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Health Care for All Fiscally conservative Socially responsible Rob Stone MD Director, Hoosiers for a Commonsense Health Pl...
DISCLOSURES <ul><li>Dr. Rob Stone has no relevant financial relationships with commercial interests. </li></ul><ul><li>Sli...
 
Lack of Insurance Kills <ul><li>1 every 12 minutes </li></ul><ul><li>120 every day </li></ul><ul><li>45,000 a year  </li><...
Insurance Premiums • Workers’ Earnings • Inflation  1999-2008 Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 20...
Our Broken System: <ul><li>1 in 5 employers  to drop health benefits in next 3-5 years   </li></ul>1 Hewitt Associates The...
Bankruptcy  2009 <ul><li>62% caused by illness  and medical bills </li></ul><ul><li>Most were middle class </li></ul><ul><...
 
Health Spending Per Capita Rampel, US Health Spending Breaks From the Pack, NYT 7/8/09
 
What Are We Paying For?  <ul><li>An incredibly complex system </li></ul><ul><li>Thousands of plans </li></ul><ul><li>Armie...
Where is the bureaucratic nightmare?
U.S. Overhead Spending International Journal of Health Services 2005; 35(1): 64-90
Medicare’s Efficiency:   3% Overhead <ul><li>2003, 31% health spending on overhead – could save $286 Billion 1 </li></ul><...
“ Kids, your mother and I have spent so much money on health insurance this year that instead of vacation, we’re all going...
Brief History <ul><li>WWII:  Wage and price controls </li></ul><ul><li>1947:  Truman pushes for National Health Insurance ...
History (continued) <ul><li>The birth of the Blues </li></ul><ul><li>1965:  Medicare and Medicaid  </li></ul><ul><li>1993:...
Anthem /WellPoint (formerly Blue Cross) <ul><li>CEO Larry Glasscock in  Indianapolis, just retired </li></ul><ul><li>Bonus...
What Do We Get For Our Money? <ul><li>The most expensive    health care in the world </li></ul><ul><li>The best health car...
 
WHO Global Health Rankings  <ul><li>At the top:  France is #1 </li></ul><ul><li>US ranks 37th, between Costa Rica and Slov...
Hospital Inpatient Days per Capita Rationing?
Physician Visits per Capita
Elderly as Percent of Total Population
Tobacco Smokers OECD, 2004 (2002 Data, U.K is 2001 )
MRI Units per Million People OECD, 2004 (2002 Data, U.S., Canada, and Germany are 2001)
Kidney Transplants OECD, 2004 (2002 Data, Canada and Sweden are 2001)
Why spend so much  AND  get so little? <ul><li>Reason # 1: Our profit-driven insurance system </li></ul><ul><li>AND   </li...
 
Myths <ul><li>Our “system” is fine,  just needs band-aids </li></ul><ul><li>The safety net </li></ul><ul><li>We can’t affo...
<ul><li>International Timeline of Universal Healthcare </li></ul><ul><li>Germany   1883 Switzerland 1911 </li></ul><ul><ul...
Myth Versus Reality <ul><li>Every wealthy democracy has    A National Program of Health Care For All </li></ul><ul><li>Soc...
Obama on Single Payer <ul><li>“ A single payer plan is what I would like to see.”  - addressing an AFL-CIO group in Chicag...
The Medical-Industrial Complex <ul><li>“ Remember that what the rest of us call health care costs, they call income.” - Pa...
The Best Democracy   Money Can Buy? <ul><li>Health industry spending - $280 million on lobbying first half of 2009 1 </li>...
Public Support – Single Payer  <ul><li>49% favor coverage from a single govt. plan 1 </li></ul><ul><li>59% prefer a system...
Physician Support – NHI  <ul><li>2003:  49% favor establish NHI 1 </li></ul><ul><li>2008:  59% now in favor 2 </li></ul><u...
Our Non-System of Illness Care
Why  Health Care for All -  Young and Old,  Rich and Poor?
What Can We Do? <ul><li>Educate Ourselves </li></ul><ul><li>Find Our Voices </li></ul><ul><li>Join In </li></ul>
HCHP.info
PHYSICIANS FOR A NATIONAL HEALTH PROGRAM PNHP.org
 
Insurance Premiums • Workers’ Earnings • Inflation  1999-2008 Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 20...
Waiting in Canada <ul><li>Fewer Canadians report  unmet health needs 1 </li></ul><ul><li>96%  prefer their system to ours ...
Waiting for   Medicare? <ul><li>Americans’ health  improves at age 65 1 </li></ul><ul><li>Americans are happier with   Med...
Choice ?  Employer Health Benefit Plans Offered Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 2008 .
Some Choices Don’t Really Matter!
Partisan Reaction – Single Payer Indiana University Center for Health Policy and Professionalism Research 8/5/0 9
Partisan Reaction – Public Option Indiana University Center for Health Policy and Professionalism Research 8/5/09
Single Payer  vs  Public Option
Already <ul><li>1 in 3  with  insurance defer needed care now </li></ul>Schoen, Health Affairs 6/10/08
<ul><li>Source: “Measuring the Health of Nations: Updating an Earlier Analysis”.  Health Affairs,  Jan./Feb. 2008. </li></ul>
Health Care Expenditures Source: The Commonwealth Fund, calculated from OECD Health Data 2006. Per Capita, Adjusted for Di...
Rampel, US Health Spending Breaks From the Pack, NYT 7/8/09  National Health Spending % GDP
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Rob Stone On Single Payer 10 24 09

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Advantages of Single Payer

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  • But if anyone in the crowd wants to offer me a corporate sponsorship….
  • 123 per day is just over 5 per hour, 1 death every 12 minutes. 45K is approximately the total of students and employees on the IUB campus Americans who died in Vietnam over 15 years (’60 - ’75) = 58,000. Where will we build the memorial to these dead? The Myth of the Safety Net. The Governor has said that we already “have universal healthcare in Indiana, because anyone can go to the ER.”
  • It’s not just Medicare that is going broke. It’s our whole system. In fact, Medicare is doing relatively well – it’s the rest of the system that is ALREADY hitting the wall. Looking at this graph, you can see that given enough time, average family premiums will overtake average household income. But it gets worse. Private insurance premiums doubled from 2000 to 2008. Did Medicare premiums double? And worse. While premiums doubled, what happened to private coverage? Co-pays and deductibles went up, which is to say, benefits went down. Did Medicare benefits go down?
  • 1 19% of employers surveyed plan to drop health benefits in the next 3-5 years. The Road Ahead: Emerging Health Trends 2009, Hewitt Associates http://www.hewittassociates.com/_MetaBasicCMAssetCache_/Assets/Articles/2009/Hewitt_2009_Emerging_Health_Trends_Survey_Report.pdf
  • More evidence we are already hitting the wall. This is the follow up study to the classic Health Affairs article on medical bankruptcy from ‘05 by the same Harvard research group. Between 2001 and 2007 the proportion of all bankruptcies attributable to medical problems rose by 49.6% Medical bills and illness are not surprisingly a major factor in half of home foreclosures: Robertson et al, Health Matrix, Summer ‘08, “Get Sick: Get Out”
  • Here’s a slide guaranteed to confuse you, just look at the blue line on the top.
  • While the number of doctors doubled, the number of administrators rose 2500%
  • And what do those armies of people look like?…
  • Medicare is a lean, mean, billing machine. Look at the investor-owned Blues, that’s why they are Wall Street darlings
  • 1 The classic study “Cost of health care administration in the United States and Canada” by Woolhandler et al shows how we spend close to $1000 per person per year more than the Canadians just on administration and overhead . Using the authors’ assumptions, the 2009 projections are that single payer would yield $350-400 billion a year in administrative savings . 2 CBO did a series of studies in ‘93. The first concluded: “ The net cost of achieving universal insurance coverage under this single payer system would be negative .” It also looked at HR 1300 (Russo) and S 491 (Wellstone) and concluded that there would be an initial rise in expenditures, but after several years the new system could cost less than baseline, while expanding coverage to all. 3 GAO Canadian Health Insurance: Lessons for the United States ” “If the US were to shift to a system of universal coverage and a single payer, as in Canada, the savings in administrative costs [10 percent of health spending] would be more than enough to offset the expense of universal coverage” Commonwealth Fund/Lewin Group study Jan ’09 only looked at Stark’s AmeriCare, not a true single payer bill, but still showed it the most effective at expanding coverage and controlling costs, reducing spending by about $58 billion. The Lewin Group has also done many state studies showing that a state single payer bill would be the most economically feasible way to reach full coverage, including Minnesota ‘95, Maryland ‘00, Vermont ‘01, Massachusetts ’02, Maine ‘02, Rhode Island ‘02, Missouri ‘03, Georgia ‘04, California ‘05, Colorado ‘07, and Kansas ‘07. CBO study December ‘08 didn’t consider single payer at all.
  • What we have today is a 20 year experiment with for-profit corporate medicine. Before the mid 90’s there were few for profit hospitals, health insurance companies, or significant physician ownership of large for-profit entities.
  • No matter how you slice and dice it, our healthcare statistics are embarrassingly bad
  • Maybe it’s something called rationing.
  • Again we stand alone: 45,000 people die per year from rationing
  • Drinking would be the same. Maybe that’s why they live longer.
  • Maybe it’s hi tech. No.
  • It’s not because we do so much more hi tech medical care.
  • Understand that the way insurance companies make a profit for their stockholders is by taking in your premiums, but figuring out ways to not pay out when people get sick. That is their model. I went to Medical school to TAKE CARE of sick people. My motivation is exactly the opposite of theirs.
  • 1. Don’t upset the status quo. 2. The reason they call it a net - it’s full of holes 3. We don’t need more money for healthcare. We need more healthcare for our money! 4. We wish we had the best healthcare in the world.
  • No matter how you slice and dice it, our healthcare statistics are embarrassingly bad
  • The PRO and CON of single payer
  • The strongest argument in favor of single payer is that of all the proposals being discussed, it is the one best able to control costs . The strongest argument against single payer is that it is the plan best able to control costs . Controling costs is a problem? As Nobel Prize-winning economist Paul Krugman put it, writing about what he calls The Medical-Industrial Complex: “Remember that what the rest of us call health care costs, they call income.” Everyone says, “single payer isn’t feasible.” What they mean is that the forces profiting from our bloated system see Medicare for Everyone as their greatest threat. Therefore, it isn’t politically feasible
  • Over $1.5 million per day spent on lobbying, over $375 million including television ads, political donations, enough to pay the entire cost of caring for 50K people for a year There are an estimated 13 health care lobbyists for each of the 535 members of Congress according to the American League of Lobbyists. Some cynically observe that we have “the best democracy money can buy.” I don’t believe that’s true. The people get it, now we need for the leaders to follow.
  • 1 The Kaiser Family Foundation polls have consistently shown less support for single payer than the media organization polls. This one from 4/8/09 asked whether people favored “ Having a national health plan in which all Americans would get their insurance from a single government plan”. I put the poorest single payer showing at the top of this slide. 2 Grove Insight’s poll 1/29/09 asked if people preferred a system &amp;quot;like Medicare that is run by the government and financed by taxpayers.” 3 The NYT/CBS poll 1/15/09 reported “59% say the government should provide national health insurance” Many other polls from 2006-2008 can be cited showing 2:1 support for “The government should provide a national health program for all Americans even if this would require higher taxes.”
  • The price of doing nothing is too great
  • You’ve seen the data, now let’s talk heart to heart. Growing up in Evansville. Conservative parents, fairness and caring. These are core American values. “ If religion were a thing that money could by, then the rich would live and the poor would die.” That’s the reality of healthcare in this country, and it’s not good for any of us, rich or poor When did the denial of sympathy and charity become patriotic American values?
  • Our Commonsense solution: Medicare Part E – E is for Everyone.
  • Note: The remaining slides I use in the q&amp;a or for special circumstances. If anyone runs any of these slides on a PC, they need to know these were made on a Mac, and colors and fonts may auto-substitute. Be wary.
  • It’s not just Medicare that is going broke. It’s our whole system. In fact, Medicare is doing relatively well – it’s the rest of the system that is ALREADY hitting the wall. Looking at this graph, you can see that given enough time, average family premiums will overtake average household income. But it gets worse. Private insurance premiums doubled from 2000 to 2008. Did Medicare premiums double? And worse. While premiums doubled, what happened to private coverage? Co-pays and deductibles went up, which is to say, benefits went down. Did Medicare benefits go down?
  • 1 O’Neill and O’Neill’s paper is critical of the Canadian system, but their study shows fewer with unmet health needs (11.3% in Canada vs 14.4% in the US). 2 This Gallup poll is old, but frequently sited. Canadians are proud of their healthcare system, and would not trade it for ours. A few years ago a nationwide poll chose former Premier Tommy Douglas, “The Father of Medicare”, as “The Greatest Canadian.” While many Conservative MP’s criticize Canadian Medicare, none call for its end. August 2009 study showed 86% of Canadians supporting their system http://www.pnhp.org/news/2009/august/new_poll_shows_canad.php 3 ” Measuring and Reducing Waiting Times: A Cross-National Comparison of Strategies” and other studies from this group show that Canadian wait times are probably exaggerated and that US wait times are under-appreciated. Canadians do complain about waiting lines, as do the British. However, it is a myth that all universal plans inherently create problems with waiting lines or queues. Waiting is simply not an issue in Germany, France, Switzerland, Japan, Taiwan, etc. For a well done treatment watch [available online free] TR Reid’s PBS Frontline show S ick Around the World http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/ from 4/15/08.
  • 1” Health of Previously Uninsured Adults After Acquiring Medicare Coverage” McWilliams et al, 298(24): 2886-2894. Concludes that there are many uninsured near elderly, especially with heart disease and diabetes, whose health improves once they turn 65, get on Medicare, and can finally get needed care . For further discussion of this issue, please see C Schoen, “Waiting for Medicare” The Commonwealth Fund, NASI Roundtable 1/28/05 2 ”Meeting Enrollees&apos; Needs: How Do Medicare And Employer Coverage Stack Up?” Karen Davis et al, Commonwealth Fund, 0.1377/hlthaff.28.4.w521. Concludes that Medicare beneficiaries report fewer problems and greater satisfaction with medical care than those under 65 with private insurance coverage, and the gap between Medicare and private employer coverage widened from 2001 to 2007.
  • Speaking of myth vs reality Few companies that offer insurance to their employees make a choice of plans available. What choice do most workers have? Very few have a choice of plans. And for those who do, is this a choice they want to make? No, it is a nightmare choice. The choice people want is of doctor and hospital, not of insurance plan . Choosing an insurance plan generally means limiting your choice of doctor. What if your old doctor is “out of network”? And the choice you get – Do I take the higher deductible plan with the lower premium, or vice versa? Which is another way of saying - It’s like placing a bet on whether I or someone in my family is likely to get sick this year? And don’t forget to be sure to read all the fine print! For more about employee choice, see “One in 5 Employers Plan to Drop Health Benefits” Drug Benefit Trends April 2009. The heading of the last section of the article on page 107 says it all: “ Health Insurance Options Mystify Most US Workers.”
  • “ It Doesn’t Matter How You Frame It – Americans Remain Divided on Support for Government Involvement in Health Insurance, No Matter What the Role.” In this study, single payer actually polled higher among Democrats than public option did, by 5%.
  • 1 C. Schoen, S. R. Collins, J. L. Kriss, and M. M. Doty, How Many Are Underinsured? Trends Among U.S. Adults, 2003 and 2007, Health Affairs Web Exclusive, June 10, 2008:w298–w309. The graph is more concerned with the underinsured, but even among those defined as Insured , not Underinsured, 31% went without needed care due to cost.
  • The most graphically confusing slide ever made.
  • Transcript of "Rob Stone On Single Payer 10 24 09"

    1. 1. Health Care for All Fiscally conservative Socially responsible Rob Stone MD Director, Hoosiers for a Commonsense Health Plan Assistant Professor of Emergency Medicine, IUSM
    2. 2. DISCLOSURES <ul><li>Dr. Rob Stone has no relevant financial relationships with commercial interests. </li></ul><ul><li>Slides can be downloaded at: HCHP.info/Presentations </li></ul>
    3. 4. Lack of Insurance Kills <ul><li>1 every 12 minutes </li></ul><ul><li>120 every day </li></ul><ul><li>45,000 a year </li></ul><ul><li>People without insurance: </li></ul><ul><li>Live sicker and die younger </li></ul><ul><li>The safety net is full of holes </li></ul>American Journal Public Health, Wilper et al, Dec 2009
    4. 5. Insurance Premiums • Workers’ Earnings • Inflation 1999-2008 Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 2000-2008. Bureau of Labor Statistics, Consumer Price Index
    5. 6. Our Broken System: <ul><li>1 in 5 employers to drop health benefits in next 3-5 years </li></ul>1 Hewitt Associates The Road Ahead: 2009
    6. 7. Bankruptcy 2009 <ul><li>62% caused by illness and medical bills </li></ul><ul><li>Most were middle class </li></ul><ul><li>78% were insured when they became ill </li></ul>Himmelstein et al, American Journal of Medicine, August 2009
    7. 9. Health Spending Per Capita Rampel, US Health Spending Breaks From the Pack, NYT 7/8/09
    8. 11. What Are We Paying For? <ul><li>An incredibly complex system </li></ul><ul><li>Thousands of plans </li></ul><ul><li>Armies of people to: </li></ul><ul><li>-deny coverage and payments </li></ul><ul><li>- collect payments </li></ul><ul><li>- determine eligibility </li></ul>
    9. 12. Where is the bureaucratic nightmare?
    10. 13. U.S. Overhead Spending International Journal of Health Services 2005; 35(1): 64-90
    11. 14. Medicare’s Efficiency: 3% Overhead <ul><li>2003, 31% health spending on overhead – could save $286 Billion 1 </li></ul><ul><li>1993, CBO: “The net cost of Single Payer would be negative.” 2 </li></ul><ul><li>1991, GAO: “If US shifted to coverage like Canada, savings would offset the expense of universal coverage” 3 </li></ul>1 New England Journal of Medicine 8/21/2003 2 Congressional Budget Office, 1993, 3 separate reports 3 General Accounting Office, 06/91 ref: T-HRD-91-35
    12. 15. “ Kids, your mother and I have spent so much money on health insurance this year that instead of vacation, we’re all going in for elective surgery.”
    13. 16. Brief History <ul><li>WWII: Wage and price controls </li></ul><ul><li>1947: Truman pushes for National Health Insurance </li></ul><ul><li>AMA and Southern legislators oppose </li></ul>
    14. 17. History (continued) <ul><li>The birth of the Blues </li></ul><ul><li>1965: Medicare and Medicaid </li></ul><ul><li>1993: Clinton Health Plan </li></ul><ul><li>Death of not-for-profit insurance </li></ul>
    15. 18. Anthem /WellPoint (formerly Blue Cross) <ul><li>CEO Larry Glasscock in Indianapolis, just retired </li></ul><ul><li>Bonus in 2003 - $42.5 Million </li></ul>Indianapolis Star 4/7/04
    16. 19. What Do We Get For Our Money? <ul><li>The most expensive health care in the world </li></ul><ul><li>The best health care in the world? </li></ul>
    17. 21. WHO Global Health Rankings <ul><li>At the top: France is #1 </li></ul><ul><li>US ranks 37th, between Costa Rica and Slovenia </li></ul>
    18. 22. Hospital Inpatient Days per Capita Rationing?
    19. 23. Physician Visits per Capita
    20. 24. Elderly as Percent of Total Population
    21. 25. Tobacco Smokers OECD, 2004 (2002 Data, U.K is 2001 )
    22. 26. MRI Units per Million People OECD, 2004 (2002 Data, U.S., Canada, and Germany are 2001)
    23. 27. Kidney Transplants OECD, 2004 (2002 Data, Canada and Sweden are 2001)
    24. 28. Why spend so much AND get so little? <ul><li>Reason # 1: Our profit-driven insurance system </li></ul><ul><li>AND </li></ul><ul><li>As long as millions are left out, everyone will suffer </li></ul>
    25. 30. Myths <ul><li>Our “system” is fine, just needs band-aids </li></ul><ul><li>The safety net </li></ul><ul><li>We can’t afford to cover everyone </li></ul><ul><li>The best health care system in the world </li></ul>
    26. 31. <ul><li>International Timeline of Universal Healthcare </li></ul><ul><li>Germany 1883 Switzerland 1911 </li></ul><ul><ul><ul><li>New Zealand 1938 </li></ul></ul></ul><ul><ul><ul><li>France 1945 </li></ul></ul></ul><ul><ul><ul><li>United Kingdom 1946 </li></ul></ul></ul><ul><ul><ul><li>Sweden 1947 </li></ul></ul></ul><ul><ul><ul><li>USA 1947* </li></ul></ul></ul><ul><ul><ul><li>Japan 1961 </li></ul></ul></ul><ul><ul><ul><li>Canada 1966 </li></ul></ul></ul><ul><ul><ul><li>Australia 1974 </li></ul></ul></ul><ul><ul><ul><li>Italy 1978 </li></ul></ul></ul><ul><ul><ul><li>Spain 1986 </li></ul></ul></ul><ul><ul><ul><li>Taiwan 1995 </li></ul></ul></ul>*President Truman proposed but failed to pass National Health Insurance
    27. 32. Myth Versus Reality <ul><li>Every wealthy democracy has A National Program of Health Care For All </li></ul><ul><li>Socialized Medicine versus Single Payer </li></ul>
    28. 33. Obama on Single Payer <ul><li>“ A single payer plan is what I would like to see.” - addressing an AFL-CIO group in Chicago, 2003 </li></ul><ul><li>“ If I were starting from scratch, if we didn't have a system in which employers had typically provided health care, I would go with a single payer system.” - January 22, 2008, and many times after that </li></ul>
    29. 34. The Medical-Industrial Complex <ul><li>“ Remember that what the rest of us call health care costs, they call income.” - Paul Krugman, Nobel Laureate New York Times 5/10/09 </li></ul>
    30. 35. The Best Democracy Money Can Buy? <ul><li>Health industry spending - $280 million on lobbying first half of 2009 1 </li></ul><ul><li>13 health lobbyists per member of Congress 2 </li></ul>1 The Center for Responsive Politics 2 American League of Lobbyists
    31. 36. Public Support – Single Payer <ul><li>49% favor coverage from a single govt. plan 1 </li></ul><ul><li>59% prefer a system like Medicare for all 2 </li></ul><ul><li>59% say government should </li></ul><ul><li> provide national health insurance 3 </li></ul>Polls from 2009 1 April, Kaiser Family Foundation 2 January, Grove Insight Opinion Research 3 January, New York Times/CBS News
    32. 37. Physician Support – NHI <ul><li>2003: 49% favor establish NHI 1 </li></ul><ul><li>2008: 59% now in favor 2 </li></ul><ul><li>2009: 58% expand Medicare 3 </li></ul>1 Ann Int Med, Carroll, Nov 18, 2003 2 Ann Int Med, Carroll, Apr 1, 2008 3 NEJM, Keyhani, Sept 14, 2009
    33. 38. Our Non-System of Illness Care
    34. 39. Why Health Care for All - Young and Old, Rich and Poor?
    35. 40. What Can We Do? <ul><li>Educate Ourselves </li></ul><ul><li>Find Our Voices </li></ul><ul><li>Join In </li></ul>
    36. 41. HCHP.info
    37. 42. PHYSICIANS FOR A NATIONAL HEALTH PROGRAM PNHP.org
    38. 44. Insurance Premiums • Workers’ Earnings • Inflation 1999-2008 Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 2000-2008. Bureau of Labor Statistics, Consumer Price Index
    39. 45. Waiting in Canada <ul><li>Fewer Canadians report unmet health needs 1 </li></ul><ul><li>96% prefer their system to ours 2 </li></ul><ul><li>No waits for cancer care or emergency surgery 3 </li></ul><ul><li>Americans without insurance wait forever </li></ul>1 O’Neill and O’Neill, Forum for Health Economics & Policy Vol 10 (2007) 2 Gallup Poll, Toronto Star 5/12/99 3 Commonwealth Fund 7/16/07
    40. 46. Waiting for Medicare? <ul><li>Americans’ health improves at age 65 1 </li></ul><ul><li>Americans are happier with Medicare than private insurance 2 </li></ul><ul><li>US Medicare – no waiting 3 </li></ul>1 Journal of the AMA 12/26/07 2 Health Affairs 5/12/09 3 Self evident, no reference needed
    41. 47. Choice ? Employer Health Benefit Plans Offered Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 2008 .
    42. 48. Some Choices Don’t Really Matter!
    43. 49. Partisan Reaction – Single Payer Indiana University Center for Health Policy and Professionalism Research 8/5/0 9
    44. 50. Partisan Reaction – Public Option Indiana University Center for Health Policy and Professionalism Research 8/5/09
    45. 51. Single Payer vs Public Option
    46. 52. Already <ul><li>1 in 3 with insurance defer needed care now </li></ul>Schoen, Health Affairs 6/10/08
    47. 53. <ul><li>Source: “Measuring the Health of Nations: Updating an Earlier Analysis”. Health Affairs, Jan./Feb. 2008. </li></ul>
    48. 54. Health Care Expenditures Source: The Commonwealth Fund, calculated from OECD Health Data 2006. Per Capita, Adjusted for Differences in Cost of Living
    49. 55. Rampel, US Health Spending Breaks From the Pack, NYT 7/8/09 National Health Spending % GDP
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