National Health Insurance: Has Its Time Come?

1. National Health Insurance:Has Its Time Come? Walter Tsou, MD, MPH Physicians for a National Health Program NASW-PA October 17, 2005

2. What is the health policy of the United States of America? How much will the US spend this year for health care? Two Questions?

3. “Iron Triangle of Health Policy” Access to Care Cost Containment Quality of Care

4. Looking at Costs

5. Health Care Costs at $1.9 Tr in 2005 and almost doubles in 9 years. Total for Decade? $27 Trillion!! 2005 06 07 08 09 10 11 12 13 2014 Source: Projected from Natl Health Expenditures, Health Affairs, Feb. 23, 2005

6. National Health Expenditures (NHE) Share of Gross Domestic Product (GDP) and Private and Public Shares of NHE Private funds Public Public funds Source: Heffler, et al. 2005. U.S. Health Spending Projections For 2004-2014. Health Affairs, web-exclusive: w5-74 – w5-85.

7. Private insurance is covering less Source: Sept. 23, 2004, AP

8. People under 65 with catastrophic health costs despite health insurance, 2004 Source: Families USA, Sept 2004

9. Our Current Health System is Absurdly Inefficient

10. Growth of Physicians and Administrators1970-1998 Source: Bureau of Labor Statistics & NCHS

11. US spends far more than other countries on health care OECD, Health Expenditures per capita, 1998

12. U.S. Public Spending Per Capita for Healthis Greater than Total Spending in Other Nations Note: Public includes benefit costs for govt. employees & tax subsidy for private insuranceSource: NEJM 1999; 340:109; Health Aff 2000; 19(3):150

13. Looking at Quality

14. Primary Care Physicians: Patients Can't Get Quality Mental Health Services Source: Center for Studying Health System Change, 1997 - survey of 5,160 primary care physicians Note - Data shown are for inpatient care; responses regarding outpatient care were similar

15. Life Expectancy For Women, 1999 Source: OECD, 1999 & NCHS

16. Life Expectancy For Men, 1999 Source: OECD, 1999 & NCHS

17. US Health Expenditures vs Female Life Expectancy by country-not a good deal! Health Expenditure Life - Expectancy Source: OECD 2004

18. Looking at Access

20. 45.8 MillionUninsured Source: US Census, 2004

21. Growing number of uninsured in PA • 10,724,000 insured (88%) • 1,454,000 uninsured over one year (12%)

22. Number of uninsured is actually worse than census statistics • Pennsylvania uninsured at any given time - 2,820,000 or 27.4% of the state’s population • United States uninsured at any given time - 85,216,000 or 33.3% Source: Families USA, Sept 2004

23. Looking at Malpractice

24. Rex Morgan, MD on Malpractice

25. Philadelphia Malpractice Rates, 2004 by specialty Source: PA Medical Society, 2004

26. Malpractice • Economic vs. Non economic damages

27. Economic Damages • Lost wages • Huge loss in high wage earners • Current and future health care costs • Huge loss without universal coverage

28. Non economic damages • To cap or not to cap? That is the question

31. Phila vs. Ontario malpractice premiums, 2004 Source: PA Medical Society, Canadian Medical Protective Assoc, US Dollars, 2004

32. Phila vs. Ontario by high malpractice specialties, 2004 Source: PA Medical Society, Canadian Medical Protective Assoc, US Dollars, 2004

33. Possible Reasons for Less Malpractice Fees in Canada • Much less money is spent on health care • Access to preventive services for all • Under universal coverage, all future health care costs covered by health care system • 95% of docs covered by Canadian Medical Protective Association, a non profit entity • Malpractice fees paid for by provinces

34. Perspectives on Health Care Reform • Managed Competition • Managed Care • Health Savings Accounts • National Health Insurance

35. Balanced and Comprehensive Health Care Reform Act of 2005

36. Highlights of the State Reform proposal • Comprehensive health, dental, mental health and Rx drug benefits for all • Free choice of private doctors, dentists, hospitals • No deductibles, co-pays, caps • Can opt out if bargaining agreement as comprehensive as Reform proposal

37. Choice of “no fault” malpractice vs. current tort remedies • No-fault malpractice assures payment to victims • Funding for electronic medical record system • Investigations of medical errors • Sufficient savings with single payer will fund all malpractice premiums for doctors, NPs

38. Added incentives • $1000 tax credit for certified volunteer firemen, EMTs, paramedics • Restoration of certificate of need • K-12 health education and phys ed funding • Transitional funding for displaced workers

39. Public financing, Private delivery

40. Funding of Reform proposal • 10% Health Care levy on payroll • 3% wellness tax on personal income • 1% tax on personal income for qualifying bargaining agreement plans

41. Physician Proposal in JAMA, Aug. 2003 www.physiciansproposal.org

42. Congress introduces Physician Proposal Conyers Himmelstein Angell House Judiciary Committee Room, Feb 4, 2003

43. US National Health Insurance Act

44. Simplified flow of funds Public Private

45. Universal Health Care will cost less now

46. Economies of Scale Saves Money

47. Sources of Revenue for NHI

48. NHI will save $5000 per capita by 2024

49. How can we get there? • Business community • American public

50. Government is the “swing” vote Business People Government