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

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• Single Payer 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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David Apsey, DDS

• drdavid2450_at_yahoo.com
• Al G knows how to reach me if any questions arise.

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Moral, Socially Responsible Vision of Society

• 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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47 MillionUninsured 45,000 Deaths Per Year
But simply helping them buy private insurance is
not a solution.
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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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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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Who Are the Uninsured?
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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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PERSPECTIVE- Practical

• Current system is unsustainable
• Private health insurance premiums are ? at
  unsustainable rate of 13-25/year
• Coverage is shrinking, as employers cap their
  contributions to health insurance workers are
  unable to pay their rapidly growing share
• Most expensive health care system in the world

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Rising Costs Less Benefits Under/Uninsurance
Proportion of Americans Covered by Employer
Insurance
Source US Census
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Problem with For-Profit Payers

• Investor-owned firms profit by avoiding
  unprofitable patients limiting services
• The administrative, marketing and profits divert
  resources from clinical care.
• Doctors hospitals maintain costly admin staff
  to deal with bureaucracy
• Adminstration consumes 31 of our health care

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Growth of Physicians Administrators 1970-2005
Source Bureau of Labor Statistics NCHS
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The Health Profitable to the Market, the Sick
Poor to the Taxpayer
73
Government Programs
80 uses less than 1000 of care per year
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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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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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 policies that cause bankruptcy going
  without needed care.
• Unaffordable With insurance subsidies, taxes
  must be raised or funds diverted from other needy
  programs. (Single-payer is revenue neutral)
• Rather than provide care to uninsured through an
  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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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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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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Solution - Single-Payer HR676

• Simpler more efficient than our private health
  care system with distributed by one entity for
  all necessary health care
• This Means extending Medicare to entire
  population
• Government-financed single-payer system with
  private, market-based system of doctors.
• Medicare is the 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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Single-Payer HR676

• Universal, Comprehensive Coverage including
  Dental and Vision with
• No out-of-pocket paymentsCo-payments
  deductibles are barriers to access and
  ineffective for cost containment
• Single insurance plan in each region,
  administered by public agency
• Global operating budgets for hospitals, nursing
  homes A capital improvement budget separate from
  operating expenses will be allowed

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Key Features of Single-Payer

• Free Choice of ProvidersPatients will be free to
  seek care from any licensed health care provider,
  without financial incentives or penalties
• Public Accountability, Not Corporate DictatesThe
  public will set overall health policies
  priorities, medical decisions will be made by
  patients providers in the region.
• Ban on For-Profit Health Care ProvidersFor -
  Profit hospitals divert resources from patients
  to investors
• Protection of health care insurance workers

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The Healthcare Americans Want

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

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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 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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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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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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