Transcript Single Payer Basics and the Effect of P-PACA

Single Payer Basics and
the Effect of P-PACA
Margaret Flowers, M.D.
Congressional Fellow
29 East Madison, Suite 602
Chicago, Il 60602
312-782-6006
www.pnhp.org
Health Care History
in 2 Slides:
1940’s:
 Europe: The destruction of WWII required the restoration of
security through social institutions. Created a system based on
human rights.
 The US retained an employment-based system of health care.
1960s belief:
 Private insurance industry would respond quickly to a changing
medical economy and cover everybody within 10 years.
Health Care History
in 2 Slides:
1980’s:
Fundamental shift occurred to private investor-owned health
corporations.
Health care was perceived as a fertile field for profit seeking
businesses. In this new environment,
Health became a commodity
Patients became consumers
US Public Spending is More than
Total Spending in other Nations
Sources: OECD 2008; Health Affairs
2002;21(4)88 – Data are for 2006
Millions of Uninsured Americans
51 Million Americans
Without Insurance Today
45
40
35
30
25
20
1976
1980
1985
1990
1995
2000
2008
Source: Himmelstein, Woolhandler, Carrasquilo –
Tabulation from CPS and NHIS data
Who are the Un-insured?
NON-WORKER
19.5%
PART-TIME
WORKER 14%
FULL-TIME
WORKER 66.5%
Urban Institute and Kaiser Commission on Medicaid and the Uninsured
estimates based on the Census Bureau's March 2008 and 2009 Current
Population Survey (CPS: Annual Social and Economic Supplements).
Highest Number of
Preventable Deaths
Measuring The Health Of Nations: Updating An Earlier
Analysis: Ellen Nolte and C. Martin McKee
Health Affairs, 27, no. 1 (2008): 58-71
A Few People Drive Most Costs
Percentage of total health spending in 2001
Top two deciles
account for 78.3%
of spending
Decile of privately insured
Source: MEPS data, from Thorpe and Reinhart
3,000%
Administrators are Growing
Faster than Physicians
2,000%
Administrators
1,000%
0
1970
Physicians
1980
1990
2000
Source: Bureau of Labor Statistics; NCHS;
Himmelstein/Woolhandler analysis of CPS
2009
Consumer-directed Health Care
= Under-insurance
• Plans with very high deductibles ($2,000 to
$15,000 per family) and often high co-insurance
rates thereafter (25 to 35%).
• Tax-free savings accounts (HSA and MSA) from
which deductible and co-insurance can be paid.
• Only “covered services” count toward deductible.
Unsustainable Cycle!
Insurance
premiums
increase
Increase
illness and
disability
UNINSURED
Decrease
use of
health
services
Choose policy
with fewer
benefits, higher
deductible
Increase out
of pocket
spending
Most of the Medically Bankrupt
had Insurance Coverage
Insurance at
onset of
illness
Source: Himmelstein et al. Am J Med, Aug. 2009
What did we get for $938 b?
Based on the “mandate model” of reform:
•
•
•
•
Medicaid expansion
Private insurance mandate
Public dollar subsidies
Regulation of private insurers
The result = more of the same!
Impact of Health Reform
on the Un-insured
Less uninsured Americans
• 46 million today; ~23 million in 2019
Less funding for safety net hospitals
• Medicare funding cut by $36 billion through 2019
Community health center funding enhanced
• Increased by $1 billion annually
Impact of Health Reform
on the Under-insured
If you like your current coverage,
you can keep it
If you don’t like your current job-based coverage,
you have to keep it
Policies will be required to cover
at least 60% of expected health costs
•e.g. $7,000 premium $2,000 deductible +
20% co-insurance for next $15,000 of care
Health Care Reform,
We are still for it!
Patient Protection and Affordable Care Act:
 continues to leave tens of millions uninsured.
 increases total health spending.
 likely to continue upward trend of underinsured.
 mandates coverage without health security.
 restricts choice.
Market Failure:
•
•
•
•
•
•
Expensive
Poor outcomes
Increasing disparities
Preventable deaths
Losing (esp. primary care) doctors
Under-insurance/Un-insurance
Role Played by Health Industry in
Health Reform
Insurance donations to both Democrats & Republicans
Insurance company ads both favoring and opposing reform
Pharma spent over $100 million on ads supporting reform
Senate framework written by Liz Fowler, former VP of Public
Policy for WellPoint/Anthem
What are the Lessons?
We still have a health care crisis in the United
States and we need the I.C.U.
 I = Independence
 C= Clarity
 U = Uncompromising
DO YOU HAVE YOUR
FIRE INSURANCE CARD?
What is Single Payer?
Improved Medicare for All
 Unified risk pool – everybody in, nobody out.
 Everybody contributes to fund health care based on ability
to pay. No financial barriers.
 All medically necessary care is covered.
 Simplified administration saves money.
 Choice of physician and treatment.
 Focused on preventative and timely care.
 Transparency and Accountability to the public
Funding for the NHP
Sources of Revenue
Recipients of Money
Hospitals, operating
Medicare & Medicaid
Hospitals, capital
State, local government
Employers
HMOs
NHP Fund
Fee-for-service MDs
Private insurance revenues
Home Care Agencies
New Taxes
Long Term Care
Source: NEJM 1989:320:102
Covering Everyone and
Saving Money
Additional costs
Covering the uninsured and poorly-insured
Elimination of cost-sharing and co-pays
Savings
Bulk purchasing of drugs & equipment
Reduced hospital administrative costs
Reduced physician office costs
Reduced insurance administrative costs
Primary care emphasis & reduce fraud
Net (Savings)
+7.2%
+5.1%
-2.8%
-1.9%
- 3.6%
-5.3%
-2.2%
-4.3%
Source: Health Care for All Californians Plan,
Lewin Group, 2005
We have what it takes!
•Excellent hospitals
•Well-trained professionals
•Superb research
•Current spending is sufficient
Where is the Single Payer
Movement Now?
• State Single Payer Efforts
• National improved Medicare for All
State Single Payer Efforts
20 states and growing!
California, Colorado, Delaware, Hawaii, Illinois,
Iowa, Maryland, Massachusetts, Minnesota,
Missouri, New Hampshire, New Mexico, New
York, North Carolina, Ohio, Oregon,
Pennsylvania, Vermont, Washington, Wisconsin.
For a summary, see:
http://pnhp.org/blog/2010/06/11/states-seek-tolead-the-way-on-single-payer/
Vermont
• Passed legislation to
design 3 universal health
systems – 1 is single payer
• Contract with William
Hsaio
• New Governor campaigned
on SP
• Plan to pass in 2011
• Sen. Sanders to request
waivers
National Improved
Medicare for All
• Education! Education! Education!
• Building coalitions at the congressional district
level
• Reaching out to state grassroots groups
• Reaching out to organizations that advocate for social
and economic justice
National Improved
Medicare for All
• Pressure on insurance corporations
• Wellpoint shareholder actions
• Divestment campaigns
• Expose health injustice
• Hospital/clinic closings
• Denied care
• Health professional firings/strikes
A
HEALTH
SYSTEM
THAT
A HEALTH SYSTEM THAT WE CAN BE PROUD OF:
WE CAN BE PROUD OF!
NATIONAL
IMPROVED
MEDICARE
FOR ALL!