Transcript Sustainable Health Care Reform

Achieving Single Payer
National Health Insurance
NOW!
Debunking the Myths
2009
A Production Of
Health Care for All Texas
Single Payer In Our Life Time Campaign
www.healthcareforalltexas.org
Opening Exercises
1. What first comes to your mind when you hear
"National Health Insurance"?
2. What percentage of your income are you
currently spending on health care expenses?
[include premiums, deductibles, co-pays, and medical necessities
that are not covered at all]
3. What percentage of your income are you willing
to spend on health care expenses?
The State of Healthcare Coverage
Today
“America has the best
health care in the world.”
Where does the U.S. rank in health
care quality compared to other
industrialized nations?
A. 5th
B. 12th
C. 21st
D. 37th
Overall Health System Performance
th
The US ranks 37 out of the
191 WHO member states,
placing it below Colombia,
Saudi Arabia, and Portugal
WHO 2000 World Health Report
US: The Only Industrialized Country
with Profit-driven
Health Care System
• Costs > $2 Trillion/year
• Spend $350 Billion/year on administration
• Costs more than twice per capita than other
countries that have universal health care
• Leaves out over 45 million including 8 million children
Yet, the US has
lower life expectancy, higher infant mortality,
higher maternal mortality, fewer doctors, and fewer
hospital beds than most industrialized countries
Source: Woolhandler S, Campbell T, Himmelstein D. Costs of Health Care Administration in
The United States and Canada. New England Journal of Medicine 2003; 349:768-75 and Anderson G, Frogner B,
Reinhardt U. Health Spending in OECD Countries in 2004: An Update. Health Affairs 2007 Vol 26, No. 5:1481-1489
“Most Texans are insured
through their employers.”
What percentage of Texans are
insured through their employers?
A.
B.
C.
D.
90%
60%
48%
30%
The Texas Health Care Pie
Today
25%
UNINSURED
48%
EMPLOYERSPONSORED
23%
PUBLIC
4%
Employer
Self
Public
Uninsured
SELF
2006
Source: www.kff.org State Facts
The Health-Care Pie
As Costs Go Up…..
Uninsured
Uninsured
Public
Employer-sponsored
Health Insurance
“Most of the uninsured are
unemployed and/or
undocumented.”
What is the fastest growing segment
of the uninsured population?
A. Illegal immigrants
B. The unemployed
C. Families with incomes at 200% of the poverty
level
D. Families with incomes of $75,000 per year
The Uninsured Today
■
■
■
■
45 million in the U.S.
5.9 million in Texas
80% of the uninsured are employed
75% of the uninsured are US citizens
People losing private health insurance
at the fastest rate are those making
> $75,000 /year
Source: 2007 US Census Bureau, Institute of Medicine and
Urban Institute, Uninsured and Dying Because of it, Jan 2008
Number of Uninsured Americans
1976 - 2006
Have You Ever Been Uninsured?
Institute of Medicine and Urban Institute,
Uninsured and Dying Because of it, Jan 2008
“The uninsured can always
get their care in the ER or
get public insurance.”
If you are uninsured, your risk of dying
increases by how much?
A. 10%
B. 15%
C. 20%
D. 25%
If you are uninsured, your risk
of dying increases by:
25%
According to a 2009 Harvard Study
45,000 Americans Die
Every Year
Due to Lack of Health Insurance
This translates into 12 deaths every hour
that could have been prevented
Source: Am. Journal of Public Health- online edition. Sept. 17 2009
Getting Public Insurance in Texas
Take a family with 2 kids, parents who
make $37,000/year (185% FPL) and no
employer-sponsored health insurance:
The 2 month-old qualifies for Medicaid
The 4 year-old qualifies for S-CHIP
Parents make over the limit to qualify for
public health insurance.
The limit?
$6,000 /year
“The best solution is to
make private health
insurance affordable.”
What is the average cost of private
health insurance for a family of four?
A.
B.
C.
D.
$3,000 per year
$9,000 per year
$12,000 per year
$24,000 per year
For-Profit Health Insurance
“Paid by Employers and Employees”
• Employer-sponsored health insurance
for a family of 4
$12,000 / year
• Minimum wage in Texas
$12,000
• Median annual income in Texas
$43,000
Since 2000
For-Profit Health Insurance
Premiums Increased
87%
Wages Increased
20%
SUSTAINABLE?
Source: KFF/HRET Survey of Employer Sponsored Health Benefits 2001-06; Bureau of Labor
Statistics Consumer Price Index US City Average of Annual Inflation (April to April), 2001-06; Bureau
of Labor Statistics, Seasonally Adjusted Data from the Current Employment Statistics Survey 2001-06
How Much is the U.S. Health
Care System Costing You NOW?
What Americans Pay Into the
U.S. Health Care System
Today
Household Income Level
$25,000 $50,000 $75,000
Share and Amount of Income
Going to Health Care via Taxes
Alone without Insurance
9.0%
($2,425)
9.8%
($5,300)
10.7%
($8,633)
Share and Amount of
Total Wage Packet
Going to Health Care
for Household with
Insurance (not
including out of
pocket costs)
Individual
22.0%
($6,904)
16.8%
($9,779)
15.4%
($13,112)
Family
37.2%
($14,531)
26.4%
($17,406)
22.3%
($20,749)
Share of total wage packet going to HC= (amount of total tax burden going to health + annual health insurance premium)
(annual salary + payroll tax [FICA and Medicare] + annual health insurance premium)
Source: Dollars & Sense, May/June 2008 OOP = co-pays, deductibles, co-insurance, uncovered expenses
“I don’t want my tax dollars
used to buy somebody
else’s healthcare.”
What percentage of health care is
financed through taxes?
A. 90%
B. 60%
C. 48%
D. 30%
60% of our Health Care is
Financed through Taxes
Individuals
TOTAL ANNUAL
SPENDING =
$2,000 BILLION
20%
Taxpayers
60%
Private
employers
20%
$1,200 B
Source: NEJM 1999; 340:109; Health Affairs 2000; 19(3):150
{Medicare, Medicaid,
VA, Indian Health
Service, Public
employees,
tax subsidies}
Public Health Insurance
Public Health
Insurance is financed
through federal and
state taxes
Texas pays:
40% Medicaid bill
30% S-CHIP bill
Taxes
State
Pays
Fed
Pays
Medicaid
40%
60%
CHIP
30%
70%
Medicare
0
100%
VA
0
100%
FEHBP
0
100%
Source: www.kff.org State Facts
If Medicaid Expanded to All Texans
Under 200% FPL, Almost Half of Texas
Would be Eligible…
43% TX live < 200% FPL
And Texans
would pay
40% of the bill =
$19 Billion / year*
*9 million adults < 200% FPL x $2,100/adult=$18.9 B/yr
Source: www.kff.org
“Health reform has to include
the private, for-profit health
insurance industry.”
What percentage of private insurance
premiums goes toward administrative
costs and profits?
A. 15 %
B. 20 %
C. 25 %
D. 30%
Percentage of Private Insurance
Premiums that goes toward
Administrative Costs and Profits
30%
Medicare administrative cost
rate is 3%
$22 million was paid by the private
insurance industry to lobbyists in
2007
- an off year for elections That money came out of your
premiums – not out of the
CEOs’ personal income
Source: Health Plan Week April 2008
US: The Industrialized Country with
the Most Fragmented
Health Care System
• 1,300 private insurance companies (each with own
billing system)
• 314 Medicare Health Plans in TX (HMOs, PPOs,
PFFS, Special Needs, MSAs)
• 1,824 stand-alone Medicare Part D plans
• 316 full-risk managed care Medicaid plans (in 1999)
• Multiple stand-alone S-CHIP Plans
•
Ends up costing us
$350 Billion/year on administration
Why do we settle for this?
US Health Care System: American
Business at a Disadvantage
• A 20% increase in HI premiums will cost 3.5 million
workers their jobs, 3.5 million workers to move from FT to
PT work, and cut average income by $1,700
• American manufacturers pay more than twice as much on
health benefits as most foreign competitors
• Small business employees account for ~27 million of the
47 million uninsured
• Incentive to hire PT workers who don’t qualify for HI
• “Job lock,” when workers do not leave jobs because they
fear losing/changing HI, impairs flexible labor markets that
strengthen the economy
Sources: Kvaal The Economic Imperative for Health Reform, Center for American Progress, Dec 2008; Joint Committee on
Taxation http://www.house.gov/jct/x-17-07.pdf ; Nichols and Axween, New America Foundation, May 2008; Gruber and
Madrian, NBER Working Paper 8817, March 2002
Daisetta, Texas Sinkhole
The U.S. For-Profit Health Care System
Proposed Health Care Reforms
Weak Health Care Reform
Keeps Corporate, For-Profit Insurance
Companies Raking in Billions
Reform Measures
Proposals
1. Mandates
All children
All employers except small businesses
2. Employers
Must offer “meaningful”
coverage or pay fine
3. Premium
subsidies
to individuals
Available to pay to expand Medicaid and CHIP
Available to purchase insurance from the new
comprehensive and portable public program
More Weak Reforms
4.Tax credits
Proposed by some to help subsidize private health
insurance plans.
5. Insurance pools
National Health Insurance Exchange to help purchase
public plan or private insurance plans that would be
required to have guaranteed issue, fair and stable
premiums, standards for quality and efficiency and be
comprehensive
6. Changes to
private insurance
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•
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•
•
Prohibit pre-existing conditions exclusions
Continue family coverage for children up to 25 years old
Pay “reasonable share” of premium on patient care
Require disclosure of % of premium used for patient care
Limit % of premium that can be used for administrative
costs and profit
Cost of Massachusetts Health Reform
HR 676 Medicare for All
The US National Health Insurance Act
HR 676 Medicare for All
The US National Health Insurance Act
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•
•
•
•
•
•
•
•
•
Everybody in, nobody out
Portable
Uniform, comprehensive benefits
Prevention oriented
Choice of physician
Ends insurance industry influence
Reduced administrative waste
Cost savings
Common sense budgeting
Public oversight
Source: http://thomas.loc.gov/cgi-bin/thomas
Single-Payer
“We can’t afford single
payer”
What percentage of your income
would be needed to pay for
National Health Insurance?
A.
B.
C.
D.
3.3%
4.75%
7%
10%
Proposed Funding for HR 676 –Single-Payer
The US National Health Insurance Act
Existing federal
revenues
3.3% employer
and employee
payroll tax
5% health tax on
top 5% earners
10% tax on
top 1% earners
¼ of 1% stock
transactions
Repeal Bush tax
cuts for wealthy
Administrative
savings
Bulk purchasing
of medications
Government
Administered
$2,931 B
Funds
National
Health
Insurance
Fund
Free-market
Pays
Source: http://thomas.loc.gov/cgi-bin/thomas
• Providers
• Hospitals
• Clinics
• Mental health
• Medications
• Medical
equipment
• Long term
care
Total HR 676 Spending < Current
Spending 2010 = $2,776 B
Public expenditures (fed/state/local)
$1305 B
Annual administrative savings
$278 B
Annual savings on bulk purchasing Rx & DME
$109 B
Payroll tax (3.3% additional on employers &
employees)
$538 B
Stock transfer tax (0.25% on seller and buyer)
$150 B
Reduce corporate welfare
$100 B
Reverse 2001/02 tax cuts
$251 B
Tax surcharge (5% on richest 5%; 10% on top 1%)
$200 B
TOTAL AVAILABLE FUNDS TO PAY FOR HR 676
$2,931 B
“Single payer is socialized
medicine!”
Which systems are truly socialized
medicine?
A. Great Britain
B. Spain
C. US Veterans Medical Health Care System
D. All of the above
Health Care Systems
Health
Care System
Funding
Type
Delivery
Type
Examples
Private For Profit
(“multi-payer”)
Private
Public
Private
Public
U.S.
National Health
Insurance
(“single-payer”)
Public
Private
Canada, Denmark,
Norway, Australia,
Taiwan, Sweden,
France
Medicare
National Health
Service
“socialized”
Public
Public
Great Britain
Spain
V.A.
Sickness Funds
(“social insurance”)
Highly-regulated, Private
private social
insurance
systems not
allowed to make
profits
Germany, Netherlands
No U.S. equivalent
“If the Canadian plan is so
great why are they all coming
here for their health care?”
How many Canadians voluntarily seek
medical care in the U.S.
A About 100
B. About 500
C. About 1000
D. Greater than 1000
“A single payer system would
limit my ability to choose.”
In a private insurance or managed
care system, the consumer has
complete freedom to choose…
A. Their private doctor
B. Which hospital they go to
C. The cost of their care
D. None of the above
In a private insurance or managed
care system…
• You can only choose doctors within their
network or pay a high fee
• You have little choice of which hospital or
laboratory you go to for services
• Decisions about medical procedures are
often made by insurance company clerks
(high school level nonmedical
professionals)
In a National Health Insurance
program…
• All doctors and health care providers would be
included
• All hospitals and laboratories would be included
• Decisions about medical procedures would be
made by you and your medical professionals
• Fees would be determined by regional boards
consisting of health care providers and
consumers
Now that
we can see our health care
system for what it is,
that the private, for-profit health
insurance industry cannot be part
of the solution,
and that single payer is the
solution to our health care crisis
Let’s do something about it!
HR 676 The US National Health Insurance Act
Endorsed By:
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86 members of the new US Congress so far
417 union organizations
U.S. Conference of Mayors
Assembly of the Urban Caucus of the Episcopal Church
General Board on Global Ministries of the United
Methodist Church
• Presbyterian Health, Education and Welfare Association
of the Presbyterian Church
I propose that ________ endorse the
Resolution in support of the US National
Health Insurance Act
These TX Members of US Congress have
not endorsed HR 676 The US National
Health Insurance Act
Barton, Joe, 6th
*Gonzalez, Charlie A., 20th
Olson, Pete, 22nd
Brady, Kevin, 8th
Granger, Kay, 12th
Ortiz, Solomon P., 27th
Burgess, Michael, 26th
*Green, Gene, 29th
Paul, Ron, Texas, 14th
Carter, John, 31st
Hall, Ralph M., 4th
Poe, Ted, 2nd
Conaway, K. Michael, 11th
Hensarling, Jeb, 5th
*Reyes, Silvestre, 16th
*Cuellar, Henry, 28th
Hinojosa, Rubén, 15th
Rodriguez, Ciro, 23rd
Culberson, John, 7th
Johnson, Sam, 3rd
Sessions, Pete, 32nd
*Doggett, Lloyd, 25th
Marchant, Kenny, 24th
Smith, Lamar, 21st
Edwards, Chet, 17th
McCaul, Michael T, 10th
Thornberry, Mac, 13th
Gohmert, Louie, 1st
Neugebauer, Randy, 19th
*Part of “Single Payer In Our Life Time” Campaign
Source: http://thomas.loc.gov/cgibin/thomas
We need a groundswell!
• Sign our postcard and recruit others to do
the same
• Our goal: 2,000 postcards per
Congressional District
Help Achieve Single Payer
National Health Insurance
Now!
Speak Out! Donate! Write!
[email protected]
www.healthcareforalltexas.org
www.hcfat.org
Single Payer In Our Life Time Campaign
Send tax-deductible contributions to
Health Care for All Texas
P.O. Box 421704
Houston, TX 77242
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