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.