Health Care Reform

A Crash Course for Consumers Susan Wildin, M.D.

Ken Kenegos, R.N.

Margaret Nosek, Ph.D.

Health Care for All-Texas www.hcfat.org

Topics

1. Status of health care financing in the US 2. Patient Protection and Affordable Care Act (ACA) 3. How do other countries compare with the U.S.?

4. What is the real support for single-payer?

5. HR 676: The U.S. National Health Care Act "Expanded & Improved Medicare for All" 6. What you can do

“Our systems are perfectly designed to attain the results we are currently achieving.”

W. Edwards Deming

Status of Health Care in the US

Number of Uninsured Americans: 1976 - 2006

Source: Himmelstein, Woolhandler, and Carasquillo, tabulation from CPS and NHIS data

Who Are the Uninsured?

• 80% are employed • 75% are U.S. citizens • People losing private health insurance at the fastest rate are those earning $75,000 or more Source: 2007 US Census Bureau and Institute of Medicine

Most Health Care is Publicly Financed

Individuals 100% Financed by People!

Private employers 20% 20% 60% Taxpayers

( Medicare, Medicaid, VA Public employees, tax subsidies}

Source: NEJM 1999; 340:109; Health Affairs 2000; 19(3):150

Medicare versus Medicaid • • Medicare = – an insurance program – paid into by all people who work – beneficiaries -- people who have worked and are over age 65 or work disabled (high-end healthcare users) Medicaid = – safety net (charity) program – paid for by taxpayers (state with federal match) – beneficiaries -- people who are poor

One-Third of Health Spending is Consumed by Administration

69% 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

Here's what we're paying for now with $.31 on every health care dollar • • • • • Exorbitant salaries for private insurance company executives Lobbying by private insurers (over $26 million in 2007, a non-election year) Insurance bureaucrats paid to find ways to deny treatment Dividends to stock holders Advertising

Growth of Physicians and Administrators 1970-2004

Source: Bureau of Labor Statistics; NCHS; and analysis of CPS

…and Health Insurance Costs Keep Rising

Beware of Insurance Company Doubletalk

• • • "consumer-driven" = sky-high deductibles "medical management" = deny coverage for doctor-ordered care "if you have to choose, you take margin and you sacrifice the growth line" = profits over people

Patient Protection and Affordable Care Act

The Positives • Small business tax credits • Elimination of pre-existing conditions for children (adults in 2014) • Elimination of lifetime caps • • • • Some required preventative care without payment Strengthened community health centers Improved drug coverage for Medicare Investment in medical education

What is Missing?

• About 23 million people will remain uninsured nine years out, which translates to… • An estimated 23,000 unnecessary deaths annually and an incalculable toll of suffering

What are the Costs?

•

Pressure on middle-income families to buy commercial health insurance policies means

– Costs as high as 9.5% of household income – Coverage for an average of only 70% of medical expenses – Threat of financial ruin if people become seriously ill – Insurance is unaffordable because of the high co-pays and deductibles

Does it Offer Cost-Control?

• • • • • Health care costs will continue to skyrocket, as the experience with the Massachusetts plan (after which this bill is patterned) demonstrates Employer-based coverage locks people into their plan's limited network of providers Families and individuals will face ever-rising costs and erosion of their health benefits With the rising cost of premiums, most people will be in the "Cadillac" category with mediocre coverage In 2018, “Cadillac” plans will be subject to an excise tax* *"Health Policy Brief" Health Affairs 3-9-11

Is it Equitable?

• Insurance regulations are riddled with loopholes, thanks to the central role that insurers played in crafting the legislation • People 50 years and older can be charged up to three times more than their younger counterparts • Large companies with a predominantly female workforce can be charged higher gender-based rates at least until 2017

What’s Wrong with Subsidy and Individual Mandate Schemes • Substandard Coverage: – only policies that underinsure are affordable • Unaffordable: – Amount people are presumed to be able to afford is unrealistic – Increase in taxes to pay for subsidies for low income to buy private health insurance - costing taxpayers even more • No Realistic Cost Control: – Continues to use for-profit private health plans which raise premiums every year; no system reform to control costs

But don't despair!

• Progress to date: – Victory in Vermont – More pundits admit single-payer is inevitable – Health insurance industry is scrambling – Reemergence of the public option in state insurance exchanges

How Do Other Countries Compare with the U.S.?

How Do Other Countries Compare with the U.S.?

• • • • • They have as good or better health outcomes They use the same medical technology They have better access / same wait times They have universal coverage from birth to death They spend half the amount we spend per capita (average cost per person)

What Other Countries Have that the U.S. Doesn’t Have • • • • • More preventive care More nurses, more doctor visits, longer inpatient stays More cost control with same or better health care quality as U.S.

Fewer out-of-pocket costs Most offer free medical and nursing education

How Other Countries Finance Health Care • • • Sickness funds – France, Germany • highly regulated non-profit insurance companies – No model in US Social insurance – VA model (U.K., Spain) Single-payer • Canada, Australia, Taiwan, Sweden – Medicare model

What is the Real Support for Single-payer?

65% of the public and 59% of physicians

support single-payer

(CNN Poll May 4-6 2007; : A Carroll and R Ackerman, Support for National Health Insurance Among American Physicians: Five Years Later. Annals of Internal Medicine April, 2008)

“… the government should provide an NHI program for all Americans even if this would require higher taxes.” Source: CNN poll May 4-6, 2007

HR 676: The U.S. National Health Care Act

HR 676: The U.S. National Health Care Act

• • • • • • Privately delivered, high quality Everybody in, nobody out Choice of provider & hospital Uniform, comprehensive benefits, portable Prevention, full mental health parity Cost control through “economies of scale” Source: http://thomas.loc.gov/cgi-bin/thomas

HR 676: The U.S. National Health Care Act

• • • • Reduced administrative waste & overhead Common sense budgeting, affordable, sustainable Public oversight and input/control Ending insurance industry interference Source: http://thomas.loc.gov/cgi-bin/thomas

HR 676: The U.S. National Health Care Act

• For those whose jobs are eliminated due to reduced administration – Retraining and Job Placement – 2 Years of Salary Parity Benefits – Medicare For All Employment Transition Fund – Annual Appropriations to Medicare For All Employment Transition Fund – Retention of Right to Unemployment Benefits Source: http://thomas.loc.gov/cgi-bin/thomas

What You Can Do

Actions 1. Talk about it!

– Speak truth to the lies – Spread the HCFAT message of " Expanded and Improved Medicare for All“ • Elevator talk • Spread HCFAT literature ● ● Letters to the editor or op-eds Invite us to talk to your organizations

Actions 2. Express your support to the power brokers • Attend Town Hall meetings ● Contact State and Federal Representatives ● Work with HR 676 sponsors to make improvements and to pass the bill

Actions 3. Join us • Health Care for All-Texas (HCFAT.org) ● ● Physicians for a National Health Program (PNHP.org) sign on to our listserv ● ● come to our monthly meetings come to our rallies

“Never doubt that a small group of thoughtful, committed citizens can change the world; indeed it's the only thing that ever has.” Margaret Mead