1. Achieving Single Payer National Health Insurance NOW! Debunking the Myths A Production Of Health Care for All Texas Single Payer In Our Life Time Campaign 2009 www.healthcareforalltexas.org

2. Opening Exercises 1.What first comes to your mind when you hear "National Health Insurance"? 2.What percentage of your income are you currently spending on health care expenses? [include premiums, deductibles, co-pays, and medical necessities that are not covered at all] 3.What percentage of your income are you willing to spend on health care expenses?

3. The State of Healthcare Coverage Today

4. Where does the U.S. rank in health care quality compared to other industrialized nations? A. 5 th B. 12th C. 21 st D. 37 th “America has the best health care in the world.”

6. US: The Only Industrialized Country with Profit-driven Health Care System Costs > $2 Trillion/year Spend $350 Billion/year on administration Costs more than twice per capita than other countries that have universal health care Leaves out over 45 million including 8 million children Source: Woolhandler S, Campbell T, Himmelstein D. Costs of Health Care Administration in The United States and Canada. New England Journal of Medicine 2003; 349:768-75 and Anderson G, Frogner B, Reinhardt U. Health Spending in OECD Countries in 2004: An Update. Health Affairs 2007 Vol 26, No. 5:1481-1489 Yet, the US has lower life expectancy, higher infant mortality, higher maternal mortality, fewer doctors, and fewer hospital beds than most industrialized countries

7. What percentage of Texans are insured through their employers? A. 90% B. 60% C. 48% D. 30% “Most Texans are insured through their employers.”

8. The Texas Health Care Pie Today Source: www.kff.org State Factswww.kff.org PUBLIC SELF EMPLOYER- SPONSORED UNINSURED 2006

9. The Health-Care Pie As Costs Go Up….. Uninsured Employer-sponsored Health Insurance Public Uninsured

10. What is the fastest growing segment of the uninsured population? A. Illegal immigrants B. The unemployed C. Families with incomes at 200% of the poverty level D. Families with incomes of $75,000 per year “Most of the uninsured are unemployed and/or undocumented.”

11. The Uninsured Today ■ 45 million in the U.S. ■ 5.9 million in Texas ■ 80% of the uninsured are employed ■ 75% of the uninsured are US citizens Source: 2007 US Census Bureau, Institute of Medicine and Urban Institute, Uninsured and Dying Because of it, Jan 2008 People losing private health insurance at the fastest rate are those making > $75,000 / year

12. Institute of Medicine and Urban Institute, Uninsured and Dying Because of it, Jan 2008 Have You Ever Been Uninsured? No. of Millions Uninsured Number of Uninsured Americans 1976 - 2006

13. If you are uninsured, your risk of dying increases by how much? A. 10% B. 15% C. 20% D. 25% “The uninsured can always get their care in the ER or get public insurance.”

14. 25% If you are uninsured, your risk of dying increases by:

15. Source: Am. Journal of Public Health- online edition. Sept. 17 2009 According to a 2009 Harvard Study 45,000 Americans Die Every Year Due to Lack of Health Insurance This translates into 12 deaths every hour that could have been prevented

16. Getting Public Insurance in Texas Take a family with 2 kids, parents who make $37,000/year (185% FPL) and no employer-sponsored health insurance: The 2 month-old qualifies for Medicaid The 4 year-old qualifies for S-CHIP Parents make over the limit to qualify for public health insurance. The limit? $6,000 / year

17. What is the average cost of private health insurance for a family of four? A. $3,000 per year B. $9,000 per year C. $12,000 per year D. $24,000 per year “The best solution is to make private health insurance affordable.”

18. For-Profit Health Insurance Employer-sponsored health insurance for a family of 4 $12,000 / year Minimum wage in Texas $12,000 Median annual income in Texas $43,000 Source: KFF/HRET Survey of Employer Sponsored Health Benefits 2001-06; Bureau of Labor Statistics Consumer Price Index US City Average of Annual Inflation (April to April), 2001-06; Bureau of Labor Statistics, Seasonally Adjusted Data from the Current Employment Statistics Survey 2001-06 “Paid by Employers and Employees” SUSTAINABLE? Since 2000 For-Profit Health Insurance Premiums Increased 87% Wages Increased 20%

19. How Much is the U.S. Health Care System Costing You NOW ? What Americans Pay Into the U.S. Health Care System Today Household Income Level $25,000$50,000$75,000 Share and Amount of Income Going to Health Care via Taxes Alone without Insurance 9.0% ($2,425) 9.8% ($5,300) 10.7% ($8,633) Share and Amount of Total Wage Packet Going to Health Care for Household with Insurance (not including out of pocket costs) Individual22.0% ($6,904) 16.8% ($9,779) 15.4% ($13,112) Family37.2% ($14,531) 26.4% ($17,406) 22.3% ($20,749) Source: Dollars & Sense, May/June 2008 OOP = co-pays, deductibles, co-insurance, uncovered expenses Share of total wage packet going to HC= (amount of total tax burden going to health + annual health insurance premium) (annual salary + payroll tax [FICA and Medicare] + annual health insurance premium)

20. What percentage of health care is financed through taxes? A. 90% B. 60% C. 48% D. 30% “I don’t want my tax dollars used to buy somebody else’s healthcare.”

21. Source: NEJM 1999; 340:109; Health Affairs 2000; 19(3):150 60% 20% Taxpayers Private employers Individuals { Medicare, Medicaid, VA, Indian Health Service, Public employees, tax subsidies} 60% of our Health Care is Financed through Taxes TOTAL ANNUAL SPENDING = $2,000 BILLION TOTAL ANNUAL SPENDING = $2,000 BILLION $1,200 B

22. Public Health Insurance Public Health Insurance is financed through federal and state taxes Texas pays: 40% Medicaid bill 30% S-CHIP bill Taxes State Pays Fed Pays Medicaid40%60% CHIP30%70% Medicare0100% VA0100% FEHBP 0100% Source: www.kff.org State Factswww.kff.org

23. If Medicaid Expanded to All Texans Under 200% FPL, Almost Half of Texas Would be Eligible… 43% TX live < 200% FPL *9 million adults < 200% FPL x $2,100/adult=$18.9 B/yr Source: www.kff.orgwww.kff.org And Texans would pay 40 % of the bill = $19 Billion / year*

24. What percentage of private insurance premiums goes toward administrative costs and profits? A. 15 % B. 20 % C. 25 % D. 30% “Health reform has to include the private, for-profit health insurance industry.”

25. Percentage of Private Insurance Premiums that goes toward Administrative Costs and Profits 30% Medicare administrative cost rate is 3%

26. $22 million was paid by the private insurance industry to lobbyists in 2007 - an off year for elections - That money came out of your premiums – not out of the CEOs’ personal income Source: Health Plan Week April 2008

27. 1,300 private insurance companies (each with own billing system) 314 Medicare Health Plans in TX (HMOs, PPOs, PFFS, Special Needs, MSAs) 1,824 stand-alone Medicare Part D plans 316 full-risk managed care Medicaid plans (in 1999) Multiple stand-alone S-CHIP Plans US: The Industrialized Country with the Most Fragmented Health Care System Ends up costing us $350 Billion/year on administration Why do we settle for this?

28. US Health Care System: American Business at a Disadvantage A 20% increase in HI premiums will cost 3.5 million workers their jobs, 3.5 million workers to move from FT to PT work, and cut average income by $1,700 American manufacturers pay more than twice as much on health benefits as most foreign competitors Small business employees account for ~27 million of the 47 million uninsured Incentive to hire PT workers who don’t qualify for HI “Job lock,” when workers do not leave jobs because they fear losing/changing HI, impairs flexible labor markets that strengthen the economy Sources: Kvaal The Economic Imperative for Health Reform, Center for American Progress, Dec 2008; Joint Committee on Taxation http://www.house.gov/jct/x-17-07.pdf ; Nichols and Axween, New America Foundation, May 2008; Gruber andhttp://www.house.gov/jct/x-17-07.pdf Madrian, NBER Working Paper 8817, March 2002

29. Daisetta, Texas Sinkhole The U.S. For-Profit Health Care System

30. Proposed Health Care Reforms

31. Keeps Corporate, For-Profit Insurance Companies Raking in Billions Reform MeasuresProposals 1.Mandates All children All employers except small businesses 2.Employers Must offer “meaningful” coverage or pay fine 3.Premium subsidies to individuals Available to pay to expand Medicaid and CHIP Available to purchase insurance from the new comprehensive and portable public program Weak Health Care Reform

32. More Weak Reforms 4.Tax credits Proposed by some to help subsidize private health insurance plans. 5. Insurance poolsNational Health Insurance Exchange to help purchase public plan or private insurance plans that would be required to have guaranteed issue, fair and stable premiums, standards for quality and efficiency and be comprehensive 6. Changes to private insurance Prohibit pre-existing conditions exclusions Continue family coverage for children up to 25 years old Pay “reasonable share” of premium on patient care Require disclosure of % of premium used for patient care Limit % of premium that can be used for administrative costs and profit

33. Cost of Massachusetts Health Reform 42% increase 17% increase 42 % increase 17 % increase

34. HR 676 Medicare for All The US National Health Insurance Act

35. Everybody in, nobody out Portable Uniform, comprehensive benefits Prevention oriented Choice of physician Ends insurance industry influence Reduced administrative waste Cost savings Common sense budgeting Public oversight Source: http://thomas.loc.gov/cgi-bin/thomas Single-Payer

36. What percentage of your income would be needed to pay for National Health Insurance? A. 3.3% B. 4.75% C. 7% D. 10% “We can’t afford single payer”

37. National Health Insurance Fund National Health Insurance Fund Proposed Funding for HR 676 –Single-Payer The US National Health Insurance Act Administrative savings Bulk purchasing of medications Funds Providers Hospitals Clinics Mental health Medications Medical equipment Long term care Providers Hospitals Clinics Mental health Medications Medical equipment Long term care Source: http://thomas.loc.gov/cgi-bin/thomas $2,931 B Free-market Government Administered Pays Existing federal revenues 3.3% employer and employee payroll tax 5% health tax on top 5% earners 10% tax on top 1% earners ¼ of 1% stock transactions Repeal Bush tax cuts for wealthy

38. Total HR 676 Spending < Current Spending 2010 = $2,776 B Public expenditures (fed/state/local) $1305 B Annual administrative savings $278 B Annual savings on bulk purchasing Rx & DME $109 B Payroll tax (3.3% additional on employers & employees) $538 B Stock transfer tax (0.25% on seller and buyer) $150 B Reduce corporate welfare $100 B Reverse 2001/02 tax cuts $251 B Tax surcharge (5% on richest 5%; 10% on top 1%) $200 B TOTAL AVAILABLE FUNDS TO PAY FOR HR 676 $2,931 B

39. Which systems are truly socialized medicine? A. Great Britain B. Spain C. US Veterans Medical Health Care System D. All of the above “Single payer is socialized medicine!”

40. Health Care Systems Health Care System Funding Type Delivery TypeExamples Private For Profit (“multi-payer”) Private Public Private Public U.S. National Health Insurance (“single-payer”) PublicPrivateCanada, Denmark, Norway, Australia, Taiwan, Sweden, France Medicare National Health Service “socialized” Public Great Britain Spain V.A. Sickness Funds (“social insurance”) Highly-regulated, private social insurance systems not allowed to make profits PrivateGermany, Netherlands No U.S. equivalent

41. How many Canadians voluntarily seek medical care in the U.S. A About 100 B. About 500 C. About 1000 D. Greater than 1000 “If the Canadian plan is so great why are they all coming here for their health care?”

44. In a private insurance or managed care system, the consumer has complete freedom to choose… A. Their private doctor B. Which hospital they go to C. The cost of their care D. None of the above “A single payer system would limit my ability to choose.”

45. In a private insurance or managed care system… You can only choose doctors within their network or pay a high fee You have little choice of which hospital or laboratory you go to for services Decisions about medical procedures are often made by insurance company clerks (high school level nonmedical professionals)

46. In a National Health Insurance program… All doctors and health care providers would be included All hospitals and laboratories would be included Decisions about medical procedures would be made by you and your medical professionals Fees would be determined by regional boards consisting of health care providers and consumers

47. Now that we can see our health care system for what it is, that the private, for-profit health insurance industry cannot be part of the solution, and that single payer is the solution to our health care crisis Let’s do something about it!

48. HR 676 The US National Health Insurance Act Endorsed By: 86 members of the new US Congress so far 417 union organizations U.S. Conference of Mayors Assembly of the Urban Caucus of the Episcopal Church General Board on Global Ministries of the United Methodist Church Presbyterian Health, Education and Welfare Association of the Presbyterian Church I propose that ________ endorse the Resolution in support of the US National Health Insurance Act

49. These TX Members of US Congress have not endorsed HR 676 The US National Health Insurance Act Source: http://thomas.loc.gov/cgi- bin/thomas Barton, Joe, 6th*Gonzalez, Charlie A., 20thOlson, Pete, 22nd Brady, Kevin, 8thGranger, Kay, 12thOrtiz, Solomon P., 27th Burgess, Michael, 26 th *Green, Gene, 29thPaul, Ron, Texas, 14th Carter, John, 31stHall, Ralph M., 4thPoe, Ted, 2nd Conaway, K. Michael, 11thHensarling, Jeb, 5th*Reyes, Silvestre, 16th *Cuellar, Henry, 28thHinojosa, Rubén, 15thRodriguez, Ciro, 23rd Culberson, John, 7thJohnson, Sam, 3rdSessions, Pete, 32nd *Doggett, Lloyd, 25thMarchant, Kenny, 24thSmith, Lamar, 21st Edwards, Chet, 17thMcCaul, Michael T, 10thThornberry, Mac, 13th Gohmert, Louie, 1stNeugebauer, Randy, 19th *Part of “Single Payer In Our Life Time” Campaign

50. We need a groundswell! Sign our postcard and recruit others to do the same Our goal: 2,000 postcards per Congressional District

51. Help Achieve Single Payer National Health Insurance Now! Speak Out! Donate! Write! info@hcfat.org www.healthcareforalltexas.org www.hcfat.org Single Payer In Our Life Time Campaign Send tax-deductible contributions to Health Care for All Texas P.O. Box 421704 Houston, TX 77242 Or donate on-line