Addressing Healthcare Crisis: Importance of a National Health Program by Mary E. O’Brien, M.D.

1. WHY THE UNITED STATES NEEDS A NATIONAL HEALTH PROGRAM Presented by Mary E. O’Brien, M.D. Columbia University Health Service Physicians for a National Health Program

2. PNHP MESSAGES 1. An unraveling insurance system is leaving more and more Americans feeling insecure about the high cost of health care and their access to it. 2. Our reliance on private insurance is responsible for the high cost. 3. Current proposals based on private insurance do not address the real problems we face.

3. PNHP MESSAGES 4.Only a single payer national health care insurance program that is publicly funded like Medicare will ensure comprehensive care for all. This program would cover all necessary medical services such as doctor visits, hospitalization, long-term care, prescription drugs, dental care, mental health, and preventive care .

4. Cumulative Changes in Health Insurance Premiums, Inflation, and Workers’ Earnings, 1999-2008 Note: Due to a change in methods, the cumulative changes in the average family premium are somewhat different from those reported in previous versions of the Kaiser/HRET Survey of Employer-Sponsored Health Benefits. See the Survey Design and Methods Section for more information, available at http://www.kff.org/insurance/7790/index.cfm. Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 2000-2008. Bureau of Labor Statistics, Consumer Price Index, U.S. City Average of Annual Inflation (April to April), 2000-2008; Bureau of Labor Statistics, Seasonally Adjusted Data from the Current Employment Statistics Survey, 2000-2008 (April to April).

5. National Health Expenditures per Capita, 1990-2007 Source: Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group, at http://www.cms.hhs.gov/NationalHealthExpendData/ (see Historical; NHE summary including share of GDP, CY 1960-2007; file nhegdp07.zip).

6. High Cost of Health Insurance Premiums: It’s Even Too Expensive for the Middle Class Today National Average for Employer-provided Insurance Single Coverage $4,479 per year Family Coverage $12,016 per year Note: Median household income = $50,233 Source: Kaiser Family Foundation/HRET Survey of Employee Benefits, 2007; U.S. Census Bureau, 2008

8. Impact of Unemployment Growth on Medicaid and SCHIP and the Number Uninsured $3.4 $1.4 State 1.1 1.0 = 1% & Increase in National Unemployment Rate Federal $2.0 Increase in Medicaid and SCHIP Enrollment (million) Increase in Uninsured (million) Increase in Medicaid and SCHIP Spending (billion) Source: Stan Dorn, Bowen Garrett, John Holahan, and Aimee Williams, Medicaid, SCHIP and Economic Downturn: Policy Challenges and Policy Responses, prepared for the Kaiser Commission on Medicaid and the Uninsured, April 2008

11. Characteristics of the Uninsured, 2007 Family Work Status Family Income Age Part-Time Workers 12% 0-18 20% 45-64 24% No Workers 19% 19-29 29% 30-44 27% 1 or More Full-Time Workers 69% Total = 45 million uninsured The federal poverty level was $21,203 for a family of four in 2007.SOURCE: Kaiser Commission on Medicaid and the Uninsured/Urban Institute analysis of March 2008 CPS.

14. Medical costs create serious financial problems for millions of us Source: Health Tracking Poll, Kaiser Family Foundation, April 2008

15. 18,314 Adult Deaths Annually Due to Uninsurance

16. 2. Our reliance on private insurance is responsible for the high cost. 3. Current proposals based on private insurance do not address the real problems we face.

18. International Comparison: Universal Coverage at Less Cost -- They Must Be Doing Something Right! Average spending on health per capita ($US PPP*) * PPP = Purchasing Power Parity. Data: OECD Health Data 2008, June 2008 version. All have a strong role for government in funding and regulating their health care system.

20. U.S. Health Costs are 70% Greater than the Median of Other Countries United States

21. The Outlier Nation: Our Public System Covers Fewer… United States Source: F. Colombo and N. Tapay, Private Health Insurance in OECD Countries, OECD 2004

22. While Private Insurance Dominates United States Source: F. Colombo and N. Tapay, Private Health Insurance in OECD Countries, OECD 2004

23. Private Insurers’ High Overhead International Journal of Health Services 2005; 35(1): 64-90

24. Billing and Insurance: Nearly 30% of All Health Care Spending 28%

30. Only a single payer national health care insurance program that is publicly funded like Medicare will ensure comprehensive care for all. • This program would cover all necessary medical services such as doctor visits, hospitalization, long-term care, prescription drugs, dental care, mental health, and preventive care .

32. Ten Percent of All Medicare Beneficiaries Account For More than Two Thirds of Medicare Spending Exhibit 13 6% 10% 2002 average = $5,370 per capita 69% Total Number of Beneficiaries: 41.8 million Total Medicare Spending: $224.5 billion SOURCE: Kaiser Family Foundation analysis of the Medicare Current Beneficiary Survey 2002 Cost and Use File.

33. Medicaid Enrollees and Expendituresby Enrollment Group, 2003 Elderly 9% Elderly 26% Disabled 16% Adults 27% Disabled 43% Children 48% Adults 12% Children 19% Total = 52.4 million Total = $252 billion Note: Total expenditures on benefits excludes DSH payments. SOURCE: KCMU estimates based on CBO and OMB data, 2004.

34. Rising Health Insurance and Medicaid Costs for City Government

35. Conyers: Expanded and Improved Medicare for All“single payer national health insurance” HR 676 Automatic enrollment Comprehensive benefits Free choice of doctor and hospital Doctors and hospitals remain independent Public agency processes and pays bills Financed through progressive taxes Costs contained through capital planning, budgets, emphasis on primary care

36. New – Sanders (& McDermott): American Health Security Act S 703 (HR 1200) Automatic enrollment Comprehensive benefits Operated by States using Federal standards Free choice of doctor and hospital Doctors and hospitals remain independent Public agency processes and pays bills Financed through payroll taxes

37. How Single Payer Could Be Paid For: One Example from a Recent Study of a California Plan

38. Billing and Insurance: Nearly 30% of All Health Care Spending 28%

40. COMPARE THE PUBLIC-OPTIONAND SINGLE PAYER Public-Option Single-payer Coverage Millions un-insured Universal and under-insured Automatic enrollment Cost $1.5 trillion over No additional cost 10 years How to pay Increase taxes; Redirect $363 billion Cuts to providers administrative waste Sustainability Use HIT, prevent Global budgeting; disease management capital planning

41. 2. Mandates Won’t Lead to Universal Coverage below 65 yrs Source: Sherry Glied et al, “Consider It Done? The Likely Efficacy of Mandates for Health Insurance,”, Health Affairs, 26(6), Nov/Dec 2007; Insurance Research Council, June 2006

42. Will We Get Real Health Care Reform Before the Premium Takes All our Income? Today Source: American Family Physician, November 14, 2005