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Planning Committee in Boston for a Single-Payer System in Vermont.
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Planning Committee in Boston for a Single-Payer System in Vermont • Happy New Year everyone!Recently, there's been a buzz in the Boston Globe about VT having the chance to form a state wide single-payer system. Peter Shumlin, a single-payer supporting governor won the election and is leading an effort to get single-payer. Physicians and single-payer advocates in VT have asked that medical and health professional students come to VT to show our support. So....we're organizing a trip to show our support in Montpelier, VT at 1 pm on March 26th. We're expecting Senator Bernie Sanders, Gov. Shumlin, and hopefully Howard Dean at the big event. The goal is to get 100 people from the area medical and health professional schools to trek up. Come help make this happen. We'll start planning over brunch this Saturday. Information about where and when is below. Just let me know if you'll be able to make it, so I know how much food to make. Please pass this along to other individual people --- medical students, nursing students, social work students, public health students etc who you think would be interested in spearheading a group to join us. Onward, Sim VT Action Planning Meeting11 AM Saturday, January 8th36 Goodrich Rd. Apt. 1 --- at the end of the blockJamaica Plain, BostonBUS: Right off the 39 Bus line (get off at Lakeville Rd and walk one block further to Goodrich)Train: Or, take the orange line to Green St. Left out of the station on to Green St. Take a right on Centre St. Left on Goodrich. Email simeon.kimmel [at] gmail [dot] com if you are interested in attending or have any questions.
Pillars of medical ethics • Beneficence: Do what is good, what is needed • Nonmaleficence: Don’t do harm • Autonomy: Respect a patient’s choice • Justice: Do what is right, what is just
Pillars of medical ethics: crumbling?! • Beneficence: Do what is good, what is needed • Doctors can’t afford to treat everyone • Nonmaleficence: Don’t do harm • It’s hard not to do harm when you can’t treat patients • Autonomy: Respect a patient’s choice • Insurance status limits treatment options, choice of provider • Justice: Do what is right, what is just • Difficult in our current system
New Figures? • In 2009: • 50.7 million uninsured • That’s 16.7% of all Americans Source: U.S. Census Bureau http://www.census.gov/newsroom/releases/archives/income_wealth/cb10-144.html
There must be a better way… Will premiums surpass income?? Today Source: American Family Physician, November 15, 2005
What is single payer? • “Expanded and improved medicare for all” • Everybody in, nobody out • All necessary medical care • Option to buy supplementary insurance • Choose any provider, any medical center • Progressively funded through payroll or income taxation • With current national spending, we could cover everyone for all necessary care • This is not a radical idea – many Western countries have something similar • Generally with better health outcomes than we have!
And don’t worry, salaries are comparable! Canadian Physicians’ Incomes 2004/2005 Source: Canadian Institute for Health Information
Advantages of single payer for patients • All necessary care is paid for • Everyone gets the same benefits • Choose any doctor • Never lose your coverage • Enjoy preventive care before getting sick • Pay the same or less for better care in a better system
Advantages of single payer for doctors • Gain the ability to care for everyone • Social justice – fight disparities • Do less paperwork • One payer, not hundreds • See the end of insurance company claim denials! • Practice in a friendlier litigation climate • Get a real health system in place • Structures in place for mandating electronic records • Enabling health database research • All patients with equal access to primary care
Advantages of single payer for doctors • Practice in a system with a sound structure
Advantages of single payer for the budget • Cover everyone for less than we are currently paying
Advantages of single payer for everyone • Everybody in, nobody out http://sebchang.blogspot.com/2010/09/manon-in-black-white.html
What’s the situation in Vermont ? Medical Students @ Physicians for a National Health Program January, 2011
Vermont… not just Maple Syrup! http://upload.wikimedia.org/wikipedia/commons/thumb/d/d1/Map_of_USA_VT.svg/2000px-Map_of_USA_VT.svg.png
Vermont: Background • Long tradition of independent thought • Bernie Sanders (I-VT Senator) is a long-time supporter • Authored the Senate single payer bill • The stars aligned… • Governor Shumlin ran on a single payer platform • Other legislators (Welch, Leahy) support single payer • After ACA’s passage, health reform is still on everyone’s minds
Vermont in early 2011 • William Hsiao, Harvard Economist: • To provide Vermonters with 3 state health reform options: • 1. Single payer • 2. Public option • 3. Plan of Hsiao’s choice • “a viable and practical single payer plan”
Who is William Hsiao? • Born in China, emigrated to NYC as a child • Worked for predecessor to CIGNA • Chief Actuary of the Social Security Administration in 1960’s • Helped design the Resource-Based Relative Value Scale • Professor of Economics at Harvard School of Public Health • Key player in designing Taiwan’s single payer system • Memberships • National Academy of Sciences • Institute of Medicine • Society of Actuaries • National Academy of Social Insurance
Why not go with a public option? • Adverse selection. • Only those who can’t find affordable insurance will buy in • Cherry-picking by private companies • These are high risk patients that are expensive to insure • Public option rates skyrocket to keep up with costs • The public option becomes unaffordable to everyone • Lack of administrative savings. • Makes expanded coverage unaffordable
Another plan… • A new creation of William Hsiao’s? ?
The best path: • Single payer • Hsiao already helped create Taiwan’s single payer system • Incredibly successful • In 1995, • 41% of population uninsured • 4.8% of GDP spent on healthcare • Now, • National health insurance • 6.1% of GDP spent on healthcare (2009) • The US is not Taiwan • However, those are stunning results! Source: Cheng, T. (2009). Lessons from Taiwan's universal national health insurance: A conversation with taiwan's health minister ching-chuan yeh. Health Affairs, 28(4), 1035-1044.
Call to action!! • Come to Vermont to meet with legislators • One day, and one day only! • A Saturday in March 2011 (date TBA) • Show your enthusiasm for practicing in a single payer system • Rally for social justice in health care • Meet doctors passionate about healthcare for all • Hang out with like-minded students • Optional: declare your intention to move to Vermont if single payer is enacted • Afterparty??
Can’t come? Sign our statement! • A quick and easy way to show your support “We support a universal health care system for the State of Vermont, one that includes all Vermonters, offers free choice of providers, is progressively financed, decoupled from employment, affordable for all, and pays for all necessary care out of public funds; a system which retains the private delivery of health care and has a publicly accountable budget process to ensure adequate capacity to meet the health care needs of all Vermonters.”
