Presentation on theme: "The PNHP Vision for National Health Insurance in the United States"— Presentation transcript:
1The PNHP Vision for National Health Insurance in the United States Oliver Fein, M.D., ChairPhysicians for a National Health Program Metro NY
2The PNHP Program for NHI What will the delivery system look like?Most physicians are in private or group practice and paid fee-for-service, although salary and capitation payment possibleHospitals are non-profit governed by local Boards of TrusteesComplete free choice of physician and hospital.
3The PNHP Program for NHI What will the insurance system look like?Everybody has insurance: citizens, legalimmigrants, and the undocumentedEligibility is defined by length of residencyEverybody receives an NHI cardThere is universal coverage“Everybody in, nobody out”
4The PNHP Program for NHI Universal coverage means more than who iscovered, it means the same coverage foreverybodyCoverage does not depend on your employment status, your age or your incomeCoverage must be adequate for everybody, including the poorThis means no co-payments or deductibles, no need for a Medicaid-like program
5The PNHP Program for NHI Universal coverage means no more tieringin health careNo private insurance will duplicate the public coverage.Private insurance would be allowed to cover what is not covered by the NHI – such as cosmetic procedures.
6The PNHP Program for NHI Benefits will cover “All medically necessary services” including:Hospital carePhysician servicesMental health servicesMedication expensesHome careNursing home careDental careVision care
7The PNHP Program for NHI Will there be any exclusions?Determined by your local health boardPrivate rooms, unless medically necessaryPrivate duty nurses, unless medically necessaryBotox for wrinkles?Elective Facial cosmetic surgery??? Viagra – good sex is good for health – covered!!
8The PNHP Program for NHI How will the inclusions/exclusions bedecided?Evidence-based medicinePatient preferenceCoverage board, including health professionals, patients, the public, health care advocates
9The PNHP Program for NHI Why is the Program called “single payer” NHI? Because there is a single insurer paying hospitals, doctors, pharmacies, nursing homesBecause there is no other way to avoid “cherry-picking” by private, for-profit insurance companies Because it results in the lowest administrativecosts: Medicare=2-3% vs private insurance=16-30%Because it returns the largest amount of money tothe care of patients: 97% for Medicare; 70-84% for private insurance.
12The PNHP Program for NHI How do we pay for single payer NHI?Not with premiums: they are regressiveWith a payroll tax: Medicare Part A (presentlyequals 1.45% from employee % from theemployer) With income taxes: improved Medicare Part B – no beneficiary contribution
13The PHNP Program for NHI Can we afford single payer NHI?The gap between Canadian (single payer) and US(1500 private insurers) amounts to $298 billion/year. (NEJM August 21, 2003)If we move from our multi-payer to a single-payerwe will save $298 billion/yearWith these administrative savings, all the uninsured and underinsured could be covered, without increasing costs to the overall system
14Bureaucracy: U.S. vs. Canada, 2003 Money Spent Per Capita on Administrative Costs(includes insurance, hospital and physician administrative costs)Source: “Administrative Waste in the U.S. Health Care System,” Woolhandler, Himmelstein & Wolfe
15Who Delivers Health Care? Growth in Physicians and Administrators since 1970Source: BLS & Himmelstein/Woolhandler/Lewontin Analysis of CPS Data
16Is single payer NHI politically feasible? Employers face international competition.Health insurance is not the insurance industry’s most lucrative product – no long term investment benefitWith the growth of underinsurance - increased out-of-pocket expenses (premium shifts from employer to employee, increased co-pays, growth of health savings accounts) all Americans are affected!
17HARRIS POLL: “Government Should Provide Quality Medical Coverage to All Adults . . .” For more than twenty years, polls have shown wide public support for government-assured universal health care coverage. But those closest to the seat of power are least likely to concur with the public.Americans and Canadians have similar views on health care. More than 80% in each nation favor "one-class care;" more than three-quarters believe that government should assure access to care; and about two-thirds advocate taxing the rich to pay for care. Fewer than one in five believe the sick should pay more for care.Source: USA Today/Harris Poll - 11/23/98
18SUPPORT ACROSS POLITICAL PARTIES TO EXPAND MEDICARE BENEFITS Percent who favor each proposal when arguments for and against are presented…Having Medicare cover long-termNursing home care “even if it meanshigher premiums or taxes”Having Medicare cover prescriptionDrugs “even if it means higher premiumsor taxes”Expansion of Medicare so that peopleAged are able to buy into theprogram before they turn 65Source: Kaiser Family Foundation/Harvard School of Public Health National Survey on Medicare, 10/20/98 (conducted Aug-Sept 1998)
19Americans Pay World’s Highest Taxes For Healthcare Per Capita Health Spending, 2002OECD and “Paying for National Health Insurance—And Not Getting It”Health Affairs: July / August 2003
20The PNHP Program for NHI (The Physicians’ Proposal) JAMA 2003: August 13 Single-payer National Health InsuranceUniversal coverageComprehensive coverageProgressive financingLow administrative costsNon-profit delivery system
21What can you do about health reform? Pro-active efforts on the federal levelJohn Conyers: HR 676: National Health Insurance ActBarbara Lee: US National Health Service ActJesse Jackson, Jr.: Constitutional amendment – health as a human rightWellstone/Baldwin: Federalist approach – incentives for State reformBush: Community Health Centers Act
22What can you do about health reform? Pro-active efforts on the state level California: Options Commission - Kuehl state single-payer billMassachusetts: Constitutional amendment – health as a human rightMaine: Dirigo – Subsidized private insuranceMaryland: Pay or playNew York: Gottfried – Commission for Healthcare Options
23What can you do about health reform? 3. Incremental ReformsMedicare expansions: down to age 60 or 55 or 50; children up to age 18; unemployedEmployer-mandate lawsNYC: Health Security Act – QuinnMarket-based reforms: Healthy-NYCommunity Health Centers Act
24What can you do about health reform? 4. Defensive FightsStopping the privatization of Social SecurityRepealing portions of the MMA: donut-hole Rx coverage, prohibiting Medicare from negotiating prices with Pharma, subsidies to HMOs (Medicare-Advantage), HSAsFighting Medicaid cutbacks: block grants and waivers
25What can you do about health care reform? 5. Reactive FightsStop Health Savings Accounts (HSAs)Expose Consumer Driven Health Care (CDHC)Evaluate Tax CreditsSupport alternatives to caps on non-economic damages in malpractice reformOppose trade agreements: result in higher drug prices abroad
26The Institute of Medicine says: Between the health care we have and could have, lies not just a gap but a chasmThe American health care delivery system in need of a fundamental changeThe challenge is the enormity of the change requiredCommon Sense: “You cannot cross a chasm in two jumps”
27PHYSICIANS FOR A NATIONAL HEALTH PROGRAM (PNHP) says: We’ve tried and failed with incremental reforms for 100 yearsThe time has come for single-payer National Health Insurance-an improved Medicare-for-All.
28REFERENCES AND CONTACTS Bodenheimer TS, Grumbach K. Understanding Health Policy: A Clinical Approach. Appleton & LangeCalifornia Health Options Project: 9 different plans ranging from Medical Savings Accounts to Single Payer Plans are compared.Commonwealth Fund, One East 75th Street, New York, NYHimmelstein D, Woolhandler S, Hellander I. Bleeding the Patient: The Consequences of Corporate Healthcare. Common Courage Press, 2001.Physicians for a National Health Program (PNHP), 29 East Madison St., Rm. 602, Chicago, Ill PNHP-NY, 2753 Broadway #198, New York, NY