Health Care Reform A Crash Course for Consumers

1
Health Care Reform A Crash Course for Consumers

• Susan Wildin, M.D.
• Ken Kenegos, R.N.
• Margaret Nosek, Ph.D.

Health Care for All-Texas www.hcfat.org
2
Topics

1. Status of health care financing in the US
2. Patient Protection and Affordable Care Act (ACA)
3. How do other countries compare with the U.S.?
4. What is the real support for single-payer?
5. HR 676 The U.S. National Health Care Act
   "Expanded Improved Medicare for All"
6. What you can do

3
Our systems are perfectly designed to attain the
results we are currently achieving.
W. Edwards Deming
4
Status of Health Care in the US
5
Number of Uninsured Americans 1976 - 2006
Source Himmelstein, Woolhandler, and
Carasquillo, tabulation from CPS and NHIS data
6
Who Are the Uninsured?

• 80 are employed
• 75 are U.S. citizens
• People losing private health insurance at the
  fastest rate are those earning 75,000 or more

Source 2007 US Census Bureau and Institute of
Medicine
7
Most Health Care is Publicly Financed
Individuals
100 Financed by People!
20
Taxpayers
60
(Medicare, Medicaid, VA Public employees, tax
subsidies
20
Private employers
Source NEJM 1999 340109 Health Affairs 2000
19(3)150
8
Medicare versus Medicaid

• Medicare
• an insurance program
• paid into by all people who work
• beneficiaries -- people who have worked and are
  over age 65 or work disabled (high-end healthcare
  users)
• Medicaid
• safety net (charity) program
• paid for by taxpayers (state with federal match)
• beneficiaries -- people who are poor

9
One-Third of Health Spending is Consumed by
Administration
31
69
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
10
Here's what we're paying for now with .31 on
every health care dollar

• Exorbitant salaries for private insurance company
  executives
• Lobbying by private insurers (over 26 million in
  2007, a non-election year)
• Insurance bureaucrats paid to find ways to deny
  treatment
• Dividends to stock holders
• Advertising

11
Growth of Physicians and Administrators 1970-2004
Source Bureau of Labor Statistics NCHS and
analysis of CPS
12
and Health Insurance Costs Keep Rising
13
Beware of Insurance Company Doubletalk

• "consumer-driven" sky-high deductibles
• "medical management" deny coverage for
  doctor-ordered care
• "if you have to choose, you take margin and you
  sacrifice the growth line"
• profits over people

14
Patient Protection and Affordable Care Act
15
The Positives

• Small business tax credits
• Elimination of pre-existing conditions for
  children (adults in 2014)
• Elimination of lifetime caps
• Some required preventative care without payment
• Strengthened community health centers
• Improved drug coverage for Medicare
• Investment in medical education

16
What is Missing?

• About 23 million people will remain uninsured
  nine years out, which translates to
• An estimated 23,000 unnecessary deaths annually
  and an incalculable toll of suffering

17
What are the Costs?

• Pressure on middle-income families to buy
  commercial health insurance policies means
• Costs as high as 9.5 of household income
• Coverage for an average of only 70 of medical
  expenses
• Threat of financial ruin if people become
  seriously ill
• Insurance is unaffordable because of the high
  co-pays and deductibles

18
Does it Offer Cost-Control?

• Health care costs will continue to skyrocket, as
  the experience with the Massachusetts plan (after
  which this bill is patterned) demonstrates
• Employer-based coverage locks people into their
  plan's limited network of providers
• Families and individuals will face ever-rising
  costs and erosion of their health benefits
• With the rising cost of premiums, most people
  will be in the "Cadillac" category with mediocre
  coverage
• In 2018, Cadillac plans will be subject to an
  excise tax

"Health Policy Brief" Health Affairs 3-9-11
19
Is it Equitable?

• Insurance regulations are riddled with loopholes,
  thanks to the central role that insurers played
  in crafting the legislation
• People 50 years and older can be charged up to
  three times more than their younger counterparts
• Large companies with a predominantly female
  workforce can be charged higher gender-based
  rates at least until 2017

20
Whats Wrong with Subsidy and Individual Mandate
Schemes

• Substandard Coverage
• only policies that underinsure are affordable
• Unaffordable
• Amount people are presumed to be able to afford
  is unrealistic
• Increase in taxes to pay for subsidies for low
  income to buy private health insurance - costing
  taxpayers even more
• No Realistic Cost Control
• Continues to use for-profit private health plans
  which raise premiums every year no system reform
  to control costs

21
But don't despair!

• Progress to date
• Victory in Vermont
• More pundits admit single-payer is inevitable
• Health insurance industry is scrambling
• Reemergence of the public option in state
  insurance exchanges

22
How Do Other Countries Compare with the U.S.?
23
How Do Other Countries Compare with the U.S.?

• They have as good or better health outcomes
• They use the same medical technology
• They have better access / same wait times
• They have universal coverage from birth to death
• They spend half the amount we spend per capita
  (average cost per person)

24
What Other Countries Have that the U.S. Doesnt
Have

• More preventive care
• More nurses, more doctor visits, longer inpatient
  stays
• More cost control with same or better health care
  quality as U.S.
• Fewer out-of-pocket costs
• Most offer free medical and nursing education

25
How Other Countries Finance Health Care

• Sickness funds
• France, Germany
• highly regulated non-profit insurance companies
• No model in US
• Social insurance (U.K., Spain)
• VA model
• Single-payer
• Canada, Australia, Taiwan, Sweden
• Medicare model

26
What is the Real Support for Single-payer?
27

• 65 of the public and
• 59 of physicians
• support single-payer
• (CNN Poll May 4-6 2007 A Carroll and R
  Ackerman, Support for National Health Insurance
  Among American Physicians Five Years Later.
  Annals of Internal Medicine April, 2008)

28
the government should provide an NHI program
for all Americans even if this would require
higher taxes.
Source CNN poll May 4-6, 2007
29
HR 676 The U.S. National Health Care Act
30
HR 676 The U.S. National Health Care Act

• Privately delivered, high quality
• Everybody in, nobody out
• Choice of provider hospital
• Uniform, comprehensive benefits, portable
• Prevention, full mental health parity
• Cost control through economies of scale

Source http//thomas.loc.gov/cgi-bin/thomas
31
HR 676 The U.S. National Health Care Act

• Reduced administrative waste overhead
• Common sense budgeting, affordable, sustainable
• Public oversight and input/control
• Ending insurance industry interference

Source http//thomas.loc.gov/cgi-bin/thomas
32
HR 676 The U.S. National Health Care Act

• For those whose jobs are eliminated due to
  reduced administration
• Retraining and Job Placement
• 2 Years of Salary Parity Benefits
• Medicare For All Employment Transition Fund
• Annual Appropriations to Medicare For All
  Employment Transition Fund
• Retention of Right to Unemployment Benefits

Source http//thomas.loc.gov/cgi-bin/thomas
33
What You Can Do
34
Actions

• Talk about it!
• Speak truth to the lies
• Spread the HCFAT message of
• " Expanded and Improved Medicare for All
• Elevator talk
• Spread HCFAT literature
• Letters to the editor or op-eds
• Invite us to talk to your organizations

35
Actions

• Express your support to the power brokers
• Attend Town Hall meetings
• Contact State and Federal Representatives
• Work with HR 676 sponsors to make improvements
  and to pass the bill

36
Actions

• Join us
• Health Care for All-Texas (HCFAT.org)
• Physicians for a National Health Program
  (PNHP.org)
• sign on to our listserv
• come to our monthly meetings
• come to our rallies

37

• Never doubt that a small group of thoughtful,
  committed citizens can change the world indeed
  it's the only thing that ever has.
• Margaret Mead