The PNHP Vision for National Health Insurance in the United States

1. The PNHP VisionforNational Health Insurancein the United States Oliver Fein, M.D., Chair Physicians for a National Health Program Metro NY

2. The PNHP Program for NHI What will the delivery system look like? • Most physicians are in private or group practice and paid fee-for-service, although salary and capitation payment possible • Hospitals are non-profit governed by local Boards of Trustees • Complete free choice of physician and hospital.

3. The PNHP Program for NHI What will the insurance system look like? • Everybody has insurance: citizens, legal immigrants, and the undocumented • Eligibility is defined by length of residency • Everybody receives an NHI card • There is universal coverage “Everybody in, nobody out”

4. The PNHP Program for NHI Universal coverage means more than who is covered, it means the same coverage for everybody • Coverage does not depend on your employment status, your age or your income • Coverage must be adequate for everybody, including the poor • This means no co-payments or deductibles, no need for a Medicaid-like program

5. The PNHP Program for NHI Universal coverage means no more tiering in health care • No private insurance will duplicate the public coverage. • Private insurance would be allowed to cover what is not covered by the NHI – such as cosmetic procedures.

6. The PNHP Program for NHI Benefits will cover “All medically necessary services” including: • Hospital care • Physician services • Mental health services • Medication expenses • Home care • Nursing home care • Dental care • Vision care

7. The PNHP Program for NHI Will there be any exclusions? • Determined by your local health board • Private rooms, unless medically necessary • Private duty nurses, unless medically necessary • Botox for wrinkles? • Elective Facial cosmetic surgery?? • ? Viagra – good sex is good for health – covered!!

8. The PNHP Program for NHI How will the inclusions/exclusions be decided? • Evidence-based medicine • Patient preference • Coverage board, including health professionals, patients, the public, health care advocates

9. The PNHP Program for NHI Why is the Program called “single payer” NHI? • Because there is a singleinsurer paying hospitals, doctors, pharmacies, nursing homes • Because there is no other way to avoid “cherry-picking” by private, for-profit insurance companies  • Because it results in the lowest administrative costs: Medicare=2-3% vs private insurance=16-30% • Because it returns the largest amount of money to the care of patients: 97% for Medicare; 70-84% for private insurance.

10. Private insurers’ High Overhead

12. The PNHP Program for NHI How do we pay for single payer NHI? • Not with premiums: they are regressive • With a payroll tax: Medicare Part A (presently equals 1.45% from employee + 1.45% from the employer)   • With income taxes: improved Medicare Part B – no beneficiary contribution

13. The PHNP Program for NHI Can we afford single payer NHI? • The gap between Canadian (single payer) and US (1500 private insurers) amounts to $298 billion/year. (NEJM August 21, 2003) • If we move from our multi-payer to a single-payer we will save $298 billion/year • With these administrative savings, all the uninsured and underinsured could be covered, without increasing costs to the overall system

14. Bureaucracy: U.S. vs. Canada, 2003 Money Spent Per Capita on Administrative Costs (includes insurance, hospital and physician administrative costs) Source: “Administrative Waste in the U.S. Health Care System,” Woolhandler, Himmelstein & Wolfe

15. Who Delivers Health Care? Growth in Physicians and Administrators since 1970 Source: BLS & Himmelstein/Woolhandler/Lewontin Analysis of CPS Data

16. Is single payer NHI politically feasible? • Employers face international competition. • Health insurance is not the insurance industry’s most lucrative product – no long term investment benefit • With the growth of underinsurance - increased out-of-pocket expenses (premium shifts from employer to employee, increased co-pays, growth of health savings accounts) all Americans are affected!

17. HARRIS POLL: “Government Should ProvideQuality Medical Coverage to All Adults . . .” Source: USA Today/Harris Poll - 11/23/98

18. SUPPORT ACROSS POLITICAL PARTIES TO EXPAND MEDICARE BENEFITSPercent who favor each proposal when arguments for and against are presented… Having Medicare cover long-term Nursing home care “even if it means higher premiums or taxes” Having Medicare cover prescription Drugs “even if it means higher premiums or taxes” Expansion of Medicare so that people Aged 62-64 are able to buy into the program before they turn 65 Source: Kaiser Family Foundation/Harvard School of Public Health National Survey on Medicare, 10/20/98 (conducted Aug-Sept 1998)

19. Americans Pay World’s Highest Taxes For Healthcare Per Capita Health Spending, 2002 OECD and “Paying for National Health Insurance—And Not Getting It” Health Affairs: July / August 2003

20. The PNHP Program for NHI(The Physicians’ Proposal)JAMA 2003: August 13 Single-payer National Health Insurance • Universal coverage • Comprehensive coverage • Progressive financing • Low administrative costs • Non-profit delivery system

21. What can you do about health reform? • Pro-active efforts on the federal level • John Conyers: HR 676: National Health Insurance Act • Barbara Lee: US National Health Service Act • Jesse Jackson, Jr.: Constitutional amendment – health as a human right • Wellstone/Baldwin: Federalist approach – incentives for State reform • Bush: Community Health Centers Act

22. What can you do about health reform? • Pro-active efforts on the state level • California: Options Commission - Kuehl state single-payer bill • Massachusetts: Constitutional amendment – health as a human right • Maine: Dirigo – Subsidized private insurance • Maryland: Pay or play • New York: Gottfried – Commission for Healthcare Options

23. What can you do about health reform? 3. Incremental Reforms • Medicare expansions: down to age 60 or 55 or 50; children up to age 18; unemployed • Employer-mandate laws • NYC: Health Security Act – Quinn • Market-based reforms: Healthy-NY • Community Health Centers Act

24. What can you do about health reform? 4. Defensive Fights • Stopping the privatization of Social Security • Repealing portions of the MMA: donut-hole Rx coverage, prohibiting Medicare from negotiating prices with Pharma, subsidies to HMOs (Medicare-Advantage), HSAs • Fighting Medicaid cutbacks: block grants and waivers

25. What can you do about health care reform? 5. Reactive Fights • Stop Health Savings Accounts (HSAs) • Expose Consumer Driven Health Care (CDHC) • Evaluate Tax Credits • Support alternatives to caps on non-economic damages in malpractice reform • Oppose trade agreements: result in higher drug prices abroad

26. The Institute of Medicine says: • Between the health care we have and could have, lies not just a gap but a chasm • The American health care delivery system in need of a fundamental change • The challenge is the enormity of the change required Common Sense: “You cannot cross a chasm in two jumps”

27. PHYSICIANS FOR A NATIONAL HEALTH PROGRAM (PNHP) says: • We’ve tried and failed with incremental reforms for 100 years • The time has come for single-payer National Health Insurance-an improved Medicare-for-All.

28. REFERENCES AND CONTACTS • Bodenheimer TS, Grumbach K. Understanding Health Policy: A Clinical Approach. Appleton & Lange. 2005. • California Health Options Project: 9 different plans ranging from Medical Savings Accounts to Single Payer Plans are compared. www.healthcare.options.ca.gov • Commonwealth Fund, One East 75th Street, New York, NY 10021. www.cmwf.org • Himmelstein D, Woolhandler S, Hellander I. Bleeding the Patient: The Consequences of Corporate Healthcare. Common Courage Press, 2001. • Physicians for a National Health Program (PNHP), 29 East Madison St., Rm. 602, Chicago, Ill 60602. www.pnhp.org. PNHP-NY, 2753 Broadway #198, New York, NY 10025. www.pnhpnyc.org.