Can we have comprehensive

health care reform that provides all medically necessary care to all residents and saves

money?

Europe: The destruction of WWII required the restoration of security through social institutions. Created a system based on human rights.

The US retained an employment-based system of health care.

1960s belief: Private insurance industry would respond quickly to a

changing medical economy and cover everybody within 10 years.

• In the 1980s, a fundamental shift occurred to private In the 1980s, a fundamental shift occurred to private investor-owned health corporations. investor-owned health corporations.

• Health care was perceived as a fertile field for profit Health care was perceived as a fertile field for profit seeking businesses. In this new environmenseeking businesses. In this new environmentt

Health became a commodity, Health became a commodity, patients became consumerspatients became consumers

The United States is one of three industrialized nations that does not have a

HEALTH CARE SYSTEMHEALTH CARE SYSTEM

Expensive Low quality/poor outcomes Lack of prevention People avoid medical care Lack of coordination/medical errors Increasing disparities Losing primary care doctors

We spend two times more and cover less; fewer benefits and fewer people

AMONG INDUSTRIALIZED NATIONS THE U.S. HAS:

The lowest ranking in health careThe highest infant mortality The highest maternal mortalityThe lowest life expectancy

* Recommended care includes seven key screening and preventive services: blood pressure,cholesterol, Pap, mammogram, fecal occult blood test or sigmoidoscopy/colonoscopy, and flu shot.Data: B. Mahato, Columbia University analysis of 2002 Medical Expenditure Panel Survey.Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006.

Percent of adults (ages 18+) who received all recommended screening andpreventive care within a specific time frame given their age and sex*

29(47%)% households - someone skips a medical treatment, cuts pills or does not fill a prescription because of cost

23%(32%) Americans have problems paying medical bills

21% Americans had an overdue medical bill.

1 million people experience medical bankruptcy each year

Health Care Costs Survey, USA Today/Kaiser Family Foundation/Harvard School of Public Health, August 2005; D. Himmelstein et al, Health Affairs, 2005( KFF Survey Oct., 2008)

The number of preventable deaths (per 100,000) from treatable conditions in 19 leading industrialized nations (2002-2003):

1. France = 64.8 2. Japan = 71.2 3. Australia = 71.3

The worst: 19. United States = 109.7 = 110,000

preventable deaths per year!(due to lack of access to care)

Journal of Health Affairs

For most core quality measures, Blacks (73%), Hispanics (77%), and poor people (71%) received worse quality care than their reference groups.

For most measures for poor people (67%) disparities were increasing.

Increasing disparities were especially prevalent in chronic disease management.

Agency for Healthcare Research and Quality: National Healthcare Disparities Report, 2006.

Shortages in pediatrics, internal Shortages in pediatrics, internal medicine and family medicine.medicine and family medicine.

Decreased access Decreased access to geriatricians and gynecologists.

Low interest by medical students Low interest by medical students because of:

high student loan debtmalpractice insurancelow starting salaries

• The current average graduation debt is: $155,000

• Medical school tuition is increasing

• Loan deferment is disappearing

• Primary care physicians earn 30% less (2006)

0%

500%

1000%

1500%

2000%

2500%

3000%

1970 1975 1980 1985 1990 1995 2000

Physicians Administrators

Administration is the Fastest Growing job in

Health Care

Source: Bureau of Labor Statistics and NCHS

69%

31%Clinical Care

Administrative Costs

Source: Woolhandler, et al, New England Journal of Medicine, August 2003 & Int. Jrnl. Of Hlth. Services, 2004

($2000 per person)

0

10

20

30

40

50

60

70

80

10% 10% 10% 10% 10% 10% 10% 10% 10% 10%

Source:Agency for Healthcare Research and QualityMEPS, 1999

Percentof health CareExpenditures

1% 1% 2% 4% 6%

13%

73%

0% 0% 0%

80% uses less than $1000 of care per year

Premiums are rising five times faster than inflation

UNINSUREUNINSUREDD

Respect for human dignity demands that

no one refrain from seeking medical care

from fear of the consequences of doing so,

and that no one suffer financial adversity

as a result of having sought care. The

moral foundations of universal coverage

are as simple as that. American Journal of Public Health January 2003, vol 93

BANDAID REFORM:patchwork reforms

that expand current health care programs, shift responsibility to the individual and/or subsidize the purchase of health insurance.

COMPREHENSIVE REFORM:

fundamental reform that reorganizes the funding, unifies the administrative process and creates a health care system that serves the whole community.

STATE PLAN EXPECTATION RESULT

Maine DIRIGO 31,000 enrolled in first year, 130,000 more by 2009

Less than 10,000 enrolled by the fourth year, less than half of them uninsured prior to enrolling

Minnesota Care Subsidized insurance up to 275% poverty line, 158,000 enrolled by 1997 at $252.3 million

142,000 enrolled by 2005 and declining at a cost of $409 million

Washington Basic Health Plan

1987 : all under 200% poverty line 1993: “universal” coverage

Forced to cap enrollment at 125,000 in 2001 but 400,000 people eligible

TennCare All under 400% poverty line300,000 in first year500,000 in second year

14.7% uninsured at onset16.3% uninsured in 2005The system is collapsing because too costly

Percent of previously uninsured newly covered as of 11/1/07, calculated from CPS

Rights-Based: Access is given to all residents and is funded through progressive taxation. The only proven means of achieving universal coverage.

Incentive-Based: Access is purchased and voluntary, but subsidies/tax credits are offered as incentives.

Criminalization: Purchasing access is required by law, failure to purchase access is penalized.

Unified risk pool – everybody in, nobody out.

Everybody contributes to fund health care based on ability to pay.

All medically necessary care is covered.

Simplified administration saves money.

Focused on preventative and timely care.

Transparency and Accountability to the public

DO YOU HAVE YOUR FIRE INSURANCE CARD?

H.R. 676H.R. 676THE UNITED STATES THE UNITED STATES NATIONAL HEALTH NATIONAL HEALTH INSURANCE ACTINSURANCE ACT (Expanded and

Improved Medicare For All)

“We will never be able to control health care costs and provide quality health care to all Americans

unless we establish a universal health care system with single payer financing.”

- Dr. Marcia Angell

To ensure that all Americans have:

A single standard of high-quality, affordable health care guaranteed by federal law

Access to health care services whenever medical attention is needed

Every person living in the United States is eligible from birth throughout life

Every person living in the United States and the U.S. Territories would receive a United States National Health Insurance Card & ID number once enrolled

All patients are presumed eligible to receive services, even if not carrying card at time of need

Patients will be able to seek treatment from the physician, clinic or hospital of their choice

• preventative care• primary care• inpatient hospital

care • outpatient care• emergency care• prescription drugs

• durable medical equipment

• long term care• mental health services • dentistry • eye care• substance abuse

treatment

Additional costsCovering the uninsured and poorly-insured +7.2%Elimination of cost-sharing and co-pays +5.1%

SavingsBulk purchasing of drugs & equipment -2.8%Reduced hospital administrative costs -1.9%Reduced physician office costs - 3.6%Reduced insurance administrative costs -5.3%Primary care emphasis & reduce fraud -2.2%

Net (Savings)Net (Savings) -4.3%-4.3%

Source: Health Care for All Californians Plan, Lewin Group, 2005

Savings $387 billion Revenue:

Existing Revenue $1,305 billionNew Revenue $1,259 billion

TOTAL (Savings and Revenue)$2.951 trillion

TOTAL PROJECTED SPENDING $2.776 trillion

It is time to end the cruelty inherent in the failed U.S. health care system.

The opportunity exists to restore national dignity and do what every other civilized nation on earth does—take care of its people.

Margaret Flowers and Brigitte Marti

For more information:

Physicians for a National Health Programwww.pnhp.org (local chapters in Washington,

D.C. and Maryland).

Healthcare-Now! www.healthcare-now.org

Healthcare-Now of Maryland www.mdsinglepayer.org

Leadership Conference on Guaranteed Healthcare

www.guaranteedhealthcare4all.org