PHYSICIANS FOR A NATIONAL HEALTH PROGRAM

29 EAST MADISONSUITE 602CHICAGO, IL 60602TEL: (312) 782-6006

WWW.PNHP.ORG

47 MillionUninsured

Who Are The Uninsured?

Source: Himmelstein & Woolhandler - Tabulation from 1999 CPS

*Students>18, Homemakers,

Disabled, Early retirees

»Employed»50%

»Children»25%

»Unemployed»5%

»*Out of labor »force»20%

Health Costs As % Of GNP:U.S. & Canada, 1960-2001

CANADA'S NHP ENACTED

NHP FULLY IMPLEMENTED

Source: Statistics Canada, Canadian Inst. for Health Info., & NCHS/Commerce Dept

5

6

7

8

9

10

11

12

13

14

15

1960

1965

1970

1975

1980

1985

1990

1995

2000

% o

f G

NP

CANADA

U.S.

National Health Care SpendingIn Billions

Note: Selected rather than continuous years of data are shown prior to 2002. Years 2005 and forward are CMS projections.

Number Uninsured in Poverty 1967-2001

Source: Social Security Bul, HIAA, CPS

Many Americans Can't Afford the BasicsPercent of Insured and Uninsured With Unmet Needs

Source: Census Bureau - "Extended Measures of Well-Being: Meeting Basic Needs"

7%

13%10%

15%

3%5% 3% 3%

0%

5%

10%

15%

Utilityshut off

Behind onrent/mort.

Not enoughfood

Unmet needfor doctor

Uninsured Insured

Unmet Health Needs of the Uninsured

Chronically Ill and Uninsured

18,314 Adult Deaths Annually Due to Uninsurance

Illness and Medical Costs,A Major Cause of Bankruptcy

• Nearly half of all bankruptcies involve a medical reason or large medical debt

• 326,441 families identified illness/injury as the main reason for bankruptcy in 1999

• An additional 269,757 had large medical debts at time of bankruptcy

• 7 per 1000 single women, and 5 per 1000 men suffered medical-related bankruptcy in 1999

• 2005 study confirms the above findings and notes that 3/4 of those bankrupted had insurance at the start of their illness!

Source: Norton's Bankruptcy Advisor, May, 2000 Health Affairs, February, 2005

Private Insurers’ High Overhead

CEO Pay and Stockholdings, 1998

Source: Jenks Healthcare Business Report 7/24/99

CEO Firm Pay (mill) Stock (mil)

Wilson Taylor Cigna $5.0 $64.2 Norman Payson Oxford $3.3 $44.7 Leonard Shaeffer Wellpoint $2.2 $45.5 Richard Huber Aetna $2.2 $21.3 William McGuire United Hlthcr. $1.5 $87.8

Melvin Goodes Warner Lambert $16.5 $287 Paul Ormond Manor Care $7.8 $43.7 Peter Nicholas Boston Scientific $0.8 $1198 Thomas Frist Jr..... Columbia/HCA $.025 $445

Investor-Owned CareSummary of Evidence

• Hospitals: Costs 3%-11% higher, fewer nurses, higher overhead, death rates 6%-7% higher, fraud

• HMOs: Higher overhead, worse quality, collaboration with tobacco industry

• Dialysis: Death rates 20% higher, less use of transplants & peritoneal dialysis, fraud

• Nursing Homes: More citations for poor quality, fraud

• Rehab Hospitals: Costs 19% higher

What's Wrong WithTax Subsidies and Vouchers?

• Taxes go to wasteful private insurers, overhead >13%

• Amounts too low for good coverage, especially for the sick

• High costs for little coverage - much of subsidy replaces employer-paid coverage

• Encourages shift from employer-based to individual policies with overhead of 35% or more

• Costs continue to rise (e.g. FEHBP)

• Many are unable to purchase wisely - e.g. Frail elders, severely ill, poor literacy

Non-group Plans, High Overhead

Source: J Health Policy, Pol & Law 2000;25:19

17%13%

40%35%

0%

10%

20%

30%

40%

50%

Life/HealthInsurers

Hospital/MedInsurers

Per

cent

of P

rem

ium

s fo

r O

verh

ead

Group Non-Group

CBO on price sensitivity

• They modeled what the uptake of insurance would be for a typical working person who did not have employer based insurance in August 2005.

• 50% subsidy ($1700 per person per year) would increase those buying insurance from about 16% to about 20%-an increase of about 4%.

Medical Savings Accounts: No Savings• Sickest 10% of Americans use 72% of care. MSA's

cannot lower these catastrophic costs

• The 15% of people who get no care would get premium “refunds”, removing their cross-subsidy for the sick but not lowering use or cost

• Discourages prevention

• Complex to administer - insurers have to keep track of all out-of-pocket payments

• Congressional Budget Office projects that MSAs would increase Medicare costs by $2 billion.

Early experience with CDHP and HDHP

• Lower satisfaction

• Higher out of pocket costs

• More missed health care

• More cost consciousness

• Lack of information to act as a consumer Commonwealth Fund

December, 2005

Health Care Realities

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

10% 10% 80%

73%

14%13%

Per

cen

t o

f h

ealt

h c

are

$

Percent of the population

$39,000

$6,900 $900

When you are really sick, health care is very expensive

Why There Will Never Be an Efficient Competitive Market for Health Care Services

– 1) there should be easy entry and exit from the market for both the buyer and the seller.

– 2) The consumer is sovereign. The buyer not the seller determines demand and the buyer wants the most for the money.

– 3) there must be easy access to adequate information for buyers to make a choice of products and services

– 4) The seller optimizes quality and meets market price to maximize profits

– 5) no natural or government supported monopolies exist and no significant external forces exist to distort the market

• The market for health care services fails to pass the test on every element

Health Care for All Ohioans Act and HB 676

• Universal - covers everyone

• Comprehensive - all needed care, no co-pays

• Single, public payer - simplified reimbursement

• Improved health planning

• Public accountability for quality and cost, but minimal bureaucracy

What Would It Look Like?

• Everyone receives a health care card assuring payment for all needed care

• Complete free choice of doctor & hospital

• Doctors and hospitals remain independent and non-profit, negotiate fees and budgets with the Ohio or NHP

• Local planning boards allocate expensive technology

• Progressive payroll income and sales taxes go to health care trust fund with reserves like any insurer

• Publicly accountable agency processes and pays bills

The Pew Research Center Scrap Tax Cuts for Health Insurance

• 72% agree that the government should provide universal health care, even if it means repealing most of the Bush tax cuts

• Democrats - (86%-11%)

• Independents - (78%-19%)

• Republicans - (51%-44%)

• Of those who agree 61% think of it as a moral as well as a political issue, while most opponents tend to see this in strictly political terms (58%)

•(7/24/2003)

How Reform Happens in the USA• Congress and regression to the mean =

incremental reform only• 50 states = 50 chances• Reform must be tried at the state level

and be proven to be successful and that the sky will not fall

• There will need to be a broad grassroots movement in support of reform and this may take years or even decades to build

Social Reforms That Were First Passed at the State Level

• Women’s suffrage

• Child labor laws

• Workers compensation

• Social security disability

• 40 hour work week

• Family and medical leave

• Environmental laws

How Do We Know It Can Be Done?

$0 $1,000 $2,000 $3,000 $4,000 $5,000 $6,000

Japan

U.K.

Italy

Sweden

France

Germany

Canada

U.S.

Total Spending U.S. Public U.S. Private

U.S. Public spending per capita for health is greater than the Total spending in other nations.

What Can You Do?• You can join SPAN Ohio. (spanohio.org has links and

contact persons)• You can check out the Physicians for a National

Health Program website. (pnhp.org)• You can speak to your constituents, write letters to

your local paper, and donate time and money to SPAN Ohio. You can co-sponsor the Health Care for All Ohioans act and push for hearings.

• This is the civil rights struggle of the new century. You need to be with us to fight for yourself, your family and your friends. The common ground? We will all likely be patients some day.

Canadian Satisfaction With Hospital Care

49.6

43.5 48.

0

45.8

32.7

47.3

37.6

47.1

42.5

47.2

37.0

53.6

38.2 48.

135.3

41.5

49.3

37.3

55.0

29.9

69.3

44.3

41.2

23.3

29.7

60.3

According to the 2000-2001 Canadian Community Health Survey, more than 85% of respondents had received good or excellent quality care

Canada47.8

37.4

Excellent

Good

Canadian Health Care System

New Canadians Seek Care in the US

Waiting Lists in the US

Less Spending and Better Results

76.0077.0078.0079.0080.0081.0082.00

Life Expectancy

Despite higher health spending than any of these countries, the U.S. has the lowest life expectancy, a key indicator of a nation’s health.

05

10152025303540

France

Canad

aU.K

.

Ger

man

y

Swed

enU.S

.Ita

ly

Japa

n

# of MRIs

MRI Units Per Million Population

Similarly, the U.S. has more MRI machines per million than some nations with lower spending and fewer than others.

Australia Canada England N.Z. U.S.

Breast Cancer 2nd 4th worst 3rd bestColorectal Cancer 2nd 3rd worst best 4thCervical Cancer best 3rd worst 4th 2ndChildhood Leukemia worst best 3rd 4th 2ndKidney Transplant 2nd best 3rd 3rd worstLiver Transplant 2nd best worst * 3rdNon-Hodgkin’s Lymphoma

best 4th worst 2nd 3rd

AMI, ages 20-84 best worst NA 2nd NAStroke, ages 20-84 2nd best NA worst NA

Comparison of Quality of CareSurvival Rates for 5 Countries