Stephen Colbert on the Bush Health Plan

1. Stephen Colbert on the Bush Health Plan “It's so simple. Most people who can't afford health insurance also are too poor to owe taxes. But if you give them a deduction from the taxes they don't owe, they can use the money they're not getting back to buy the health care they can't afford.”

2. US Health Care System Crisis: A Single Payer Solution Joshua Freeman, MD MASW Annual Conference Columbia, MO October 22, 2008

3. What is the Problem? • 47 Million Uninsured • 75 Million un-or-underinsured • Even having “good” insurance doesn’t protect • Inadequate health care outcomes and quality • Extraordinary cost • Health care primarily a business for making profits rather than enhancing health

5. JayDoc Student-run Free Clinic Patient Population by Employment Status

6. 18,314 Adult Deaths Annually Due to Uninsurance

9. Life Expectancy Source OECD 2007, data from 2005

15. National Scorecard 2008 • Commonwealth Fund, July 2008 • US Scores 65 out of 100 • No improvement since 2006 • 42% (75M) adults uninsured or underinsured (up from 35% 2006) • 19th out of 19 countries on mortality amenable to medical care (down from 15th, 2006) • Spends twice what other industrialized countries do Ref:: accessed 7/21/08 http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=692682

16. National Health Spendingas a share of Gross Domestic Product Projected Actual Percentage GDP Source: Centers for Medicare & Medicaid Services

17. We spend twice as much on health care as other nations do $ Per person OECD, 2006. Data for Japan is an estimate

18. How are we paying for it now? $1,075 B $319B $286B Based on 2003 National Health Spending of $1.68 trilllion (CMS)

20. Get Care Bills not paid More uninsured More underinsured Higher premiums Fixed costs of healthcare services not met Cost shift Deficit! COST SHIFTING: NO END IN SIGHTThe “Insurance Death Spiral”

21. General Motors Health Care Costs“A social insurance system that sells cars to finance itself” • $5 billion in 2003 (profits $1.7 billion) • $1500 per car • $9,000 per year/per employee -average firm ($5758) • $15,000 per year /per retiree under age 65 • $4,000 per year /per retiree on Medicare Source: New York Times 7/15/03

22. Health Care Administrative Costs in the U.S. Administrative Costs 31% Clinical Care 69% ($2000 per person) New England Journal of Medicine 8/03

24. Investor-Owned CareSummary ofEvidence • Hospitals: Costs 3%-11% higher, fewer nurses, higher overhead, death rates 6%-7% higher, fraud • HMOs: Higher overhead, worse quality • Dialysis: Death rates 20% higher, less use of transplants & peritoneal dialysis. • Nursing Homes: More citations for poor quality, fraud • Rehab Hospitals: Costs 19% higher

26. Financing Single-Payer Medicare Single-Payer Health Care Fund $$$ Medicaid Payroll Tax Income Tax Bonus: Negotiated formulary with physicians, global budget for hospitals, increased primary and preventive care, reduction in unnecessary high-tech interventions, bulk purchasing of drugs and medical supplies = long term cost control.

32. How It Could Work • Regional Health Board allocates resources • Board accountable to patients rather than stockholders • Private hospitals remain in tact • Patients have ID that allow them to get care wherever they wish • Physicians work fee-for-service

33. Or – Medicare for All • Already covers majority of sickest • Aged, Blind and Disabled • Marginal Costs relatively low • Overhead very low

34. Covering Everyone and Saving Money through Medicare for All Additional costs Covering the uninsured and poorly-insured +7.2% Elimination of cost-sharing and co-pays +5.1% Savings Bulk purchasing of drugs & equipment -2.8% Reduced hospital administrative costs -1.9% Reduced physician office costs - 3.6% Reduced insurance administrative costs -5.3% Primary care emphasis & reduce fraud -2.2% Net Savings -4.3% Source: Health Care for All Californians Plan, Lewin Group, 2005

35. NHI will save $5000 per capita by 2024

36. Expansion of Universal Health • 1973 – Denmark • 1974 – Australia • 1978 – Italy • 1979 – Portugal • 1986 – Spain • 1996 – South Africa • 2002 – Taiwan • 1883 – Germany • 1911 – Switzerland • 1938 – New Zealand • 1945 – Belgium • 1945 – France • 1946 – United Kingdom • 1966 – Canada None of these countries rely on private, for-profit insurance companies

37. Obama’s Health Plan • Expand Medicaid, SCHIP. • National Health Insurance Exchange. • Public plan for small business and individuals, similar to FEHBP. • Business tax credits • Income based tax credits. • Savings by IT, transparency, negotiated drug prices for Medicare, tort reform. • Payment based on outcomes.

38. McCain • Tax credit for individuals • Eliminate business tax deduction for employee health insurance • Encourage HSA’s • Income related tax credits. • Guaranteed Access Plan—pooled resources by states for chronic illness and poor. • Reduce cost by IT, reimport drugs, tort reform, transparency. • Payment based on outcomes.

39. “If done right, health care in America could be dramatically better with true single-payer coverage.” -Ben Brewer, WSJ, April 18, 2006 • “[single-payer] is an idea that's so easy to slam politically yet so sensible for business that only Republicans can sell it! …it may take a Republican President to bless the socialization of health spending we need.” • -Matt Miller, Fortune, April 18, 2006 CNBC / MSN Money • “Think, as a small business, how you could benefit from a single-payer system: you wouldn’t lose potential employees to larger firms that offer more attractive health benefits; health insurance costs would cease to be a line item in your budget. A serious illness befalling you or an employee wouldn’t be a company-wide financial crisis. You might even save money.” • -Joseph Antony, CNBC / MSN Money, Winter 2003

40. Problems • McCain • Minimal cost containment • HSA’s lead to less preventive care • Free market has failed to deliver quality and efficiency. • Obama • Minimal cost containment • No cost savings on administrative overhead • Free market has failed to deliver quality and efficiency.

42. Health Savings Accounts • No savings globally • No reduction of administrative costs • Discourage preventive care

43. Case: Kansas Health Reform • 2007 SB 13 – Options (to KHPA) • KHPA contracted with outside consultant • Foundations paid the tab • Consultant: Steve Schramm • Report on various options • Presumed Premium Assistance

44. Current KS % (<65 yo)

45. Options vary on: • # new people covered • How covered / how paid • Employer (private) vs. Medicaid expansion (public) • Cost (and to whom)

46. 4 Plans: change in Uninsured • Reference: Decr. 144K • Affordable: Decr. 50K • Universal: Decr. 247K • Single Payer: Decr. 247K

47. 5 Plans (Incl. Baseline): Cost

48. Who Pays? • Prevention saves lives, but maybe not money • If it – or any other intervention – saves money, who pays? Social good? • And how do we ensure quality?

49. “Sick Around the World” • PBS “Frontline” program – T. R. Reid • 5 Countries: • Britain • Germany • Japan • Taiwan • Switzerland • http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/

50. Annals of Internal Medicine: April 1, 2008