Single Payer Basics and the Effect of P-PACA

1. Single Payer Basics andthe Effect of P-PACA Margaret Flowers, M.D. Congressional Fellow 29 East Madison, Suite 602Chicago, Il 60602312-782-6006www.pnhp.org

2. Health Care History in 2 Slides: 1940’s: • Europe: The destruction of WWII required the restoration of security through social institutions. Created a system based on human rights. • The US retained an employment-based system of health care. 1960s belief: • Private insurance industry would respond quickly to a changing medical economy and cover everybody within 10 years.

3. Health Care History in 2 Slides: 1980’s: • Fundamental shift occurred to private investor-owned health corporations. • Health care was perceived as a fertile field for profit seeking businesses. In this new environment, Health became a commodity Patients becameconsumers

4. US PublicSpending is More than TotalSpending in other Nations Sources: OECD 2008; Health Affairs 2002;21(4)88 – Data are for 2006

5. 51 Million Americans Without Insurance Today Millions of Uninsured Americans 1976 2008 Source: Himmelstein, Woolhandler, Carrasquilo – Tabulation from CPS and NHIS data

6. Who are the Un-insured? NON-WORKER 19.5% PART-TIME WORKER 14% FULL-TIME WORKER 66.5% Urban Institute and Kaiser Commission on Medicaid and the Uninsured estimates based on the Census Bureau's March 2008 and 2009 Current Population Survey (CPS: Annual Social and Economic Supplements).

8. Highest Number of Preventable Deaths Measuring The Health Of Nations: Updating An Earlier Analysis: Ellen Nolte and C. Martin McKee Health Affairs, 27, no. 1 (2008): 58-71

9. A Few People Drive Most Costs Percentage of total health spending in 2001 Top two deciles account for 78.3% of spending Decile of privately insured Source: MEPS data, from Thorpe and Reinhart

10. Administrators are Growing Faster than Physicians Administrators Physicians 1970 1980 1990 2000 2009 Source: Bureau of Labor Statistics; NCHS; Himmelstein/Woolhandler analysis of CPS

11. Consumer-directed Health Care = Under-insurance • Plans with very high deductibles ($2,000 to $15,000 per family) and often high co-insurance rates thereafter (25 to 35%). • Tax-free savings accounts (HSA and MSA) from which deductible and co-insurance can be paid. • Only “covered services” count toward deductible.

12. Unsustainable Cycle! UNINSURED

13. Most of the Medically Bankrupthad Insurance Coverage Insurance at onset of illness Source: Himmelstein et al. Am J Med, Aug. 2009

14. What did we get for $938 b? Based on the “mandate model” of reform: • Medicaid expansion • Private insurance mandate • Public dollar subsidies • Regulation of private insurers The result = more of the same!

15. Impact of Health Reform on the Un-insured

16. Impact of Health Reform on the Under-insured

17. Health Care Reform, We are still for it! Patient Protection and Affordable Care Act: • continues to leave tens of millions uninsured. • increases total health spending. • likely to continue upward trend of underinsured. • mandates coverage without health security. • restricts choice.

18. Market Failure: • Expensive • Poor outcomes • Increasing disparities • Preventable deaths • Losing (esp. primary care) doctors • Under-insurance/Un-insurance

19. Role Played by Health Industry in Health Reform

21. What are the Lessons? We still have a health care crisis in the United States and we need the I.C.U. • I = Independence • C= Clarity • U = Uncompromising

22. DO YOU HAVE YOUR FIRE INSURANCE CARD?

23. What is Single Payer? Improved Medicare for All • Unified risk pool – everybody in, nobody out. • Everybody contributes to fund health care based on ability to pay. No financial barriers. • All medically necessary care is covered. • Simplified administration saves money. • Choice of physician and treatment. • Focused on preventative and timely care. • Transparency and Accountability to the public

24. Funding for the NHP Source: NEJM 1989:320:102

25. Covering Everyone and Saving Money 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

26. We have what it takes! • Excellent hospitals • Well-trained professionals • Superb research • Current spending is sufficient

27. Where is the Single Payer Movement Now? • State Single Payer Efforts • National improved Medicare for All

28. State Single Payer Efforts 20 states and growing! California, Colorado, Delaware, Hawaii, Illinois, Iowa, Maryland, Massachusetts, Minnesota, Missouri, New Hampshire, New Mexico, New York, North Carolina, Ohio, Oregon, Pennsylvania, Vermont, Washington, Wisconsin. • For a summary, see: http://pnhp.org/blog/2010/06/11/states-seek-to-lead-the-way-on-single-payer/

29. Vermont • Passed legislation to design 3 universal health systems – 1 is single payer • Contract with William Hsaio • New Governor campaigned on SP • Plan to pass in 2011 • Sen. Sanders to request waivers

30. National Improved Medicare for All • Education! Education! Education! • Building coalitions at the congressional district level • Reaching out to state grassroots groups • Reaching out to organizations that advocate for social and economic justice

31. National ImprovedMedicare for All • Pressure on insurance corporations • Wellpoint shareholder actions • Divestment campaigns • Expose health injustice • Hospital/clinic closings • Denied care • Health professional firings/strikes

32. A HEALTH SYSTEM THAT WE CAN BE PROUD OF! A HEALTH SYSTEM THAT WE CAN BE PROUD OF: NATIONAL IMPROVED MEDICARE FOR ALL!