Transcript AN OVERWIEW of the U.S. HEALTH CARE DELIVERY SYSTEM

PNHP
ACTIVISM
2008-2009
Oliver Fein, M.D.
President
Physicians for a National Health Program
Professor of Clinical Medicine and Public Health
Associate Dean
Office of Affiliations and Global Health Education
Weill Cornell Medical College
October 2009
DISCLOSURES
Dr. Oliver Fein has no relevant financial
relationships with commercial interests.
Dr. Oliver Fein would like to acknowledge
the assistance of Dr. Margaret Flowers in the
preparation of slides for this talk.
CHAPTER ORGANIZING
• April 2008 Philadelphia
• June 2008 New Haven
• Sept 2008
New Mexico
• Nov 2008
Atlanta
CHAPTER ORGANIZING
• March 2009
Seattle
• April 2009
Toledo/Ohio SPAN
• May 2009
Miami
• June 2009
Minneapolis
• Sept 2009
Indianapolis
• Oct 2009
Houston
CHAPTER ORGANIZER
• Contact person for local leaders
• Assess organizing opportunities
• Local media and communications
• Leadership visits to chapters
Thanks to Joanne Landy and Ali Thebert
MINNEAPOLIS – June 2009
Hosts: Elizabeth Frost, Susan Hasti, Ann Settgast
Wednesday
7 PM Forum: Equality and Health Access
Thursday
10 am ER Conference: Regions Hospital
Noon IM Grand Rounds: Univ of Minnesota
1 pm Student discussion
3 pm Pioneer Press: Editorial Board
5 pm Cocktail fund raiser
7 pm Minnesota Universal HC Coalition
MINNEAPOLIS - continued
Friday
9 am Star Tribune: Editorial Board
10 am Radio Interview
11 am Press Conference
Noon IM Grand Rounds: Hennepin Country
3 pm NPR: Studio Interview
7 pm Reception at Susan Hasti’s home
Saturday
8 am Organizers’ breakfast and planning
OPINIONS ABOUT SINGLE PAYER
• Obama: “If we started from scratch, I would
favor single-payer”
• Baucus: “Single payer is off the table”
• Progressive Caucus: “...the entire 77-member CPC
prefers a single payer approach to HC reform”
• Republicans: “...single payer is socialism”
PNHP IN WASHINGTON
• Robert Zarr, M.D., Chapter Chair
• Danielle Alexander, intern
(July 2008 – June 2009)
• Nick Skala, judiciary intern
(June – August 2009)
• Margaret Flowers, M.D., Congressional Fellow
(July 2009 – present)
LEADERSHIP CONFERENCE FOR
GUARANTEEDHEALTH CARE (LCGHC)
November 2008
• Physicians for a National Health Program
• California Nurses Association
• Healthcare-Now
• Progressive Democrats of America
WASHINGTON ACTIVITY
Working to get “a seat at the table” at every opportunity
• January 20th – Health Care for All Inaugural Ball
• January 28th – Congressional briefing
Health Care Economics
• February 25th – Congressional Briefing
State-based Reform
• March 5th – White House Health Care Summit
THE WHITE HOUSE HC SUMMIT
March 5, 2009
• Friday, February 27th
No single-payer advocates invited
• Monday, March 2nd
Press release and call for demo
WHITE HOUSE SUMMIT
THE WHITE HOUSE HC SUMMIT
March 5, 2009
• Tuesday, March 3rd
John Conyers invited
• Wednesday, March 4th
4 PM: Oliver Fein, PNHP
President, called by White
House
WHITE HOUSE
HEALTH CARE SUMMIT
PARTICIPANTS
(150)
• Congress
• Community/Consumers
• Stakeholders
WHITE HOUSE
HEALTH CARE SUMMIT
FORMAT
1:00 – 1:45 PM
Plenary
2:00 – 3:15 PM
Breakout Groups
3:30 – 4:45 PM
Theater in the Round
THE HAND SHAKE
“Glad you are here.”
“Give my best to Dr. Quentin Young.”
SUMMIT GOALS
• Bipartisanship
• Transparency
 Congressional responsibility
WASHINGTON ACTIVITY
• March 5th – Sanders announces S. 703
• March 14th – Senate HELP: stakeholders
Dr. Quentin Young
• March 25th – White House Doctors:
Dr. David Himmelstein
• April 1st – Congressional Briefing:
Private Health Insurance in the U.S.
BAUCUS-13 ARRESTS
• May 5th – Senate Finance Roundtable
8 Arrests
• May 12th – Senate Finance Roundtable
5 Arrests
SENATE FINANCE
COMMITTEE
Dr. Margaret Flowers, Pediatrician from
Baltimore
Dr. Judy Dasocvich, internist from St. Louis
THE NURSES COME TO
TOWN
OUTCOMES OF
CIVIL DISOBEDIENCE
• Mainstream Media begins to cover Single Payer
– Ed Schultz: MS-NBC
– Bill Moyers: PBS
• June 3rd – Meeting with Senator Baucus
• June 9th – Hearing at House Education and Labor
Conyers, Angel, Tsou and Jenkins testify
• June 11th – Margaret Flowers at Senate HELP
SINGLE PAYER VOICES
• June 24th - Quentin Young testifies at House Ways and
Means
• July 16th - Anthony Weiner announces an Amendment to
HR 3200 which would substitute HR 676
• July 21st - Dr. Aaron Carroll appears on the Colbert Report
• July 29th - Dr. Woolhandler testifies on medical bankruptcy
• July 30th - Single Payer Rally at the Capitol: Dr. David
Scheiner
• July 31st - Nancy Pelosi agrees to allow Weiner’s
Amendment to be introduced in the House
SUMMER LOBBYING
Doctors, Nurses and Advocates from around the country came to D.C .
throughout June and July.
PNHP opens Washington office!
AUGUST ACTIVITY
• Rep. Anthony Weiner meets with PNHP and
decides to request a CBO analysis of his
Amendment
• Bullies take over many Town Hall meetings
• Single payer is heard at many Town Hall
and congressional representative meetings
• David Scheiner takes to the air waves
• Ted Kennedy dies
SEPTEMBER ACTIVITY
• Sept 8th - Congress returns to Washington
“Mad as Hell Doctors” leave
Portland
• Sept 9th - Obama addresses Congress and
the nation
• Sept 21 -25th - Health Care Justice week
• Sept 30th - “Mad as Hell Doctors” arrive in
Washington
MAD AS HELL DOCTORS
TOUR
26 STOPS IN 22 DAYS
WHITE RIBBON RALLY AT THE
WHITE HOUSE
Memorial to Dead, 9/21-27/2009
WHY CONTINUE TO
ADVOCATE FOR SINGLE
PAYER?
• The economic crisis calls for government
stimulus of the economy
• Everyone benefits: the uninsured, the underinsured,
and everyone else who is insecurely insured
• Employers will be relieved of the burden of
rising health care costs/retiree benefits and unfair
competition from employers who don’t offer HI
• Every other industrialized country has done it
• It is morally the right thing to do!
OBAMA’S FATEFUL CHOICE
• He did not want to “start from scratch”
• He had two fundamental choices:
1) to build on the public sector (Medicare); or
2) to build on the private sector
• He chose to try to reach universal coverage by
expanding private insurance
Progress(?) of US Health Reform
Employer mandate
Medicare
Individual mandate*
??
* “each eligible individual must
enroll in an applicable health plan
for the individual and must pay any
premium required with respect to
such enrollment.” (S.1775)
Public option**
** “you can choose to enroll
in the new public plan”
THE MANDATE MODEL
1.
Everyone required to have health insurance
2.
Employers must offer insurance or contribute
3.
Rely on private insurance, but offer a public option
4.
“You can keep what you have”
5.
No regulation of insurance company premiums,
deductibles, co-pays, or payment and denial practices
Result: System costs increase by billions
THE EMERGING CONGRESSIONAL PLAN
1. New requirements for “qualified plans”
-- no pre-existing condition exclusions
-- no co-pays for preventive care
-- $5,000/$10,000 annual limits on cost-sharing
-- no limits on lifetime coverage
Result: higher premiums
2. Employment-based insurance otherwise unchanged
-- Employers can change coverage and plan
-- Insurers can change provider networks
-- Employees are still locked into their jobs
3. Employees must accept employer plan, if they
can afford the premium (< 11-12.5% of income)
THE EMERGING CONGRESSIONAL PLAN
4.
Starting in 2013, the uninsured and small
employers can access an “insurance exchange”
5.
Subsidies (“affordability credits”) in the exchange
up to 300% or 400% of the federal poverty level
6.
Public option only available in the exchange
7.
“Hardship waiver” for those who can’t afford
premiums: they can remain uninsured
8.
Expand Medicaid eligibility to all below 133% FPL
WHAT HAPPENED TO THE
PUBLIC OPTION?
The original “robust” Plan
• Open enrollment
• Medicare-like: backed by the Fed govt
• 119 million members (Lewin)
The Congressional Plan
• Restricted enrollment (only the uninsured)
• 10 million members (only 5% of population)
• Self-sustaining: follow same rules as private
insurers
BOTTOM LINE ON
THE CONGRESSIONAL PLAN
If it does pass in some form, it will:
• Make the world’s most expensive health
care system even more costly
• Not achieve universal coverage
• Not make affordable insurance available
• Leave millions underinsured
• Not control the continuing growth in costs
Why? Because it doesn’t really change the way
we pay for health care
PRIVATE INSURANCE BAILOUT
• Employer based health insurance enrollment
is declining: 15-17 million over 10 years
• Mandates increase private insurance enrollment
• Significant percent are young and healthy
• Government subsidies to assist low/moderate
income families will further increase private
insurance enrollment
CONCLUSIONS
• A system based in private insurance plans
-- will not lead to universal coverage
-- will not create affordable insurance
• A Medicare for All System
-- can provide comprehensive services
while costing no more than present
-- can provide tools to control costs
in the future
If a mandate plan is passed, the problems of
the health care system will not go away. Real
health care reform will continue to be essential
We Can’t Wait Another 16 Years! We
Need Real Health Care Reform Before
the Premium Takes All our Income!
Today
Source: American Family Physician, November 14, 2005
WHY CONTINUE TO
ADVOCATE FOR SINGLE
PAYER?
• The economic crisis calls for government
stimulus of the economy
• Everyone benefits: the uninsured, the underinsured,
and everyone else who is insecurely insured
• Employers will be relieved of the burden of
rising health care costs/retiree benefits and unfair
competition from employers who don’t offer HI
• Every other industrialized country has done it
• It is morally the right thing to do!
CONTACTS AND REFERENCES
• PNHP-NY Metro: www.pnhpnymetro.org
• PNHP National: www.pnhp.org
• Bodenheimer TS, Grumbach K, Understanding Health Policy: A
Clinical Approach. McGraw-Hill, 2005
• Fein O, Birn AE. (editors), Comparative Health Systems. Am Jour
Public Health 2003; 93: 1-176
• O’Brien ME, Livingston M (editors), 10 Excellent Reasons for
National Health Care. New Press, 2008
• Geyman J, Do Not Resuscitate: Why the Health Insurance
Industry is Dying and How We Must Replace It. Common Courage
Press, 2008
FUNDAMENTAL FLAW WITH
THE PUBLIC OPTION
• It retains multiple private insurance companies
• It assumes market competition will work
• Private HI will dump the sick on the Public Option
• Public Option cost/beneficiary will rise
• Private HI will pressure to underfund Public Option
• Only one-seventh of administrative cost savings
COMPARE THE PUBLIC-OPTION
AND SINGLE PAYER
Public-Option
Millions un-insured
and under-insured
Single-payer
Universal
Automatic enrollment
Cost
$1.5 trillion over
10 years
No additional cost
How to pay
Increase taxes;
Cuts to providers
Redirect $400 billion
administrative waste
Sustainability
Use HIT, preventGlobal budgeting;
disease management
capital planning
Coverage