Stephen Colbert on the Bush Health Plan

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Stephen Colbert on the Bush Health Plan

• It's so simple. Most people who can't afford
  health insurance also are too poor to owe taxes.
  But if you give them a deduction from the taxes
  they don't owe, they can use the money they're
  not getting back to buy the health care they
  can't afford.

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US Health Care System Crisis A Single Payer
Solution

• Joshua Freeman, MD
• MASW Annual Conference
• Columbia, MO
• October 22, 2008

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What is the Problem?

• 47 Million Uninsured
• 75 Million un-or-underinsured
• Even having good insurance doesnt protect
• Inadequate health care outcomes and quality
• Extraordinary cost
• Health care primarily a business for making
  profits rather than enhancing health

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JayDoc Student-run Free Clinic Patient
Population by Employment Status
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18,314 Adult Deaths Annually Due to Uninsurance
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Life Expectancy
Source OECD 2007, data from 2005
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National Scorecard 2008

• Commonwealth Fund, July 2008
• US Scores 65 out of 100
• No improvement since 2006
• 42 (75M) adults uninsured or underinsured (up
  from 35 2006)
• 19th out of 19 countries on mortality amenable to
  medical care (down from 15th, 2006)
• Spends twice what other industrialized countries
  do
• Ref accessed 7/21/08
• http//www.commonwealthfund.org/publications/publi
  cations_show.htm?doc_id692682

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National Health Spendingas a share of Gross
Domestic Product
Projected
Actual
Percentage GDP
Source Centers for Medicare Medicaid Services
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We spend twice as much on health care as other
nations do
Per person
OECD, 2006. Data for Japan is an estimate
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How are we paying for it now?
1,075 B
319B
286B
Based on 2003 National Health Spending of 1.68
trilllion (CMS)
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COST SHIFTING NO END IN SIGHTThe Insurance
Death Spiral
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General Motors Health Care CostsA social
insurance system that sells cars to finance
itself

• 5 billion in 2003 (profits 1.7 billion)
• 1500 per car
• 9,000 per year/per employee
• -average firm (5758)
• 15,000 per year /per retiree under age 65
• 4,000 per year /per retiree on Medicare

Source New York Times 7/15/03
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Health Care Administrative Costs in the U.S.
Administrative Costs
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Clinical Care
69

(2000 per person)
New England Journal of Medicine 8/03
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Investor-Owned CareSummary of Evidence

• Hospitals Costs 3-11 higher, fewer nurses,
  higher overhead, death rates 6-7 higher, fraud
• HMOs Higher overhead, worse quality
• Dialysis Death rates 20 higher, less use of
  transplants peritoneal dialysis.
• Nursing Homes More citations for poor quality,
  fraud
• Rehab Hospitals Costs 19 higher

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Financing Single-Payer
Medicare
Single-Payer Health Care Fund
Medicaid
Payroll Tax
Income Tax
Bonus Negotiated formulary with physicians,
global budget for hospitals, increased primary
and preventive care, reduction in unnecessary
high-tech interventions, bulk purchasing of drugs
and medical supplies long term cost control.
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How It Could Work

• Regional Health Board allocates resources
• Board accountable to patients rather than
  stockholders
• Private hospitals remain in tact
• Patients have ID that allow them to get care
  wherever they wish
• Physicians work fee-for-service

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Or Medicare for All

• Already covers majority of sickest
• Aged, Blind and Disabled
• Marginal Costs relatively low
• Overhead very low

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Covering Everyone and Saving Money through
Medicare for All

• Additional costs
• Covering the uninsured and poorly-insured
  7.2
• Elimination of cost-sharing and co-pays
  5.1
• Savings
• Bulk purchasing of drugs equipment
  -2.8
• Reduced hospital administrative costs
  -1.9
• Reduced physician office costs
  - 3.6
• Reduced insurance administrative costs
  -5.3
• Primary care emphasis reduce fraud
  -2.2
• Net Savings
  -4.3

Source Health Care for All Californians Plan,
Lewin Group, 2005
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NHI will save 5000 per capita by 2024
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Expansion of Universal Health

• 1973 Denmark
• 1974 Australia
• 1978 Italy
• 1979 Portugal
• 1986 Spain
• 1996 South Africa
• 2002 Taiwan

• 1883 Germany
• 1911 Switzerland
• 1938 New Zealand
• 1945 Belgium
• 1945 France
• 1946 United Kingdom
• 1966 Canada

None of these countries rely on private,
for-profit insurance companies
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Obamas Health Plan

• Expand Medicaid, SCHIP.
• National Health Insurance Exchange.
• Public plan for small business and individuals,
  similar to FEHBP.

• Business tax credits
• Income based tax credits.
• Savings by IT, transparency, negotiated drug
  prices for Medicare, tort reform.
• Payment based on outcomes.

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McCain

• Tax credit for individuals
• Eliminate business tax deduction for employee
  health insurance
• Encourage HSAs
• Income related tax credits.

• Guaranteed Access Planpooled resources by states
  for chronic illness and poor.
• Reduce cost by IT, reimport drugs, tort reform,
  transparency.
• Payment based on outcomes.

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If done right, health care in America could be
dramatically better with true single-payer
coverage. -Ben Brewer, WSJ, April 18, 2006

• single-payer is an idea that's so easy to slam
  politically yet so sensible for business that
  only Republicans can sell it! it may take a
  Republican President to bless the socialization
  of health spending we need.
• -Matt Miller, Fortune, April 18, 2006

CNBC / MSN Money

• Think, as a small business, how you could
  benefit from a single-payer system you wouldnt
  lose potential employees to larger firms that
  offer more attractive health benefits health
  insurance costs would cease to be a line item in
  your budget. A serious illness befalling you or
  an employee wouldnt be a company-wide financial
  crisis. You might even save money.
• -Joseph Antony, CNBC / MSN Money, Winter 2003

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Problems

• McCain
• Minimal cost containment
• HSAs lead to less preventive care
• Free market has failed to deliver quality and
  efficiency.

• Obama
• Minimal cost containment
• No cost savings on administrative overhead
• Free market has failed to deliver quality and
  efficiency.

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Health Savings Accounts

• No savings globally
• No reduction of administrative costs
• Discourage preventive care

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Case Kansas Health Reform

• 2007 SB 13 Options (to KHPA)
• KHPA contracted with outside consultant
• Foundations paid the tab
• Consultant Steve Schramm
• Report on various options
• Presumed Premium Assistance

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Current KS (lt65 yo)
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Options vary on

• new people covered
• How covered / how paid
• Employer (private) vs. Medicaid expansion
  (public)
• Cost (and to whom)

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4 Plans change in Uninsured

• Reference Decr. 144K
• Affordable Decr. 50K
• Universal Decr. 247K
• Single Payer Decr. 247K

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5 Plans (Incl. Baseline) Cost
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Who Pays?

• Prevention saves lives, but maybe not money
• If it or any other intervention saves money,
  who pays? Social good?
• And how do we ensure quality?

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Sick Around the World

• PBS Frontline program T. R. Reid
• 5 Countries
• Britain
• Germany
• Japan
• Taiwan
• Switzerland
• http//www.pbs.org/wgbh/pages/frontline/sickaround
  theworld/

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Annals of Internal Medicine April 1, 2008
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Single Payer NHI in the U.S.

• HR 676
• Congressional bill to establish Single Payer
  National Health Insurance in the U.S.
• Currently has more members of Congress signed on
  than any other health reform bill (88)

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Thank you!
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Pascal Couchepin, Center-right President of the
Swiss Confederation

• Q But I can hear in what you're saying that that
  concern that everyone get covered, everyone get
  equal care, that's really important
• A Oh, yes. ... For the Swiss, whether you are
  right or left doesn't matter I think there is a
  consensus on that. We want that every one of
  our citizens can get the best medical treatment
  when they need it. ...

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Couchepin (Switzerland) 2

• Q ... One of the problems we have in America is
  that many people -- it's a huge number of people
  -- go bankrupt because of medical bills some
  studies say 700,000 people a year. How many
  people in Switzerland go bankrupt because of
  medical bills?
• A Nobody. Doesn't happen. It would be a huge
  scandal if it happens.

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Current KS (lt65 yo)

• Large Employer (gt50) 56
• Small Employer 9
• Medicaid 11
• Individual 8
• Military 3
• Medicare 1
• Prem. Assistance 1
• Uninsured 11

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• 2008 KHPA Recommendations
• Increased Health Coverage
• Combined plan
• Promote Medical Homes
• Promote Personal Responsibility
• Legislative Action 2008 None
• Not even premium assistance