PHYSICIANS FOR A NATIONAL HEALTH PROGRAM 29 EAST MADISON SUITE 602 CHICAGO, IL 60602 TEL: (312) 782-6006 WWW.PNHP.ORG
The Uninsured
 
 
 
 
 
 
 
 
Financial Suffering Among the  INSURED
 
 
 
 
 
 
Rising Economic Inequality
 
 
 
 
 
Persistent Racial Inequalities
 
 
 
 
 
Racial Disparity in Access to Kidney Transplants
 
Rationing Amidst a Surplus of Care
Unnecessary Procedures
Variation in Medicare Spending: Some Regions Already Spend at Canadian Level
 
 
Half of Americans Live Where Population Is Too Low for Competition Source: NEJM 1993;328:148 A town’s only hospital will n...
Profit-Driven HMOs:  A Problem, Not a Solution
 
 
 
 
 
Medicare HMOs: A Cautionary Tale About Competition Between Public and Private Plans  (AKA Public Plan Option)
 
Despite Medicare’s Lower Overhead, Enrollment of Medicare Patients in Private Plans Has Grown
 
Private Medicare Plans Have Prospered by Cherry Picking
 
 
 
 
 
 
 
Investor-Owned Care: Inflated Costs, Inferior Quality
 
 
For-Profit Hospitals’ Death Rates are 2% Higher Source: CMAJ 2002;166:1399
For-Profit Hospitals Cost 19% More Source: CMAJ 2004;170:1817
 
For-Profit Dialysis Clinics’ Death Rates are 9% Higher Source: JAMA 2002;288:2449
 
 
Drug Companies’ Cost Structure
 
High Deductible Insurance: Except for the Healthy and Wealthy, It’s Unwise
 
 
 
 
 
 
 
Mandate Model Reform: Keeping Private Insurers In Charge
“ Mandate” Model for Reform <ul><li>Proposed by Richard Nixon in 1971 to block Edward Kennedy’s NHI proposal </li></ul>
“ Mandate” Model for Reform <ul><li>Government uses its coercive power to make people buy private insurance. </li></ul>
“ Mandate” Model for Reform <ul><li>Expanded Medicaid-like program </li></ul><ul><ul><li>Free for poor  </li></ul></ul><ul...
 
“ Mandate” Model - Problems <ul><li>Absent cost controls, expanded coverage unaffordable </li></ul><ul><li>Computers, care...
The Massachusetts Reform: Headed Towards Failure
Massachusetts Health Reform New Coverage <ul><li>< 150% Poverty -  Medicaid HMO </li></ul><ul><li>150% - 300% poverty -  P...
Massachusetts: Required Coverage (Income > $31k) <ul><li>Premium:  $4,800 Annually (56 year old) </li></ul><ul><li>$2000 d...
Crimes and Punishments in Massachusetts $1068 Being Uninsured In Massachusetts $1000 min. Communication of a Terrorist Thr...
How Many are Uninsured in Massachusetts? <ul><li>State and Blue Cross Surveys – 2.6% </li></ul><ul><li>  Phone survey, few...
 
 
 
 
Tried and Failed: State Experiments with Mandate Model and Other Incremental Reforms
Massachusetts 2006 “ Every uninsured citizen in Massachusetts will soon have affordable health insurance and the costs of ...
Massachusetts 1988 “ I am very proud of the fact that Massachusetts will be the first state in the country to enact univer...
 
Sources:Washington Post 6/9/92 and 3/20/`93 Oregon 1992 “ Today our dreams of providing effective and affordable health ca...
 
Sources: Federal & State Insurance Week 4/12/93; and NY Times 9/16/94 “ The most radical health care plan in America.”  “T...
 
Vermont 1992 “ This is an incredibly exciting moment that should make all Vermonters proud.” Gov. Dean Source: New York Ti...
 
Sources: New York Times 4/19/92; and Richard Reece, Medical World News 7/1/92. “ Minnesota is enacting a program that will...
 
Washington 1993 Source: New York Times 5/2/93 Washington state “passed one of the most aggressive health care experiments ...
 
Sources: AP Newswire 4/25/06 and Ellen Goodman, Washington Post Writers Group 7/7/03. “ It’s bold and comprehensive, and i...
 
Public Plan Option: The Next Disappointment
In 1962 Republicans Jacob Javits and John Lindsay proposed a Public Plan Option (H.R. 11253 and S. 2664) as an alternative...
Public Plan Option Saves Little Even if Half of Privately-Insured Switch <ul><li>No savings on hospitals’ billing or inter...
 
Public Plan Option Cannot Solve Cost Problems   <ul><li>Achieves only a fraction (1/7 th ) of administrative savings possi...
Public Money, Private Control
 
The U.S. Trails Other Nations
 
 
 
 
 
 
 
 
 
 
 
 
 
Canada’s National Health Insurance Program
 
 
 
 
 
 
 
 
 
 
 
 
Quality of Care Slightly Better in Canada Than U.S. A Meta-Analysis of Patients Treated for Same Illnesses (U.S. Studies I...
 
 
 
 
 
 
 
 
A National Health Program for the U.S.
 
 
 
 
 
 
 
Phony vs. Real Reform <ul><li>Phony </li></ul><ul><li>Choice  of HMO/insurer </li></ul><ul><li>Coverage  = Copays, exclusi...
Public Opinion Favors Single Payer National Health Insurance
 
 
 
 
 
 
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Pnhp Health Reform Slide Set 11 09

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Pnhp Health Reform Slide Set 11 09

  1. 1. PHYSICIANS FOR A NATIONAL HEALTH PROGRAM 29 EAST MADISON SUITE 602 CHICAGO, IL 60602 TEL: (312) 782-6006 WWW.PNHP.ORG
  2. 2. The Uninsured
  3. 11. Financial Suffering Among the INSURED
  4. 18. Rising Economic Inequality
  5. 24. Persistent Racial Inequalities
  6. 30. Racial Disparity in Access to Kidney Transplants
  7. 32. Rationing Amidst a Surplus of Care
  8. 33. Unnecessary Procedures
  9. 34. Variation in Medicare Spending: Some Regions Already Spend at Canadian Level
  10. 37. Half of Americans Live Where Population Is Too Low for Competition Source: NEJM 1993;328:148 A town’s only hospital will not compete with itself
  11. 38. Profit-Driven HMOs: A Problem, Not a Solution
  12. 44. Medicare HMOs: A Cautionary Tale About Competition Between Public and Private Plans (AKA Public Plan Option)
  13. 46. Despite Medicare’s Lower Overhead, Enrollment of Medicare Patients in Private Plans Has Grown
  14. 48. Private Medicare Plans Have Prospered by Cherry Picking
  15. 56. Investor-Owned Care: Inflated Costs, Inferior Quality
  16. 59. For-Profit Hospitals’ Death Rates are 2% Higher Source: CMAJ 2002;166:1399
  17. 60. For-Profit Hospitals Cost 19% More Source: CMAJ 2004;170:1817
  18. 62. For-Profit Dialysis Clinics’ Death Rates are 9% Higher Source: JAMA 2002;288:2449
  19. 65. Drug Companies’ Cost Structure
  20. 67. High Deductible Insurance: Except for the Healthy and Wealthy, It’s Unwise
  21. 75. Mandate Model Reform: Keeping Private Insurers In Charge
  22. 76. “ Mandate” Model for Reform <ul><li>Proposed by Richard Nixon in 1971 to block Edward Kennedy’s NHI proposal </li></ul>
  23. 77. “ Mandate” Model for Reform <ul><li>Government uses its coercive power to make people buy private insurance. </li></ul>
  24. 78. “ Mandate” Model for Reform <ul><li>Expanded Medicaid-like program </li></ul><ul><ul><li>Free for poor </li></ul></ul><ul><ul><li>Subsidies for low income </li></ul></ul><ul><ul><li>Buy-in without subsidy for others </li></ul></ul><ul><li>Employer Mandate +/- Individuals </li></ul><ul><li>Managed Care / Care Management </li></ul>
  25. 80. “ Mandate” Model - Problems <ul><li>Absent cost controls, expanded coverage unaffordable </li></ul><ul><li>Computers, care management, prevention not shown to cut costs </li></ul><ul><li>Adds administrative complexity and cost; retains wasteful private insurers </li></ul><ul><li>Impeccable political logic, economic nonsense </li></ul>
  26. 81. The Massachusetts Reform: Headed Towards Failure
  27. 82. Massachusetts Health Reform New Coverage <ul><li>< 150% Poverty - Medicaid HMO </li></ul><ul><li>150% - 300% poverty - Partial subsidy </li></ul><ul><li>> 300% poverty – Buy Your Own </li></ul>
  28. 83. Massachusetts: Required Coverage (Income > $31k) <ul><li>Premium: $4,800 Annually (56 year old) </li></ul><ul><li>$2000 deductible </li></ul><ul><li>20% co-insurance AFTER deductible is reached </li></ul>
  29. 84. Crimes and Punishments in Massachusetts $1068 Being Uninsured In Massachusetts $1000 min. Communication of a Terrorist Threat $1000 max. Cruelty to or Malicious Killing of Animals $1000 max. Domestic Assault $500 min. Driving Under the Influence, First Offense $500 max. Illegal Sale of Firearms, First Offense $295 Employers Failing to Partially Subsidize a Poor Health Plan for Workers $50 Violation of Child Labor Laws The Fine The Crime
  30. 85. How Many are Uninsured in Massachusetts? <ul><li>State and Blue Cross Surveys – 2.6% </li></ul><ul><li> Phone survey, few non-english speakers </li></ul><ul><li>Census Bureau – 5.5% </li></ul><ul><li>Door-to-door survey, all local languages </li></ul><ul><li>Mass. Department of Revenue – 5% </li></ul><ul><li> of taxpayers, as of 1/1/2008 – based on tax </li></ul><ul><li>returns </li></ul>
  31. 90. Tried and Failed: State Experiments with Mandate Model and Other Incremental Reforms
  32. 91. Massachusetts 2006 “ Every uninsured citizen in Massachusetts will soon have affordable health insurance and the costs of health care will be reduced. Gov. Romney.” Sources: Wall Street Journal 4/11/06 and New York Times 4/5/06. “ The bill does what health experts say no other state has been able to do: provide a mechanism for all of its citizens to obtain health insurance.”
  33. 92. Massachusetts 1988 “ I am very proud of the fact that Massachusetts will be the first state in the country to enact universal health insurance.” Gov. Dukakis` Sources: New York Times 4/14/88 and 4/26/88 “ Massachusetts last week ventured where no state has gone before: it guaranteed health insurance for every resident.”
  34. 94. Sources:Washington Post 6/9/92 and 3/20/`93 Oregon 1992 “ Today our dreams of providing effective and affordable health care to all Oregonians has come true.” Gov. Roberts “ The most far-reaching health care reform in the nation.”
  35. 96. Sources: Federal & State Insurance Week 4/12/93; and NY Times 9/16/94 “ The most radical health care plan in America.” “Tennessee will cover at least 95% of its citizens with health insurance by the end of 1994. ” Gov. Ned McWherter Tennessee 1992
  36. 98. Vermont 1992 “ This is an incredibly exciting moment that should make all Vermonters proud.” Gov. Dean Source: New York Times 4/12/92 “ Governor Howard Dean, the only governor who is a doctor, signed a law here today that sets in motion a plan to give Vermont universal healthcare by 1995.”
  37. 100. Sources: New York Times 4/19/92; and Richard Reece, Medical World News 7/1/92. “ Minnesota is enacting a program that will be the most sweeping effort yet to provide health insurance to people who lack it . . . the first complete reform proposal in the U.S.” “ Minnesota is about to embark on a plan to solve the health-insurance crisis that could hold lessons for other states and the nation.” Minnesota 1992/1993
  38. 102. Washington 1993 Source: New York Times 5/2/93 Washington state “passed one of the most aggressive health care experiments in the nation, a program that would extend medical benefits to all 5.1 million residents of the state . . . .”
  39. 104. Sources: AP Newswire 4/25/06 and Ellen Goodman, Washington Post Writers Group 7/7/03. “ It’s bold and comprehensive, and it’s now the law of the state.” Gov. Baldacci Maine 2003 “ Maine has just become the first state in the union to approve a plan to provide universal access to affordable health insurance.”
  40. 106. Public Plan Option: The Next Disappointment
  41. 107. In 1962 Republicans Jacob Javits and John Lindsay proposed a Public Plan Option (H.R. 11253 and S. 2664) as an alternative to a public Medicare plan
  42. 108. Public Plan Option Saves Little Even if Half of Privately-Insured Switch <ul><li>No savings on hospitals’ billing or internal cost tracking </li></ul><ul><ul><li>Hospitals already use computerized uniform bill (UB-82) </li></ul></ul><ul><ul><li>Global budgeting could save $90 bil. annually </li></ul></ul><ul><li>No savings on NH/home care bureaucracy ($24 bil. saved with single payer) </li></ul><ul><li>No savings on MD office bureaucracy </li></ul><ul><ul><li>Single payer would save $85 bil. annually through simple, uniform fee schedule, eliminating prior-approval etc. </li></ul></ul><ul><li>Insurance overhead reduced $38 bil. v $131 bil. under single payer </li></ul><ul><ul><li>Private insurers retain significant market share </li></ul></ul><ul><ul><li>Hospital/NH payment can’t be simplified without global budgets </li></ul></ul><ul><ul><li>Need to collect premiums, track enrollment disenrollment etc. </li></ul></ul>
  43. 110. Public Plan Option Cannot Solve Cost Problems <ul><li>Achieves only a fraction (1/7 th ) of administrative savings possible through single payer – makes expanded coverage unaffordable </li></ul><ul><li>Medicare HMO experience shows private plans undermine fair competition despite regulations – avoid expensively ill </li></ul><ul><li>Public plan effectively serves as subsidy for private insurers, taking on many high cost patients and few profitable ones </li></ul>
  44. 111. Public Money, Private Control
  45. 113. The U.S. Trails Other Nations
  46. 127. Canada’s National Health Insurance Program
  47. 140. Quality of Care Slightly Better in Canada Than U.S. A Meta-Analysis of Patients Treated for Same Illnesses (U.S. Studies Included Mostly Insured Patients) Source: Guyatt et al, Open Medicine, April 19, 2007
  48. 149. A National Health Program for the U.S.
  49. 157. Phony vs. Real Reform <ul><li>Phony </li></ul><ul><li>Choice of HMO/insurer </li></ul><ul><li>Coverage = Copays, exclusions etc. </li></ul><ul><li>Security = Lose it if you can’t work or can’t pay </li></ul><ul><li>Savings = Less care </li></ul><ul><li>Real </li></ul><ul><li>Choice of doctor and hospital </li></ul><ul><li>Coverage = First $, Comprehensive </li></ul><ul><li>Security = For everyone, forever </li></ul><ul><li>Savings >$400 bil on bureaucracy </li></ul>
  50. 158. Public Opinion Favors Single Payer National Health Insurance

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