<ul><li>A Presentation for Health Professional Students </li></ul><ul><li>By Joseph L. Lin and Aalok Agarwala </li></ul><u...
Health-Care Spending Per Capita, 1997 Source: OECD, 1998
Infant Mortality, 1995 Deaths in First Year of Life/1,000 Births Source, OECD, 1997
Hospital Inpatient Days Per Capita, 1996 Source: OECD, 1998 Days/Person
44.3 Million Uninsured
Who Are the Uninsured? Source: Himmelstein & Woolhandler, Tabulations CPS, 1997
Percent Uninsured by Race/Ethnicity Source: Census Bureau CPS, 1998
Milliman & Robertson Says That Patients Can’t… <ul><li>have cataracts removed in more than one eye unless the patient is y...
How Managed Care Makes Profits <ul><li>Rationing and Denials of Care </li></ul><ul><li>Implementation of Capitation </li><...
How Managed Care Makes Profits Cherry Picking Healthy Patients Source:  Health Affairs  1997; 16(3):239 Projected Health- ...
Dissatisfaction with HMOs Source:  Modern Healthcare  10/7/96  (Data from National Research Corp. survey of 160,000 househ...
Quality of Care in Investor-Owned vs Not-for-Profit HMOs   <ul><li>Compared with not-for-profit HMOs, investor-owned plans...
HMO Overhead and Profits Overhead and Profits as a Percentage of Premiums Source:  Outlook for Managed Care 1997 , Corpora...
For-Profit Medicine Corporate Social Responsibility?? “ Few trends could so thoroughly undermine the very foundations of o...
Health Care Costs Projected to Rise Source: Health Care Financing Administration, Office of the Actuary, 1998 *  Projected
Increase in Number of Physicians and Administrators, 1970-1995 Source: Bureau of Labor Statistics & NCHS, Approximate
HMO CEO Pay and Stockholdings CEO FIRM PAY STOCK (in millions) (in millions) 1996 mid 1997 Malik Hassan Foundation  $ 17.2...
Options and Avenues for Reform <ul><li>Continuing Attempts to Reform  </li></ul><ul><li>For-Profit Managed Care </li></ul>...
Continuing Attempts to Reform For-Profit Managed Care <ul><li>Incremental Reform </li></ul><ul><li>Patient Bill of Rights ...
Medical Savings Accounts <ul><li>Sickest 10 percent of Americans use 72 percent of care.  MSAs cannot  lower these catastr...
Medical Savings Accounts: “A Scam” “ We would make out like bandits, but as a physician I have a very serious concern [tha...
Expansion of Medicare <ul><li>Expand Medicare coverage to additional populations incrementally (i.e. children) </li></ul><...
Single Payer: What Is It  <ul><li>Universal, comprehensive coverage, including preventive care </li></ul><ul><li>No out-of...
<ul><li>Administration Savings </li></ul><ul><li>Significant reduction of administrative costs. </li></ul><ul><li>Provides...
Health Costs as % of GDP United States and Canada, 1960-1995 Source: Statistics Canada & NCHS/Commerce Department
Paperwork Costs United States and Canada, 1991 Source:  Woolhandler/Himmelstein  NEJM  1991; 324:1253 U.S. Canada Clinical...
What Does Single Payer Mean to the Average Family The average middle-income family would have an income tax increase of $7...
<ul><li>Will there be long waiting times for procedures? </li></ul>Single Payer in Action
Single Payer in Action <ul><li>Will there be long waiting times for procedures? </li></ul><ul><li>Waiting for Coronary Art...
Single Payer in Action <ul><li>Will there be long waiting times for procedures? </li></ul>Although Canada spends half of w...
<ul><li>Will there be long waiting times for procedures? </li></ul>Single Payer In Action What about physician salaries?
Single Payer in Action Will there be long waiting times for procedures? What about physician salaries? <ul><ul><li>Average...
Will the government determine which doctor the patient can see, and what the doctor can do?  Will there be long waiting ti...
Will the government determine which doctor the patient can see and what the doctor can do?  Will there be long waiting tim...
Will there be long waiting times for procedures? What about physician salaries? Will the government determine which doctor...
Will there be long waiting times for procedures? What about physician salaries? Will the government determine which doctor...
Will there be long waiting times for procedures? What about physician salaries? Will the government determine which doctor...
The Decision Is Yours! “Speak Up, America!  Health Care Is Our Right!” <ul><li>44.3 Million Uninsured </li></ul><ul><li>Re...
For More Information Physicians for a National Health Program Physicians for a National Health Program  332 S. Michigan, S...
For More Information About AMSA’s Initiatives, Contact: American Medical Student Association Simon Ahtaridis, Legislative ...
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HEALT CARE

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HEALT CARE

  1. 1. <ul><li>A Presentation for Health Professional Students </li></ul><ul><li>By Joseph L. Lin and Aalok Agarwala </li></ul><ul><li>Edited by Simon Ahtaridis </li></ul>The Ailing U.S. Health-Care System: A Prescription for the 21 st Century by the Doctors of the 21 st Century Adapted from the Physicians for a National Health Program Slide Show, by Drs. David Himmelstein and Steffie Woolhandler The American Medical Student Association, 2000
  2. 2. Health-Care Spending Per Capita, 1997 Source: OECD, 1998
  3. 3. Infant Mortality, 1995 Deaths in First Year of Life/1,000 Births Source, OECD, 1997
  4. 4. Hospital Inpatient Days Per Capita, 1996 Source: OECD, 1998 Days/Person
  5. 5. 44.3 Million Uninsured
  6. 6. Who Are the Uninsured? Source: Himmelstein & Woolhandler, Tabulations CPS, 1997
  7. 7. Percent Uninsured by Race/Ethnicity Source: Census Bureau CPS, 1998
  8. 8. Milliman & Robertson Says That Patients Can’t… <ul><li>have cataracts removed in more than one eye unless the patient is young and needs both eyes to work. </li></ul><ul><li>stay overnight for a mastectomy. </li></ul><ul><li>stay > one day for a vaginal delivery, > two days for a cesarean. </li></ul><ul><li>see a neurologist for new onset seizures. </li></ul><ul><li>stay > three days for a stroke, even if you can’t walk. </li></ul>Source: NY Times, 3/20/95
  9. 9. How Managed Care Makes Profits <ul><li>Rationing and Denials of Care </li></ul><ul><li>Implementation of Capitation </li></ul><ul><li>Fee Discounts </li></ul><ul><li>Shifting Costs to Patients in the Form of Co-Pays and Deductibles </li></ul>
  10. 10. How Managed Care Makes Profits Cherry Picking Healthy Patients Source: Health Affairs 1997; 16(3):239 Projected Health- Care Costs
  11. 11. Dissatisfaction with HMOs Source: Modern Healthcare 10/7/96 (Data from National Research Corp. survey of 160,000 households)
  12. 12. Quality of Care in Investor-Owned vs Not-for-Profit HMOs <ul><li>Compared with not-for-profit HMOs, investor-owned plans had lower rates for 14 HEDIS quality-of-care indicators. </li></ul><ul><li>If all women in the United States were covered in investor owned HMOs rather than non-profit plans, there would be an estimated 5925 additional deaths per year from breast cancer alone. </li></ul>Source: JAMA. 7 / 14 / 99. Vol. 282 No. 2.
  13. 13. HMO Overhead and Profits Overhead and Profits as a Percentage of Premiums Source: Outlook for Managed Care 1997 , Corporate Research Group; Stat Canada, NCHS & OECD
  14. 14. For-Profit Medicine Corporate Social Responsibility?? “ Few trends could so thoroughly undermine the very foundations of our free society as the acceptance by corporate officials of a social responsibility other than to make as much money for their stockholders as possible.” Milton Friedman, Capitalism & Freedom, 1962
  15. 15. Health Care Costs Projected to Rise Source: Health Care Financing Administration, Office of the Actuary, 1998 * Projected
  16. 16. Increase in Number of Physicians and Administrators, 1970-1995 Source: Bureau of Labor Statistics & NCHS, Approximate
  17. 17. HMO CEO Pay and Stockholdings CEO FIRM PAY STOCK (in millions) (in millions) 1996 mid 1997 Malik Hassan Foundation $ 17.2 $ 166.4 William McGuire United Healthcare 14.7 74.7 Leonard Shaeffer Wellpoint 14.2 16.5 David Jones Humana 10.5 223.4 George Jochum MAMSI 5.0 16.9 Alan Hoops Pacificare 4.7 26.9 Stephen Wiggins Oxford 4.6 230.4 Larry House MedPartners 2.5 108.5 Source: Managed Healthcare Marketing Report, 1/31/97, 7/15/97
  18. 18. Options and Avenues for Reform <ul><li>Continuing Attempts to Reform </li></ul><ul><li>For-Profit Managed Care </li></ul><ul><li>Medical Savings Accounts </li></ul><ul><li>Expansion of Medicare </li></ul><ul><li>Establishment of a Single-Payer Universal Health-Care System </li></ul>
  19. 19. Continuing Attempts to Reform For-Profit Managed Care <ul><li>Incremental Reform </li></ul><ul><li>Patient Bill of Rights and Other Consumer Protection Measures </li></ul><ul><li>Ensuring Accountability of Health Plans </li></ul>
  20. 20. Medical Savings Accounts <ul><li>Sickest 10 percent of Americans use 72 percent of care. MSAs cannot lower these catastrophic costs. </li></ul><ul><li>The 15 percent of people who use no care would get premium “refunds,” removing their cross-subsidy for the sick, but not lowering use or cost. </li></ul><ul><li>MSAs would discourage prevention </li></ul><ul><li>Complex to administer—Insurers would have to keep track of all out-of-pocket payments. </li></ul><ul><li>MSAs would increase Medicare costs by $2 billion, as projected by the Congressional Budget Office. </li></ul>No Savings
  21. 21. Medical Savings Accounts: “A Scam” “ We would make out like bandits, but as a physician I have a very serious concern [that we would be] fragmenting the insurance pool…We are going into [MSAs} because these things are going to be a gold mine…let there be no doubt. They are a scam and we will get our share of that scam.” Source: NEJM 1997; 336:1828 Malik Hasan, M.D. Former CEO, Foundation Health Systems
  22. 22. Expansion of Medicare <ul><li>Expand Medicare coverage to additional populations incrementally (i.e. children) </li></ul><ul><li>Would not provide comprehensive coverage </li></ul><ul><li>Significant out-of-pocket costs would remain </li></ul>
  23. 23. Single Payer: What Is It <ul><li>Universal, comprehensive coverage, including preventive care </li></ul><ul><li>No out-of-pocket payments </li></ul><ul><li>A single, public payer </li></ul><ul><li>Public accountability </li></ul><ul><li>No for-profit HMOs or providers </li></ul><ul><li>Centrally funded, locally administered with minimal bureaucracy </li></ul><ul><li>Coordinated community-based care </li></ul>
  24. 24. <ul><li>Administration Savings </li></ul><ul><li>Significant reduction of administrative costs. </li></ul><ul><li>Provides a more simplified and uniform system for distribution of funds. </li></ul><ul><li>Patients and Clinical Providers </li></ul><ul><li>More funds for patients and clinical providers. </li></ul><ul><li>More funds for diagnostic and treatment technologies. </li></ul><ul><li>Physicians still remain autonomous, and patients can choose their doctors. </li></ul>U.S. General Accounting Office. Canadian Health Care: Lessons for the U.S. 1991 $67 Billion Single Payer in Action
  25. 25. Health Costs as % of GDP United States and Canada, 1960-1995 Source: Statistics Canada & NCHS/Commerce Department
  26. 26. Paperwork Costs United States and Canada, 1991 Source: Woolhandler/Himmelstein NEJM 1991; 324:1253 U.S. Canada Clinical Care 76% Clinical Care 89% Administration 24% Administration 11%
  27. 27. What Does Single Payer Mean to the Average Family The average middle-income family would have an income tax increase of $731. That increase in income tax would replace premium payments and any out-of-pocket expenses. Universal Health Coverage: How Do We Pay for It? Edie Rasell, M.D., Ph.D. Single-payer insurance would be financed through a progressive tax, spreading the burden of health care more evenly. Source: http://www.epinet.org/
  28. 28. <ul><li>Will there be long waiting times for procedures? </li></ul>Single Payer in Action
  29. 29. Single Payer in Action <ul><li>Will there be long waiting times for procedures? </li></ul><ul><li>Waiting for Coronary Artery Bypass Surgery in Ontario </li></ul><ul><li>A Study of 8,517 Consecutive Patients Referred for CABS </li></ul><ul><li>0.4% died before surgery. </li></ul><ul><li>Overall median wait pre-op = 17 days. </li></ul><ul><li>Median wait for urgent cases = 1 day. </li></ul><ul><li>Waiting time varied substantially between hospitals. </li></ul><ul><li>Best predictors of waiting time were symptom status and coronary anatomy. </li></ul>
  30. 30. Single Payer in Action <ul><li>Will there be long waiting times for procedures? </li></ul>Although Canada spends half of what we do on health care, surveys show that Canadians have significantly lower out-of-pocket expenses, can see a specialist or get needed care more easily than Americans. Source: Health Affairs 1996; 15(2): 263, OECD 1995 and ANN INT MED 1992;116:507 Canadians receive high-technology care at a rate comparable to Americans. A comparison of heart and/or lung, kidney, liver and bone marrow transplants revealed similar rates for the two countries.
  31. 31. <ul><li>Will there be long waiting times for procedures? </li></ul>Single Payer In Action What about physician salaries?
  32. 32. Single Payer in Action Will there be long waiting times for procedures? What about physician salaries? <ul><ul><li>Average physician salaries would remain essentially the same, though the range of salaries would narrow due to standardization of reimbursements. </li></ul></ul>
  33. 33. Will the government determine which doctor the patient can see, and what the doctor can do? Will there be long waiting times for procedures? What about physician salaries? Single Payer in Action
  34. 34. Will the government determine which doctor the patient can see and what the doctor can do? Will there be long waiting times for procedures? What about physician salaries? Single payer is not “socialized medicine.” A single-payer system does not dictate what a doctor can do, and which doctors patients choose to visit. The single-payer system allows more doctor and patient autonomy than the current system under managed care. Single Payer in Action
  35. 35. Will there be long waiting times for procedures? What about physician salaries? Will the government determine which doctor the patient can see, and what the doctor can do? How will medical students be affected? Single Payer in Action
  36. 36. Will there be long waiting times for procedures? What about physician salaries? Will the government determine which doctor the patient can see, and what the doctor can do? How will medical students be affected? Medical students in Canada graduate with a significantly lower debt than American graduates due to large public subsidies for education. Single Payer in Action
  37. 37. Will there be long waiting times for procedures? What about physician salaries? Will the government determine which doctor the patient can see, and what the doctor can do? How will medical students be affected? Single Payer in Action Is a single-payer system politically feasible?
  38. 38. The Decision Is Yours! “Speak Up, America! Health Care Is Our Right!” <ul><li>44.3 Million Uninsured </li></ul><ul><li>Restricted Patient Choice </li></ul><ul><li>High Patient Dissatisfaction </li></ul><ul><li>High Physician Dissatisfaction </li></ul><ul><li>Over $100 billion wasted each year on unnecessary administrative costs and profit </li></ul><ul><li>Higher out-of-pocket costs for those who are insured </li></ul><ul><li>Bottom line more important than patient care </li></ul><ul><li>Universal, comprehensive coverage for all populations </li></ul><ul><li>Greater freedom of choice for patients and physicians </li></ul><ul><li>Improved preventive care </li></ul><ul><li>Improved quality of care for all, especially the uninsured, disabled, poor, chronically and mentally ill, and children </li></ul><ul><li>Cost-efficient system of delivery with minimal bureaucracy </li></ul>Today’s System Single Payer
  39. 39. For More Information Physicians for a National Health Program Physicians for a National Health Program 332 S. Michigan, Suite 500 / Chicago, IL 60604 (312) 554-0382; fax (312) 554-0383 www.pnhp.org The Center for National Health Program Studies Harvard Medical School/The Cambridge Hospital 1493 Cambridge Street, Cambridge, MA 02139 (617) 498-1032
  40. 40. For More Information About AMSA’s Initiatives, Contact: American Medical Student Association Simon Ahtaridis, Legislative Affairs Director 1902 Association Drive Reston, VA 20191 (703) 620-6600, ext. 211 E-mail: [email_address] Check our universal health care initiative web site for ideas on how you can get involved. www.amsa.org

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