Physicians for a National Health Program 29 E Madison Suite 602, Chicago, IL 60602

1. Health Care Reform Universal Health Care: The Only Solution Diljeet K. Singh, MD, DrPH Physicians for a National Health Program 29 E Madison Suite 602, Chicago, IL 60602 Phone (312) 782-6006 | Fax: (312) 782-6007 email: info@pnhp.org www.pnhp.org

2. 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

3. PERSPECTIVE - Philosophical We are the only developed nation that does not provide comprehensive health care to all its citizens 47 million Americans are uninsured Many are underinsured - lack comprehensive coverage egs preventive care, long-term care & drug costs 45,000 die a year from lack of coverage Markets are good for many things, but they are not a good way to distribute health care

4. 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

5. PERSPECTIVE - Practical • Spend twice as much as other developed nations • But 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 - 47 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

6. 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 • Adminstration consumes 31% of our health care $

7. Solution - Single-Payer • Simpler & more efficient than our private health care system • Health care $ distributed by one entity, so that health care could be coordinated to eliminate gaps • Conceptual extension of Medicare to entire population. • Medicare is: • Government-financed single-payer system embedded within our private, market-based system. • Most efficient part of our health-care system, with overhead costs of < 3% • Covers virtually everyone over 65 • Most popular part of U S health care system

8. Solution - Single-Payer Universal, Comprehensive Coverage No out-of-pocket paymentsCo-payments & deductibles are barriers to access, administratively unwieldy, & ineffective for cost containment Single insurance plan in each region, administered by public or quasi-public agency Global operating budgets for hospitals, nursing homes, allowed group & staff model HMOs & other providers with separate allocation of capital fundsBilling on per-patient basis creates unnecessary administrative complexity & expense. A budget separate from operating expenses will be allowed for capital improvements

9. Key Features of Single-Payer Free Choice of ProvidersPatients should be free to seek care from any licensed health care provider, without financial incentives or penalties Public Accountability, Not Corporate DictatesThe public has an absolute right to democratically set overall health policies & priorities, but medical decisions must be made by patients & providers in the region rather than dictated by corporate executives. Market mechanisms principally empower employers & insurance bureaucrats pursuing narrow financial interests Ban on For-Profit Health Care ProvidersProfit seeking inevitably distorts care & diverts resources from patients to investors Protection of health care & insurance workers

10. 47 MillionUninsured 45,000 Deaths Per Year But simply helping them buy private insurance is not a solution.

11. Meet Thomas Wilkes • Born in 2004 with Severe Hemophilia A. • Dad: Senior Engineer at a small high-tech computer firm with good benefits. • 2005: Develops an inhibitor to his hemophilia treatment. • $750,000 annual claims.

12. Private Insurance for Thomas • Company faces 40% to 55%  in premiums. • Only insurer that will cover them requires $10,000 out-of-pocket & $1 million cap. • Thomas is projected to reach the $1 million benefit cap in summer 2009 • Options • Dad can quit job he loves & work for mega-firm that will take longer to be affected by high claims • Mom can go to work for a mega-firm. • Thomas’ father can divorce his mother to leave her & Thomas legally destitute & eligible for public programs.

13. Who Are the Uninsured? • Children • 25% • Unemployed • 5% • *Out of labor force • Employed • 20% • 50%

14. “…,people have access to health care in America. After all, you just go to an emergency room.” -No Longer President Bush

15. America’s Underinsured Proportion of Americans Going Without Care due to Costs, 2005 (skipping doctor visit, specialist appointment, treatment or prescription when needed) Source: Commonwealth Fund Biennial Health Insurance Survey, 2005

17. Medical Bankruptcy Illness & Medical Bills Contributed to 1,000,000 Personal Bankruptcies in 2004. (Half of All Bankruptcies) Insurance Status at Onset of Illness Uninsured Had Insurance Source: Himmelstein, Health Affairs 2005 (state estimates provided by author)

19. International Health Spending, 2005 U.S. Public Spending is Greater than Other Nations’ Public/Private Spending Combined Source: OECD 2007; Japan data are from 2004

20. The Healthcare AmericansWant Guaranteed access Free choice of doctor High quality Affordability Trust & respect

21. Other Industrialized Nations • Have similar demographics • Availability of expensive technology • Rising drug costs • Similar levels of service Why are their costs so much lower?

22. Why are costs lower in other countries? Administrative simplicity Lower prices Higher ratio of primary care to specialists Health planning Global budgets

23. If you were in an insurance CEO, who would you want to insure? 73% Percent of health Care Costs 80% uses less than $1000 of care per year 13% 6% 4% 0% 0% 0% 1% 1% 2% Source:Agency for Healthcare Research & Quality MEPS

24. The Health & Profitable to the “Market,” the Sick & Poor to the Taxpayer 73% Government Programs Percent of health Care Costs Private Insurers 13% 6% 4% 0% 0% 0% 1% 1% 2% Source:Agency for Healthcare Research & Quality MEPS

25. Rising Costs = Less Benefits = Under/Uninsurance Proportion of Americans Covered by Employer Insurance Source: US Census

26. Life Expectancy, 2005 (Data in Years)

27. Infant Mortality, 2005 (Deaths in first year of life per 10,000 live births)

29. Growth of Physicians & Administrators1970-2005 Source: Bureau of Labor Statistics & NCHS

30. One-Third of Health Spending is Consumed by Administration 31% 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

32. Costs to Business Skyrocketing costs for health care are hurting U.S. business: • Health care cost General Motors $5.6 billion in 2005 adding $1500 to the price of each car • Companies that offer coverage often pay 10% or more of payroll on health benefits and are at a disadvantage competing with companies that don’t offer coverage or where there is public coverage • Toyota located a new plant in Canada and Lifesavers moved a Michigan factory to Ontario

33. GM retiree cost is $60 Billion! Source: Wall St. Journal, March 11, 2004

34. 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: 1) Offer Coverage More Comprehensive than that Currently Available on the Private Market. 2) Control Costs so that Benefits are Sustainable.

35. Only Two Paths to Reform • Preserve Private Insurance Companies & their Waste • Create a National Health Insurance System

36. 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. • Hospitals guaranteed a secure, regular budget.

37. Financing Single-Payer Medicare Single-Payer Health Care Fund $$$ Medicaid Payroll Tax Income Tax Bonus: Negotiated formulary with physicians, global budget for hospitals,  primary & preventive care, bulk purchasing of drugs & medical supplies = long term cost control.

38. Health Savings Accounts • A bank account in which a limited amount of money may be deposited tax-free for expenditures on health services. • Must be paired with a “high-deductible” health plan. (e.g., $5,000). • First few thousand dollars are paid from the HSA, at some point, “catastrophic” coverage kicks in. • Theory: Patients now using “their own money” = better consumers = lower costs.

39. High-Deductibles = No Savings 73% Percent of health Care Costs 13% 6% 4% 0% 0% 0% 1% 1% 2% Source:Agency for Healthcare Research & Quality MEPS

41. Health Savings Accounts Won’t • Provide Meaningful Choice for Patients • Reduce Administration • Produce Savings Health Savings Accounts Will • Discourage Preventive & Primary Care • Create Huge New Administrative Waste • Produce Few Savings (a few sick people cost the most)

42. “Individual Mandate” “Let them buy insurance.”

43. Criminalizing the Uninsured:A Massachusetts Punitive Index *Note: Original version of House Bill would have suspended individuals’ driving licenses for uninsurance as well.

44. 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. • 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.

45. “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.

46. Single-Payer: Glen BartonFormer CEO, Caterpillar Inc. (Fortune 100)Past Chairman, Health & Retirement Task Force Business RoundtableRepresents 150 Largest EmployersTotal Assets: $4.0 Trillion “The quickest & simplest solution… is to go to a single-payer system”- Written Testimony to AHCTF, Feb. 1 2006

47. “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 company-wide financial crisis. You might even save money.” • -Joseph Antony, CNBC / MSN Money, Winter 2003

50. Is “The Perfect the Enemy of the Good?” • The central flaws of the “Obama” plan remain the central flaws of our current system • Uncontrolled Costs • Lack of Universal Coverage • Without eliminating the overhead of a patchwork for-profit system we will not achieve the system we deserve