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Reforming Health Care Law and Policy: Achieving Universal Health Care in 2008. Presented by: Northwestern University School of Law , Feinberg School of Medicine, American Constitution Society and the American Medical Student Association.

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reforming health care law and policy achieving universal health care in 2008
Reforming Health Care Law and Policy: Achieving Universal Health Care in 2008

Presented by:

Northwestern University School of Law , Feinberg School of Medicine,

American Constitution Society and

the American Medical Student Association

Congressman John ConyersChairman, Committee on the JudiciaryU.S. House of Representatives

achieving universal health care in 2008 options for and implications of reform

Achieving Universal Health Care in 2008Options for and Implications of Reform

Nicholas Skala

Senior Research Associate

Physicians for A National Health Program

n-skala@law.northwestern.edu

slide4

United States:

47 Million Uninsured

Institute of Medicine: 18,000 Deaths Per Year

But simply helping them buy private insurance is not a solution.

meet thomas wilkes
Meet Thomas Wilkes
  • Born in 2003 with Severe Hemophilia A.
  • Dad: Senior Engineer at a high-tech computer firm with good benefits.
  • 2004: Develops an inhibitor to his hemophilia treatment.
  • $750,000 annual claims.
private insurance for thomas
Private Insurance for Thomas
  • Company faces 40% to 55% increase in premiums.
  • Only insurer that will cover them requires $10,000 out-of-pocket and a $1 million cap.
  • Thomas is projected to reach the $1 million benefit cap in summer 2008.
options for thomas family
Options for Thomas’ Family
  • Thomas’ father can quit the job he loves and go to work for a mega-firm that will take longer to be affected by high claims.
  • Thomas’ mother can stop raising the children and go to work for a mega-firm.
  • Thomas’ father can divorce his mother to leave her and Thomas legally destitute and eligible for public programs.
slide8

America’s Underinsured

Proportion of Americans Going Without Care due to Costs, 2005

(skipping doctor visit, specialist appointment, treatment or prescription when needed)

Source: Commonwealth Fund Biennial Health Insurance Survey, 2005

slide9

Medical Bankruptcy

Illness and Medical Bills Contributed to 1,000,000 Personal Bankruptcies in 2004. (Half of All Bankruptcies)

Insurance Status at Onset of Illness

Uninsured

Had Insurance

Source: Himmelstein, Health Affairs 2005 (state estimates provided by author)

slide10

Rising Costs = Less Benefits = Under/Uninsurance

Proportion of Americans Covered by Employer Insurance

Source: US Census

expansion of public programs an schip math problem
Expansion of Public Programs:An SCHIP Math Problem!

8 Million Uninsured Kids (1995)

+

5 Million get coverage through SCHIP

-

5 Million more become uninsured

expansion of public programs a zero sum game
Expansion of Public Programs:A Zero Sum Game

Number of Uninsured Kids (0-18 yrs.) 1988 - 2005

Source: U.S. Census Bureau

slide13

Lesson #1: Simply Giving More People Existing Private Insurance Policies Is Not a Solution.

Current Private Insurance Policies Offer Inadequate Protection.

Any Gains in Coverage Will Be Quickly Offset as Costs Rise and Employers Shed Benefits.

slide14

Lesson #2: Any Real Solution to the Health Crisis Must Do Two Things:

1) Offer Coverage More Comprehensive than that Currently Available on the Private Market.

2) Control Costs so that Benefits are Sustainable.

slide15

Life Expectancy, 2005

(Data in Years)

slide16

Infant Mortality, 2005

(Deaths in first year of life per 10,000 live births)

slide17

International Health Spending, 2005

U.S. Public Spending is Greater than Other Nations’ Public/Private Spending Combined

Source: OECD 2007; Japan data are from 2004

slide18

If you were in an insurance CEO, who would you want to insure?

73%

Percent

of

health

Care

Costs

13%

6%

4%

0% 0% 0%

1% 1% 2%

Source:Agency for Healthcare Research and Quality

MEPS

slide19

The Health and Profitable to the “Market,” the Sick and Poor to the Taxpayer

73%

Government Programs

Percent

of

health

Care

Costs

Private Insurers

13%

6%

4%

0% 0% 0%

1% 1% 2%

Source:Agency for Healthcare Research and Quality

MEPS

slide21

Growth of Physicians and Administrators1970-2005

Source: Bureau of Labor Statistics and NCHS

one third of health spending is consumed by administration
One-Third of Health Spending is Consumed by Administration

31%

Potential Savings: $350 billion per year

Enough to Provide Comprehensive Coverage to Everyone

Source: Woolhandler, et al, New England Journal of Medicine, August 2003 & Int. Jrnl. Of Hlth. Services, 2004

financing single payer
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.

single payer benefits
Single-Payer Benefits
  • Comprehensive Coverage for all medically necessary services (doctor, hospital, long-term care, mental health, vision, dental, drug, etc.) in a single-tier system.
  • Free Choice of doctor and hospital.
  • Health Workers Unleashed from corporate dictates over patient care.
  • Hospitals guaranteed a secure, regular budget.
only two paths to reform
Only Two Paths to Reform
  • Preserve Private Insurance Companies and their Waste
  • Create a National Health Insurance System
the republicans
The Republicans

“Consumer-Directed Health Care”

health savings accounts
Health Savings Accounts
  • A bank account in which a limited amount of money may be deposited tax-free for expenditures on health services.
  • Must be paired with a “high-deductible” health plan. (e.g., $5,000).
  • First few thousand dollars are paid from the HSA, at some point, “catastrophic” coverage kicks in.
  • Theory: Patients now using “their own money” = better consumers = lower costs.
high deductibles no savings
High-Deductibles = No Savings

73%

Percent

of

health

Care

Costs

13%

6%

4%

0% 0% 0%

1% 1% 2%

Source:Agency for Healthcare Research and Quality

MEPS

health savings accounts won t
Health Savings Accounts Won’t

Provide Meaningful Choice for Patients

Reduce Administration

Produce Savings

Health Savings Accounts Will

Discourage Preventive and Primary Care

Create Huge New Administrative Waste

Produce Few Savings (a few sick people cost the most)

market medicine a nearly stupid idea
Market Medicine: A “Nearly Stupid” Idea?

I do not believe that making the individual patients more “cost-sensitive” has any rationale in science, ethics, or medicine. It will fail, and it will fail miserably. It will result in a shifting of care away from the people who need it the most. If Xerox or GE can’t change health care using their purchasing power, then I absolutely promise you that Mrs. Jones can’t. The idea that she will now be more sensitive because she pays an extra ten bucks out of pocket is, to me, nearly stupid.

- Dr. Donald Berwick

Institute for Healthcare Improvement

individual mandate
“Individual Mandate”

“Let them buy insurance.”

criminalizing the uninsured a massachusetts punitive index
Criminalizing the Uninsured:A Massachusetts Punitive Index

*Note: Original version of House Bill would have suspended individuals’ driving licenses for uninsurance as well.

subsidy and individual mandate schemes
Subsidy and Individual Mandate Schemes
  • Substandard Coverage: forces the uninsured to buy defective insurance industry products that are already causing families to face bankruptcy and go without needed care.
  • Unaffordable: Without the savings achievable with single-payer, taxes must raised or funds diverted from other needy programs.
  • Micro-coverage, Macro-costs: Preserves wasteful private insurers and adds yet another layer of state administrative waste. Rather than provide care to the uninsured through a relatively efficient program like Medicare, the plan launders tax dollars through wasteful private insurers.
  • No Realistic Cost Control: Any gains in public coverage will be unsustainable due to rising costs.
sounds great but it s not politically feasible

“Sounds Great, but it’s not politically feasible”

2/3rds of population want it

Most (59 percent) of physicians want it

Business community is now realizing the need for it.

single payer
Single-Payer:

Glen BartonFormer CEO, Caterpillar Inc. (Fortune 100)Past Chairman, Health and Retirement Task Force Business RoundtableRepresents 150 Largest EmployersTotal Assets: $4.0 Trillion

“The quickest and simplest solution… is to go to a single-payer system”- Written Testimony to AHCTF, Feb. 1 2006

slide38

“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

is the perfect the enemy of the good the radical and the republican
Is “The Perfect the Enemy of the Good?”The Radical and the Republican

“Many of Lincoln’s admirers have painted him as a man who wanted exactly what the abolitionists did but cannily waited for a perfect moment to achieve it. [In fact], radicals like Douglass set an agenda Lincoln gradually adopted as his own. Without abolitionists, there would have been no Lincoln.”

- James Oakes, Historian, UC Berkeley

single payer politically feasible

Other “Politically Infeasible” Movements

Single-Payer: “Politically Feasible?”

Abolition of Human Slavery

(1860s)

Women’s Suffrage Movement

(1840-1920)

Civil Rights Act

(1964)

reforming health care law and policy achieving universal health care in 20081
Reforming Health Care Law and Policy: Achieving Universal Health Care in 2008

Presented by:

Northwestern University School of Law , Feinberg School of Medicine, American Constitution Society and

the American Medical Student Association

Congressman John ConyersChairman, Committee on the JudiciaryU.S. House of Representatives