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You Bet Your Life: Why We Need a National Health Program

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  1. You Bet Your Life: Why We Need a National Health Program Richard D. Quint, MD, MPH Health Sciences Clinical Professor of Pediatrics, Emeritus (UCSF) California Physicians Alliance

  2. Universal Health Care:The International Communist Conspiracy

  3. US National Health Program Efforts Pre-WWII • American Association for Labor Legislation, 1915 • Social Security, 1935

  4. The Road to Employment-Based Private Insurance in the US

  5. The Provider - Insurer Pact • Health insurance plans initially sponsored by hospital and physician organizations • Hospitals and physicians wrote “cost-based” payment rules

  6. 1943-1948: The Murray Wagner Dingell Bill

  7. Keep Politics Out of This Picture When the life – or health – of a loved one is at stake, hope lies in the devoted service of your Doctor. Would you change this picture? Compulsory health insurance is political medicine. It would bring a third party – a politician – between you and your doctor. It would bind up your family’s health in red tape. It would result in heavy payroll taxes – and inferior medical care for you and your family. Don’t let that happen here!

  8. 1965 • Medicare • Medicaid

  9. 1970-1974 Nixon vs. Kennedy Proposals

  10. The Watery Demise of Health Care Reform

  11. California Activism 1985-89 • Anti-patient dumping legislation • Proposals for Universal Coverage • Birth of California Physicians’ Alliance and Physicians for a National Health Program

  12. The sincerest form of flattery...

  13. Here Comes the AMA Again...

  14. Proposition 186 1994

  15. Number Uninsured California: 6.6 million PNHP, 2004; California Healthcare Foundation, 2005

  16. Health Care Options Project (HCOP) • Convened by California Health and Human Services Agency in 1999 • Examined options for extending health care coverage in California • Analyzed and compared by consultants from The Lewin Group and AZA Consulting

  17. How do the HCOP Plans Compare?

  18. 2006: Where do we go from here? First, let’s look at what we’ve got High quality? Cost efficient? Ready for change?

  19. Overall Health System Performance The US ranks 37th out of the 191 WHO member states, placing it below Colombia, Saudi Arabia, and Portugal WHO 2000 World Health Report

  20. Lack of insurance increases morbidity and mortality • 18,000 excess deaths per year due to lack of health coverage • People without health insurance: • Receive less medical care and receive it later • Are sicker when diagnosed • Have 25% higher mortality rates • Earn less because of poorer health • 81% are from working families • “Care Without Coverage”, Institute of Medicine, May 2002 • “Sicker and Poorer”, Medical Care Research and Review, June 2003

  21. Life Expectancy Ranking: 21/30; OECD, 2005

  22. Infant Mortality per 1000 Births Source: OECD Health Data 2005

  23. MRI Units per Million People OECD, 2004 (2002 Data, U.S., Canada, and Germany are 2001)

  24. How hard is it to get care? Commonwealth Fund Survey, 1998

  25. Continuity of Care Commonwealth Fund Survey, 1998

  26. Financing healthcare in the U.S. Individuals / Businesses Direct or Out-of-Pocket Payments Health Service Providers Taxes Medicare, Medicaid, etc. Provider Payments Premiums Government [payer] Public employees’ premiums Private Insurers [payers] |------Collection of funds-------||---------Reimbursement--------|

  27. Percent of GDP Spent on Health 2003 The Economist, January 27, 2006

  28. Cost Excesses in the US • Administrative waste • Over-utilization of non-beneficial high-tech care • Inadequate, inefficient primary care infrastructure • Excess pricing of pharmaceuticals D.McCanne, Quote of the Day, PNHP

  29. Health-care spending per capita, 2005 Source: OECD Health Data 2005

  30. Health-care spending per capita, 2005 Source: OECD Health Data 2005

  31. Insurance Overhead Spending OECD, 2003

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

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

  34. HMO Overhead Spending Managed Care Magazine July, 2003; Kaiser data: CMA Knox-Keane Report, May 2005

  35. Which administrative costs should we reduce? Source: Kenneth Thorpe, 1992.

  36. Government Health Insurance for All, Even if Taxes Increase? No opinion 5% Pew Report, May 2005

  37. The Institute of Medicine recommends that health-care should… • Be universal: Everybody in, nobody out • Be comprehensive and continuous • Be affordable to individuals and families • Use an insurance strategy that is affordable and sustainable for society • Enhance health and well-being by promoting access to high-quality care that is effective, efficient, safe, timely, patient-centered, and equitable Institute of Medicine Report, 2004

  38. 2006: What are Solutions? • Market (consumer driven health care) • Incremental Reform • More Major Reform (“national” health care, “universal” health care, “Medicare for All” or “single payer health care”) • California • SB 840 • US • HR 676 "Expanded & Improved Medicare For All Bill (Conyers)"

  39. What does Dobie Gillis have to do with healthcare in California? State Senator Sheila Kuehl (D, Santa Monica)

  40. California Single Payer SB 840Eligibility • All state residents eligible. • Individuals lacking legal immigration status (i.e., “undocumented”) included if they document residence.

  41. Inpatient and outpatient ER visits All physician services Prescription drugs Laboratory and diagnostic tests Mental health and substance abuse treatment Vision care, incl. glasses Hearing exams and aids DME Home health and adult daycare Rehabilitation Dental care California Single Payer SB 840Benefits

  42. Single payer financing: simplified Individuals / Businesses Direct or Out-of-Pocket Payments Health Service Providers CHIRA (SB 840) Taxes Government [payer] |------Collection of funds-------||---------Reimbursement--------|

  43. Projected Savings SB 840: 2006-2015 (in billions) Year State/local Total 2006 0.9 8.0 2007 1.6 12.3 2008 2.2 17.0 2009 2.8 22.4 2010 3.6 28.4 2011 4.5 35.0 2012 5.3 42.2 2013 6.4 50.2 2014 7.6 59.2 2015 8.8 68.9 43.7 331.3 Lewin Report, 2004

  44. Single payer financing: reality Individuals / Businesses Direct or Out-of-Pocket Payments Health Service Providers CHIRA (SB 840) Taxes Government [payer] Provider Payments Premiums Private insurers (non-covered services) |------Collection of funds-------||---------Reimbursement--------|