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Deborah Richter, MD.  Change their perception to view healthcare as a public good rather an itemized purchase in the marketplace  To understand that.

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Presentation on theme: "Deborah Richter, MD.  Change their perception to view healthcare as a public good rather an itemized purchase in the marketplace  To understand that."— Presentation transcript:

1 Deborah Richter, MD

2  Change their perception to view healthcare as a public good rather an itemized purchase in the marketplace  To understand that we can’t fix anything without a healthcare system  To understand we are paying the whole bill anyway  If you get these points across, the business case for single payer is much easier

3  They are paying too much for healthcare  The reason costs are so high is people are using too much care  The uninsured are not their responsibility  They don’t trust the government

4  Systems  Budgets  Fixed Costs  Efficiency

5 Deborah Richter, MD

6  Review of the problems  Why we are in this mess  What we can do about it

7 Walter Cronkite

8 $2.5 trillion Source: Health Affairs Jan/Feb %

9 Source: Centers for Medicare & Medicaid Services Projected Actual Percentage GDP

10 $/Car Source: Modern Healthcare 10/24/05: 14 Japan Has a $1400 competitive advantage on every car they sell

11 Health Insurance Costs Keep Rising Health Insurance Costs Keep Rising

12

13 46 Million Uninsured

14 Source: Care Without Coverage;Institute of Medicine,2002

15 1. Few people are using healthcare at any one time 2. Most costs are fixed 3. We are already paying the whole bill 4. We don’t have a health care system so we can’t fix anything

16 Source: Centers for Medicare & Medicaid Services ProjectedActual Per capita expenditures

17 Source: Centers for Medicare & Medicaid Services ProjectedActual National Health Spending: Per Person Per capita expenditures

18

19 JOE Is he the problem?

20 Source:Agency for Healthcare Research and Quality MEPS, 1999 Percent of health Care Expenditures 1% 1% 2% 4% 6% 13% 73% 0% 0% 0% 80% uses less than $1400 of care per year

21 Source:Agency for Healthcare Research and Quality MEPS, 1999 Percent of health Care Expenditures 1% 1% 2% 4% 6% 13% 73% 0% 0% 0% 20% use 86% of the care Few are using most of the healthcare

22

23 Source: Health Affairs Jan/Feb % spent on services & infrastructure 30%

24 As of 2004, the U.S. had:  13.5 million health care jobs  7,228 hospitals with a total of 955,768 staffed beds  210,939 physician ’ s offices  70,589 nursing homes  19,006 home care agencies  121,172 dentist ’ s offices  3 million administrative jobs Source: National Center for Health Statistics& Bureau of Labor Statistics Health Care Infrastructure :

25  The cost of the infrastructure is there whether or not it is used (nurse, hospital)  Trying to save money by keeping patients out of the hospital is like trying to save money on schools by keeping kids home for the day

26  Whose responsibility should it be to pay for the health care services we all expect to be there should we need them?

27

28

29  We have no state or national healthcare policy  We finance health care services on a wing and a prayer (no dedicated funds)  Financing of health care amounts to a shell game… no payer wants to pay the fixed costs of health care  When that fails we ask the public to step in (risk shift)

30 Source:Agency for Healthcare Research and Quality MEPS, 1999 Percent of health Care Expenditures 1% 1% 2% 4% 6% 13% 73% 0% 0% 0% AVOID THESE PEOPLE If you were an insurance company CEO, who would you want to insure?

31 Administration is the Fastest Growing job in Health Care Source: Bureau of Labor Statistics and NCHS

32 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)

33 Lower wages Private employers pay for health insurance Higher prices for goods Out of pocket Individual health insurance Taxes for Medicare and Medicaid Property taxesHealth insurance for public employees INDIVIDUAL HOUSEHOLDS In the End Individual Households Pay for All of Health Care

34 Source: NEJM 1999; 340:109; Health Affairs 2000; 19(3):150 60% 20% Taxpayers Private employers Individuals { Medicare, Medicaid. Public employees, tax subsidies}

35

36 Health Care Overspending  $650 billion- the amount overspent on health care compared with other industrialized nations with no discernable benefit to population health. McKinsey Global Institute Dec 2008

37 OECD, Data for Japan is an estimate $ Per person

38 Source: Health United States 2005, Natl. Center for Health Statistics

39 OECD, 2006 & Health Affairs 2002; 21(4): 99

40 $/per capita Source: OECD 2006 Data are for 2004 or for most recent year available Figures adjusted for purchasing power parity

41 OECD, 2006 (2003 Data)

42

43

44

45 OECD, 2006 Data are for 2004 or more recent year available

46 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 bestworstNA2ndNA Stroke, ages ndbestNAworstNA Source: Health Affairs Vol 23:#3, 2004 Our Quality is Not the Best in the world Survival Rates for 5 Countries

47 OECD, 2006 (2003 Data)

48

49 OECD, 2004 Transplants/million population

50 Source: OECD, 2005 Note: data are for 2004,or most recent year available MRIs/ million population

51 Procedures per 100,000 population Source: OECD 2006 Data are for 2004 or most recent year available 197

52  Availability of expensive technology  Rising drug costs  Have similar demographics  Similar levels of service Why are their costs so much lower?

53  Administrative simplicity  Negotiated prices  More primary care and prevention  Health planning  Global budgets They have a system

54  Everyone included  Clear accountability  Public Stewardship  Budget Process  Public Financing

55 1. What is the overall goal? (Preserve, restore and maintain health) 2. How much do we need? (McKinsey says $650 excess spending) 3. How get more for your money?(administrative savings,formularies, negotiating prices, more primary care and prevention) 4. How would you collect money? 5. How to control overall costs?-(Budget process, 6. Who is in charge?-How to fix when things go wrong-accountability

56  Healthcare is regarded as a public good with investment in needed services for the whole population  The costs of these shared services are spread across the whole population  Pools money and pays for health care directly

57  Sweden, Norway, Denmark, Canada, Finland, Iceland, Australia, and Taiwan all have single payer financing  Single publicly financed risk pool that pays for health care directly from a fund ear-marked for health care  Everyone has access to privately delivered, publicly financed health care services  Public can buy health insurance for services not covered by public plan.

58

59 Deborah Richter, MD PO Box 1467 Montpelier, VT

60

61

62 The oft-repeated canard that doctors are fleeing Canada in droves is not supported by the data.

63

64 PROS  Everyone Covered  Better benefits  Effective Cost Containment  Fairer financing  Stability of financing of services  Coverage not linked to employment CONS  Problems are aired in public  Some will pay more than they are now  Cost containment measures may cut availability of some services

65 “If done right, health care in America could be dramatically better with true single-payer coverage.” - Ben Brewer, WSJ, April 18, 2006 “[single-payer] is an idea that's so easy to slam politically yet so sensible for business that only Republicans can sell it! …it may take a Republican President to bless the socialization of health spending we need.” -Matt Miller, Fortune, April 18, 2006 “Think, as a small business, how you could benefit from a single-payer system: you wouldn’t lose potential employees to larger firms that offer more attractive health benefits; health insurance costs would cease to be a line item in your budget. A serious illness befalling you or an employee wouldn’t be a company- wide financial crisis. You might even save money.” -Joseph Antony, CNBC / MSN Money, Winter 2003 CNBC / MSN Money

66

67

68

69

70

71 International Journal of Health Services 2005; 35(1): 64-90

72  Profit  Politics  Paranoia  Perception Universal healthcare system

73 February 7, 2009 Deborah Richter, MD

74  Change their perception to view healthcare as a public good rather an itemized purchase in the marketplace  To understand that we can’t fix anything without a healthcare system  To understand we are paying the whole bill anyway  If you get these points across, the business case for single payer is much easier

75  They are paying too much for healthcare  The reason costs are so high is people are using too much care  The uninsured are not their responsibility  They don’t trust the government

76  Systems  Budgets  Fixed Costs  Efficiency

77 Deborah Richter, MD

78  Review of the problems  Why we are in this mess  What we can do about it

79 Walter Cronkite

80 $2.2 trillion Source: Health Affairs Jan/Feb %

81 Source: Centers for Medicare & Medicaid Services Projected Actual Percentage GDP

82 $/Car Source: Modern Healthcare 10/24/05: 14 Japan Has a $1400 competitive advantage on every car they sell

83 Health Insurance Costs Keep Rising Health Insurance Costs Keep Rising

84

85 46 Million Uninsured

86 Source: Care Without Coverage;Institute of Medicine,2002

87 1. Few people are using healthcare at any one time 2. Most costs are fixed 3. We are already paying the whole bill 4. We don’t have a health care system so we can’t fix anything

88 Source: Centers for Medicare & Medicaid Services ProjectedActual Per capita expenditures

89 Source: Centers for Medicare & Medicaid Services ProjectedActual National Health Spending: Per Person Per capita expenditures

90

91 JOE Is he the problem?

92 Source:Agency for Healthcare Research and Quality MEPS, 1999 Percent of health Care Expenditures 1% 1% 2% 4% 6% 13% 73% 0% 0% 0% 80% uses less than $1400 of care per year

93 Source:Agency for Healthcare Research and Quality MEPS, 1999 Percent of health Care Expenditures 1% 1% 2% 4% 6% 13% 73% 0% 0% 0% 20% use 86% of the care Few are using most of the healthcare

94

95 Source: Health Affairs Jan/Feb % spent on services & infrastructure 30%

96 As of 2004, the U.S. had:  13.5 million health care jobs  7,228 hospitals with a total of 955,768 staffed beds  210,939 physician ’ s offices  70,589 nursing homes  19,006 home care agencies  121,172 dentist ’ s offices  3 million administrative jobs Source: National Center for Health Statistics& Bureau of Labor Statistics Health Care Infrastructure :

97  The cost of the infrastructure is there whether or not it is used (nurse, hospital)  Trying to save money by keeping patients out of the hospital is like trying to save money on schools by keeping kids home for the day

98  Whose responsibility should it be to pay for the health care services we all expect to be there should we need them?

99

100

101  We have no state or national healthcare policy  We finance health care services on a wing and a prayer (no dedicated funds)  Financing of health care amounts to a shell game… no payer wants to pay the fixed costs of health care  When that fails we ask the public to step in (risk shift)

102 Source:Agency for Healthcare Research and Quality MEPS, 1999 Percent of health Care Expenditures 1% 1% 2% 4% 6% 13% 73% 0% 0% 0% AVOID THESE PEOPLE If you were an insurance company CEO, who would you want to insure?

103 Administration is the Fastest Growing job in Health Care Source: Bureau of Labor Statistics and NCHS

104 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)

105 Lower wages Private employers pay for health insurance Higher prices for goods Out of pocket Individual health insurance Taxes for Medicare and Medicaid Property taxesHealth insurance for public employees INDIVIDUAL HOUSEHOLDS In the End Individual Households Pay for All of Health Care

106 Source: NEJM 1999; 340:109; Health Affairs 2000; 19(3):150 60% 20% Taxpayers Private employers Individuals { Medicare, Medicaid. Public employees, tax subsidies}

107

108 Health Care Overspending  $650 billion- the amount overspent on health care compared with other industrialized nations with no discernable benefit to population health. McKinsey Global Institute Dec 2008

109 OECD, Data for Japan is an estimate $ Per person

110 Source: Health United States 2005, Natl. Center for Health Statistics

111 OECD, 2006 & Health Affairs 2002; 21(4): 99

112 $/per capita Source: OECD 2006 Data are for 2004 or for most recent year available Figures adjusted for purchasing power parity

113 OECD, 2006 (2003 Data)

114

115

116

117 OECD, 2006 Data are for 2004 or more recent year available

118 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 bestworstNA2ndNA Stroke, ages ndbestNAworstNA Source: Health Affairs Vol 23:#3, 2004 Our Quality is Not the Best in the world Survival Rates for 5 Countries

119 OECD, 2006 (2003 Data)

120

121 OECD, 2004 Transplants/million population

122 Source: OECD, 2005 Note: data are for 2004,or most recent year available MRIs/ million population

123 Procedures per 100,000 population Source: OECD 2006 Data are for 2004 or most recent year available 197

124  Availability of expensive technology  Rising drug costs  Have similar demographics  Similar levels of service Why are their costs so much lower?

125  Administrative simplicity  Negotiated prices  More primary care and prevention  Health planning  Global budgets They have a system

126  Everyone included  Clear accountability  Public Stewardship  Budget Process  Public Financing

127 1. What is the overall goal? (Preserve, restore and maintain health) 2. How much do we need? (McKinsey says $650 excess spending) 3. How get more for your money?(administrative savings,formularies, negotiating prices, more primary care and prevention) 4. How would you collect money? 5. How to control overall costs?-(Budget process, 6. Who is in charge?-How to fix when things go wrong-accountability

128  Healthcare is regarded as a public good with investment in needed services for the whole population  The costs of these shared services are spread across the whole population  Pools money and pays for health care directly

129  Sweden, Norway, Denmark, Canada, Finland, Iceland, Australia, and Taiwan all have single payer financing  Single publicly financed risk pool that pays for health care directly from a fund ear-marked for health care  Everyone has access to privately delivered, publicly financed health care services  Public can buy health insurance for services not covered by public plan.

130

131 Deborah Richter, MD PO Box 1467 Montpelier, VT

132

133

134 The oft-repeated canard that doctors are fleeing Canada in droves is not supported by the data.

135

136 PROS  Everyone Covered  Better benefits  Effective Cost Containment  Fairer financing  Stability of financing of services  Coverage not linked to employment CONS  Problems are aired in public  Some will pay more than they are now  Cost containment measures may cut availability of some services

137 “If done right, health care in America could be dramatically better with true single-payer coverage.” - Ben Brewer, WSJ, April 18, 2006 “[single-payer] is an idea that's so easy to slam politically yet so sensible for business that only Republicans can sell it! …it may take a Republican President to bless the socialization of health spending we need.” -Matt Miller, Fortune, April 18, 2006 “Think, as a small business, how you could benefit from a single-payer system: you wouldn’t lose potential employees to larger firms that offer more attractive health benefits; health insurance costs would cease to be a line item in your budget. A serious illness befalling you or an employee wouldn’t be a company- wide financial crisis. You might even save money.” -Joseph Antony, CNBC / MSN Money, Winter 2003 CNBC / MSN Money

138

139

140

141

142

143 International Journal of Health Services 2005; 35(1): 64-90

144  Profit  Politics  Paranoia  Perception Universal healthcare system

145 February 7, 2009 Deborah Richter, MD

146  Change their perception to view healthcare as a public good rather an itemized purchase in the marketplace  To understand that we can’t fix anything without a healthcare system  To understand we are paying the whole bill anyway  If you get these points across, the business case for single payer is much easier

147  They are paying too much for healthcare  The reason costs are so high is people are using too much care  The uninsured are not their responsibility  They don’t trust the government

148  Systems  Budgets  Fixed Costs  Efficiency

149 Deborah Richter, MD

150  Review of the problems  Why we are in this mess  What we can do about it

151 Walter Cronkite

152 $2.2 trillion Source: Health Affairs Jan/Feb %

153 Source: Centers for Medicare & Medicaid Services Projected Actual Percentage GDP

154 $/Car Source: Modern Healthcare 10/24/05: 14 Japan Has a $1400 competitive advantage on every car they sell

155 Health Insurance Costs Keep Rising Health Insurance Costs Keep Rising

156

157 46 Million Uninsured

158 Source: Care Without Coverage;Institute of Medicine,2002

159 1. Few people are using healthcare at any one time 2. Most costs are fixed 3. We are already paying the whole bill 4. We don’t have a health care system so we can’t fix anything

160 Source: Centers for Medicare & Medicaid Services ProjectedActual Per capita expenditures

161 Source: Centers for Medicare & Medicaid Services ProjectedActual National Health Spending: Per Person Per capita expenditures

162

163 JOE Is he the problem?

164 Source:Agency for Healthcare Research and Quality MEPS, 1999 Percent of health Care Expenditures 1% 1% 2% 4% 6% 13% 73% 0% 0% 0% 80% uses less than $1400 of care per year

165 Source:Agency for Healthcare Research and Quality MEPS, 1999 Percent of health Care Expenditures 1% 1% 2% 4% 6% 13% 73% 0% 0% 0% 20% use 86% of the care Few are using most of the healthcare

166

167 Source: Health Affairs Jan/Feb % spent on services & infrastructure 30%

168 As of 2004, the U.S. had:  13.5 million health care jobs  7,228 hospitals with a total of 955,768 staffed beds  210,939 physician ’ s offices  70,589 nursing homes  19,006 home care agencies  121,172 dentist ’ s offices  3 million administrative jobs Source: National Center for Health Statistics& Bureau of Labor Statistics Health Care Infrastructure :

169  The cost of the infrastructure is there whether or not it is used (nurse, hospital)  Trying to save money by keeping patients out of the hospital is like trying to save money on schools by keeping kids home for the day

170  Whose responsibility should it be to pay for the health care services we all expect to be there should we need them?

171

172

173  We have no state or national healthcare policy  We finance health care services on a wing and a prayer (no dedicated funds)  Financing of health care amounts to a shell game… no payer wants to pay the fixed costs of health care  When that fails we ask the public to step in (risk shift)

174 Source:Agency for Healthcare Research and Quality MEPS, 1999 Percent of health Care Expenditures 1% 1% 2% 4% 6% 13% 73% 0% 0% 0% AVOID THESE PEOPLE If you were an insurance company CEO, who would you want to insure?

175 Administration is the Fastest Growing job in Health Care Source: Bureau of Labor Statistics and NCHS

176 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)

177 Lower wages Private employers pay for health insurance Higher prices for goods Out of pocket Individual health insurance Taxes for Medicare and Medicaid Property taxesHealth insurance for public employees INDIVIDUAL HOUSEHOLDS In the End Individual Households Pay for All of Health Care

178 Source: NEJM 1999; 340:109; Health Affairs 2000; 19(3):150 60% 20% Taxpayers Private employers Individuals { Medicare, Medicaid. Public employees, tax subsidies}

179

180 Health Care Overspending  $650 billion- the amount overspent on health care compared with other industrialized nations with no discernable benefit to population health. McKinsey Global Institute Dec 2008

181 OECD, Data for Japan is an estimate $ Per person

182 Source: Health United States 2005, Natl. Center for Health Statistics

183 OECD, 2006 & Health Affairs 2002; 21(4): 99

184 $/per capita Source: OECD 2006 Data are for 2004 or for most recent year available Figures adjusted for purchasing power parity

185 OECD, 2006 (2003 Data)

186

187

188

189 OECD, 2006 Data are for 2004 or more recent year available

190 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 bestworstNA2ndNA Stroke, ages ndbestNAworstNA Source: Health Affairs Vol 23:#3, 2004 Our Quality is Not the Best in the world Survival Rates for 5 Countries

191 OECD, 2006 (2003 Data)

192

193 OECD, 2004 Transplants/million population

194 Source: OECD, 2005 Note: data are for 2004,or most recent year available MRIs/ million population

195 Procedures per 100,000 population Source: OECD 2006 Data are for 2004 or most recent year available 197

196  Availability of expensive technology  Rising drug costs  Have similar demographics  Similar levels of service Why are their costs so much lower?

197  Administrative simplicity  Negotiated prices  More primary care and prevention  Health planning  Global budgets They have a system

198  Everyone included  Clear accountability  Public Stewardship  Budget Process  Public Financing

199 1. What is the overall goal? (Preserve, restore and maintain health) 2. How much do we need? (McKinsey says $650 excess spending) 3. How get more for your money?(administrative savings,formularies, negotiating prices, more primary care and prevention) 4. How would you collect money? 5. How to control overall costs?-(Budget process, 6. Who is in charge?-How to fix when things go wrong-accountability

200  Healthcare is regarded as a public good with investment in needed services for the whole population  The costs of these shared services are spread across the whole population  Pools money and pays for health care directly

201  Sweden, Norway, Denmark, Canada, Finland, Iceland, Australia, and Taiwan all have single payer financing  Single publicly financed risk pool that pays for health care directly from a fund ear-marked for health care  Everyone has access to privately delivered, publicly financed health care services  Public can buy health insurance for services not covered by public plan.

202

203 Deborah Richter, MD PO Box 1467 Montpelier, VT

204

205

206 The oft-repeated canard that doctors are fleeing Canada in droves is not supported by the data.

207

208 PROS  Everyone Covered  Better benefits  Effective Cost Containment  Fairer financing  Stability of financing of services  Coverage not linked to employment CONS  Problems are aired in public  Some will pay more than they are now  Cost containment measures may cut availability of some services

209 “If done right, health care in America could be dramatically better with true single-payer coverage.” - Ben Brewer, WSJ, April 18, 2006 “[single-payer] is an idea that's so easy to slam politically yet so sensible for business that only Republicans can sell it! …it may take a Republican President to bless the socialization of health spending we need.” -Matt Miller, Fortune, April 18, 2006 “Think, as a small business, how you could benefit from a single-payer system: you wouldn’t lose potential employees to larger firms that offer more attractive health benefits; health insurance costs would cease to be a line item in your budget. A serious illness befalling you or an employee wouldn’t be a company- wide financial crisis. You might even save money.” -Joseph Antony, CNBC / MSN Money, Winter 2003 CNBC / MSN Money

210

211

212

213

214

215 International Journal of Health Services 2005; 35(1): 64-90

216  Profit  Politics  Paranoia  Perception Universal healthcare system

217 February 7, 2009 Deborah Richter, MD

218 February 7, 2009 Deborah Richter, MD

219  Change their perception to view healthcare as a public good rather an itemized purchase in the marketplace  To understand that we can’t fix anything without a healthcare system  To understand we are paying the whole bill anyway  If you get these points across, the business case for single payer is much easier

220  They are paying too much for healthcare  The reason costs are so high is people are using too much care  The uninsured are not their responsibility  They don’t trust the government

221  Systems  Budgets  Fixed Costs  Efficiency

222 Deborah Richter, MD

223  Review of the problems  Why we are in this mess  What we can do about it

224 Walter Cronkite

225 $2.2 trillion Source: Health Affairs Jan/Feb %

226 Source: Centers for Medicare & Medicaid Services Projected Actual Percentage GDP

227 $/Car Source: Modern Healthcare 10/24/05: 14 Japan Has a $1400 competitive advantage on every car they sell

228 Health Insurance Costs Keep Rising Health Insurance Costs Keep Rising

229

230 46 Million Uninsured

231 Source: Care Without Coverage;Institute of Medicine,2002

232 1. Few people are using healthcare at any one time 2. Most costs are fixed 3. We are already paying the whole bill 4. We don’t have a health care system so we can’t fix anything

233 Source: Centers for Medicare & Medicaid Services ProjectedActual Per capita expenditures

234 Source: Centers for Medicare & Medicaid Services ProjectedActual National Health Spending: Per Person Per capita expenditures

235

236 JOE Is he the problem?

237 Source:Agency for Healthcare Research and Quality MEPS, 1999 Percent of health Care Expenditures 1% 1% 2% 4% 6% 13% 73% 0% 0% 0% 80% uses less than $1400 of care per year

238 Source:Agency for Healthcare Research and Quality MEPS, 1999 Percent of health Care Expenditures 1% 1% 2% 4% 6% 13% 73% 0% 0% 0% 20% use 86% of the care Few are using most of the healthcare

239

240 Source: Health Affairs Jan/Feb % spent on services & infrastructure 30%

241 As of 2004, the U.S. had:  13.5 million health care jobs  7,228 hospitals with a total of 955,768 staffed beds  210,939 physician ’ s offices  70,589 nursing homes  19,006 home care agencies  121,172 dentist ’ s offices  3 million administrative jobs Source: National Center for Health Statistics& Bureau of Labor Statistics Health Care Infrastructure :

242  The cost of the infrastructure is there whether or not it is used (nurse, hospital)  Trying to save money by keeping patients out of the hospital is like trying to save money on schools by keeping kids home for the day

243  Whose responsibility should it be to pay for the health care services we all expect to be there should we need them?

244

245

246  We have no state or national healthcare policy  We finance health care services on a wing and a prayer (no dedicated funds)  Financing of health care amounts to a shell game… no payer wants to pay the fixed costs of health care  When that fails we ask the public to step in (risk shift)

247 Source:Agency for Healthcare Research and Quality MEPS, 1999 Percent of health Care Expenditures 1% 1% 2% 4% 6% 13% 73% 0% 0% 0% AVOID THESE PEOPLE If you were an insurance company CEO, who would you want to insure?

248 Administration is the Fastest Growing job in Health Care Source: Bureau of Labor Statistics and NCHS

249 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)

250 Lower wages Private employers pay for health insurance Higher prices for goods Out of pocket Individual health insurance Taxes for Medicare and Medicaid Property taxesHealth insurance for public employees INDIVIDUAL HOUSEHOLDS In the End Individual Households Pay for All of Health Care

251 Source: NEJM 1999; 340:109; Health Affairs 2000; 19(3):150 60% 20% Taxpayers Private employers Individuals { Medicare, Medicaid. Public employees, tax subsidies}

252

253 Health Care Overspending  $650 billion- the amount overspent on health care compared with other industrialized nations with no discernable benefit to population health. McKinsey Global Institute Dec 2008

254 OECD, Data for Japan is an estimate $ Per person

255 Source: Health United States 2005, Natl. Center for Health Statistics

256 OECD, 2006 & Health Affairs 2002; 21(4): 99

257 $/per capita Source: OECD 2006 Data are for 2004 or for most recent year available Figures adjusted for purchasing power parity

258 OECD, 2006 (2003 Data)

259

260

261

262 OECD, 2006 Data are for 2004 or more recent year available

263 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 bestworstNA2ndNA Stroke, ages ndbestNAworstNA Source: Health Affairs Vol 23:#3, 2004 Our Quality is Not the Best in the world Survival Rates for 5 Countries

264 OECD, 2006 (2003 Data)

265

266 OECD, 2004 Transplants/million population

267 Source: OECD, 2005 Note: data are for 2004,or most recent year available MRIs/ million population

268 Procedures per 100,000 population Source: OECD 2006 Data are for 2004 or most recent year available 197

269  Availability of expensive technology  Rising drug costs  Have similar demographics  Similar levels of service Why are their costs so much lower?

270  Administrative simplicity  Negotiated prices  More primary care and prevention  Health planning  Global budgets They have a system

271  Everyone included  Clear accountability  Public Stewardship  Budget Process  Public Financing

272 1. What is the overall goal? (Preserve, restore and maintain health) 2. How much do we need? (McKinsey says $650 excess spending) 3. How get more for your money?(administrative savings,formularies, negotiating prices, more primary care and prevention) 4. How would you collect money? 5. How to control overall costs?-(Budget process, 6. Who is in charge?-How to fix when things go wrong-accountability

273  Healthcare is regarded as a public good with investment in needed services for the whole population  The costs of these shared services are spread across the whole population  Pools money and pays for health care directly

274  Sweden, Norway, Denmark, Canada, Finland, Iceland, Australia, and Taiwan all have single payer financing  Single publicly financed risk pool that pays for health care directly from a fund ear-marked for health care  Everyone has access to privately delivered, publicly financed health care services  Public can buy health insurance for services not covered by public plan.

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276 Deborah Richter, MD PO Box 1467 Montpelier, VT

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279 The oft-repeated canard that doctors are fleeing Canada in droves is not supported by the data.

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281 PROS  Everyone Covered  Better benefits  Effective Cost Containment  Fairer financing  Stability of financing of services  Coverage not linked to employment CONS  Problems are aired in public  Some will pay more than they are now  Cost containment measures may cut availability of some services

282 “If done right, health care in America could be dramatically better with true single-payer coverage.” - Ben Brewer, WSJ, April 18, 2006 “[single-payer] is an idea that's so easy to slam politically yet so sensible for business that only Republicans can sell it! …it may take a Republican President to bless the socialization of health spending we need.” -Matt Miller, Fortune, April 18, 2006 “Think, as a small business, how you could benefit from a single-payer system: you wouldn’t lose potential employees to larger firms that offer more attractive health benefits; health insurance costs would cease to be a line item in your budget. A serious illness befalling you or an employee wouldn’t be a company- wide financial crisis. You might even save money.” -Joseph Antony, CNBC / MSN Money, Winter 2003 CNBC / MSN Money

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288 International Journal of Health Services 2005; 35(1): 64-90

289  Profit  Politics  Paranoia  Perception Universal healthcare system


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