This document summarizes a webinar presented by the American Sustainable Business Council (ASBC) on the business case for a single-payer "Medicare for All" healthcare system in the United States. The webinar discusses the economic benefits of a single-payer system compared to the current multi-payer system, highlighting analyses showing that a single-payer system would lower overall healthcare costs while improving outcomes. Experts on the webinar address criticisms of single-payer and explain why the U.S. has not adopted such a system previously, noting the significant financial interests of private insurers and others that benefit from the current inefficient approach. The webinar aims to make the economic argument for why single-

1. The Business Case
for “Medicare for
All”
Webinar
July 12, 2017

2. • Represent over 250,000 businesses in 40 states.
• Over 130 direct member businesses.
• Over 80 association members.
• Wide range of sustainability issues.
• Advocate at federal level and in state capitals.
• Place Op-eds and Policy Statements in media.
• Have Biz leaders be spokes to media on issues.
• Bring Biz leaders to DC to testify & lobby Congress & Administration.
ASBC’s Reach & Capabilities
asbcouncil.org/webinars

3. ASBC’s Reach/Capabilities
asbcouncil.org/webinars
DAVID LEVINE, CO-FOUNDER AND CEO, ASBC
David is the co-founder and chief executive officer of
the American Sustainable Business Council. He has
worked as a social entrepreneur for over 30 years
focusing on the development of whole systems
solutions for a more sustainable society through
building strategic partnerships and broad
stakeholders initiatives. Previously, he was the
Founding Director of Continuing Education & Public
Programs at The Graduate Center, City University of
New York. From 1984–1997, David was Founder and
executive director of the Learning Alliance, an
independent popular education organization.
.

4. BLTH is a campaign that has its frontline mission: to
transform the healthcare system so that processes are
transparent, evidence-based and priced as a function of
measurable value.
The current, multi-payer-financing health care model—
with its costly layers of middlemen that add little or no
value—must be addressed. BLTH advocates
constructively for the transformation of the healthcare
system by advancing policy consistent with members’
overall principles.
WHAT IS BUSINESS LEADERS
TRANSFORMING HEALTHCARE?
asbcouncil.org/webinars

5. • Transparency
• Evidence-based
• Value
• Lean Production
• Competitive
Our Principles
asbcouncil.org/webinars

6. ASBC’s Reach/Capabilities
asbcouncil.org/webinars
RICHARD MASTER, FOUNDER AND CEO OF MCS INDUSTRIES
INC.,
Richard Master is the Founder and CEO of MCS Industries
Inc., North America’s leading supplier of picture frames and
decorative mirrors.
He is the Executive Producer of two documentaries “FixIt,
Healthcare at the Tipping Point” and “Big Pharma...Market
Failure”.
Richard’s interest in healthcare is triggered by the annual,
relentless cost increases his company and its employees have
experienced since 2000. Initial research and investigation led
to the formation of the “Unfinished Business Foundation”
which led to the productions. Richard has an active interest in
public policy with particular focus on finding practical, common
sense solutions to problems that many characterize as too

8. “Healthcare costs are the tapeworm of our economy.”
Warren Buffet
“A single payer system, with no insurance aspect is the way to
go”
Charlie Munger
THE ECONOMIC MESSAGE FOR SINGLE
PAYER
asbcouncil.org/webinars

19. THE ECONOMIC
CONSEQUENCES OF
SINGLE PAYER REFORM

21. WHY CAN’T WE GET IT DONE WHEN THE
PUBLIC IS IN FAVOR?
Expanding Medicare to provide coverage to every American.
All Democrats Republicans
For 60% 75% 46%
Oppose 23% 12% 38%
Not Sure 17% 13% 17%
Creating a new federal program that covers everyone.
All Democrats Republicans
For 62% 80% 43%
Oppose 24% 10% 44%
Not sure 15% 10% 13%
The Economist April 2017

22. “When you take on pharma, you take on
this whole town.”
Andy Slavitt, former Acting Administrator for the Centers for Medicare and Medicaid Services (CMS), on the
power of pharmaceutical lobbyists in Washington.
THE BIG CHALLENGE…
MONEY IN POLITICS

23. TOXIC SPIN: THE GOVERNMENT IS NOT COMPETENT
TO HANDLE SUCH A HUGE UNDERTAKING.
 Government is not going to run the system.
 This is not socialized medicine.
 The Government will do what it does best. Tax Efficiently.
Negotiate Prices. Pay bills when presented.
 Medicare is the escrow agent.

24. TOXIC SPIN : SINGLE PAYER IS TOO EXPENSIVE.
 Countries that have adopted a Single Payer healthcare
system spend less per capita and produce better public health
care results.
 On average, many economic studies show a 10% savings
through a Single Payer universal system.
 Single Payer, eliminating administrative complexity, and
central negotiation with power is the only way to curb run
away cost in healthcare.

25. TOXIC SPIN: FEAR MONGERING

26. www.fixithealthcare.com

27. ECONOMIC ANALYSIS OF THE HEALTHY CALIFORNIA SINGLE-
PAYER HEALTH CARE PROPOSAL (SB-562)
• Dr. Robert Pollin
• Distinguished Professor of Economics and
• Co-Director, Political Economy Research Institute (PERI) University of
Massachusetts-Amherst
• Dr. James Heintz
• Andrew Glyn Professor of Economics and
• Associate Director, PERI
• University of Massachusetts-Amherst
• Dr. Peter Arno
• Senior Fellow and Director of Health Policy Research, PERI
• University of Massachusetts-Amherst
• Dr. Jeannette Wicks-Lim
• Assistant Research Professor, PERI University of Massachusetts-Amherst

28. ASBC’s Reach/Capabilities
asbcouncil.org/webinars
JERRY FRIEDMAN, PHD
Professor of Economics at the University of Massachusetts, Gerald
Friedman was born in New York City in 1955. After graduation from
Columbia College in 1977 he worked on the research staff of the
International Ladies’ Garment Workers’ Union, before attending
graduate schools at Harvard where he earned a Ph.D. in economics. In
addition to his 1998 book, State-Making and Labor Movements. The
United States and France, 1876-1914, he has written Reigniting the
Labor Movement: Restoring means to ends in a democratic labor
movement (2008) and Microeconomics: Individual Choice in
Communities (2nd edition 2016). Professor Friedman is also the author
of numerous articles on topics in the labor history of the United States
and Europe, on the evolution of economic thought, labor economics,
economic theory, the history of slavery in the Americas, and on current
economic issues. He has been a regular correspondent on economics
to television and other media outlets and a consultant to labor unions
and to campaigns for single-payer health insurance.

29. WHAT IS NEXT FOR HEALTH CARE?
FROM ACA TO TRUMPCARE TO . . .
SINGLE PAYER?
GERALD FRIEDMAN
PROFESSOR OF ECONOMICS
UNIVERSITY OF MASSACHUSETTS AT AMHERST
AMHERST, MA. 01003
MARCH 27, 2017
@GFRIEDMA

30. THE REAL ISSUE: AMERICAN HEALTH CARE
COSTS TOO MUCH FOR TOO LITTLE.
Where we are going
• What is wrong with competitive markets in health insurance: the 70:10
problem and adverse selection
• Why US health care is so expensive, and why so many are locked out
• Let no crisis go wasted? Now, more than ever, single payer is the
answer.
– Why we haven’t done it yet.

31. PRIVATE INSURANCE RAISES COSTS
BECAUSE INSURERS PROFIT FROM WASTE
70:10 rule –70% of costs go to
10%
– Shoe companies want to sell more
shoes. Insurers profit by selling less.
Find the 10%; drive them out!
• Copays, deductibles, paperwork, hassles to
drive away sick
• Selection policies feed
bureaucratic bloat
Cherry picking
Lemon
dropping

32. PRIVATE INSURERS WHO PRACTICE
ADVERSE SELECTION PROSPER
Others face insurance death spiral
Rising
premiums
Relatively
healthy opt
out
Pool becomes
more
expensive
Rising
coverage costs

33. OTHER PROBLEMS: PRIVATE INSURERS
ARE TOO SMALL TO BE EFFICIENT
• They are too small to achieve efficiency in claim processing
• They profit from restricting information
• They profit by restricting access, undermining quality of care by
disrupting continuity
• Too small to drive down significant monopoly rents
– Market is very sensitive to access to brands but relatively
insensitive to price

34. PROBLEMS WITH US HEALTHCARE: COST AND QUALITY
Life expectancy short 6 years.
Or spending $7000 per person too much compared with
Chile (with about equal life expectancy).
72
74
76
78
80
82
84
86
7 7.5 8 8.5 9
Life Expectancy and Health Spending OECD
US
Note: healthcare
spending associated
with longer life
expectancy. Except, for
the US

35. COMPARED WITH OTHER COUNTRIES,
WE SPEND MORE TO GET LESS
Change in real per capita spending and life expectancy, 1970-2008.
Country
Increase in per-
capita spending
Life Expectancy
gain
Cost/year of
life gained
Extra US Cost
(waste)
Canada $ 3,785 6.6 $ 573.48 $ 4,085
France $ 3,503 8.5 $ 412.12 $ 4,957
Germany $ 3,469 8.9 $ 389.78 $ 5,077
Sweden $ 3,159 5.7 $ 554.21 $ 4,189
UK $ 2,970 6.8 $ 436.76 $ 4,823
USA $ 7,182 5.4 $1,330.00 $ -

36. WE DON’T USE TOO MUCH HEALTH CARE.
WE USE LESS THAN OTHER AFFLUENT COUNTRIES
3.5
4.5
5.5
6.5
7.5
United States OECD AVERAGE
Physician Consultations per
person

37. WE HAVE TRIED USING MARKETS TO CONTROL COSTS.
RESULT: REDUCED ACCESS TO CARE
0%
5%
10%
15%
20%
25%
30%
35%
USA Average for 9 national health systems
Experienced access barrier because of cost
in past year

38. AMERICANS DIE BECAUSE THEY CAN’T
AFFORD HEALTH CARE
y = 10.452x + 234.15
R² = 0.3245
0
200
400
600
800
1000
1200
0 5 10 15 20 25 30 35 40 45
AgeAdjustedMortality
Proportion with Cost Related Access Problems
Mortality rate and cost-related access
problems

39. WE ALL KNOW THE SOLUTION
$3,000
$3,500
$4,000
$4,500
$5,000
$5,500
$6,000
$6,500
2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026
CMS and Single-Payer Spending: United States

40. WHY WE HAVEN’T DONE IT? CASE FOR
SINGLE PAYER EXPLAINS OPPOSITION
• Every saving comes from someone’s income
• Benefits are prospective
• Beneficiaries are the poor
We have been losing against settled interests, including some rich and
powerful, we are promising possible benefits going disproportionately to largely
disfranchised groups, the poor and the sick

41. US HAS CREATED $3 TRILLION OF PRIVATE INTEREST IN
INEFFICIENT AND INEQUITABLE HEALTH CARE
• Health insurers
• Elite (a.k.a. overpaid) hospitals and providers
• Big Pharma
• Medical equipment suppliers
• People with good, and heavily subsidized, private
insurance
• . . .
It might have been easier to do single payer in 1935, or
1965 . . .

42. Questions?
OUTSIDE ADVOCACY TECHNIQUES
asbcouncil.org/webinars

43. OUTSIDE ADVOCACY TECHNIQUES
asbcouncil.org/webinars
For More Information or
Get Involved with BLTH
• Visit blth.org and join our campaign.
• Talk to fellow business owners about BLTH and ask
them to join.
• Visit fixithealthcare.com to view Fix It: Healthcare at
the Tipping Point and Big Pharma…Market Failure.
• Email Eliza Kelsten at ekelsten@asbcouncil.org
with questions.