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Universal Healthcare and Single-Payer

Universal Healthcare and Single-Payer. v7.3 01/27/10 JB Fenix, MPH, CaPA Fellow 2009-2010 MD degree candidate 2011 CaPA.Fellow@PNHP.org www.PNHP.org. Who am I?. CaPA and PNHP California Physicians’ Alliance Physicians for a National Health Program http://www.PNHP.org The CaHPSA team

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Universal Healthcare and Single-Payer

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  1. Universal Healthcare and Single-Payer v7.3 01/27/10 JB Fenix, MPH, CaPA Fellow 2009-2010 MD degree candidate 2011 CaPA.Fellow@PNHP.org www.PNHP.org

  2. Who am I? • CaPA and PNHP • California Physicians’ Alliance • Physicians for a National Health Program • http://www.PNHP.org • The CaHPSA team • California Health Professional Student Alliance • Check out the website: http://www.CaHPSA.org/ • Check out the Facebook Group (search “CaHPSA”)!

  3. Overview • How this affects you! • The problem. • Potential solutions. • Common concerns. • Taking action.

  4. How this affects you!

  5. This is a moral and ethical issue! “Of all the forms of inequality, injustice in healthcare is the most shocking and inhumane.” -- Rev. Martin Luther King, Jr. • We must be leaders on this issue. • We have an ethical responsibility to follow the evidence and be guided by our principles.

  6. The Problem.

  7. Poor Outcomes. The Uninsured. The Underinsured. High Costs. The Problem.

  8. Mortality Amenable to Health Care:U.S. Failing to Keep Pace with Other Countries Deaths per 100,000 population* * Countries’ age-standardized death rates before age 75; including ischemic heart disease, diabetes, stroke, and bacterial infections. Data: E. Nolte and C. M. McKee, London School of Hygiene and Tropical Medicine analysis of World Health Organization mortality files (Nolte and McKee, Health Affairs 2008). Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2008.

  9. Poor Outcomes. The Uninsured. The Underinsured. High Costs. The Problem.

  10. The Uninsured >46 MillionUninsured in the US. >6.5 MillionUninsured in the California. • US Census Bureau Data • CHIS, 2005

  11. The Uninsured - Toll on the Communities and the Country • The diminished health and shorter life spans of Americans who lack health insurance are worth between $65 billion and $130 billion for each year spent without health insurance. • Communities with high uninsured rates have reduced access to essential services and community overall health status is adversely affected. Insuring America’s Health, Institute of Medicine 2004.

  12. The Bottom Line >40,000 deaths annually due to lack of coverage Source: Wilper et al. 2009. American Journal of Public Health

  13. Poor Outcomes. The Uninsured. The Underinsured. High Costs. The Problem.

  14. The Underinsured and Barriers to Healthcare • Unaffordable co-pays, and deductibles • Benefits not included  Rx Drugs, specialists • Denial for “pre-existing conditions” • Little or no ability to choose doctor Blewett et al. 2006. Medical Care Research and Review; Michael Moore. 2007. “SiCKO”

  15. Lack of continuity of care amongst the Underinsured Commonwealth Fund Survey, 1998

  16. Difficulty accessing care amongst the Underinsured Commonwealth Fund Survey, 1998

  17. Poor Outcomes. The Uninsured. The Underinsured. High Costs. The Problem.

  18. Income Growth vs Premium Growth Am Fam Physician, 72(10):2005

  19. Where is the money going? • Unnecessary care… • Malpractice and defensive medicine… • Administrative costs…

  20. Where is the money going? Number of Administrators Number of RNs 2500% 2000% 1500% Growth since 1970 1000% 500% 0% 1970 1975 1980 1985 1990 1995 2001 Source: Bureau of Labor Statistics & Himmelstein/Woolhandler/Lewontin Analysis of CPS data

  21. Where is the money going? Number of Administrators Number of Physicians 2500% 2000% 1500% Growth since 1970 1000% 500% 0% 1970 1975 1980 1985 1990 1995 2000 Source: Bureau of Labor Statistics & Himmelstein/Woolhandler/Lewontin Analysis of CPS data

  22. U.S. Overhead Spending International Journal of Health Services 2005; 35(1): 64-90

  23. But maybe?... • Maybe market competition is driving towards lower costs, and better quality?...

  24. For-Profit Hospitals’ Cost More

  25. For-Profit Hospitals’ Death Rates are Higher

  26. The Unit of competition matters! Health of the patient vs. the health of the investor

  27. Potential Solutions.

  28. WWW.IOM.EDU

  29. Guiding Principles • Health care coverage should be universal. • Health care coverage should be continuous. • Health care coverage should be affordable to individuals and families. • The health insurance strategy should be affordable and sustainable for society. • Health care coverage should enhance health and well-being by promoting accessto high quality care that is effective, efficient, safe, timely, patient-centered and equitable.

  30. Alternative Solutions • Major public program extension and new tax credit. • Employer mandate, premium subsidy, and individual mandate. • Individual mandate and tax credit. • Single-payer system.

  31. Nothing is perfect!

  32. Employer and Individual Mandate with Premium Subsidy (aka Current National Reform)

  33. Mandate Problems. • Do we want to criminalize healthcare? • Will we get minimum benefit packages? • Will we get maximum cost ceilings? • Will insurance companies cover everyone?

  34. Tax Credits. Summed up by Stephen Colbert • “It’s so simple. Most people who can’t afford health insurance are also 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.”

  35. …maybe incremental reform is a step in the right direction? Lessons from other states…

  36. Minnesota 1992/1993 “Minnesota has set a goal of achieving universal coverage by July 1, 1997. In 1992, the state passed legislation to subsidize premiums for the uninsured and let employers buy coverage from a state pool.” “‘Minnesota is about to embark on a plan to solve the health-insurance crisis that could hold lessons for other states and the nation. It will begin to subsidize coverage for the uninsured. HealthRight will begin signing up families with children in the fall and will be fully open to Minnesota's estimated 370,000 eligible uninsured by 1994.’ Sources: New York Times 9/16/94; and Richard Reece, Medical World News 7/1/1992.

  37. Minnesota? small public plan option

  38. Tennessee 1992 “Tennessee Gov. Ned McWherter unveiled a plan April 8 for what he called ‘the most radical health care plan in America’ and claimed it would become the national model. The Tennessee plan would gather nearly 1 million current Medicaid patients with 500,000 uninsured Tennesseans into a single managed care program called TennCare.” Gov. Ned McWherter “TennCare is a five-year demonstration project that will use managed care organizations to deliver care to a million Medicaid recipients. TennCare will cover an additional 300,000 currently uninsured in the first year. The number of uninsured enrolled in the program could reach 500,000 in the second year.” Sources: Federal & State Insurance Week 4/12/93; and PR Newswire 11/19/93.

  39. Tennessee? Medicaid expansion + Public Plan Option

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