IDIOT-PROOF US HEALTHCARE

1. Text and graphics by: Solveig Wilder, MSW Based on a class given in Spring 2006 at the CUNY Graduate Center for Worker Education by: Nick Unger –Health Advisor to TWU Local 100 and board member of Universal Healthcare Action Network (UHCAN). Featuring Guest Speakers: Dianne Archer- Medicaid Rights Center Jeff Gold – Working Families Party of New York Mark Hannay – Director of Metro NY Health Care for All Martha Livingstone, Ph.D.– Health and Society Department at SUNY Old Westbury Len Rodberg, MD - Physicians for a National Health Program (PNHP) With information and data from: Richmond, Julius B., MD, and Fein, Rashi, MD (2005): The Health Care Mess – How We Got Into It and What It Will Take To Get Out. Cambridge, MA: Harvard University Press. Bodenheimer, Thomas S., and Grumbach, Kevin (2005): Understanding Health Policy – A Clinical Approach (4th Edition). New York: Lange Medical Books/McGraw-Hill. IDIOT-PROOF US HEALTHCARE a.k.a. I-PUSH Plan

2. WHEN I WAS YOUNG • I was mostly healthy and did not give much thought to healthcare in the United States.

3. BUT THEN… • I became very sick.

4. AND ALL OF A SUDDEN… • I found myself caught up in the U.S. healthcare MAZE!!!

5. WITHOUT… • Money • Degrees • Friends in High Places • OR HEALTH INSURANCE!!!

6. I WAS NOT ALONE • There are 40 million UNINSURED Americans. • There are 31 million UNDERINSURED Americans. • These statistics do not include the 8 to 14 million undocumented workers and children living in America without healthcare coverage.

7. MOST UNINSURED AMERICANS ARE: • Between 19 and 64Low-Income • Employed Non-White

8. THE PROGNOSIS IS ABYSMALFOR AMERICANS WITHOUT HEALTHCARE • Uninsured Americans have 25 percent higher mortality rates. • Approximately 18,000 Americans die prematurely each year because they lack health insurance; • Uninsured women are 50 percent more likely to die of breast cancer. • 55 percent of uninsured Americans postpone getting help with ailments because they fear the cost. • 33 percent forego medical treatments deemed necessary; • 18 percent cannot afford to purchase prescribed medications; • Approximately 32,000 Americans forego life-saving medical treatments for heart disease. • Many children in uninsured households never see a doctor, including: • Approximately 270,000 children suffering from asthma; • Approximately 350,000 children with recurrent earaches; and • Approximately 350,000 children with severe sore throats. • Uninsured Americans account for approximately 50 percent of all bankruptcies.

9. EXPENDITURES ON HEALTHCARE IN THE USHAVE INCREASED DRAMATICALLY SINCE 1960

10. TOTAL HEALTH EXPENDITURESAS A PERCENT OF GROSS DOMESTIC PRODUCTARE HIGHEST IN THE US

11. COUNTRY COUNTRY INFANT MORTALITY LIFE EXPECTANCY-MEN RANKING (2002) RANKING (2001) LIFE EXPECTANCY FOR WOMEN RANKING (2001) Sweden Japan 2.8 78.1 2 2 84.9 1 Sweden Finland 3.0 77.6 4 3 82.1 9 Japan Switzerland 3.0 77.4 4 4 83.0 3 Spain Canada 3.4 77.1 6 5 82.2 8 Australia Norway 3.5 77.0 7 7 82.4 7 Austria Italy 4.1 76.7 8 8 82.8 6 Norway France 4.1 76.2 8 10 81.5 11 Germany New Zealand 4.3 76.0 11 11 80.9 17 Denmark Netherlands 4.4 75.8 12 13 80.7 18 Switzerland Spain 4.5 75.6 13 14 82.9 4 Italy Austria 4.7 75.6 14 14 81.5 11 Belgium Germany 4.9 75.6 16 14 81.3 14 France Australia 5.0 75.5 17 18 82.9 4 Netherlands Greece 5.0 75.4 17 19 80.7 18 Belgium Portugal 5.0 74.9 17 21 81.1 15 Ireland Denmark 5.1 74.7 20 22 79.3 27 Ireland Canada 5.4 74.7 23 22 79.7 26 Finland Greece 5.9 74.6 25 25 81.5 11 New Zealand United States 6.2 74.4 26 26 79.8 25 United States Portugal 7.0 73.5 28 27 80.3 21 Poland Hungary 7.2 70.2 29 32 78.3 32 Hungary Poland 7.5 68.1 30 35 76.4 34 BUT HEALTH OUTCOME RANKINGS FOR THE USARE AMONG THE WORST IN THE WORLD

12. GREAT BRITAIN HAS UNIVERSAL HEALTHCAREAND MUCH BETTER RESULTS

13. FINANCING: SINGLE-PAYER (mostly Government Financing) DELIVERY: SOCIALIZED (mostly Government-Run Facilities) ACCESS: OPEN TO EVERYONE UK NATIONAL HEALTH INSURANCE VS. US HEALTHCARE SYSTEM Tier 3 - Tertiary Care: Focus is on the most serious ailments that affect approximately 10 percent of the population. Patients are assigned to a Sub-Specialist for things like heart disease and spinal injuries. Progressive Tax: 82% Employer-Employee Contributions: 13% User Charges: 4% No distinction is made between the employed and unemployed, or social insurance and public assistance. Tier 2 - Secondary Care: Focus is on more serious ailments that affect approximately 10 to 50 percent of the population. Patients are assigned to a Specialist in things like surgery, neurology, OB/GYN, pediatrics, and psychiatry. Tier 1 - Primary Care: Focus is on treating common health problems and implementing preventive measures throughout the UK. Everyone is assigned a General Practitioner (GP), who is responsible for developing treatment plans, providing treatment for common health problems, monitoring health, and making referrals for more serious health problems.  FINANCING: MULTI-PAYER DELIVERY: MULTIPLE PROVIDERS ACCESS: OPEN TO SOME CITIZENS For-Profit Agencies Government (Regressive Tax) Hospitals Those with MONEY Schools & Universities Private Insurers Non-Profit Agencies Mental Institutions Those with INSURANCE Employers Nursing Homes Private Practice Individuals Research Programs The DESERVING POOR

14. THE INSTITUTE FOR MEDICINE OFFERS FOUR PROTOTYPES FOR HEALTHCARE REFORM IN THE US PROTOTYPE 1: MAJOR PUBLIC PROGRAM EXPANSION AND NEW TAX CUTS • Employer-based health coverage would remain as is. • Employers would not be required to provide any more health coverage than they do now, and tax breaks for employers and untaxed health benefits for employees would continue. • Tax credits would be given to individuals who purchase healthcare coverage from private insurers. • Medicare would be offered to Americans at age 55 for a modest premium. • Medicaid and SCHIP would be combined. PROTOTYPE 2: EMPLOYER MANDATE, PREMIUM SUBSIDY, AND INDIVIDUAL MANDATE • All citizens would have healthcare coverage from either the government, their employers, or private insurers. • Employers would be required to provide healthcare coverage for all employees and contribute to employee premiums. • The federal government would subsidize the healthcare costs of employers of low-wage workers. • Medicare would remain as is, while Medicaid and SCHIP would be combined. PROTOTYPE 3: INDIVIDUAL MANDATE AND TAX CREDIT • All citizens would be required to secure healthcare coverage through the private market. • The federal government would provide all citizens with an advance, refundable tax credit. • State governments would regulate healthcare insurance. • Medicare would remain as is, while Medicaid and SCHIP would be eliminated. PROTOTYPE 4: SINGLE-PAYER SYSTEM • All citizens would be enrolled in a single, comprehensive healthcare program. • All citizens would have the option to purchase supplemental healthcare coverage for services not covered. • The government would monitor but not manage healthcare delivery. • Costs would be contained with “global budgets” and caps.

15. PRESIDENT GEORGE W. BUSH SUGGESTED MORE MODEST REFORMS IN HIS STATE OF THE UNION ADDRESS HEALTH CARE FINANCING WHO WILL PAY? Healthcare will pay for itself with money saved from “health savings accounts,” and by curtailing lawsuits, closing loopholes, privatizing healthcare, and increasing efficiency (i.e., reducing medical errors and increasing the use of electronic records). WHO WILL BENEFIT? American business, because it keeps them “competitive;” the elderly; and “the needy.” WHO WILL SACRIFICE? Virtually no one, because it “eliminates the need for sacrifice.” HEALTH CARE DELIVERY HEALTHCARE DELIVERED BY:more private agencies and fewer government agencies. UNCLEARhow healthcare will be organized. UNCLEARwhat the quality of healthcare will be. HEALTH CARE ACCESS HEALTHCARE AVAILABLE TO:“All Americans.” UNCLEARhow all Americans will access healthcare. UNCLEARwhat the barriers to access will be.

16. SO FAR, ATTEMPTS TO INTRODUCE UNIVERSALUS HEALTHCARE HAVE FAILED MISERABLY • W E W A N T C H O I C E ! • W E W A N T F R E E D O M ! • W E D O N ’ T W A N T T O W A I T ! • W E W A N T T O D E C I D E ! • N O B I G G O V E R N M E N T ! • N O N E W T A X E S ! • I T ’ S A S L I P P E R Y S L O P E T O S O C I A L I S M !

17. BUT I PREDICT AMERICANS ARE GOING TO LOVE IDIOT-PROOF US HEALTHCARE

18. IDIOT-PROOF US HEALTHCAREIS SO EASY TO UNDERSTAND HEALTH CARE FINANCING WHO WILL PAY? Federal/State governments with funds from a progressive tax (Single-Payer). WHO WILL BENEFIT?Virtually everyone. WHO WILL MAKE SACRIFICES? Rich people with VERY little time to spare. HEALTH CARE DELIVERY HEALTHCARE DELIVERED BY: Government-Run Agencies (Single-Provider). HEALTHCARE ORGANIZED: As simply and comprehensively as possible, with a heavy emphasis on general practitioners. QUALITY ASSURED BY: Top-notch computer tracking systems and quality assurance teams staffed with consumer advocates. HEALTH CARE ACCESS HEALTHCARE AVAILABLE TO:Everyone in the US, including immigrants and tourists. BARRIERS TO ACCESS: All barriers related to financial circumstances, employment, geography, demographics, etc., will be eliminated – along with the paperwork!

19. AND IDIOT PROOF US HEALTHCARE IS SO EASY FOR CONSUMERS AND PROVIDERS TO MANAGE FINANCING: SINGLE-PAYER (Government Financing) DELIVERY: SOCIALIZED (Government-Run Facilities) ACCESS: OPEN TO EVERYONE IN THE UNITED STATES Tier 3 - Tertiary Care: Focus is on the most serious ailments that affect approximately 10 percent of the population. Patients are assigned to a Sub-Specialist for things like heart disease and spinal injuries. NO DISTINCTIONS ARE MADE BETWEEN: • Employed/Unemployed • Social Insurance/Public Assistance • Citizens/Aliens • Progressive Tax: 90% Employer: 10% Consumer: Not a Red Cent Tier 2 - Secondary Care: Focus is on more serious ailments that affect approximately 10 to 50 percent of the population. Patients are assigned to a Specialist in things like surgery, neurology, OB/GYN, pediatrics, and psychiatry. Tier 1 - Primary Care: Focus is on treating common health problems and implementing preventative measures throughout the US. Everyone is assigned a General Practitioner (GP), who is responsible for developing treatment plans, providing treatment for common health problems, monitoring health, and making referrals for more serious health problems.

20. IDIOT-PROOF US HEALTHCARE COMBINES THE BEST IDEAS FROM LEADING PROPONENTS OF HEALTHCARE REFORM • Dr. Len Rodberg of Physicians for a National Health Program (PNHP)says National US Healthcare MUST: • Guarantee automatic enrollment in a national healthcare program that is publicly financed; • Be critically supervised to guard against “parasitic companies.” • Dianne Archer of the Medicaid Rights Center says National US Healthcare MUST BE: • Modeled after the US Medicare program, which works because it is: • Affordable; • Automatic; • Able to negotiate prices; • Reliable and efficient; • Shares costs and benefits across the American spectrum. • Mark Hannay of Metro Healthcare for All and Professor Martha Livingstone of SUNY Old Westbury says National US Healthcare MUST BE: • A Single-Payer system, which is a financial reform, not a systemic reform; and is social insurance, not socialized healthcare. Both Mark Hannay and Professor Livingstone would like to see things “go further.” But single-payer healthcare reforms would move us a step forward. • Instead of healthcare being a “for profit enterprise,” it will come out of our taxes (progressively); • It is portable coverage, so we won’t lose our coverage when we move from job to job; • It will cover all “necessary” treatment, as well as preventive healthcare measures. Jeff Gold of the Working Families Party (WFP) say National US Healthcare MUST BE: • Universal; • Portable and long term; • Equitably financed; • Flexible regarding choice of provider and treatment; • Readily available in even remote areas; • All-inclusive, covering all physical, mental, and pharmaceutical healthcare needs.

21. ALL AMERICANS WILL BE GIVEN THE OPTION TOWITHDRAW FROM IDIOT-PROOF US HEALTHCARE • Just go to WWW.IPULLOUT.COM. • Click on “I Don’t Want Idiot-Proof US Healthcare.” • Fill out the form designed to ensure that you are a US citizen of sane mind and body capable of making complex choices about your health and well-being. • After a background check of your health records, you will be interviewed by an Idiot-Proof US Healthcare Specialist. • You will be asked to sign a consent form stating that you understand refusing Idiot-Proof US Healthcare will leave you without coverage in the event of any and all illnesses. • You will receive notice in the mail of your removal from Idiot-Proof US Healthcare. • Your employer and family members will be informed of your decision. • Each year, you will receive a rebate check of about $2,516 – the average amount spent in 2003 on healthcare in Canada by the government ($1,886 USD) plus private sources ($630 USD) per person. • BUT PLEASE NOTE: The average amount spent in 2003 on healthcare in the US by the government was $2,548, and by private sources was $2,719 – totaling $5,267 per person.

22. AMERICANS CAN ALSO CHOOSENOT TO PUT UP THE MONEY FOR NON-CITIZENS • Just call 1-800-I-PUT-OUT, and an Idiot-Proof Call Representative will be ready to assist you. • At the end of each year, you will receive a rebate check calculated by dividing the total estimated cost of undocumented workers to State and Federal US governments by the total number of US citizens. For example, in 2002, a 10.4 billion dollar net loss would be divided by 300 million, resulting in a rebate check of $34.66.* * See http://aad.english.ucsb.edu/services.html

23. Dr. Len Rodberg of Physicians for a National Health Program (PNHP) Keeping it simple and making it work with what’s already out there! Mark Hannay of Metro Healthcare for All. Accepting that US healthcare policy is inextricably intertwined with politics; Realizing that a good idea alone is not enough; Beating back bad ideas like the ones presented by President Bush in his State of the Union Address; Building a movement on all levels – local, state and federal – and staying abreast of municipal, state and federal healthcare proposals; Stressing moral, medical, public health, and economic imperatives; Building alliances with religious, civil rights, medical, public health, labor, and business groups. Dianne Archer of the Medicaid Rights Center Letting Americans know that the current US public healthcare system is not bad and is not “broken;” Making sure the issue of National Healthcare remains at the forefront of the political debate, and actively engage the media; Exposing the narrow interests of those who are opposing national healthcare, including private insurers, pharmaceutical companies, and other powerful business groups; Stressing the financial benefits of national healthcare. Jeff Gold of the Working Families Party (WFP) and Professor Martha Livingstone of SUNY Westbury Recognizing that healthcare issues cut across the political spectrum, and can promote unity across racial, ethnic and class lines; Recognizing that the struggle for healthcare is also a separate and distinct one that should not just piggyback on other struggles. DESPITE CRIES FROM EVERY CORNER AGAINSTSOCIALIZED MEDICINE, WE WILL RALLY SUPPORTFOR IDIOT-PROOF US HEALTHCARE BY…

24. 10. You and your loved ones will live longer; 9. You and your loved ones will get sick less often; 8. You and your loved ones will live with less pain; 7. You and your loved ones will have fewer financial worries; 6. You and your loved ones will be more likely to receive only appropriate and warranted treatment; 5. You and your loved ones will be less likely to contract communicable diseases; 4. You and your loved ones will be much less likely to be fleeced when seeking cutting-edge treatments and life-saving prescription drugs; 3. You and your loved ones will no longer be consumed with guilt over disparities in health care along racial, ethnic, gender and economic lines; 2. In the event of a catastrophe (i.e., terrorist attack, nuclear warfare, global warming, etc.), you and your loved ones will be less likely to be left to die… TOP-TEN REASONS TO SUPPORT IDIOT-PROOF US HEALTHCARE:

25. AND THE NUMBER ONE REASON FOR SUPPORTING IDIOT-PROOF US HEALTH CARE IS: No American should ever have to suffer the way I did when I became sick without healthcare insurance!!! E PLURIBUS UNUM!!! SO PLEASE, DON’T BE AN IDIOT. SUPPORT UNIVERSAL HEALTHCARE FOR ALL!!!