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Single Payer National Health Insurance

Explore the exorbitant costs of the US healthcare system, reflecting high drug prices, administrative expenses, and costly procedures compared to other countries. Learn about the potential benefits of a single-payer national health insurance system and HR 676, the Improved and Expanded Medicare for All Act.

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Single Payer National Health Insurance

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  1. Single PayerNational Health Insurance Ed Weisbart, MD, CPE, FAAFP Chair, PNHP-MO Unpaid volunteer No conflicts of interest to disclose

  2. We’re Number 28 in Life Expectancy 2014 Life Expectancy at birth 2014 data from OECD accessed Nov 29 2016 https://data.oecd.org/healthstat/life-expectancy-at-birth.htm

  3. The Most ExpensiveHealth Care System In the World Annual per capita dollars spent on health care Data are for 2015 US$ Purchasing Power Parity OECD data accessed Nov 29, 2016

  4. Source: Himmelstein & Woolhandler– Analysis of NCHS data Taxes Already Fund 2/3 of USA Health Spending Tax Funded 65%

  5. Why Do We Spend So Much? Prices Complexity

  6. We Pay the World’s Highest Prices USA $225 USA $6,214 USA $3,903 USA $215 New Zealand $989 UK $862 Canada $51 Netherl $23 2013 data from the International Federation of Health Plans 2013 US Dollars; scales differ by group; includes hosp. and physician charges Surgery prices includes hospital and physician charges https://static1.squarespace.com/static/518a3cfee4b0a77d03a62c98/t/534fc9ebe4b05a88e5fbab70/1397737963288/2013+iFHP+FINAL+4+14+14.pdf

  7. Source: OECD, Health at a Glance, 2015 Note: Data are for 2013 or most recent year available. OCED average includes 29 developed nations. USA Spends the Most on DrugsDouble the OECD Average Per capita spending on retail prescription drugs

  8. Many Of Us Now Buy Our Medications Outside the USA 19,000,000 Americans November 2016 Four-fold increase above 2011 estimate http://khn.org/news/faced-with-unaffordable-drug-prices-tens-of-millions-buy-medicine-outside-u-s/ Accessed Dec. 20, 2016

  9. Most Americans Agree:Let Medicare Negotiate Drug Prices 93% 83% 74% Kaiser Health Tracking Poll: August 2015 http://kff.org/health-costs/poll-finding/kaiser-health-tracking-poll-august-2015/?hsCtaTracking=b83fa145-a15e-4dde-97bd-6af7345cf8cc%7C967c3ed4-a616-43e2-bde6-942262110026&utm_campaign=Polling%2FSurveys&utm_medium=email&_hsenc=p2ANqtz--wGt-xP58SnHQezk8r-V4AkUV7KoS5PMX07O5nsXksZsqhUfJc1gPZlvgeSwCbGYkajTPxImTh0n0vTbUbqWI7s3eYiQ&_hsmi=21447283&utm_source=hs_email&utm_content=21447283

  10. We Pay the World’s Highest Prices USA $225 USA $896 USA $6,214 USA $13,910 USA $3,903 USA $215 USA $10,002 New Zealand $989 UK $862 Canada $51 Spain $2,251 Argent. $1,723 Canada $97 Netherl $23 2013 data from the International Federation of Health Plans 2013 US Dollars; scales differ by group; includes hosp. and physician charges Surgery prices includes hospital and physician charges https://static1.squarespace.com/static/518a3cfee4b0a77d03a62c98/t/534fc9ebe4b05a88e5fbab70/1397737963288/2013+iFHP+FINAL+4+14+14.pdf

  11. 750,000 Americans Travel Abroad for health care each year What Kind of Care? Where? • Cardiac Surgery • Orthopedic Surgery • Cosmetic Surgery • Oncology • Dentistry • Thailand • Mexico • India • Singapore • Malaysia • Cuba • Brazil • Argentina • Costa Rica http://wwwnc.cdc.gov/travel/yellowbook/2016/the-pre-travel-consultation/medical-tourism Accessed Sept 23 2015

  12. Americans Don’t Often Go to Physicians Annual physician visits per capita, 2015 Source: OECD data, accessed 11/29/2016

  13. We Don’t Have Very Many Physicians Practicing physicians per 1,000 people http://international.commonwealthfund.org/stats/number_practicing_physicians/ Accessed Dec 2 2017

  14. Bureau of Labor Statistics; NCHS; Himmelstein/Woolhandler analysis of CPS Managers shown as moving average of current year and two previous years We Have Plenty of Administrators It takesa lot of people to impede access to care. Most US hospitals now have more staff in the billing department than beds. Growth since 1970

  15. Source: HimmelsteinD et al. Health Affairs Sept. 2014 Updated Nov. 2015 Hospital Administration Becoming Increasingly Expensive USA Hospital Administration Costs as a percentage of GDP

  16. Billing and Insurance-Related (BIR) AdminCosts Are 18% of Our Total Expense Public Insurers 1.3% Non-BIR Admin: 9.4% Clinical Care: 72.7% Private Insurers 7.5% Physicians 2.7% BIR: 18% Hospitals 2.8% Other Services 3.6% Jiwani et al. BMC Health Services Research 2014, 14:556 www.biomedcentral.com/1472-6963/14/556

  17. Why Do We Spend So Much? Prices Complexity

  18. Before We Solve All of This…

  19. We Can Learn From Other Nations • National Health Service • National Health Insurance • Wild Wild West Health Insurance • Public Funding • Public Delivery • Great Britain • Veterans Administration • Socialized medicine • Public Funding • Private Delivery • Canada • Medicare • Mixed Funding • Mixed Delivery • High cost, mixed quality and access • Only in the USA

  20. Something Fabulousfor the USA • National Health Insurance “The Improved and Expanded Medicare for All Act” HR 676 • Public Funding • Private Delivery • Canada • Medicare

  21. HR 676:National Health Insurance Improve Medicare Expand Medicare • Comprehensive benefits • Eliminate financial barriers to care • No need for “Medicare supplemental” or “wrap” or “Advantage” • All Americans, including Congress • Roll up most other programs • No need for state-based programs like Medicaid

  22. HR 676:National Health Insurance Publicly Funded Privately Delivered Patient-Centric • Public agency organizes health care finance • Reduced administrative burdens on practice • Patients regain choice of physicians and hospitals

  23. What Is “Single Payer”? Also known as “National Health Insurance” also known as “Medicare for All” “Single Payer”

  24. National Health InsuranceMakes Economic Sense $ Billions Increased market power (better pricing on drugs and devices) Admin costs to providers (hospitals and physicians) Increased utilization (home health, dental, etc.) Covering the uninsured Health insurance admin Medicaid Rate Adjustment Gov. admin ($23B) New Costs New Savings Analysis of HR676 Friedman, G. Dollars & Sense. March/April 2012

  25. Excessive Expense on BIRIsUniquely American $ Billions Jiwani et al. BMC Health Services Research 2014, 14:556 www.biomedcentral.com/1472-6963/14/556

  26. Excessive Expense on BIRIs Uniquely American Total Annual BIR $471Billion BIR Equivalent in Single Payer Countries $96 Billion 80% of our BIR isdriven by our unique multi-payer model Added Annual BIR in the USA $375 Billion Jiwani et al. BMC Health Services Research 2014, 14:556 www.biomedcentral.com/1472-6963/14/556

  27. How Much Is $375 Billion / year? $375 billion is a lot of money we could be spending on other things. Jiwani et al. BMC Health Services Research 2014, 14:556 www.biomedcentral.com/1472-6963/14/556

  28. Why Base the Solution On Medicare?

  29. Medicare Makes Americans Healthier Men USA Rank Medicare Eligibility Women Age Institute of Medicine. Shorter Lives, Poorer Health. Fig 1-9: Ranking of US mortality rates by age group among 17 peer countries, 2006-2008. 2013 Peer nations are Australia, Austria, Canada, Denmark, Finland, France, Germany, Italy, Japan, Norway, Portugal, Spain, Sweden, Switzerland, Netherlands, United Kingdom

  30. Medicare Is Highly Efficient Insurance Overhead Q1 2016 Medicare Parts C and D Source: Day, Himmelstein, Broder, Woolhandler– Int. J Health Serv 2014 Updated data from firms’ SEC filings (Q12016) Overhead = (Premium revenue – Medical Expenses) / Premium Revenues Medicare updated with 2016 Medicare Trustee Report 2012 data as cited by Kip Sullivan, Journal of Health Politics, Policy, and Law. Vol 38, No. 3, June 2013 DOI 10.1215/03616878-2079523 available at http://www.pnhp.org/sites/default/files/Medicare_admin_costs_JHPPL.pdf .

  31. The Grand Experiment • 1971 • USA • HMO Act signed into law • 1971 • Canada • National Health Insurance fully implemented

  32. Sources: Statistics Canada, Canadian Inst. for Health Inf., and NCHS/Commerce Dept. The Grand Experiment HMO Act Passed USA Health costs % of GDP NHP Fully Implemented Canada

  33. The Grand Experiment 14% of Americans Have Unmet Health Needs 11% of Canadians Have Unmet Health Needs 5%: Other reasons 14% 11% 4%: Other reasons 8%: Cost 1%: Cost 6%: Wait or unavailable 1%: Wait or unavailable Ages 18-64 NBER Joint Canada / US Survery of Health www.nber.org/papers/w13429.pdf Table 12, accessed Sept 2 2015

  34. The Grand Experiment Life Expectancy Gap (CA minus US) (years) Source: http://stats.oecd.org/index.aspx?DataSetCode=HEALTH_STAT# Accessed 12/4/2016

  35. The Grand Experiment Canadians now spend half as much as we do, have less unmet health needs, and live 2½ years longer.

  36. How Would National Health InsuranceImpact Physicians?

  37. USA Physician Satisfaction Is Low Percent of primary care doctors saying they are satisfied or very satisfied http://www.commonwealthfund.org/interactives-and-data/chart-cart/in-the-literature/2012-a-survey-of-primary-care-doctors-in-ten-countries/physician-satisfaction-with-practicing-medicine Accessed Aug 5, 2016

  38. More Time on Administration –Lower Career Satisfaction Physician hours per week on non-clinical documentation/ communication National survey of physicians Woolhandler & Himmelstein. Int J Health Serv. 2014;44:635 Administrative time excludes time spent on patient-related documentation and communication

  39. An Average Week of Family Medicine in Canada Canadian FPs average 2.4 hours per week on non-clinical administration Includes GPs; Excludes on-call hours 2013 National Physician Survey. CFPC, CMA, Royal College www.cma.ca/Assets/assets-library/document/en/advocacy/Family-e.pdf Accessed April 6 2015

  40. More Time on Administration –Lower Career Satisfaction Physician hours per week on non-clinical documentation/ communication National survey of physicians Woolhandler & Himmelstein. Int J Health Serv. 2014;44:635 Administrative time excludes time spent on patient-related documentation and communication

  41. Source: Sinsky et al. Ann Int Med 9/6/2016 – based on time/motion observation + home diary Note: Figures are percent of office hours – exclude the 1-2 hrs/night of home EHR/desk work USA Doctors Spend Twice as Much Time onEHR/Desk Work as With Patients

  42. It’s Less Expensive to Practice in Canada Canada USA Practice overhead (family physicians) 28.2% 55% 2014 data; Canadian dollars Source: Canadian Medical Protective Association www.cmpa-acpm.ca http://medicaleconomics.modernmedicine.com/medical-economics/content/tags/2013-salary-survey/competition-driving-malpractice-premiums-down?page=full http://www.merritthawkins.com/pdf/2008-mha-survey-primary-care.pdf

  43. *Ontario reimburses physicians for premiums above 1986 level. All figures in Canadian $s. Source: Canadian Medical Protective Association www.cmpa-acpm.ca Canadian Malpractice Insurance Costs, 2017

  44. Source: Canadian Institute for Health Information Figures are in Canadian $ Canadian Physicians’ Incomes Average FFS billings per FTE physician, 2014-2015

  45. Medicine Is Hard EnoughPractice Is Really Tough Accounts Receivable for a typical single physician practice More than $200,000 Nearly 12 Months Average physician Accounts Receivable aging balance: Personal communication with Missouri State Medical Association. April 12, 2013

  46. Meet Dr. Zalzala, Formerly at Wayne State UniversityMoved from Michigan to Ontario “Thanks to USA insurance company loopholes, family physicians aren’t paid up to 30% of the time. Only 2% of my bills aren’t covered in Canada’s single payer system.” Glauser, W. Canadian Medical Association Journal. June 19, 2014 (paraphrased)

  47. American Physicians Are Moving to Canada American Physicians Practicing in Canada https://www.cma.ca/Assets/assets-library/document/en/advocacy/10-phys-by-country.pdf Accessed Dec. 2 2016

  48. Canadian Physicians Are Going Back Home Net loss (number moving abroad - number returning) A negative number indicates that more physicians returned from abroad then moved abroad Source: https://www.cma.ca/En/Pages/canadian-physician-statistics.aspx Accessed Dec. 2 2016

  49. How Would National Health InsuranceImpact Physicians? Preserved earning potential Increased satisfaction Decreased administrative burdens

  50. Most American Physicians Want National Health Insurance Percent supporting National Health Insurance 2007 detail of surveys of random samples of US physicians. Carroll and Ackerman. Ann Int Med 2008;148:566

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