HealthcareReform5.3.2

Health Care for All : 

Health Care for All Fiscally conservative Socially responsible Rob Stone MD Director, Hoosiers for a Commonsense Health Plan Assistant Professor of Emergency Medicine, IUSM

DISCLOSURES : 

DISCLOSURES Dr. Rob Stone has no relevant financial relationships with commercial interests.

Lack of Insurance Kills : 

Lack of Insurance Kills 45,000 a year die 123 every day People without insurance: Receive less care and receive it later The safety net is full of holes American Journal Public Health, Wilper et al, Dec 2009

Insurance Premiums • Workers’ Earnings • Inflation 1999-2008 : 

Insurance Premiums • Workers’ Earnings • Inflation 1999-2008 Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 2000-2008. Bureau of Labor Statistics, Consumer Price Index

Our Broken System: : 

1Hewitt Associates The Road Ahead: 2009 Our Broken System: 1 in 5 employers to drop health benefits in next 3-5 years

Bankruptcy 2009 : 

Bankruptcy 2009 62% caused by illness and medical bills Most were middle class 78% were insured when they became ill Himmelstein et al, American Journal of Medicine, August 2009

Health Care Expenditures : 

Health Care Expenditures Source: The Commonwealth Fund, calculated from OECD Health Data 2006. Per Capita, Adjusted for Differences in Cost of Living

What Are We Paying For? : 

What Are We Paying For? An incredibly complex system Thousands of plans Armies of people to: -deny coverage and payments - collect payments - determine eligibility

Slide 12: 

Where is the bureaucratic nightmare?

U.S. Overhead Spending : 

U.S. Overhead Spending International Journal of Health Services 2005; 35(1): 64-90

Medicare’s Efficiency: 3% Overhead : 

Medicare’s Efficiency: 3% Overhead 2003, 31% health spending on overhead – could save $286 Billion1 1993, CBO: “The net cost of Single Payer would be negative.”2 1991, GAO: “If US shifted to coverage like Canada, savings would offset the expense of universal coverage”3 1New England Journal of Medicine 8/21/2003 2Congressional Budget Office, 1993, 3 separate reports 3General Accounting Office, 06/91 ref: T-HRD-91-35

Slide 15: 

“Kids, your mother and I have spent so much money on health insurance this year that instead of vacation, we’re all going in for elective surgery.”

Brief History : 

Brief History WWII: Wage and price controls 1947: Truman pushes for National Health Insurance AMA and Southern legislators oppose

History (continued) : 

History (continued) The birth of the Blues 1965: Medicare and Medicaid 1993: Clinton Health Plan Death of not-for-profit insurance

Anthem /WellPoint(formerly Blue Cross) : 

Anthem /WellPoint(formerly Blue Cross) CEO Larry Glasscock in Indianapolis, just retired Bonus in 2003 - $42.5 Million Indianapolis Star 4/7/04

What Do We Get For Our Money? : 

What Do We Get For Our Money? The most expensive health care in the world The best health care in the world?

WHO Global Health Rankings : 

WHO Global Health Rankings At the top: France is #1 US ranks 37th, between Costa Rica and Slovenia

Slide 22: 

Hospital Inpatient Days per Capita Rationing?

Slide 23: 

Physician Visits per Capita

Elderly as Percent of Total Population : 

Elderly as Percent of Total Population

Tobacco Smokers : 

Tobacco Smokers OECD, 2004 (2002 Data, U.K is 2001)

MRI Units per Million People : 

MRI Units per Million People OECD, 2004 (2002 Data, U.S., Canada, and Germany are 2001)

Kidney Transplants : 

Kidney Transplants OECD, 2004 (2002 Data, Canada and Sweden are 2001)

Why spend so much AND get so little? : 

Why spend so much AND get so little? Reason # 1: Our profit-driven insurance system AND As long as millions are left out, everyone will suffer

Myths : 

Myths Our “system” is fine, just needs adjustment The safety net We can’t afford to cover everyone The best health care system in the world

Slide 31: 

International Timeline of Universal Healthcare Germany 1883 Switzerland 1911 New Zealand 1938 France 1945 United Kingdom 1946 Sweden 1947 USA 1947* Japan 1961 Canada 1966 Australia 1974 Italy 1978 Spain 1986 Taiwan 1995 *President Truman proposed but failed to pass National Health Insurance

Myth Versus Reality : 

Myth Versus Reality Every wealthy democracy has A National Program of Health Care For All Socialized Medicine versus Single Payer

Choice? Employer Health Benefit Plans Offered : 

Choice? Employer Health Benefit Plans Offered Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 2008.

Some Choices Don’t Really Matter! : 

Some Choices Don’t Really Matter!

Obama on Single Payer : 

Obama on Single Payer “A single payer plan is what I would like to see.” - addressing an AFL-CIO group in Chicago, 2003 “If I were starting from scratch, if we didn't have a system in which employers had typically provided health care, I would go with a single payer system.” - January 22, 2008, and many times after that

The Medical-Industrial Complex : 

The Medical-Industrial Complex “Remember that what the rest of us call health care costs, they call income.” - Paul Krugman, Nobel Laureate New York Times 5/10/09

The Best Democracy Money Can Buy? : 

The Best Democracy Money Can Buy? Health industry spending - $134 million on lobbying first quarter 20091 13 health lobbyists per member of Congress2 1The Center for Responsive Politics 2American League of Lobbyists

Public Support – Single Payer : 

Public Support – Single Payer Polls from 2009 1 April, Kaiser Family Foundation 2 January, Grove Insight Opinion Research 3January, New York Times/CBS News 49% favor coverage from a single govt. plan1 59% prefer a system like Medicare for all2 59% say government should provide national health insurance3

Physician Support – NHI : 

Physician Support – NHI 1Ann Int Med, Carroll, Nov 18, 2003 2Ann Int Med, Carroll, Apr 1, 2008 3NEJM, Keyhani, Sept 14, 2009 2003: 49% favor establish NHI1 2008: 59% now in favor2 2009: 58% expand Medicare3

Slide 40: 

Our Non-System of Illness Care

Why Health Care for All - Young and Old, Rich and Poor? : 

Why Health Care for All - Young and Old, Rich and Poor?

What Can We Do? : 

What Can We Do? Educate Ourselves Find Our Voices Join In

Slide 43: 

HCHP.info

Slide 44: 

PHYSICIANS FOR A NATIONAL HEALTH PROGRAM PNHP.org

Insurance Premiums • Workers’ Earnings • Inflation 1999-2008 : 

Insurance Premiums • Workers’ Earnings • Inflation 1999-2008 Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 2000-2008. Bureau of Labor Statistics, Consumer Price Index

Waiting inCanada : 

Waiting inCanada Fewer Canadians report unmet health needs1 96% prefer their system to ours2 No waits for cancer care or emergency surgery3 Americans without insurance wait forever 1O’Neill and O’Neill, Forum for Health Economics & Policy Vol 10 (2007) 2Gallup Poll, Toronto Star 5/12/99 3Commonwealth Fund 7/16/07

Waiting for Medicare? : 

Waiting for Medicare? Americans’ health improves at age 651 Americans are happier with Medicare than private insurance2 US Medicare – no waiting3 1Journal of the AMA 12/26/07 2Health Affairs 5/12/09 3Self evident, no reference needed

Partisan Reaction – Single Payer : 

Partisan Reaction – Single Payer Indiana University Center for Health Policy and Professionalism Research 8/5/09

Already : 

Schoen, Health Affairs 6/10/08 Already 1 in 3 with insurance defer needed care now

Slide 51: 

Source: “Measuring the Health of Nations: Updating an Earlier Analysis”. Health Affairs, Jan./Feb. 2008.