1. An Intro to Single Payer Health Care Molly Tavella, MPH Shearer Student Fellow 2010-2011 PNHP California

2. Who am I? Shearer Student Fellow PNHP California CaHPSA – California Health Professional Student Alliance Health care is a right

3. What is a Single-Payer System? Publicly Funded, Privately Delivered Improved and Expanded Medicare for All Single Plan with Same Benefits An Actual System Run by a Public Entity The Public Option for Everyone

4. Current Financing Individuals/ Businesses direct/out-of-pocket payments Health Service Providers Government Private Insurers Subsidie s Taxes Public Employees’ Premiums Payment to providers Medicare, Medicaid, SCHIP, VA, IHS Premiums

5. Single Payer Financing Medicare $ Medi-Cal $ Employer Payroll Tax $ Single Payer Healthcare Fund $$$$$$ Rx Healthcare Providers Lewin 2004 Integrated Health Systems Income tax $

6. So… For-Profit Insurers… Would not be allowed to offer any services that the single payer covers Could offer non-necessary services (like plastic surgery insurance) although there would be no medical need to have this insurance

7. What are the goals of Single Payer Care? Universal Comprehensive Continuous Equitable Affordable Sustainable

8. What about 2010 Reform?

9. BOTTOM LINE: REFORM DOESN’T MEET OUR GOALS Still 23 million uninsured, millions more will be underinsured because the plans are not comprehensive, still not attached to the person, still unfair, still no proven cost controls

10. What do we get for $938 Billion? Segregation of Sick and Healthy Medicaid Expansion Private Insurance Mandate Public Subsidies Regulation of Private Insurance?

11. No Accountability

12. Ethical?

14. WHAT ARE THE EFFECTS?

15. Health Care Ranking by Country  1 France  2 Italy  3 San Marino  4 Andorra  5 Malta  6 Singapore  7 Spain  8 Oman  9 Austria  10 Japan  11 Norway  12 Portugal  13 Monaco  14 Greece  15 Iceland  16 Luxembourg  17 Netherlands  18 UK  19 Ireland  20 Switzerland  21 Belgium  22 Colombia  23 Sweden  24 Cyprus  25 Germany  26 Saudi Arabia  27 United Arab Emirates  28 Israel  29 Morocco  30 Canada  31 Finland  32 Australia  33 Chile  34 Denmark  35 Dominica  36 Costa Rica  37 USA  38 Slovenia  39 Cuba  40 Brunei

16. Infant Mortality Rates, 2010 OECD Per 1000 live births Maternal Mortality, 2010 OECD Per 100,000 live births Life Expectancy in Years: 2010 OECD

17. Underinsured

18. Uninsured People without health insurance: – Receive less medical care and receive it later – Are sicker when diagnosed – Have 25% higher mortality rates – Earn less because of poorer health “Health Insurance and Mortality in US Adults”, A. Wilper et al, Am. Journal of Public Health, Dec 09 “Care Without Coverage”, Institute of Medicine, May 2007 “Sicker and Poorer”, Medical Care Research and Review, June 2003

19. Unsustainable Cycle Choose Policy with fewer benefits, higher deductible, lower premium Increases Out-Of- Pocket Spending if you needed to get health care Decrease use of health care because you can’t afford it Increased Illness/Disability, as you put off needed care When it becomes an Emergency, More Economic Resources go towards medical care / decreases take home pay Become Uninsured

20. More Americans Opt for a High Deductible Insurance Plan

21. High Cost We spend more public dollars than other countries spend in total OECD

22. The High Cost of Overhead…

23. http://www.health-insurance-2008.org/united-states-vs-canada.php

24. The For-Profit Insurance Industry Over the past 9 years: – Average premiums have increased nearly 120% – Profits at the 10 largest publicly traded insurance companies have risen 428% (reported). – Average annual CEO salary was $11.9 Million, 468 times what the average US worker makes.

26. HOW DO WE FIX THIS?

28. Why is Single Payer Better? Stop segregation of healthy and sick Everybody in, nobody out Single plan Emphasize prevention Non-profit Bulk-buying power Streamline administration

29. THE HISTORY OF SB810

30. Myths About Single Payer It will cost too much! We need to pay high prices for drug R&D. I have insurance, I’m happy with it. It’s SOCIALISM!

31. Myth: “It will cost too much” Additional costs Covering the uninsured and poorly-insured +6.4% Elimination of cost-sharing and co-pays +5.1% Savings Reduced insurance administrative costs -5.3% Reduced hospital billing costs -1.9% Reduced physician office costs -3.6% Bulk purchasing of drugs & equipment -2.8% Primary care emphasis & reduce fraud -2.2% 31 Total Costs +11.5% Total Savings -15.8% Net Savings: 11.5% + -15.8% = - 4.3% Source: Lewin Group, January 2005

32. How will we save money?  California will save $29 billion in the first year  $20 billion in administrative costs through streamlining our system to one payer  $5.2 billion in bulk purchase of pharmaceuticals and medical equipment  $3.4 billion through emphasis of primary care and preventive medicine  $900 million in spending on health benefits for government employees Lewin Group, 2005

33. Single-Payer Savings Source: Lewin Group, 2005

34. Myth: “We need to pay high drug prices to fund research and development” Out of $222 billion dollar budget – $32 billion = Research and Development – $39 billion = Profit (16% profit margin) Profit Margin for other Fortune 500 Companies = <6% – $71 billion = Marketing and Administration Source: Health, Money and Fear DVD, Paul Hochfeld, MD

35. It’s really not funny…

36. Myth: “I have insurance, I’m happy” Source: August 2009 issue of the American Journal of Medicine

37. Myth: “It’s SOCIALISM!” It is Socialistic like: – Public Schools – Police Department – Fire Department – 911 Services

38. Will Businesses Lead the Way? AT&T revealed that they currently pay $2.4 billion annually to cover their employees. Under PPACA, if they did not cover their employees, the fine would be $600 million.

39. How do we know this will work?  Medicare  VA  Other Countries  “Our system is not proven, and in fact it is proving not to work” Ellen Beck, MD

40. Why is it good for Physicians? Eliminate the role of insurance companies Stop arguing over compensation Lower overhead costs in your practice Lower the cost of malpractice fees Negotiate fair and timely reimbursement Patient centered care Increase continuity of care for patients Increase access for new patients

41. Physician Shortages SB810 provides an opportunity to restructure our physician workforce: – Reimbursement reform – Loan forgiveness programs for primary care – Increase funding for graduate medical education in primary care – Reallocate graduate medical education by specialty

42. Physician Salaries SpecialtyUS Average MalpracticeCanada Average Malpractice OB/GYN$64,000$35,000 Ref: US General Accounting Office/National Bureau of Economic Research

43. Why should Nursing Students Care? Patients have greater choice Focus on prevention, education and public health Providers spend time with patients not paper Providers can effectively coordinate care across disciplines and specialties Single Payer systems eliminates profits made from pain, suffering, and illness

44. SB810 and Nursing SB 810 will help address the nursing crisis. – Mandates to establish a budget to support the development and training of a health system workforce that is sufficient to meet the health care needs of the population. – This would include assuring that adequate numbers of nurses were trained and available to maintain quality of care standards.

45. Why is it good for OT students? All have the right to engage in meaningful activities that provide each individual with a sense of identity and self efficacy Being able to engage in occupations is based on the ability to access basic healthcare. Rehabilitation services and OT/PT/SLP would be covered under single payer under the category of coverage of all "medically necessary” outpatient and inpatient care. All licensed providers would be covered, and there would be no arbitrary caps on utilization.

46. Why is this important to Public Health?  The TRIFECTA! – Increase Access – Increase Prevention – Reduce Disparities And… it saves money!

47. Who will Run the Single Payer?  The Public – Through a vote would elect:  The California Healthcare Agency: A public body with representatives of patients and medical experts ▪ Commissioner ▪ Chief Medical Officer ▪ Health Planning, Quality, Funding, Payments ▪ Patient Advocate  All meetings would be open  All documents (except privacy-protected documents) would be public  All officers may be impeached for malfeasance

48. How will SB810 protect the California Health Care Agency?  SB 810 has provisions to protect the health care system from some of the problems that governments face – Strong conflict of interest rules – No partisan activity or collusion with for-profit firms – Health system officers protected from special interests – The health care system is exempted from oversight by other government agencies

49. WHAT CAN YOU DO?

50.  Join CaHPSA: cahpsa.org  Start a CaHPSA Chapter  Attend Lobby Day!

51. Lobby Day 2010 www.cahpsa.org/CaHPSA/Lobby_Day.html

52. Building a Movement Believe!!! Be Active!!! Tell Your Friends!!!

53. Thank You! Questions? Contact: – molly@pnhpcalifornia.org – Phone: 408-892-1255 Resources http://www.pnhp.org http://www.pnhpcalifornia.org http://www.cahpsa.org http://www.healthcare-now.org/ http://californiaonecare.org/ http://www.calnurses.org/ www.guaranteedhealthcare.org http://www.amsa.org http://madashelldoctors.com/ http://www.pdamerica.org/ http://www.lwv.org www.everybodyinnobodyout.org www.singlepayeraction.org/ http://singlepayernow.net/ Get For-Profit Ins. OUT of my health care!