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Health Care Reform A Crash Course for Consumers Susan Wildin, M.D. Ken Kenegos, R.N. Margaret Nosek,...
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Transcript of Health Care Reform A Crash Course for Consumers Susan Wildin, M.D. Ken Kenegos, R.N. Margaret Nosek,...
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Health Care Reform Health Care Reform A Crash Course for ConsumersA Crash Course for Consumers
Susan Wildin, M.D.Ken Kenegos, R.N.
Margaret Nosek, Ph.D.
Health Care for All-Texaswww.hcfat.org
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Topics Topics 1. Status of health care financing in the US2. 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
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““Our systems are perfectly Our systems are perfectly designed to attain the results designed to attain the results we are currentlywe are currently achieving.” achieving.”
W. Edwards Deming
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Status of Health Care Status of Health Care in the USin the US
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Number of Uninsured Americans: Number of Uninsured Americans: 1976 - 20061976 - 2006
Source: Himmelstein, Woolhandler, and Carasquillo, tabulation from CPS and NHIS data
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Who Are the Uninsured?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
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Source: NEJM 1999; 340:109; Health Affairs 2000; 19(3):150
Most Health Care is Most Health Care is Publicly FinancedPublicly Financed
60%20%
20%
Taxpayers
Private employers
Individuals
(Medicare, Medicaid, VA Public employees,tax subsidies}
100% Financed by People!
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Medicare versus MedicaidMedicare 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
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One-Third of Health Spending is One-Third of Health Spending is Consumed by AdministrationConsumed by Administration
AdministrationAll Other
31%
Potential Savings: $350 billion per Potential Savings: $350 billion per yearyear
Enough to Provide Comprehensive Coverage to Everyone
Source: Woolhandler, et al, New England Journal of Medicine, August 2003 & Int. Jrnl. Of Hlth. Services, 2004
69%
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Here's what we're paying for now Here's what we're paying for now with with $.31$.31 on every health care dollar 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
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Growth of Physicians and Growth of Physicians and Administrators 1970-2004Administrators 1970-2004
Source: Bureau of Labor Statistics; NCHS; and analysis of CPS
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……and Health Insurance Costs Keep Risingand Health Insurance Costs Keep Rising
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Beware of Insurance Company Beware of Insurance Company DoubletalkDoubletalk
• "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
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Patient Protection and Patient Protection and Affordable Care ActAffordable Care Act
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The PositivesThe 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
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What is Missing?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
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What are the Costs?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
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Does it Offer Cost-Control?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
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Is it Equitable?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
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What’s Wrong with Subsidy What’s Wrong with Subsidy and Individual Mandate and Individual Mandate
SchemesSchemes• 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
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But don't despairBut 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
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How Do Other Countries How Do Other Countries Compare with the U.S.?Compare with the U.S.?
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How Do Other Countries How Do Other Countries Compare with the U.S.?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)
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What Other Countries What Other Countries Have Have
that the U.S. Doesn’t that the U.S. Doesn’t HaveHave
• 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
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• 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
How Other Countries Finance How Other Countries Finance Health CareHealth Care
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What is the Real Support What is the Real Support for Single-payer?for Single-payer?
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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)
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“… “… the government should provide an the government should provide an NHI program for all Americans even if NHI program for all Americans even if
this would require higher taxes.”this would require higher taxes.”
Source: CNN poll May 4-6, 2007
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HR 676: The U.S. National HR 676: The U.S. National Health Care ActHealth Care Act
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• 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
HR 676: The U.S. National HR 676: The U.S. National Health Care ActHealth Care Act
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• 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
HR 676: The U.S. National HR 676: The U.S. National Health Care ActHealth Care Act
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• 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
HR 676: The U.S. National HR 676: The U.S. National Health Care ActHealth Care Act
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What You Can DoWhat You Can Do
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ActionsActions
1. Talk about it!– Speak truth to the lies– Spread the HCFAT message of
" Expanded and Improved Medicare for All“" 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
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ActionsActions
2. 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
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ActionsActions
3. 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
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“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