Transcript Slide 1

 Can
we have
comprehensive health
care reform that
provides all medically
necessary care to all
residents and saves
money?

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.
•
In the 1980s, a 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
 The
United States is one of
three industrialized nations
that does not have a
HEALTH CARE SYSTEM
Expensive
 Low quality/poor outcomes
 Lack of prevention
 People avoid medical care
 Lack of coordination/medical errors
 Increasing disparities
 Losing primary care doctors

 We
spend two times more and cover
less; fewer benefits and fewer people
AMONG INDUSTRIALIZED NATIONS
THE U.S. HAS:
 The
lowest ranking in health care
 The highest infant mortality
 The highest maternal mortality
 The lowest life expectancy
Percent of adults (ages 18+) who received all recommended screening and
preventive care within a specific time frame given their age and sex*
* Recommended care includes seven key screening and preventive services: blood pressure,
cholesterol, Pap, mammogram, fecal occult blood test or sigmoidoscopy/colonoscopy, and flu shot.
Data: B. Mahato, Columbia University analysis of 2002 Medical Expenditure Panel Survey.
Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006.
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29(47%)% households - someone skips a
medical treatment, cuts pills or does not fill a
prescription because of cost
23%(32%) Americans have problems paying
medical bills
21% Americans had an overdue medical bill.
1 million people experience medical
bankruptcy each year
Health Care Costs Survey, USA Today/Kaiser Family Foundation/Harvard
School of Public Health, August 2005; D. Himmelstein et al, Health
Affairs, 2005( KFF Survey Oct., 2008)
The number of preventable deaths (per 100,000)
from treatable conditions in 19 leading
industrialized nations (2002-2003):
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1. France = 64.8
2. Japan = 71.2
3. Australia = 71.3
The worst:
19. United States = 109.7 = 110,000
preventable deaths per year!
(due to lack of access to care)
Journal of Health Affairs
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For most core quality measures, Blacks (73%),
Hispanics (77%), and poor people (71%) received
worse quality care than their reference groups.
For most measures for poor people (67%)
disparities were increasing.
Increasing disparities were especially prevalent in
chronic disease management.
Agency for Healthcare Research and Quality: National Healthcare Disparities Report, 2006.
Shortages in pediatrics, internal
medicine and family medicine.
Decreased access to geriatricians
and gynecologists.
Low interest by medical students
because of:
high student loan debt
malpractice insurance
low starting salaries
•
The current average graduation debt is: $155,000
•
Medical school tuition is increasing
•
Loan deferment is disappearing
•
Primary care physicians earn 30% less (2006)
Administration is the Fastest
Growing job in Health Care
3000%
2500%
2000%
1500%
1000%
500%
0%
1970
1975
Source: Bureau of Labor Statistics and NCHS
1980
1985
Physicians
1990
1995
Administrators
2000
Administrative
Costs
Clinical
Care
31%
($2000 per person)
69%
Source: Woolhandler, et al, New England Journal of Medicine, August 2003 & Int. Jrnl. Of Hlth. Services, 2004
73%
80
80% uses less than $1000
of care per year
70
60
Percent
of
50
health
Care
40
Expenditures
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 and Quality
MEPS, 1999
Cumulative Changes in Health Insurance Premiums,
Workers’ Earnings, and Overall Inflation 2000 - 2006
100%
80%
60%
40%
20%
0%
Health
Insurance
Premiums
Worker's
Earnings
Overall
Inflation
Premiums are rising five times faster than inflation
UNINSURED
Increase
illness and
disability
Decrease
use of
health
services
Insurance
premiums
increase
Choose policy
with fewer
benefits, higher
deductible
Increase out
of pocket
spending
Who are the uninsured ?
PART TIME
NON WORKER:
students, homemakers
disabled, early retirees,
unemployed
19%
WORKER
11%
FULL TIME
WORKER
70%
Respect for human dignity demands that no
one refrain from seeking medical care from
fear of the consequences of doing so, and
that no one suffer financial adversity as a
result of having sought care. The moral
foundations of universal coverage are as
simple as that.
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American Journal of Public Health January 2003, vol 93
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BANDAID REFORM:
patchwork reforms
that expand current
health care programs,
shift responsibility to
the individual and/or
subsidize the
purchase of health
insurance.
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COMPREHENSIVE
REFORM:
fundamental reform that
reorganizes the funding,
unifies the
administrative process
and creates a health care
system that serves the
whole community.
STATE PLAN
EXPECTATION
RESULT
Maine DIRIGO
31,000 enrolled in first
year, 130,000 more by
2009
Less than 10,000
enrolled by the fourth
year, less than half of
them uninsured prior to
enrolling
Minnesota Care
Subsidized insurance up
to 275% poverty line,
158,000 enrolled by
1997 at $252.3 million
142,000 enrolled by
2005 and declining at a
cost of $409 million
Washington Basic Health
Plan
1987 : all under 200%
poverty line
1993: “universal”
coverage
Forced to cap enrollment
at 125,000 in 2001 but
400,000 people eligible
TennCare
All under 400% poverty
line
300,000 in first year
500,000 in second year
14.7% uninsured at onset
16.3% uninsured in 2005
The system is collapsing
because too costly
Percent of previously uninsured newly covered as of 11/1/07, calculated
from CPS
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Rights-Based: Access is given to all
residents and is funded through
progressive taxation. The only
proven means of achieving
universal coverage.
Incentive-Based: Access is
purchased and voluntary, but
subsidies/tax credits are offered as
incentives.
Criminalization: Purchasing access
is required by law, failure to
purchase access is penalized.
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Unified risk pool – everybody in, nobody out.
Everybody contributes to fund health care based on
ability to pay.
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All medically necessary care is covered.
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Simplified administration saves money.
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Focused on preventative and timely care.
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Transparency and Accountability to the public
DO YOU HAVE YOUR
FIRE INSURANCE CARD?
H.R. 676
THE UNITED STATES
NATIONAL HEALTH
INSURANCE ACT
(Expanded and Improved
Medicare For All)
“We will never be able to control health care costs and
provide quality health care to all Americans unless we
establish a universal health care system with single payer
financing.”
- Dr. Marcia Angell
To ensure that all Americans have:
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A single standard of high-quality,
affordable health care guaranteed by
federal law
Access to health care services
whenever medical attention is
needed
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Every person living in the United
States is eligible from birth
throughout life
Every person living in the United
States and the U.S. Territories
would receive a United States
National Health Insurance Card &
ID number once enrolled
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All patients are presumed eligible to
receive services, even if not carrying card
at time of need
Patients will be able to seek treatment
from the physician, clinic or hospital of
their choice
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preventative care
primary care
inpatient hospital
care
outpatient care
emergency care
prescription drugs
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durable medical
equipment
long term care
mental health services
dentistry
eye care
substance abuse
treatment
Additional costs
Covering the uninsured and poorly-insured
Elimination of cost-sharing and co-pays
+7.2%
+5.1%
Savings
Bulk purchasing of drugs & equipment
Reduced hospital administrative costs
Reduced physician office costs
Reduced insurance administrative costs
Primary care emphasis & reduce fraud
-2.8%
-1.9%
- 3.6%
-5.3%
-2.2%
Net (Savings)
Source: Health Care for All Californians Plan, Lewin Group, 2005
-4.3%
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Savings
Revenue:
$387 billion
Existing Revenue
New Revenue
$1,305 billion
$1,259 billion
TOTAL (Savings and Revenue) $2.951 trillion
TOTAL PROJECTED SPENDING $2.776 trillion
It is time to end the cruelty
inherent in the failed U.S.
health care system.
The opportunity exists to
restore national dignity and
do what every other civilized
nation on earth does—take
care of its people.
Margaret Flowers and Brigitte Marti
For more information:
Physicians for a National Health Program
www.pnhp.org (local chapters in Washington, D.C.
and Maryland).
Healthcare-Now! www.healthcare-now.org
Healthcare-Now of Maryland
www.mdsinglepayer.org
Leadership Conference on Guaranteed Healthcare
www.guaranteedhealthcare4all.org