALTHCARE WE CAN HEAL THE NATION Most Americans clearly favor free-market systems, but in healthcare, we don’t have a free market … Since the 1970s, the transformation of healthcare has been driven by market power over prices* and perverted (hegemonic) investment strategies. *There is “price inelasticity of demand” for medical services

40. www.voiceinstituteofnewyork.com