PROPOSALS FOR HEALTH CARE REFORM: WHAT IS REALISTIC

1
PROPOSALS FOR HEALTH CARE REFORMWHAT IS
REALISTIC?

• Leonard Rodberg, PhD
• Urban Studies Dept., Queens College/CUNY
• and
• NY Metro Chapter
• Physicians for a National Health Program
• Presented to the DC Chapter, PNHP
• September 25, 2008

2
THE ARGUMENT

• 1. Americans are concerned about the high cost of
  health care and their access to it. 
• 2. Our reliance on multiple private insurance
  companies is responsible for the high cost.
• 3. The Presidential candidates proposals will
  not solve the problems we face.
• 4. Single payer national health insurance will
  address these problems effectively.

3
Why Health Care Is On the Agenda
Average Annual Premiums for Single and Family
Coverage, 1999-2008
Estimate is statistically different from
estimate for the previous year shown
(pEmployer-Sponsored Health Benefits, 1999-2008.
4
..And Costs Will Continue to Rise
5
A Declining Number of Firms Are Offering
Insurance
6
Rising Number of uninsured
Leading to a Rising Number of Uninsured
7
High Cost of Health Insurance Premiums Its Even
Too Expensive for the Middle Class Today

• National Average for Employer-provided
  Insurance
• Single Coverage 4,704 per year
• Family Coverage 12,680 per year
• Note Median household income
  50,233
• Source Kaiser Family Foundation/HRET
  Survey of Employee Benefits, 2008
• U.S. Census Bureau,
  2008

8
Lowest-cost but Very Costly Unsubsidized
Insurance under the Massachusetts Plan
Also MD co-pays hospital co-insurance Source
www.mahealthconnector.org (Boston Area) February
2008
9
Medical costs create financial problems
10
and they create health problems as well.
Source Health Tracking Poll, Kaiser Family
Foundation, April 2008
Source Health Tracking Poll, Kaiser Family
Foundation, April 2008
11
U.S. Health Costs are 70 Greater than the Median
of Other Countries
United States
12
and our Health Status is Worse
13
The Outlier Nation Our Public System Covers
Fewer
United States
Source F. Colombo and N. Tapay, Private Health
Insurance in OECD Countries, OECD 2004
14
While Private Insurance Dominates
United States
Source F. Colombo and N. Tapay, Private Health
Insurance in OECD Countries, OECD 2004
15
Private Insurers High Overhead
International Journal of Health Services 2005
35(1) 64-90
16
The insurance industry is highly concentrated and
profitable
Profits 5 of revenues
17
Billing Costs Nearly 20 of All Health Care
Spending
18
Everybodys Got a Health Plan!
19
McCain/Wyden-Bennett Individual
ResponsibilityYoure On Your Own

• End employer-based insurance by eliminating the
  employers tax deduction for health insurance
• Make individuals more cost-conscious consumers
• Use tax credits to help low-income individuals
• Control costs through market competition
• No evidence - Faith-based health policy Will
  Mom Pop do better than GM and the Federal
  Government (FEHBP)?

20
The Mandate ModelClinton/ObamaJacob
HackerCommonwealth Fund

• The problem Too many uninsured
• The solution Require everyone to have insurance,
  employers to contribute
• Continued reliance on private insurance
• Control costs through market competition,
  computerization, chronic disease management
• No regulation of insurance company premiums or
  reimbursement practices

21
Will Mandates Lead to Universal Coverage?
below 65 yrs
Source Sherry Glied et al, Consider It Done?
The Likely Efficacy of Mandates for Health
Insurance,, Health Affairs, 26(6), Nov/Dec 2007
Insurance Research Council, June 2006
22
The Mandate Model Wont Work

• Will not lead to universal coverage
• Private health insurance will be a continuing
  consumers nightmare (copays, deductibles,
  denials)
• Does not address widespread underinsurance
• Increases the cost of the system by hundreds of
  billions of dollars
• Will not control rising costs
• It treats the symptom the uninsured
• and ignores the disease private insurance.

23
These Plans Offer a Public Plan along with
Private Plans. Whats Wrong with That?

• Private plans avoid sick people leading to
  adverse selection and high cost for the public
  plan.
• Many payers remain, so costs are increased.
• The savings from a single funding source cannot
  be achieved.
• There is no way to control costs.

24
These Plans Are Not Politically Realistic!

• They cost hundreds of billions of dollars
• Little public support, since they benefit only
  those without insurance
• Insurance companies will resist regulation
• They dont solve any of the problems --
  especially rising costs -- that concern everyone

25
A FALSE POLICY CHOICE

• Assertion Lets first cover everybody. Then we
  can deal with the systems inefficiencies.
• Fact We will never have enough money to provide
  everyone with decent coverage until we eliminate
  the principal sources of waste and inadequate
  coverage.

26
Conyers HR 676 Expanded and Improved Medicare
for All single payer national health insurance

• Automatic enrollment
• Comprehensive benefits
• Free choice of doctor and hospital
• Doctors and hospitals remain independent
• Financed through progressive taxes
• Costs contained through capital planning,
  budgeting, quality reviews, primary care

27
Paying for Health Care Today
28
How Single Payer Could Be Paid For One Example
from a Recent Study of a California Plan
29
Covering Everyone with No Additional Spending

• Additional costs
• Covering the uninsured and poorly-insured
  6.4
• Elimination of cost-sharing and co-pays
  5.1
• Savings
• Reduced insurance administrative costs
  -5.3
• Reduced hospital billing costs -1.9
• Reduced physician office costs
  -3.6
• Bulk purchasing of drugs equipment
  -2.8
• Primary care emphasis reduce fraud
  -2.2

Total Costs 11.5
Total Savings -15.8
Net Savings - 4.3
Source Health Care for All Californians Plan,
Lewin Group, January 2005
30
Its Not Only the Cost, its the Growth in Costs
that Must be Addressed

• Single payer offers tools to contain costs
• Budgeting, especially for hospitals
• Investment planning
• Emphasis on primary care and coordination of care
• Mandate plans offer only hopes
• Computerization
• Chronic disease management
• Insurance company competition
• There is no data or experience to suggest that
• these will cut costs or limit the rise in cost.

31
Why a National Health Insurance Program is
Possible Today

• Everyone benefits the uninsured, the
  underinsured, and everyone else who is insecurely
  insured.
• Employers will no longer face rising costs and
  competition from those who don't offer insurance.
• Limited reforms have been tried and failed.
• Every other advanced country has done it.

32
Would you prefer the current system or Universal
Health Insurancelike Medicarerun by
Governmentfinanced by Taxpayers
Dont know
Current
Universal Health
Insurance
Source Washington Post/ABC News Poll, 10/20/03
33
Will We Get Real Health Care Reform Before the
Premium Takes All our Income?
Today
Source American Family Physician, November 14,
2005
34

• Physicians for a
• National Health Program
• For more information
• www.pnhp.org
• www.pnhpnymetro.org