Your Money or Your Life

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Your Money or Your Life

• On Your Own in Bushs
• Ownership Society
• Consumer-Directed Health Care
• Leonard Rodberg, PhD
• PNHP-NY Metro Forum
• January 25, 2005

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Caution Bewareof Neo-Orwellian Bush-speak

• "Political language ... is designed to make lies
  sound truthful and murder respectable, and to
  give an appearance of solidity to pure wind."
• George Orwell

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Consumer-directedvs.Consumer-friendlyand
Doctor-friendly
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Ingredients of a Consumer-Directed Health Plan

• Tax-deductible Health Savings Account (HSA)
• e.g, 2,000
• High-deductible Insurance Plan, e.g., 4,000
• 20 coinsurance
• Limit on out-of-pocket expenses, e.g., 10,000
• No pre-existing conditions
• Preferred-physician organization (PPO)
• Large out-of-network costs

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Sample Consumer-Directed Health Plan
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Origins of CDHC

• Economists opposition to insurance
• create health care market
• Employers desire to shift costs to employees
• Right-wing support for individualism
• and privatization

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Two Views of Consumer-Directed Health Care

• The health care system must be responsive
  primarily to individual consumers, rather than to
  third-party payersA consumer-drive system will
  empower all people to make decisions that will
  directly affect their own health. This
  empowerment gives people a greater stake in, and
  more responsibility for, their own health care.
• Sen. Bill Frist (R, TN), NEJM, Jan. 20 2005
•  
• These high-deductible plans are not
  consumer-driven, nor do they offer much choice.
  They simply shift costs to so-called consumers
  who pay more out of pocket, making it difficult
  for patients to get the care they need.
• Cong. Pete Stark (D, CA)
•  

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Variation in Health Care Costs
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Health Care Costs Concentrated in Sick Few
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Cost Sharing Reduces Likelihood of Receiving
Effective Medical Care
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Cost Sharing Reduces use of Essential Drugs
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Problems with CDHC

• Regressive benefits higher-income people
• more than lower-income
• Does not help those with pre-existing
• conditions
• Reduces necessary care
• Will lead to more medical bankruptcies

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More Problems with CDHC

• Would lead to insurance death spiral
• Destroys shared risk concept of insurance
• Will not reduce or control health care costs
• Imposes cash nexus in doctor-patient relationship

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Kennedy calls for Medicare for All

• I propose that, as a 40th birthday gift to the
  American people, we expand Medicare over the next
  decade to cover every citizen - from birth to the
  end of life
• It's no secret that America is still dearly in
  love with Medicare. Administrative costs are low.
  Patients' satisfaction is high. Unlike with many
  private insurers, they can still choose their
  doctor and their hospital
• I propose to phase in Medicare for All, age group
  by age group, starting with those closest to
  retirement, between 55 and 65, and every young
  child Payroll taxes should be part of the
  financing, but so should general revenues, to
  make the financing as progressive as possible.
• January 12, 2005