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Medicare for All!!

Medicare for All!!. Paul Y. Song, MD Physicians for a National Health Program. Hippocratic Oath. “I will follow that system of regimen, which according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous”. The Problem.

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Medicare for All!!

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  1. Medicare for All!! Paul Y. Song, MD Physicians for a National Health Program

  2. Hippocratic Oath • “I will follow that system of regimen, which according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous”.

  3. The Problem • The US spends $2.5 Trillion a year which is 17.3% of our GDP on healthcare and more than any other industrialized country in the world by far. • The CBO estimates it will grow to 25% of our GDP by 2025. • The average family premium is $14,000 a year. • 17% of American income now goes to pay for health care. • 75 million Americans are underinsured. • The number of uninsured in the US now exceeds 50.7 million and has actually increased since the passage of the healthcare bill.

  4. Broken System?? The Commonwealth Fund 6/23/10

  5. 51 Million Americans Without Insurance Today Millions of Uninsured Americans 1976 2008 Source: Himmelstein, Woolhandler, Carrasquilo – Tabulation from CPS and NHIS data

  6. Who are the Uninsured? NON-WORKER 19.5% PART-TIME WORKER 14% FULL-TIME WORKER 66.5% • Of the 50.7 million, over 20 million are fully employed and • 70% of all uninsured are from families with one or more full-time workers. Urban Institute and Kaiser Commission on Medicaid and the Uninsured estimates based on the Census Bureau's March 2008 and 2009 Current Population Survey (CPS: Annual Social and Economic Supplements).

  7. Uninsured Deaths • 50,000 annual deaths are attributed simply to a lack of coverage.

  8. Medical Related Bankruptcies • Number of medical related bankruptcies increased 50% during the last 9 years. • In 2011, it is estimated that there will be over 4 million bankruptcies. • 2/3 are due to a medical illness.

  9. Most of the Medically BankruptHad Insurance Coverage Insurance at onset of illness Source: Himmelstein et al. Am J Med, Aug. 2009

  10. Hard for Employers Too! • For every $100 that US companies spend on health care, companies in Japan, Germany, France, and Canada spend 63 cents which leads to more off-shoring of jobs and less job creation. • Ford spent $3.2 Billion on health premiums; Prior to the bailout, GM spent more on health premiums than on steel. • It is estimated that health care costs add $1500-2000 to the sticker price of a US made car.

  11. The For-Profit Insurance Industry is Not Your Friend! • Take 31 cents out of every dollar away from actual patient care. • Increase overall health care costs by discouraging people from receiving preventative care and by driving the sick into more expensive care settings • 1/6 of all policies are actually grossly inadequate to cover a serious illness. • 70% of losses (money paid out in claims) goes to cover about 10% of their subscribers creating a powerful incentive to screen subscribers and harass them to drop their coverage and go elsewhere. • They encourage higher deductibles and co-pays by increasing premiums to insure they cover very little.

  12. The For-Profit Insurance Industry is Not Your Friend! Over the past 9 years: • Only recession proof industry that consistently raises prices 10-15% every year regardless of the economy. Far outpacing inflation. • Average premiums have increased nearly 120% • Profits at the 10 largest publicly traded insurance companies have rose 428% (reported). • Average annual CEO salary at these companies was $11.9 Million which is 468 times what the average US worker makes. • In CA, the six largest insurers denied over 45.7 million claims in the last six years.

  13. CEO Salaries (2008) • Roy Williams – CEO Aetna - $ 24,300,122 • H. Edward Hanway – Cigna - $ 12,236740 • Angela Bray – Wellpoint - $ 9,844,212 • Dale Wolf – Coventry Healthcare - $ 9,047,469 • Michael Niedorff –Centene - $ 8,744, 483 • James Carlson – Amerigroup - $ 5,292,546 • Michael McAllister – Humana - $ 4,764,309 • Jay Gellert – Health Net - $ 4,425,355 • Steven Helmsley – United Health Group - $ 3,241,042 • Billy Tauzin – CEO PhRMA - $2,000,000 • Karen Ignani – Amer. Health Insurance Plans - $ 1,580,000

  14. Whenever profits are not enough, patients get crucified!! Anthem Blue Cross proposed 39% rate increases in 2010.

  15. Blue Shield of California proposed to raise health insurance rates a whopping 59% for individual policyholders in 2011, saying the increase is “absolutely necessary” to deal with rising health care costs and restrictions in the new health care law.

  16. Insurance Industry Efforts • 4525 lobbyists for the 535 Congressional members (8:1) – 450 lobbyists are former congressional staffers and 12 were former Max Baucus Staffers. • $1.4 Million was spent each day!! • $260+ Million was spent by the health insurance industry and big Pharma – more than on the 2004 Bush-Kerry presidential campaign. • Insurance stocks hit a 52 week high once there was no public option.

  17. June 17, 2009 – As 22 Senators began hearings and work on healthcare reform, the room was full of registered healthcare Lobbyists.

  18. Easy to Blame the GOP, but… • The Democrats had a supermajority for most of the debate. • 60% of all money went to Democrats. • Max Baucus (Chairman of the Senate Finance Committee) received over $2 million. • Ben Nelson received more money from the health insurance industry than any other industry. • Joe Lieberman received over $1 million and his wife was employed by several healthcare and Pharma companies.

  19. Arguments Against Reform • “Will explode the deficit!”

  20. Nixon/Ford: 6.8% per year Carter: 2.0% per year Reagan: -1.3% per year Bush 1: 4.0% per year Clinton: 2.5% per year Bush Jr: 8.2% per year

  21. Arguments Against Reform • “Will explode the deficit!” • “This is the largest government run health care program ever”.

  22. Originally passed in 2004 at a projected cost of $400B over 10 years, some estimates suggest it will cost over $900 Billion. Passed by a GOP controlled house and senate led by then Rep. Billy Tauzin (R-La) who left immediately after its passage to become the head of PhRMA.

  23. Arguments Against Reform “Will explode the deficit!” “This is the largest government run health care program ever”. “Socialized medicine”

  24. “If you don’t stop Medicare and I don’t do it, one of These Days, you and I are going to spend our sunset years telling our children, and our children’s children what it once was like In America when men were free” - Ronald Regan 1961 Socialized Medicine was popularized by a public relations firm working for the American Medical Association in 1947 to disparage President Truman's proposal for a national health care system. It was a label, at the dawn of the cold war, meant to suggest that anybody advocating universal access to health care must be a communist. And the phrase has retained its political power for six decades.

  25. The original meaning of “socialized medicine” was confined to systems in which the government owns and operates health care facilities and employs health care professionals, support staff, and all ancillary workers. England, Germany, Israel, Sweden, Finland, New Zealand, France, Canada, Taiwan, Japan all have “socialized medicine”.

  26. October 22, 2009 - Veterans Health Care Budget Reform And Transparency Act More than 1400 hospitals, clinics and nursing homes, 14,800 doctors, 61,000 nurses , and 5 million patients. Rand Corporation found that 67% of veterans received appropriate care compared to 55% for the general public. University of Michigan study found 83% satisfaction for Veterans compared to 73% for general public.

  27. Let the Free Market Rule! • There currently is no free market! Only two industries in the US have antitrust exemptions – Major League Baseball and The Health Insurance Industry. • There has been heavy consolidation and near monopolies established in the past 10 years. • One or two insurers generally control the top 94 metropolitan areas in the US. • In some states like Alabama, 90% have Blue Cross. • By allowing insurers to sell across state lines, patient protections will be reduced due to variations between states.

  28. So What Did We End Up With? • The Patient Protection and Affordable Care Act, not Obamacare. • It is not socialized medicine or a government takeover of medicine. • There are no death panels. • CBO estimates it will cost $940 Billion over the first 10 years. • Majority of the provisions will not begin until 2014.

  29. Impact of Health Reform On the Uninsured

  30. Problems With the Reform Bill • $475 Billion subsidy to the insurance industry that forces 30 Million Americans to buy coverage from these companies that do not care about patients! • 23 Million people will still be uninsured nine years from now. • Millions of middle income people will be forced to buy commercial policies costing up to 9.5% of their income, but covering only 70% of their medical expenses, leaving them still very vulnerable to medical related bankruptcies due to high deductibles and co-pays which will still be permitted. • Fee-For-Service

  31. Problems With the Reform Bill • While Insurers will no longer be able to deny coverage or set maximum caps, they will still be able to increase co-pays, deductibles, and premiums which will only serve to preclude access to healthcare. • Enforcement of new regulations such as ending denials on the basis of pre-existing conditions are riddled with loopholes and waivers, and there is nothing to prevent older people or women from being charged more based on age or gender until 2017. • HHS has already scaled back rules on health insurance appeal denials making the process even more difficult for patients! • People with employer based coverage will remain locked in their plans and have no choice of providers or hospitals. No competition for most of us!

  32. Medicare – A Single Payer System!! • Established in 1965 when only 56% of adults over 65 years of age were insured. • Prior to Medicare, 1/3 of all seniors were living in poverty. • Commonwealth Fund Study (5/09) – Medicare patients had much greater satisfaction, better access to care, and fewer billing problems than those with employer sponsored plans. • Kaiser Family foundation study showed greater overall satisfaction and much more cost efficiency than private insurance companies. • Medicare spends approximately 3.6% on administrative costs and 96.4% on actual patient care! • Patients have greater choice and do not need pre-authorizations.

  33. Medicare – A Single Payer System!! • The government does not tell doctors how to practice, what tests to order, which hospitals to go to, or what medications to prescribe. • It is the private insurance companies that tell patients who to see, where to go, and what doctors can do. • Since 2008, more providers are dropping more patients with private non capitated insurance than patients with Medicare.

  34. A Few Sick People Drive Most Costs Percentage of total health spending in 2001 Top two deciles account for 78.3% of spending Decile of privately insured Source: MEPS data, from Thorpe and Reinhart

  35. Current Medicare Has Limitations • Medicare doesn’t cover everything – 45% of outpatient mental health services, no dental coverage. • Medicare Part B which covers doctors’ services generally pays for 80% of all reasonable charges, leaving seniors responsible for the remaining 20% which can be very expensive when dealing with a life threatening or serious illness. • Medicare is fully privatized and there is no price negotiations for bulk purchasing. • Without PPACA, Medicare is forecast to be bankrupt by 2016. • Due to the anticipated savings due to PPACA of more than $120 Billion, Medicare should now be insolvent in 2024. • In 1999, the Bipartisan Commission on the Future of Medicare predicted that Medicare would be bankrupt by 2008.

  36. “I think very likely what the president intends is that Medicare will go broke and ultimately that answer will be Obamacare for senior citizens” - Michele Bachmann 8/25/09

  37. Private insurers waste 31 cents of every dollar on overhead, sales and marketing, lobbying, billing, underwriting, and exorbitant executive compensation.This waste is now estimated to be over $400 Billion a year!!

  38. Administrators Are Growing Faster Than Physicians Administrators Physicians 1970 1980 1990 2000 2009 Source: Bureau of Labor Statistics; NCHS; Himmelstein/Woolhandler analysis of CPS

  39. Single Payer System • Single payer financing is the only way to recapture this wasted money and provide comprehensive coverage to everyone without paying more than we already do. • Would be financed by eliminating private insurance and recapturing their administrative waste. • Modest new taxes would replace premiums and costs would be controlled through negotiated fees, global budgeting, and bulk purchasing. • Unified risk pool – everybody in, nobody out, continuous which would provide a new financial solvency to Medicare!! • Everybody contributes to fund health care based on ability to pay. • Transparency and Accountability to the public • We can save over $4 Trillion in the next 10 years with a Medicare for All program.

  40. Covering Everyone and Saving Money Source: Health Care for All Californians Plan, Lewin Group, 2005 Additional costs Covering the uninsured and poorly-insured +7.2% Elimination of cost-sharing and co-pays +5.1% Savings Bulk purchasing of drugs & equipment -2.8% Reduced hospital administrative costs -1.9% Reduced physician office costs - 3.6% Reduced insurance administrative costs -5.3% Primary care emphasis & reduce fraud -2.2% Net (Savings) -4.3%

  41. Single Payer System • Physicians would still be able to practice medicine the way they think is best, but with far less paperwork and administrative costs!! • Average private practice currently spend about 25% on administrative costs. This would save about $70,000 a year. • All medically necessary care is covered. Patients would have choice of physician and treatment. • Strong emphasis on comprehensive, focused, and preventative care in a timely manner. • Would lead to higher wages as employers would not have to pay for healthcare premiums. • Would lead to more capital investments by companies. • CA Nurses Association study found it would create 2.6 Million new jobs and infuse $317 Billion in new business revenue. • Patients would not feel trapped in their current jobs due to the fear of losing their health care coverage.

  42. Benefits/Portability Patients have unlimited choice of physicians, hospitals, and clinics regardless of location USNHI will cover all medically necessary services, including: • preventative care • primary care • inpatient hospital care • outpatient care • emergency care • prescription drugs • durable medical equipment • long term care • mental health services • dentistry • eye care • substance abuse treatment

  43. Single Payer System • HR 676 – Expanded and Improved Medicare Act for All - Conyers (now with 64 co-sponsors) • California SB 810 – Mark Leno

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