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Single Payer Health Care Reform

Single Payer Health Care Reform. Impact on State and Local Governments in Oregon. Peter Mahr, MD PNHP Portland OR Chapter April 6 th , 2010. Our Current Non System. We spend more than twice as much as the rest of the industrialized nations ($8,160 per capita) or 16% of GDP.

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Single Payer Health Care Reform

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  1. Single Payer Health Care Reform Impact on State and Local Governments in Oregon Peter Mahr, MD PNHP Portland OR Chapter April 6th, 2010

  2. Our Current Non System • We spend more than twice as much as the rest of the industrialized nations ($8,160 per capita) or 16% of GDP. • We perform poorly in comparison on major health indicators such as life expectancy, infant mortality and immunization rates. • Other advanced nations provide comprehensive coverage to their entire populations, while we leave 46.3 million completely uninsured and millions more inadequately covered.

  3. Our Current Non System • The reason we spend more and get less than the rest of the world is because we have a patchwork system of for-profit payers. • Private insurers necessarily waste health dollars on overhead, underwriting, billing, sales and marketing departments as well as huge profits and exorbitant executive pay. • Doctors and hospitals must maintain costly administrative staffs to deal with the bureaucracy. Combined, this needless administration consumes one-third (31 percent) of Americans’ health dollars.

  4. Current Solution • Build on current system- subsidize purchase of private insurance • Some new insurance regulation • State exchanges • Expand Medicaid • Some delivery changes • Like Massachusetts

  5. Massachusetts as the Example • Uninsured improved • Underinsured a continuing problem • VERY EXPENSIVE!!!

  6. Massachusetts: Required Coverage(Income > $31k) • Premium: $4,800 Annually (56 year old) • $2000 deductible • 20% co-insurance AFTER deductible is reached

  7. Other Developed Nations • 3 Necessities: • A single system for everybody • No for-profit health insurance • No uninsured. Everybody in, nobody out. • Federal Reform: contains none of these. • Single Payer: contains all.

  8. What About Single Payer? • Financed by eliminating private insurers and recapturing their administrative waste. • Modest new taxes would replace premiums and out-of-pocket payments currently paid by individuals and business. • Costs would be controlled through negotiated fees, global budgeting and bulk purchasing.

  9. What About Single Payer? • Benefits: all Americans would be covered for all medically necessary services: doctor, hospital, preventive, long-term care, mental health, reproductive health care, dental, vision, prescription drug and medical supply costs. • Free choice of doctor and hospital. • Doctors regain autonomy over patient care.

  10. Single Payer and State Economies • What do existing studies show (or… show me the money!)

  11. Single Payer – AffordableRhode Island November 2002: Rhode Island: Single Payer would save $270 million Cover 75,000 uninsured, improve access for many more. Source: (Sager, A.; Boston University School of Public Health; “Rhode Island Can Afford Health Care for All: A Report to the Rhode Island General Assembly” )

  12. Single Payer – AffordableMissouri October 2003: Missouri Single-Payer would save $1.7 billion A single payer health care plan in the state of Missouri would reduce overall health care spending by about $3 billion. Source: ( Missouri Foundation For Health; “A Universal Health Care Plan for Missouri”; online: http://www.mffh.org/ShowMe3.pdf)

  13. Single Payer – AffordableGeorgia June 2004: Single-Payer health would cover all Georgia residents and save $716 million annually. Nearly all Georgia families would pay less for health care than they are today for much better coverage. Source: (The Lewin Group, Inc. “The Georgia SecureCare Program: Estimated Cost and Coverage Impacts” Final report 10/21/03)http://www.pnhp.org/news/lewinanalysis.pdf)

  14. Single Payer- AffordableCalifornia SB 810 • 2005 Lewin Group: Reduction in overall health spending by $344 billion over 10 years • Families with under $150,000 in annual income would, on average, see savings ranging between $600 and $3,000 per family. • Employers who currently offer health benefits would realize average savings of 16% compared to the current system. Source: Lewin Group Report; “The Health Care for all Californians Act: Cost and Economic Impacts Analysis” Jan 19th, 2005.

  15. Single Payer – AffordableKansas • December, 2007: • Single payer (“the Mountain plan”) would cover all the uninsured and reduce state health spending by $869 million annually. • The other plans would cover a portion of the uninsured and would raise costs between $150 million to $500 million in the state. (www.healthfund.org/reportspubs/11012007fdn_report_khpa.php)

  16. Single Payer- AffordableColorado • 2007 Lewin Group Study¹ • CHSP (single payer) would reduce spending by $1.4 billion. • Primarily due to the reduction in costs of administering insurance under a uniform program of coverage for all state residents. 1. Cost and Coverage Impacts of Five Proposals to Reform the Colorado Health Care SystemLewin Group Study, 2007

  17. Single Payer and State Economies • What do existing studies show • What about Oregon

  18. City of Portland FY 2009 • Health Care Costs: $65.9 million • Number of Employees: 5,017 • Total Payroll: not given, but assume $70,000/employee would be: $351 million • Health Care Costs Under Single Payer¹: $28.1 million • Savings Under Single Payer: $ 37.8 million 1. Assuming 8% employer payroll tax as funding.

  19. Lane County FY 2009 • Health Care Costs: $21.2 million • Eligible Employees: 1300 • Total payroll: $76 million • Health Costs as a Percentage of payroll: 28% • Savings Under a Single Payer Program¹: $15.1 million 1. Assuming 8% employer payroll tax

  20. Washington County FY 2009 • Health Care Costs: $20 million • Number of Employees: 1760 • Total payroll: $114 million • % of payroll Now: 17.5% • Health Care Costs Under Single Payer¹: $9.1 million • Savings Under Single Payer: $10.9 million 1. Assuming 8% employer payroll tax

  21. Multnomah County FY 2009 • Health Care Costs: $55.5 million • Number of employees: 4480 • Total Payroll: $248.3 million • Health Care Costs as % of Payroll Now: 22% • Health Care Costs Under Single Payer¹: $19.9 million • Savings Under Single Payer: $35.6 million 1. Assuming 8% employer payroll tax

  22. State of Oregon FY 2009 • Health Care Costs: $598.6 million • Number of Employees: 48,695 • Health Care Benefit Staff Salary: $1.2 million • Total payroll: not reported yet, but if using $60,000 per year per employee: $2.9 billion. • Health care Costs under Single Payer¹: $233.7 million • Savings with Single Payer: $365.3 million 1. Assuming 8% employer payroll tax for funding

  23. OR State and Local Governments:A Summary • Current Health Care Costs: $13,900 per employee • % of payroll: (estimate assuming $60,000 a year for those not reporting payroll)¹: 19.2% • Savings per Public Employee: $8,108 1. Excluding lane County which was an outlier

  24. Public Education in OR • Total teachers: 32,626 • Cost Savings under Single Payer¹: $265 million • Teachers plus Staff: 45,093 • Cost Savings Under Single Payer¹: $365.6 million 1. From Previous Slide: $8,108 per public employee

  25. Bill BradburyThe Education Governor • How many new teachers could you hire with $365 million??? • 6083

  26. What Can a State Politician Do? • Mandate a study of a single payer plan in OR as part of HB2009 • Discuss the economic ball and chain of health care costs at every opportunity. • Don’t be afraid of single payer!

  27. In November 2004, Canadians voted Tommy Douglas, Canada's "father of Medicare," the Greatest Canadian of all time following a nationwide contest sponsored by the CBC

  28. Or maybe I should have titled this talk…..

  29. Single Payer Health Reform for Oregon How Bill Bradbury Can Save Oregon’s Economy and Become a National Hero…

  30. Resources • http://www.localschooldirectory.com/state-schools/OR • State of Oregon Data: e-mail exchange with • Washington County Data: email exchange with Valerie Weekly 3/30-3/31 • Multnomah County Data: email exchange with Caren Cox 3/26-29 • Lane County Data: email exchange with Amber Fossen 3/26-4/2 • Portland OR Data: email exchange with Cathy Bless and Vicki Arch 3/26-29 • Eugene OR Data: web site: http://www.localschooldirectory.com/state-schools/OR

  31. Resources • Peter J. Cunningham; The Growing Financial Burden Of Health Care: National And State Trends, 2001–2006;Health Affairs, (Published online March 25, 2010) • www.pnhp.org

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