Universal Health Care as the Civil Rights Struggle of the 21st Century

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• Health Care Reform
• Universal Health Care
• The Only Solution
• Diljeet K. Singh, MD, DrPH

Physicians for a National Health Program 29 E
Madison Suite 602, Chicago, IL 60602 Phone (312)
782-6006 Fax [phone] email
info_at_pnhp.org www.pnhp.org
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PERSPECTIVE - Philosophical

• Health care is
• A Human Right
• A social service distributed according to need
• Not a commodity distributed according to ability
  to pay
• Not a business whose beneficiaries are company
  executives and investors not patients
• Most Americans believe everyone should have
  access to good care without financial hardship

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PERSPECTIVE - Philosophical

• We are the only developed nation that does not
  provide comprehensive health care to all its
  citizens
• 47 million Americans are uninsured
• Many are underinsured - lack comprehensive
  coverage egs preventive care, long-term care
  drug costs
• 45,000 die a year from lack of coverage
• Markets are good for many things, but they are
  not a good way to distribute health care

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PERSPECTIVE- Practical

• Current system is unsustainable
• Burden it places on our economy/businesses
• Private health insurance premiums are ? at
  unsustainable rate of 13/year as much as 25
  in some areas of country
• Coverage is shrinking, as more employers decide
  to cap their contributions to health insurance
  workers find they cannot pay their rapidly
  growing share
• Most expensive health care system in the world

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PERSPECTIVE - Practical

• Spend twice as much as other developed nations
• But we dont get more care - Canadians, see their
  doctors more often spend more time in hospital
• We dont get better results - do worse than most
  other developed countries on usual measures of
  health such as life expectancy, infant mortality,
  immunization rates
• we still dont cover everyone - 47 million
  uninsured
• In sum, our health care system is outrageously
  expensive, yet inadequate.
• Why?
• Theres something enormously inefficient about
  the way we finance deliver health care

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Problem with For-Profit Payers

• Investor-owned firms compete not by ? quality or
  ? costs, but by avoiding unprofitable patients
  limiting services
• Creates paradox of a health care system based on
  avoiding the sick
• It generates huge administrative costs, which,
  along with profits, divert resources from
  clinical care to demands of business.
• Doctors hospitals maintain costly admin staff
  to deal with bureaucracy
• Adminstration consumes 31 of our health care

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Solution - Single-Payer

• Simpler more efficient than our private health
  care system
• Health care distributed by one entity, so that
  health care could be coordinated to eliminate
  gaps
• Conceptual extension of Medicare to entire
  population.
• Medicare is
• Government-financed single-payer system embedded
  within our private, market-based system.
• Most efficient part of our health-care system,
  with overhead costs of lt 3
• Covers virtually everyone over 65
• Most popular part of U S health care system

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Solution - Single-Payer

• Universal, Comprehensive Coverage
• No out-of-pocket paymentsCo-payments
  deductibles are barriers to access,
  administratively unwieldy, ineffective for cost
  containment
• Single insurance plan in each region,
  administered by public or quasi-public agency
• Global operating budgets for hospitals, nursing
  homes, allowed group staff model HMOs other
  providers with separate allocation of capital
  funds Billing on per-patient basis creates
  unnecessary administrative complexity expense.
  A budget separate from operating expenses will be
  allowed for capital improvements

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Key Features of Single-Payer

• Free Choice of ProvidersPatients should be free
  to seek care from any licensed health care
  provider, without financial incentives or
  penalties
• Public Accountability, Not Corporate DictatesThe
  public has an absolute right to democratically
  set overall health policies priorities, but
  medical decisions must be made by patients
  providers in the region rather than dictated by
  corporate executives. Market mechanisms
  principally empower employers insurance
  bureaucrats pursuing narrow financial interests
• Ban on For-Profit Health Care ProvidersProfit
  seeking inevitably distorts care diverts
  resources from patients to investors
• Protection of health care insurance workers

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47 MillionUninsured 45,000 Deaths Per Year
But simply helping them buy private insurance is
not a solution.
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Meet Thomas Wilkes

• Born in 2004 with Severe Hemophilia A.
• Dad Senior Engineer at a small high-tech
  computer firm with good benefits.
• 2005 Develops an inhibitor to his hemophilia
  treatment.
• 750,000 annual claims.

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Private Insurance for Thomas

• Company faces 40 to 55 ? in premiums.
• Only insurer that will cover them requires
  10,000 out-of-pocket 1 million cap.
• Thomas is projected to reach the 1 million
  benefit cap in summer 2009
• Options
• Dad can quit job he loves work for mega-firm
  that will take longer to be affected by high
  claims
• Mom can go to work for a mega-firm.
• Thomas father can divorce his mother to leave
  her Thomas legally destitute eligible for
  public programs.

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Who Are the Uninsured?
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,people have access to health care in America.
After all, you just go to an emergency room. -No
Longer President Bush
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Americas Underinsured
Proportion of Americans Going Without Care due to
Costs, 2005 (skipping doctor visit, specialist
appointment, treatment or prescription when
needed)
Source Commonwealth Fund Biennial Health
Insurance Survey, 2005
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Medical Bankruptcy
Illness Medical Bills Contributed to 1,000,000
Personal Bankruptcies in 2004. (Half of All
Bankruptcies)
Insurance Status at Onset of Illness
Uninsured
Had Insurance
Source Himmelstein, Health Affairs 2005 (state
estimates provided by author)
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International Health Spending, 2005
U.S. Public Spending is Greater than Other
Nations
Public/Private Spending Combined
Source OECD 2007 Japan data are from 2004
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The Healthcare Americans Want

• Guaranteed access
• Free choice of doctor
• High quality
• Affordability
• Trust respect

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Other Industrialized Nations

• Have similar demographics
• Availability of expensive technology
• Rising drug costs
• Similar levels of service
• Why are their costs
• so much lower?

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Why are costs lower in other countries?

• Administrative simplicity
• Lower prices
• Higher ratio of primary care to specialists
• Health planning
• Global budgets

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If you were in an insurance CEO, who would you
want to insure?
73
Percent of health Care Costs
80 uses less than 1000 of care per year
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6
4
1 1 2
0 0 0
SourceAgency for Healthcare Research
Quality MEPS
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The Health Profitable to the Market, the Sick
Poor to the Taxpayer
73
Government Programs
Percent of health Care Costs
Private Insurers
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6
4
1 1 2
0 0 0
SourceAgency for Healthcare Research
Quality MEPS
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Rising Costs Less Benefits Under/Uninsurance
Proportion of Americans Covered by Employer
Insurance
Source US Census
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Life Expectancy, 2005
(Data in Years)
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Infant Mortality, 2005
(Deaths in first year of life per 10,000 live
births)
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Growth of Physicians Administrators 1970-2005
Source Bureau of Labor Statistics NCHS
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One-Third of Health Spending is Consumed by
Administration
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Potential Savings 350 billion per year Enough
to Provide Comprehensive Coverage to Everyone
Source Woolhandler, et al, New England Journal
of Medicine, August 2003 Int. Jrnl. Of Hlth.
Services, 2004
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Costs to Business
Skyrocketing costs for health care are hurting
U.S. business

• Health care cost General Motors 5.6 billion in
  2005 adding 1500 to the price of each car
• Companies that offer coverage often pay 10 or
  more of payroll on health benefits and are at a
  disadvantage competing with companies that dont
  offer coverage or where there is public coverage
• Toyota located a new plant in Canada and
  Lifesavers moved a Michigan factory to Ontario

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GM retiree cost is 60 Billion!
Source Wall St. Journal, March 11, 2004
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Lesson 1 Simply Giving More People Existing
Private Insurance Policies Is Not Solution

• Current Private Insurance Policies Offer
  Inadequate Protection.
• Any Gains in Coverage Will Be Quickly Offset as
  Costs Rise Employers Shed Benefits.

Lesson 2 Real Solution to Health Crisis Must
Do 2 Things
1) Offer Coverage More Comprehensive than that
Currently Available on the Private Market.
2) Control Costs so that Benefits are Sustainable.
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Only Two Paths to Reform

• Preserve Private Insurance Companies their
  Waste
• Create a National Health Insurance System

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Single-Payer Benefits

• Comprehensive Coverage for all medically
  necessary services (doctor, hospital, long-term
  care, mental health, vision, dental, drug, etc.)
  in a single-tier system.
• Free Choice of doctor hospital.
• Health Workers Unleashed from corporate dictates
  over patient care.
• Hospitals guaranteed a secure, regular budget.

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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, ? primary
preventive care, bulk purchasing of drugs
medical supplies long term cost control.
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Health Savings Accounts

• A bank account in which a limited amount of money
  may be deposited tax-free for expenditures on
  health services.
• Must be paired with a high-deductible health
  plan. (e.g., 5,000).
• First few thousand dollars are paid from the HSA,
  at some point, catastrophic coverage kicks in.
• Theory Patients now using their own money
  better consumers lower costs.

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High-Deductibles No Savings
73
Percent of health Care Costs
13
6
4
1 1 2
0 0 0
SourceAgency for Healthcare Research
Quality MEPS
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Health Savings Accounts Wont

• Provide Meaningful Choice for Patients
• Reduce Administration
• Produce Savings

Health Savings Accounts Will

• Discourage Preventive Primary Care
• Create Huge New Administrative Waste
• Produce Few Savings (a few sick people cost the
  most)

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Individual Mandate

• Let them buy insurance.

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Criminalizing the UninsuredA Massachusetts
Punitive Index
The Crime The Fine
1 Violation of Child Labor Laws 50
2 Illegal Sale of Firearms, First Offense 500 max.
3 Driving Under the Influence, First Offense 500 min.
4 Domestic Assault 1000 max.
5 Cruelty to or Malicious Killing of Animals 1000 max.
6 Communication of a Terrorist Threat 1000 min.
7 Being Uninsured 1500 min.
Note Original version of House Bill would have
suspended individuals driving licenses for
uninsurance as well.
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Subsidy Individual Mandate Schemes

• Substandard Coverage forces uninsured to buy
  defective insurance industry products that are
  already causing families to face bankruptcy go
  without needed care.
• Unaffordable Without savings achievable with
  single-payer, taxes must raised or funds diverted
  from other needy programs.
• Micro-coverage, Macro-costs Preserves wasteful
  private insurers adds yet another layer of
  state administrative waste. Rather than provide
  care to uninsured through a relatively efficient
  program like Medicare, the plan launders tax
  dollars through wasteful private insurers.
• No Realistic Cost Control Any gains in public
  coverage will be unsustainable due to rising
  costs.

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Sounds Great, but its not politically feasible

• 2/3rds of population want it
• Most (59 percent) of physicians want it
• Business community is now realizing the need for
  it.

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Single-Payer
Glen BartonFormer CEO, Caterpillar Inc. (Fortune
100)Past Chairman, Health Retirement Task
Force Business RoundtableRepresents 150 Largest
EmployersTotal Assets 4.0 Trillion
The quickest simplest solution is to go to
a single-payer system- Written Testimony to
AHCTF, Feb. 1 2006
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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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Is The Perfect the Enemy of the Good?

• The central flaws of the Obama plan remain the
  central flaws of our current system
• Uncontrolled Costs
• Lack of Universal Coverage
• Without eliminating the overhead of a patchwork
  for-profit system we will not achieve the system
  we deserve

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Is The Perfect the Enemy of the Good?The
Radical the Republican
Many of Lincolns admirers have painted him as a
man who wanted exactly what the abolitionists did
but cannily waited for a perfect moment to
achieve it. In fact, radicals like Douglass set
an agenda Lincoln gradually adopted as his own.
Without abolitionists, there would have been no
Lincoln. - James Oakes, Historian, UC Berkeley
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Single-Payer Politically Feasible?
Other Politically Infeasible Movements

• Abolition of Human Slavery
• (1860s)
• Womens Suffrage Movement
• (1840-1920)
• Civil Rights Act
• (1964)

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