Healthcare Security and Justice

1. Healthcare Security and Justice Joey Foy Shearer Fellow PNHP-CA University of London UCSF School of Nursing

2. Overview • Current State of US Health System • Community Health Insurance/ “Public-option for All” • Affordable Care Act of 2010 • Community Health Insurance in CA • Senate Bill 810 • CaHPSA & The Movement in CA

3. How to organize a health system • Beveridge Model • Bismarck Model • National Health Insurance • Out-of-Pocket

4. The US has the BEST healthcare in the world! • 51+ million without ANY health insurance • 25+ million without adequate health insurance • 62% of bankruptcies are medically related • 45,000+ preventable deaths each year Himmelstein & Woolhandler, 2007

6. Life Expectancy at Birth

7. Infant Mortality

8. Maternal Mortality

9. WHO World Health Report, 2000

11. What is so different about the US System? • Only developed country without guaranteed universal coverage • Only developed country based on a for-profit insurance model to provide basic health coverage • Only developed country where people can go bankrupt from medical bills

12. "We will not sacrifice profitability for membership." • Angela Braly, CEO Wellpoint • $2.5 billion 2009 profit • $13 million 2009 executive compensation • Industry norm, not the exception Forbes.com

13. How a “Public-Option for All” Works • Everyone is covered automatically • Single plan with comprehensive benefits • Freedom to choose provider/hospital • Coverage is attached to YOU • A social public good, not a commodity • Public schools • Police and fire departments • Highways

14. How Guaranteed Health Insurance Saves Money • Streamlined administration and billing process through a single-payer • Bulk purchasing of pharmaceuticals • No marketing costs • Increased emphasis on primary and preventive care • Non-profit system

15. Streamlined administration and billing

16. Bulk purchasing of pharmaceuticals Drug Prices for 30 Most Commonly Prescribed Drugs, 2006–07 US is set at 1.0 Source: OECD Health Care Quality Indicators, 2009

17. Single Guaranteed Plan – No Marketing

18. Increased emphasis on primary and preventive care Diabetes Lower Extremity Amputation Rates per 100,000 Population Age 15 and Older, 2007* Source: OECD Health Care Quality Indicators, 2009

19. Non-profit System

20. Didn’t we just have health reform?

21. Affordable Care Act of 2010 • Individual Mandate to obtain insurance • Expansion of Medicaid (low income) • Establish state insurance exchanges (middle income subsidies) • Guaranteed issue, Community rating • Participating insurers must offer 4 levels • Large businesses (50+ employees) must offer insurance or pay a fine Kaiser Family Foundation: 2010

22. Affordable Care Act of 2010 • Does not cover everyone • Does not simplify billing and administration • Does not develop adequate cost controls • Experience of Massachusetts has been “unaffordable underinsurance” for many • Constitutionality is currently being challenged in Supreme Court Kaiser Family Foundation: 2010

24. Public vs Private Spending Admin. Costs 26.5% 19.9% 16.3% Source: Woolhandler et al, NEJM, 8/2003 & Intl. Jrnl. of Hlth. Services, 2004 Source: Woolhandler, et al, New England Journal of Medicine, August 2003 & Int. Jrnl. Of Hlth. Services, 2004 3.1%

25. Physician Salaries Ref: US General Accounting Office/National Bureau of Economic Research, 2009

26. Community Health Insurance in California • Single-payer legislation has passed twice in CA • 7.2 million additional Californians covered • $8 billion in first year savings Source: Lewin Group, January 2005

27. Senate Bill 810: The California Universal Healthcare Act • Legislation creates the California Health Care Agency • All existing state funding streams are collected • Income tax replaces insurance premiums • Did not pass a senate floor vote in January • Will be reintroduced in early 2013

28. Services Covered Under SB 810 • Inpatient/outpatient health facility services • Inpatient and outpatient services by licensed professionals • Diagnostic imaging, laboratory services • Rehabilitative care • Emergency transportation and necessary transportation for health care services • Language interpretation • Child and adult immunizations and preventive care • Health education • Hospice care • Home health care • Home and Community based care • Adult day care • Prescription drugs • Mental Health Care • Dental care • Orthodontia • Podiatric care • Chiropractic care • Acupuncture • Blood and blood products • Emergency care services • Vision Care including eyeglasses • Hearing including hearing aids • Case management • Substance abuse treatment • Durable medical equipment including hearing aids • Care in skilled nursing facilities • Dialysis.

29. California Health Professional Student Alliance • Started in 2008 • Chapters: • UCLA • USC • CSU Long Beach • Samuel Merritt University • 20 Statewide leadership positions • Campaign for a Healthy California • Student-run autonomous organization affiliated with PNHP-CA

30. Take Action! • Get educated! • www.cahpsa.org • www.pnhpcalifornia.org • www.pnhp.org • Spread the word! • Get involved at your school! • Help build the growing movement for healthcare justice in California!

31. Lobby Day • Annual Event • January 8-9, 2012 • Sunday, January 8 • Student Leadership Workshop • Monday, January 9 • March, rally and legislative visits

32. Thank YOU! • Contact me • joey@pnhpcalifornia.org • Facebook – Joseph Foy, Shearer Fellow • Additional Resources • singlepayernow.net • healthcare-now.org • youtube.com/user/CaPAFellow • Questions?