Transcript Universal Health Care as the Civil Rights Struggle of the

Health Care Reform
Universal Health Care:
The Only Solution
Diljeet K. Singh, MD, DrPH
Physicians for a National Health Program
29 E Madison Suite 602, Chicago, IL 60602
Phone (312) 782-6006 | Fax: (312) 782-6007
email: [email protected]
www.pnhp.org
PERSPECTIVE - Philosophical
Health care is…
• A Human Right
• A social service distributed according to need
• Not a commodity distributed according to ability
to pay
• Not a business whose “beneficiaries” are
company executives and investors not patients
• Most Americans believe everyone should have
access to good care without financial hardship
PERSPECTIVE - Philosophical
• We are the only developed nation that
does not provide comprehensive health
care to all its citizens
• 47 million Americans are uninsured
• Many are underinsured - lack
comprehensive coverage egs preventive
care, long-term care & drug costs
• 45,000 die a year from lack of coverage
• Markets are good for many things, but they
are not a good way to distribute health care
PERSPECTIVE- Practical
Current system is unsustainable
• Burden it places on our economy/businesses
• Private health insurance premiums are  at
unsustainable rate of 13%/year – & as much as
25% in some areas of country
• Coverage is shrinking, as more employers
decide to cap their contributions to health
insurance & workers find they cannot pay their
rapidly growing share
• Most expensive health care system in the world
PERSPECTIVE - Practical
• Spend twice as much as other developed nations
• But we don’t get more care - Canadians, see their
doctors more often & spend more time in hospital
• We don’t get better results - do worse than most other
developed countries on usual measures of health such as
life expectancy, infant mortality, immunization rates
• & we still don’t cover everyone - 47 million uninsured
• In sum, our health care system is outrageously
expensive, yet inadequate.
Why?
• There’s something enormously inefficient about the way
we finance & deliver health care
Problem with For-Profit Payers
• Investor-owned firms compete not by  quality or
 costs, but by avoiding unprofitable patients &
limiting services
• Creates paradox of a health care system based on
avoiding the sick
• It generates huge administrative costs, which, along
with profits, divert resources from clinical care to
demands of business.
• Doctors & hospitals maintain costly admin staff to
deal with bureaucracy
• Adminstration consumes 31% of our health
care $
Solution - Single-Payer
• Simpler & more efficient than our private health care
system
• Health care $ distributed by one entity, so that health
care could be coordinated to eliminate gaps
• Conceptual extension of Medicare to entire
population.
• Medicare is:
• Government-financed single-payer system
embedded within our private, market-based
system.
• Most efficient part of our health-care system, with
overhead costs of < 3%
Solution - Single-Payer
• Universal, Comprehensive Coverage
• No out-of-pocket payments
Co-payments & deductibles are barriers to access,
administratively unwieldy, & ineffective for cost
containment
• Single insurance plan in each region,
administered by public or quasi-public agency
• Global operating budgets for hospitals,
nursing homes, allowed group & staff model
HMOs & other providers with separate
allocation of capital funds
Billing on per-patient basis creates unnecessary
administrative complexity & expense. A budget
separate from operating expenses will be allowed for
Key Features of Single-Payer
• Free Choice of Providers
Patients should be free to seek care from any licensed
health care provider, without financial incentives or
penalties
• Public Accountability, Not Corporate Dictates
The public has an absolute right to democratically set
overall health policies & priorities, but medical decisions
must be made by patients & providers in the region
rather than dictated by corporate executives. Market
mechanisms principally empower employers & insurance
bureaucrats pursuing narrow financial interests
• Ban on For-Profit Health Care Providers
Profit seeking inevitably distorts care & diverts resources
from patients to investors
• Protection of health care & insurance workers
47 Million
Uninsured
45,000 Deaths Per Year
But simply helping them buy
private insurance is not a solution.
Meet Thomas Wilkes
• Born in 2004 with Severe
Hemophilia A.
• Dad: Senior Engineer at a
small high-tech computer firm
with good benefits.
• 2005: Develops an inhibitor to
his hemophilia treatment.
• $750,000 annual claims.
Private Insurance for Thomas
Company faces 40% to 55%  in premiums.
Only insurer that will cover them requires
$10,000 out-of-pocket & $1 million cap.
• Thomas is projected to reach the $1 million
benefit cap in summer 2009
• Options
1. Dad can quit job he loves & work for mega-firm
that will take longer to be affected by high claims
2. Mom can go to work for a mega-firm.
3. Thomas’ father can divorce his mother to leave
her & Thomas legally destitute & eligible for public
programs.
•
•
Who Are the Uninsured?
»Children
»25%
»Employed
»50%
»Unemployed
»5%
»*Out of labor
force
»20%
“…,people have access to health care in
America. After all, you just go to an
emergency room.”
-No Longer President Bush
America’s Underinsured
Proportion of Americans Going Without Care due to Costs, 2005
(skipping doctor visit, specialist appointment, treatment or prescription when needed)
Insured
Insured, Gap in Coverage
70
60
60
50
40
30
28
20
10
0
Source: Commonwealth Fund Biennial Health Insurance Survey, 2005
59
Uninsured
Medical Bankruptcy
Illness & Medical Bills Contributed to 1,000,000 Personal
Bankruptcies in 2004. (Half of All Bankruptcies)
Insurance Status at Onset of Illness
24.3%
Uninsured
Had Insurance
75.7%
Source: Himmelstein, Health Affairs 2005 (state estimates provided by author)
International Health Spending, 2005
U.S. Public Spending is Greater than Other Nations’
Public/Private Spending Combined
$6,000
$4,000
$2,000
Source: OECD 2007; Japan data are from 2004
U.
S.
Fr
an
ce
da
Ca
na
G
er
m
an
y
en
Sw
ed
U.
K.
Ita
ly
Ja
pa
n
$0
The Healthcare Americans Want
•
Guaranteed access
•
Free choice of doctor
•
High quality
•
Affordability
•
Trust & respect
Other Industrialized Nations
•
•
•
•
Have similar demographics
Availability of expensive technology
Rising drug costs
Similar levels of service
Why are their costs
so much lower?
Why are costs lower in
other countries?
• Administrative simplicity
• Lower prices
• Higher ratio of primary care to
specialists
• Health planning
• Global budgets
If you were in an insurance CEO,
who would you want to insure?
80
73%
70
60
Percent
of
health
Care
Costs
50
40
80% uses less than $1000
of care per year
30
20
10
0%
0%
0%
1% 1%
2%
4%
6%
13%
0
10% 10% 10% 10% 10% 10% 10% 10% 10% 10%
Source:Agency for Healthcare Research & Quality
MEPS
The Health & Profitable to the “Market,”
the Sick & Poor to the Taxpayer
80
Government
Programs
70
60
Percent
of
health
Care
Costs
73%
50
40
30
Private Insurers
20
10
0%
0%
0%
1% 1%
2%
4%
6%
13%
0
10% 10% 10% 10% 10% 10% 10% 10% 10% 10%
Source:Agency for Healthcare Research & Quality
MEPS
Rising Costs = Less Benefits = Under/Uninsurance
Proportion of Americans Covered by Employer Insurance
70.0%
68.0%
66.0%
64.0%
62.0%
60.0%
1999 2000 2001 2002 2003 2004 2005
Source: US Census
Life Expectancy, 2005
(Data in Years)
79
79
U.K.
Germany
80.3
80.2
80.4
80.6
France
Canada
Italy
Sweden
77.8
U.S.
Infant Mortality, 2005
(Deaths in first year of life per 10,000 live births)
6.8
5.3
5
4.7
3.9
3.6
2.4
U.S.
Canada
Australia
Italy
Germany
France
Sweden
Growth of Physicians & Administrators
1970-2005
3000%
2500%
2000%
1500%
1000%
500%
0%
1970
1975
1980
1985
Physicians
Source: Bureau of Labor Statistics & NCHS
1990
1995
Administrators
2000
One-Third of Health Spending is
Consumed by Administration
31%
Administration
All Other
Potential Savings: $350 billion per year
Enough to Provide Comprehensive Coverage
to Everyone
Source: Woolhandler, et al, New England Journal of Medicine, August 2003 & Int. Jrnl. Of Hlth. Services, 2004
Costs to Business
Skyrocketing costs for health care are hurting U.S.
business:
• Health care cost General Motors $5.6 billion in
2005 adding $1500 to the price of each car
• Companies that offer coverage often pay 10% or
more of payroll on health benefits and are at a
disadvantage competing with companies that
don’t offer coverage or where there is public
coverage
• Toyota located a new plant in Canada and
Lifesavers moved a Michigan factory to Ontario
GM retiree cost is $60 Billion!
Source: Wall St. Journal, March 11, 2004
Lesson #1: Simply Giving More People Existing
Private Insurance Policies Is Not Solution:
•Current Private Insurance Policies Offer Inadequate
Protection.
•Any Gains in Coverage Will Be Quickly Offset as
Costs Rise & Employers Shed Benefits.
Lesson #2: Real Solution to Health Crisis Must Do
2 Things:
1) Offer Coverage More Comprehensive than that
Currently Available on the Private Market.
2) Control Costs so that Benefits are Sustainable.
Only Two Paths to Reform
1. Preserve Private
Insurance Companies
& their Waste
2. Create a National
Health Insurance
System
Single-Payer Benefits
• Comprehensive Coverage for all medically
necessary services (doctor, hospital, long-term care, mental health,
vision, dental, drug, etc.) in a single-tier system.
• Free Choice of doctor & hospital.
• Health Workers Unleashed from corporate
dictates over patient care.
• Hospitals guaranteed a secure, regular budget.
Financing Single-Payer
Medicare
Medicaid
Payroll Tax
Single-Payer
Health Care
Fund
$$$
Income Tax
Bonus: Negotiated formulary with physicians, global budget
for hospitals,  primary & preventive care, bulk purchasing
of drugs & medical supplies = long term cost control.
Health Savings Accounts
• A bank account in which a limited amount of money
may be deposited tax-free for expenditures on health
services.
• Must be paired with a “high-deductible” health plan.
(e.g., $5,000).
• First few thousand dollars are paid from the HSA, at
some point, “catastrophic” coverage kicks in.
• Theory: Patients now using “their own money” =
better consumers = lower costs.
High-Deductibles = No Savings
80
73%
70
60
Percent
of
health
Care
Costs
50
40
30
20
10
0%
0%
0%
1% 1%
2%
4%
6%
13%
0
10% 10% 10% 10% 10% 10% 10% 10% 10% 10%
Source:Agency for Healthcare Research & Quality
MEPS
Health Savings Accounts
Won’t
•Provide Meaningful Choice for Patients
•Reduce Administration
•Produce Savings
Health Savings Accounts Will
•Discourage Preventive & Primary Care
•Create Huge New Administrative Waste
•Produce Few Savings (a few sick people cost the most)
“Individual Mandate”
“Let them buy
insurance.”
Criminalizing the Uninsured:
A Massachusetts Punitive Index
# The Crime
1
2
3
4
5
6
7
The Fine
Violation of Child Labor Laws
$50
Illegal Sale of Firearms, First Offense
$500 max.
Driving Under the Influence, First Offense
$500 min.
Domestic Assault
$1000 max.
Cruelty to or Malicious Killing of Animals
$1000 max.
Communication of a Terrorist Threat
$1000 min.
Being Uninsured*
$1500 min.
*Note: Original version of House Bill would have suspended individuals’ driving licenses for uninsurance as well.
Subsidy & Individual Mandate Schemes
• Substandard Coverage: forces uninsured to buy
defective insurance industry products that are already
causing families to face bankruptcy & go without needed
care.
• Unaffordable: Without savings achievable with singlepayer, taxes must raised or funds diverted from other
needy programs.
• Micro-coverage, Macro-costs: Preserves wasteful
private insurers & adds yet another layer of state
administrative waste. Rather than provide care to
uninsured through a relatively efficient program like
Medicare, the plan launders tax dollars through wasteful
private insurers.
• No Realistic Cost Control: Any gains in public
coverage will be unsustainable due to rising costs.
“Sounds Great, but it’s not
politically feasible”
•2/3rds of population want it
•Most (59 percent) of physicians
want it
•Business community is now
realizing the need for it.
Single-Payer:
Glen Barton
Former CEO, Caterpillar Inc. (Fortune 100)
Past Chairman, Health & Retirement Task
Force Business Roundtable
Represents 150 Largest Employers
Total Assets: $4.0 Trillion
“The quickest & simplest solution… is
to go to a single-payer system”
- Written Testimony to AHCTF, Feb. 1 2006
“If done right, health care in America could be dramatically better with true
single-payer coverage.”
-Ben Brewer, WSJ, April 18, 2006
“[single-payer] is an idea that's so easy to slam politically yet so sensible for
business that only Republicans can sell it! …it may take a Republican President
to bless the socialization of health spending we need.”
-Matt Miller, Fortune, April 18, 2006
CNBC / MSN Money
“Think, as a small business, how you could benefit from a single-payer system:
you wouldn’t lose potential employees to larger firms that offer more attractive
health benefits; health insurance costs would cease to be a line item in your
budget. A serious illness befalling you or an employee wouldn’t be a companywide financial crisis. You might even save money.”
-Joseph Antony, CNBC / MSN Money, Winter 2003
Is “The Perfect the Enemy of the
Good?”
• The central flaws of the “Obama” plan remain the
central flaws of our current system
– Uncontrolled Costs
– Lack of Universal Coverage
• Without eliminating the overhead of a patchwork
for-profit system we will not achieve the system
we deserve
Is “The Perfect the Enemy of the
Good?”
The Radical & the Republican
“Many of Lincoln’s admirers have painted him as a man who
wanted exactly what the abolitionists did but cannily waited for
a perfect moment to achieve it. [In fact], radicals like Douglass
set an agenda Lincoln gradually adopted as his own. Without
abolitionists, there would have been no Lincoln.”
- James Oakes, Historian, UC Berkeley
Single-Payer: “Politically Feasible?”
Other “Politically Infeasible” Movements
Abolition of Human
Slavery
(1860s)
Women’s Suffrage
Movement
(1840-1920)
Civil Rights Act
(1964)