Transcript Universal Health Care as the Civil Rights Struggle of the

Health Care Reform
Universal Health Care: The Only Solution
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PERSPECTIVE: Practical
Current system is unsustainable
 Burden it places on our economy/businesses
 Private health insurance premiums are  at
unsustainable rate of 13%/year – & as much
as 25% in some areas of country
 Coverage is shrinking, as more employers
decide to cap their contributions to health
insurance & workers find they cannot pay
their rapidly growing share
 Most expensive health care system in the
world
PERSPECTIVE: Practical
 Spend twice as much as other developed nations
 We don’t get more care - Canadians, see their doctors
more often & spend more time in hospital
 We don’t get better results - do worse than most other
developed countries on usual measures of health such
as life expectancy, infant mortality, immunization rates
 We still don’t cover everyone – 48.5 million uninsured
 In sum, our health care system is outrageously
expensive, yet inadequate.
Why?
 There’s something enormously inefficient about the
way we finance & deliver health care
Institute of Medicine Report
September 6, 2012
Us Health System Wastes $750 billion Annually:
Unnecessary services- $210 billion
Inefficient delivery of care- $130 billion
Excessive administrative costs- $190 billion
Inflated Prices- $105 billion
Prevention failures- $55 billion
Fraud- $75 billion
PERSPECTIVE: Philosophical
Health care is :
 A Human Right
 A social service distributed according to need
 Not a commodity distributed according to
ability to pay
 Not a business whose “beneficiaries” are
company executives and investors not
patients
 Most Americans believe everyone should
have access to good care without financial
hardship
PERSPECTIVE: Philosophical
 We are the only developed nation that does
not provide comprehensive health care to all
its citizens
 48.5 million Americans are uninsured
 Many are underinsured - lack comprehensive
coverage, preventive care, long-term care &
drug costs
 48,000 die a year from lack of coverage
 Markets are good for many things, but they
are not a good way to distribute health care
Problem with For-Profit Payers
 Investor-owned firms compete not by  quality or 
costs, but by avoiding unprofitable patients & limiting
services
 Creates paradox of a health care system based on
avoiding the sick
 It generates huge administrative costs, which, along
with profits, divert resources from clinical care to
demands of business.
 Doctors & hospitals maintain costly admin staff to
deal with bureaucracy
 Administration consumes 31% of our health care $
Who Are the Uninsured?
Uninsured by Percentage
25%
50%
5%
20%
Children
Unemployed
Out of Labor Force
Employed
“…,people have access to health care in
America. After all, you just go to an
emergency room.”
Former President George W. Bush
America’s Underinsured
Proportion of Americans Going Without Care due to Costs, 2005
(skipping doctor visit, specialist appointment, treatment or prescription when needed)
70
60
60
Insured
50
40
30
59
Insured, Gap in
Coverage
28
Uninsured
20
10
0
1
Source: Commonwealth Fund Biennial Health Insurance Survey, 2005
Medical Bankruptcy
Illness & Medical Bills Contributed to 1,000,000 Personal
Bankruptcies in 2004. (Half of All Bankruptcies)
Insurance Status
at Onset of Illness
24%
Uninsured
Had Insurance
76%
Had Insurance
Source: Himmelstein, Health Affairs 2005 (state estimates provided by author)
Health Care Americans Want


Guaranteed access
Free choice of doctor


High quality

Affordability
Trust & respect
Other Industrialized Nations
 Have similar demographics
 Availability of expensive technology
 Rising drug costs
 Similar levels of service
Why are their costs so much lower?
Why are costs lower in other
countries?
Administrative simplicity
Lower prices
Higher ratio of primary care to
specialists
Health planning
Global budgets
Life Expectancy, 2005
Life Expectancy in Years
80.3
79
80.4
80.2
80.6
79
Series1
Sw
ed
en
ly
Ita
Ca
na
da
Fr
an
ce
an
y
G
er
m
.
U.
K
.
77.8
U.
S
81
80.5
80
79.5
79
78.5
78
77.5
77
76.5
76
Infant Mortality, 2005
8
7
6
5
4
3
2
1
0
6.8
5.3
5
4.7
3.9
3.6
Sw
ed
e
n
e
nc
Fr
a
an
y
m
G
er
It a
ly
st
ra
lia
Au
C
an
a
da
.S
.
2.4
U
per 10,000 live births
Deaths in first year of life
8.9
10
8
6
2.9
4
3.6
3.2
4.6
4.2
2
Source : OECD 2005
C
an
a
da
n
ed
e
Sw
ay
or
w
N
st
ra
lia
Au
G
er
m
U
an
y
0
.S
.
Deaths/100,000 Births
Maternal Mortality 2002/2003
Growth of Physicians & Administrators
1970-2005
Source: Bureau of Labor Statistics & NCHS
One-Third of Health Spending is
Consumed by Administration
Potential Savings: $350 billion per year
Health Spending by Percentage
31%
69%
Administration
All Other
Source: Woolhandler, et al, New England Journal of Medicine, August 2003 & Int. Jrnl. Of Hlth. Services, 2004
Health Costs’ Growing Share of
Employee Benefits
Employer Spending on Benefits as a Percentage of
Total Benefit Spending 1960-2002
100%
80%
Other
60%
Retirement
40%
Health
20%
0%
1960
1970
1980
Source: Employee Benefit Research Institute, May 2004
1990
2002
Lesson #1: Simply Giving More
People Existing Private Insurance
Policies Is Not Solution:
 Current Private Insurance Policies Offer
Inadequate Protection.
 Any Gains in Coverage Will Be Quickly
Offset as Costs Rise & Employers Shed
Benefits.
Lesson #2: Real Solution to
Health Crisis Must Do 2 Things:
• Offer coverage more comprehensive
than that currently available on the
private market.
• Control Costs so that Benefits are
Sustainable.
Only Two Paths to Reform
1. Preserve Private
Insurance Companies
& their Waste
2. Create a National
Health Insurance
System
Single-Payer Benefits
 Comprehensive Coverage for all medically
necessary services (doctor, hospital, long-term
care, mental health, vision, dental, drug, etc.) in
a single-tier system.
 Free Choice of doctor & hospital.
 Health Workers Unleashed from corporate
dictates over patient care, and receive equitable
payment for all care provided.
 Hospitals guaranteed a secure, regular budget.
Financing Single-Payer
Medicare
Medicaid
Single-Payer
Health Care
Fund
Payroll Tax
Income Tax
$$$
Bonus: Negotiated reimbursement for physicians, global
budget for hospitals,  primary & preventive care, bulk
purchasing of drugs & medical supplies = long term cost
control.
Funding a
National Single-Payer
System
“Medicare for All” would
save billions
Based on the work of Gerald Friedman
Professor of Economics at the University of MassachusettsAmherst
Dollars & Sense March/April 2012
An Unrelenting Climb of Cost
20%
Healthcare
spending 16%
as percent
of GDP
12%
8%
4%
1960
1970
1980
1990
2000
2010
Friedman, G. Dollars & Sense. March/April 2012
20/20 Vision for 2020
20%
Projected
share of 16%
GDP on
healthcare
12%
Current
system
The difference is
insurance company
overhead and profits
8%
Single
Payer
4%
2013
2014
2015
2016
2017
2018
2019
2020
Friedman, G. Dollars & Sense. March/April 2012
Single Payer Would Cover Everyone
And Spend Less
$ Billions
$200
0
-$200
-$400
-$600
$142
Increased utilization (especially home health and dental)
$110
$74
Covering the uninsured
Medicaid Rate Adjustment
Government administration ($23B)
$153 Health insurance administration
$178
Reduced market power (pharma and devices)
$215
Admin costs to providers
New Costs Savings
Friedman, G. Dollars & Sense. March/April 2012
Single Payer Would Cover Everyone
And Spend Less
$ Billions
$200
New
Costs:
$326 B
Net savings:
0
-$200
-$400
-$600
New
Savings:
$569 B
$243 Billion
Cover everyone
with better benefits
and spend less.
New Costs Savings
Friedman, G. Dollars & Sense. March/April 2012
Funding for Single Payer in 2013
Dollars in Billions
Friedman, G. Dollars & Sense. March/April 2012
Changes in Disposable Income
15%
10%
Changes in
disposable
5%
income
with single 0
payer by
income -5%
group
-10%
With single payer,
95% of Americans
would have more money in their pocket.
-15%
Lowest
-20% 20%
Secon
d 20%
Middle
20%
Fourth
20%
Next
15%
Next
4%
Top
1%
Friedman, G. Dollars & Sense. March/April 2012
Subsidy & Individual Mandate Schemes
 Substandard Coverage: forces uninsured to buy defective
insurance industry products that are already causing families
to face bankruptcy & go without needed care.
 Unaffordable: Without savings achievable with single-payer,
taxes must raised or funds diverted from other needy
programs- education, infrastructure, transportation, etc.
 Micro-coverage, Macro-costs: Preserves wasteful private
insurers & adds yet another layer of state administrative
waste. Rather than provide care to uninsured through a
relatively efficient program like Medicare, the plan launders
tax dollars through wasteful private insurers.
 No Realistic Cost Control: Any gains in public coverage will
be unsustainable due to rising costs.
“Sounds Great, but it’s not
politically feasible”
2/3rds of population want it.
Most (59 percent) of physicians want it.
Business community is now realizing
the need for it.
Single-Payer:
Glen Barton
Former CEO, Caterpillar Inc. (Fortune 100)
Past Chairman, Health & Retirement Task
Force Business Roundtable
Represents 150 Largest Employers
Total Assets: $4.0 Trillion
“The quickest & simplest solution… is to go
to a single-payer system”
- Written Testimony to AHCTF, Feb. 1 2006
“If done right, health care in America could be dramatically better with true
single-payer coverage.”
-Ben Brewer, WSJ, April 18, 2006
“[single-payer] is an idea that's so easy to slam politically yet so sensible for
business that only Republicans can sell it! …it may take a Republican President
to bless the socialization of health spending we need.”
-Matt Miller, Fortune, April 18, 2006
CNBC / MSN Money
“Think, as a small business, how you could benefit from a single-payer system:
you wouldn’t lose potential employees to larger firms that offer more attractive
health benefits; health insurance costs would cease to be a line item in your
budget. A serious illness befalling you or an employee wouldn’t be a companywide financial crisis. You might even save money.”
-Joseph Antony, CNBC / MSN Money, Winter 2003
The Rising Popularity of National
Health Insurance, 1979-2009
Who should provide coverage?
2009
1979
Government
Government
Private
Enterprise
Private
Enterprise
Don't Know
Don't Know
CBS News/New York Times Poll February 1st, 2009
Is “The Perfect the
Enemy of the Good?”
 The central flaws of the PPACA law remain the
central flaws of our current system
 Uncontrolled Costs
 Lack of Universal Coverage
 Without eliminating the overhead of a patchwork forprofit system we will not achieve the system we
deserve- health system reform must be pursued at
the same time as quality reform.
Is “The Perfect the Enemy of the
Good?”
The Radical & the Republican
“Many of Lincoln’s admirers have painted him as a man who
wanted exactly what the abolitionists did but cannily waited for a
perfect moment to achieve it. [In fact], radicals like Douglass set an
agenda Lincoln gradually adopted as his own. Without abolitionists,
there would have been no Lincoln.”
- James Oakes, Historian, UC Berkeley
Single-Payer: “Politically
Feasible?”
Other “Politically Infeasible”
Movements
 Abolition of Human Slavery
(1860s)
 Women’s Suffrage Movement
(1840-1920)
 Civil Rights Act (1964)
 Voting Rights Act (1965)