1. The PNHP Vision for National Health Insurance in the United States
Oliver Fein, M.D., Chair
Physicians for a National Health Program Metro NY

2. The 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 possible
Hospitals are non-profit governed by local Boards of Trustees
Complete free choice of physician and hospital.

3. The PNHP Program for NHI
What will the insurance system look like?
Everybody has insurance: citizens, legal
immigrants, and the undocumented
Eligibility is defined by length of residency
Everybody receives an NHI card
There is universal coverage
“Everybody in, nobody out”

4. The PNHP Program for NHI
Universal coverage means more than who is
covered, it means the same coverage for
everybody
Coverage does not depend on your employment status, your age or your income
Coverage must be adequate for everybody, including the poor
This means no co-payments or deductibles, no need for a Medicaid-like program

5. The PNHP Program for NHI
Universal coverage means no more tiering
in health care
No 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.

6. The PNHP Program for NHI
Benefits will cover “All medically necessary services” including:
Hospital care
Physician services
Mental health services
Medication expenses
Home care
Nursing home care
Dental care
Vision care

7. The PNHP Program for NHI
Will there be any exclusions?
Determined by your local health board
Private rooms, unless medically necessary
Private duty nurses, unless medically necessary
Botox for wrinkles?
Elective Facial cosmetic surgery??
? Viagra – good sex is good for health – covered!!

8. The PNHP Program for NHI
How will the inclusions/exclusions be
decided?
Evidence-based medicine
Patient preference
Coverage board, including health professionals, patients, the public, health care advocates

9. The PNHP Program for NHI
Why is the Program called “single payer” NHI?  
Because there is a single insurer paying hospitals, doctors, pharmacies, nursing homes
Because there is no other way to avoid “cherry-picking” by private, for-profit insurance companies 
Because it results in the lowest administrative
costs: Medicare=2-3% vs private insurance=16-30%
Because it returns the largest amount of money to
the care of patients: 97% for Medicare; 70-84% for private insurance.

10. Private insurers’ High Overhead

12. The PNHP Program for NHI
How do we pay for single payer NHI?
Not with premiums: they are regressive
With a payroll tax: Medicare Part A (presently
equals 1.45% from employee % from the
employer)  
With income taxes: improved Medicare Part B – no beneficiary contribution

13. The 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-payer
we will save $298 billion/year
With these administrative savings, all the uninsured and underinsured could be covered, without increasing costs to the overall system

14. Bureaucracy: 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

15. Who Delivers Health Care?
Growth in Physicians and Administrators since 1970
Source: BLS & Himmelstein/Woolhandler/Lewontin Analysis of CPS Data

16. Is single payer NHI politically feasible?
Employers face international competition.
Health insurance is not the insurance industry’s most lucrative product – no long term investment benefit
With 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!

17. HARRIS 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

18. SUPPORT ACROSS POLITICAL PARTIES TO EXPAND MEDICARE BENEFITS Percent who favor each proposal when arguments for and against are presented…
Having Medicare cover long-term
Nursing home care “even if it means
higher premiums or taxes”
Having Medicare cover prescription
Drugs “even if it means higher premiums
or taxes”
Expansion of Medicare so that people
Aged are able to buy into the
program before they turn 65
Source: Kaiser Family Foundation/Harvard School of Public Health National Survey on Medicare, 10/20/98 (conducted Aug-Sept 1998)

19. Americans Pay World’s Highest Taxes For Healthcare
Per Capita Health Spending, 2002
OECD and “Paying for National Health Insurance—And Not Getting It”
Health Affairs: July / August 2003

20. The PNHP Program for NHI (The Physicians’ Proposal) JAMA 2003: August 13
Single-payer National Health Insurance
Universal coverage
Comprehensive coverage
Progressive financing
Low administrative costs
Non-profit delivery system

21. What can you do about health reform?
Pro-active efforts on the federal level
John Conyers: HR 676: National Health Insurance Act
Barbara Lee: US National Health Service Act
Jesse Jackson, Jr.: Constitutional amendment – health as a human right
Wellstone/Baldwin: Federalist approach – incentives for State reform
Bush: Community Health Centers Act

22. What can you do about health reform?
Pro-active efforts on the state level 
California: Options Commission - Kuehl state single-payer bill
Massachusetts: Constitutional amendment – health as a human right
Maine: Dirigo – Subsidized private insurance
Maryland: Pay or play
New York: Gottfried – Commission for Healthcare Options

23. What can you do about health reform?
3. Incremental Reforms
Medicare expansions: down to age 60 or 55 or 50; children up to age 18; unemployed
Employer-mandate laws
NYC: Health Security Act – Quinn
Market-based reforms: Healthy-NY
Community Health Centers Act

24. What can you do about health reform?
4. Defensive Fights
Stopping the privatization of Social Security
Repealing portions of the MMA: donut-hole Rx coverage, prohibiting Medicare from negotiating prices with Pharma, subsidies to HMOs (Medicare-Advantage), HSAs
Fighting Medicaid cutbacks: block grants and waivers

25. What can you do about health care reform?
5. Reactive Fights
Stop Health Savings Accounts (HSAs)
Expose Consumer Driven Health Care (CDHC)
Evaluate Tax Credits
Support alternatives to caps on non-economic damages in malpractice reform
Oppose trade agreements: result in higher drug prices abroad

26. The Institute of Medicine says:
Between the health care we have and could have, lies not just a gap but a chasm
The American health care delivery system in need of a fundamental change
The challenge is the enormity of the change required
Common Sense: “You cannot cross a chasm in two jumps”

27. PHYSICIANS FOR A NATIONAL HEALTH PROGRAM (PNHP) says:
We’ve tried and failed with incremental reforms for 100 years
The time has come for single-payer National Health Insurance-an improved Medicare-for-All.

28. REFERENCES AND CONTACTS
Bodenheimer TS, Grumbach K. Understanding Health Policy: A Clinical Approach. Appleton & Lange
California 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, NY
Himmelstein 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