PNHP’s Response to the Obama Health Plan

1. Dr. Ida Hellander, Executive Director Physicians for a National Health Program PNHP’s Response to the Obama Health Plan

2. Impact of Health Reform on:The Uninsured • # of uninsured reduced from 46 million today to ~23 million in 2019. • Safety net hospital funding through Medicare cut by $36 billion through 2019. • Community health centers receive extra $1 billion annually

3. Impact of Health Reform on:The Underinsured • If you like your current coverage you can keep it. • If you don’t like your current job-based coverage, you HAVE to keep it. • Policies required to cover at least 60% of expected health costs – e.g. $2,000 deductible + 20% co-insurance for next $15,000 of care.

4. Impact of Health Reform on:Medical Bankruptcy • No change for 75% of medically bankruptcy filers who have insurance. • Up to 50% reduction among the 25% of the medically bankruptcy who were uninsured in 2007 but will gain coverage under reform. • Maximum expected reduction in medical bankruptcies = 12.5%.

5. Impact of Health Reform on:Health Care Costs - 1 • Expanded Medicaid - $434 bil. • Subsidies for private coverage - $358 bil. • Small employer tax credits - $37 bil. • Temporary high risk pools, subsidy for retirees <65, etc – ~$10 bil. All figures reflect spending through 2019

7. Impact of Health Reform on:Health Care Costs – 2 (savings) • Decreased Medicare Advantage/HMO overpayment - $136 bil. • Decreased Medicare (DSH) payment to safety net hospitals - $36 bil. • Decreased Medicare fee-for-service payments to doctors/hospitals - $196 bil. • Other Medicare/Medicaid cuts - $87 bil. All figures reflect spending through 2019

8. “This round of debate is over. We lost.” • “The only kinds of fights worth fighting are those you are going to lose, because somebody has to fight them and lose and lose and lose until someday, somebody who believes as you do wins”  - I.F. Stone

9. Impact of Health Reform on:Cost Control Provisions • Insurance exchanges • Health information technology • Comparative effectiveness research • Fraud and abuse prosecution/recovery • Alternatives to F-F-S (experiments) • Coverage of preventive services • Tax on “Cadillac” coverage • Malpractice reform (experiments) • Medicare advisory board

10. Health Reform Bill:Proven Cost Control Provisions

11. Impact of Health Reform on:Administrative Costs • IRS cost to enforce mandate - $5-10 bil • Running insurance exchanges - ~4% of premiums (based on Massachusetts) • Insurance overhead - ~13% of new premium revenues = $42 bil • Cap on insurance overhead - ???? • Standardized claim forms - ????

12. Role Played by Health Industry in Health Reform • Insurance donations to Dems & Repubs + ads in favoring AND opposing • Pharma - >$100 million on ads supporting reform • Senate framework written by Liz Fowler, former VP of Public Policy for Wellpoint/Anthem

14. “This round of debate is over. We lost” • “The only kinds of fights worth fighting are those you are going to lose, because somebody has to fight them and lose and lose and lose until someday, somebody who believes as you do wins.”  - I.F. Stone

15. Next steps:National and State campaigns for single payer reform • National Campaigns: - Better Medicare for All - Divestment from private health insurance • State Campaigns: - State single payer legislation/campaigns - - More than 15 states (CA, VT, MN, others)

16. PNHP’s main educational tool:Evidence-based health policy science • Publish in medical journals - 15 peer-reviewed studies 2008-2009 - much publicity in lay media as well • Grand rounds at hospitals • Medical specialty conferences • Town hall meetings and outreach to labor, women’s, civic, faith groups to build grassroots movement

17. Corporate healthcare’s threat to democracy • Big Pharma spent $500.7 million on lobbying Congress 2008-2009 Result: Obama plan has no price controls on drugs • Insurance industry spent > $200 million on lobbying • Chair of Senate Finance Committee, Sen. Max Baucus, received > $3 million in campaign contributions Result: Single payer kept “off the table” and extra $1.0 trillion for insurers (from mandate and tax subsidies)

18. “Citizens United” ruling creates USA, Inc. • Corporations can spend unlimited amounts to influence elections: US Supreme Court, 2010 • "On its own, it will not be responsible to opening the floodgates to corporate money ... because the floodgates were pretty wide open to begin with“ - Columbia law professor • Despite majority support for single payer national health insurance, Americans have no right to health care < age 65 • But, “Physicians’ voices can be very powerful when speaking on behalf of our patients”