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
National Health Care Spending In 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 Basics Percent 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% 0% 5% 10% 15% Utility shut off Behind on rent/mort. Not enough food Unmet need for doctor UninsuredInsured
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
CEO Pay and Stockholdings, 1998 Source: Jenks Healthcare Business Report 7/24/99 CEOFirmPay (mill)Stock (mil) Wilson TaylorCigna$5.0$64.2 Norman PaysonOxford$3.3$44.7 Leonard ShaefferWellpoint$2.2$45.5 Richard HuberAetna$2.2$21.3 William McGuireUnited Hlthcr.$1.5$87.8 Melvin GoodesWarner Lambert$16.5$287 Paul OrmondManor Care$7.8$43.7 Peter NicholasBoston Scientific$0.8$1198 Thomas Frist Jr.....Columbia/HCA$.025$445
Investor-Owned Care Summary 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 With Tax 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/Health Insurers Hospital/Med Insurers Percent of Premiums for Overhead GroupNon-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 10% 10% 80% 73% 14% 13% Percent of health care $ 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? 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 48.1 35.3 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 Canada 47.8 37.4 Excellent Good Canadian Health Care System
Less Spending and Better Results 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.
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.
AustraliaCanadaEnglandN.Z.U.S. Breast Cancer 2nd4thworst3rdbest Colorectal Cancer 2nd3rdworstbest4th Cervical Cancer best3rdworst4th2nd Childhood Leukemia worstbest3rd4th2nd Kidney Transplant 2ndbest3rd worst Liver Transplant 2ndbestworst *3rd Non-Hodgkin’s Lymphoma best4thworst2nd3rd AMI, ages 20-84 bestworstNA2ndNA Stroke, ages 20-84 2ndbestNAworstNA Comparison of Quality of Care Survival Rates for 5 Countries