Presentation on theme: "HEALTH CARE FOR ALL Myths and Reality Rob Stone MD FACEP"— Presentation transcript:
1HEALTH CARE FOR ALL Myths and Reality Rob Stone MD FACEP Introduction and opening storiesRob Stone MD FACEP
2THE PROBLEM OF THE UNINSURED 46 Million is 16% of the population.Indiana has 800,000 uninsuredTo get 46 million take all of Indiana, plus Texas, Florida, and Connecticut.Indiana has a population a little over 6 million
3Uninsured Americans CPS and NHIS Data This is the picture of an epidemic.CPS and NHIS Data
4Who are the uninsured?Most of the uninsured have jobs. Some have 2 or even 3 jobs.This is one of the myths. They aren’t losers, they are workers and children.*Students>18, Homemakers,Disabled, Early retireesSource: Himmelstein & Woolhandler - Tabulation from CPS
5Lack of Insurance Increases Mortality 18,000 excess deaths per year due to lack of health coveragePeople without insurance: Receive less care and receive it later - Have 25% higher mortality rates - Receive poorer care when they are in hospitalsThis is the fifth leading cause of death in the USThe safety net is full of holesOn 9/11 a little over 3000 died at one time.The reason they call it a safety “net” is because of the holes.Care Without Coverage, Institute of Medicine, May 2002
6This slide is to demonstrate that I’m not afraid to pander to base emotionality! And it makes a point that the uninsured really miss out on preventative care.Also note the sponsors: COC, Business Roundtable
7Medical Bankruptcy in Indiana 2004 estimate: 55,000 bankruptciesAlmost 28,000 related to medical costsAffecting 77,000 family members75% had coverage at start of illnessAverage out of pocket medical expenses leading to bankruptcy - almost $12,000.Examples of a broken ankle leaving tonight, or appendicitis.Himmelstein et al, Health Affairs 2/2/05
8A Brief History Wage and price controls in WW II Truman pushes for National Health Insurance AMA opposes.A new story that has a sort of happy ending, at least for one man.
9Red Baiting“Would socialized medicine lead to socialization of other phases of life? Lenin thought so. He declared socialized medicine is the keystone to the arch of the socialist state.”AMA Pamphlet 1949
10A Brief History (continued) The birth of the BluesThe Great Society: Medicare and Medicaid 1965The Clinton Health Plan 1993The death of the not-for-profit BluesAnd here’s the happy ending: Larry Glassock
11Anthem (formerly Blue Cross) Now Wellpoint CEO Larry Glassock is in IndianapolisThe highest paid executive in IndianaBonus announced in 2003 was $42.5 MillionIndianapolis Star 4/7/04
12Where Does the Money Come From? And Where Does It Go?
14US Versus Other Countries The red line is the amount of our spending that comes from tax dollars, already more than the others spend. The green line isout of pocket.2004 data published 1/06: total health spending $1.9 trillion, $6,280 per capita, 16% GDP.OECD, 2004 & Health Affairs 2002; 21(4): 992004 data Health Affairs 1/06: $1.9 trillion or $6,280 per capita
15And Where Does It Go? The money is going to: - Overhead - Inefficiency - Waste- Profit- And graft
16Growth of Physicians, RNs & Administrators 1970-1998 Percentage GrowthBureau of Labor Statistics, NCHS
17What Do Administrators Do? Cost Shifting. The $5 aspirin pillThe $500 ER bill“Skimming the cream off the top”: Avoiding the costly, the very sick, and the uninsuredIt’s called “GAMING THE SYSTEM” or “SURVIVOR”
18What Are We Paying for? A Very Complex System 7000+ private health plansAn army of people to deny health insurance coverage and paymentsAnd an army of people to try to maximize and receive health insurance paymentsAn army of people to determine who is eligible for what program
19U.S. Overhead SpendingNow this is usually when you start hearing people complain that the LAST people to run the healthcare system is the government.After all, the government is obviously inefficient, right? Right? Well, this may surprise you…International Journal of Health Services 2005; 35(1): 64-90
20U.S. Overhead SpendingMedicare is a lean, mean, billing machine.Look at the investor-owned Blues, that’s why they are Wall Street darlingsInternational Journal of Health Services 2005; 35(1): 64-90
21Health Care Administration US and Canada US administrative spending = $399.4 Billion or 31% of total health care costs.Canada spends 17% on administrative overhead.Potential savings = $286 Billion, enough to cover the uninsured and then some.THE problem in the US is the insurance companies.Woolhandler et al. NEJM 349: /21/2003, CBO, GAO
23…. And Graft“Investor ownership has been shown to compromise quality of care in hospitals, nursing homes, dialysis facilities, and HMO’s; for-profit hospitals are particularly costly. A wide array of investor-owned firms have defrauded Medicare and been implicated in other illegal activities.”References are available.Journal of the American Medical Association, 8/13/03
24Columbia/HCAFined $1.7 Billion in 2003 for Medicare fraud, the largest fine in Medicare history.No one went to jail.CEO Richard Scott left with a $10 million severance package and over $300 million in stock.Here is just one example.Woolhandler, Canadian Medical Journal 6/8/04
25And What Do We Get For All Our Money? The most expensive health care in the world, no doubt.The best health care in the world?How would you measure the best health care in the world?*
26Life ExpectancyCan’t necessarily ascribe life expectancy figures to availability of universal healthcare, as lifestyle issues also are in factor.But the US has the 9th lowest life expectancy of the OECD member countries.US ranked 27th, right after Barbados; OECD, 2004, (2001 Data)
27Infant Mortality per 1000 Births The US has the 7th highest infant mortality rate of the 30 OECD member countries.Countries with a higher IM are Hungary, South Korea, Mexico, Poland, Turkey, and the Slovak Republic.Ranked 36th, below Cuba and Taiwan OECD, 04
28WHO Global Health Rankings Based on outcomes AND fair distribution of careAt the top: #1. France, #2. ItalyUS ranks 37th, between Costa Rica and SloveniaBartlett and Steele, Critical Condition, 2004
29Satisfaction with Health Systems in Ten Nations Harris Poll taken in US, Canada, UK, Germany, Australia, France, Sweden, Japan, Italy, and Holland.The U.S. had the lowest health care satisfaction rate (11 percent) of the 10 nations.The people here know they aren’t getting good care, and this was done in ‘90. It would be worse today.And the other countries are proud of their systems, and overall very satisfied.Blendon et al. Health Affairs, Summer 1990
30How Can We Pay So Much and Get So Little? A lot of data coming up. Pay attention for the test!
31Inpatient Days per Capita We make it hard to get into the hospital and kick you out early when you do get admitted.OECD, 2004, (2001 Data)
32Some people say it’s hard to find a nurse anymore in the hospital.
33That big bad government bureaucracy doesn’t look so bad after all.
34% Finding Difficulty in Receiving Care The question that goes with this slide is: Which country has health care rationing?Commonwealth Fund Survey, 1998
35Elderly as Percent of Total Population, 2000 So is it because we’ve got too many old people in this country and their health care is just too expensive? No.Source: Health Affairs 2000; 19(3):192
36Tobacco Smokers OECD, 2004 (2002 Data, U.K is 2001) Drinking and weight would be the same.OECD, 2004 (2002 Data, U.K is 2001)
37MRI Units per Million People The Japanese are radiation phobic.OECD, 2004 (2002 Data, U.S., Canada, and Germany are 2001)
38Renal Transplants OECD, 2004 (2002 Data, Canada and Sweden are 2001) It’s not because we do so much more hi tech medical care.OECD, 2004 (2002 Data, Canada and Sweden are 2001)
39The Health Care System Dinosaur Stumbles Toward the Tar Pit Rather than call it the “health care system” it’s more accurate to call it our “non-system of illness care.”Our non-system of illness care
41Myths Our “system” is fine, it just needs adjustment There is a safety netWe can’t afford to cover everyoneWe have the best health care system in the world
42And the Myth of “Moral Hazard” “If you think health care is expensive now, just wait until it’s free.” PJ O’RoarkeThe “logic” of Health Savings AccountsThe 80/20 ruleSome things are best not left to the marketplaceDefinition: the risk (hazard) that the insurance company takes that the insured may behave badly, dishonestlyor recklessly (moral). As applied to healthcare economics, the fear that if everyone was insured, that people wouldGo crazy going to the doctor.There are a number of problems with moral hazard. The example of auto insurance. In most states it is mandatory.Did accident rates go up after that because people started driving more recklessly?Gladwell, The New Yorker, 8/29/05
43Myth Versus RealtyEvery other industrialized country has come to the same conclusion, a national program to insure health care for all.We can learn from the Canadian experience:National health insurance (a “single payer”) Fee for service independent doctors just like our Medicare Not-for-profit independent hospitalsSocialized Medicine vs. social insurance: the Canadians call their system Medicare.
45International Timeline of Universal Health Care GermanySwitzerlandNew ZealandBelgiumFranceUnited Kingdom 1946SwedenUSA *GreeceJapanCanadaDenmarkAustraliaItalyPortugalSpainSouth AfricaAlso Taiwan and Iraq could be added to the list if there were room.
46The Health Care We Get 1/3 are uninsured or underinsured HMOs deny care to millions more with expensive illnessesDeath rates higher than other wealthy nations’Costs double Canada's, Germany's, or Sweden's - and rising fasterExecutives and investors making billionsDestruction of the doctor/patient relationship
47The Health Care We Want Guaranteed access Free choice of doctor High qualityAffordabilityTrust and respectWhat would the “best health care system in the world” look like?
48We Have What it Takes Excellent hospitals, empty beds Enough well-trained professionalsSuperb researchCurrent spending is sufficientPolls show the people are ready for changeLarge and small business are calling for change
49Government Health Insurance for All, Even if Taxes Increase? No opinion 5%Pew Report, May 2005
50Please indicate whether you support or oppose this policy: Universal Health Insurance Unsure 8%Harris Poll, Wall Street Journal October 20, 2005
51Remember Columbia/HCA? Senate Majority Leader Dr. Bill Frist owns $25 million in HCA stock.HCA is the Frist family business.Maybe it will be hard to get this legislator to support single payer.
52Why Health Care for Every Person, Young or Old, Rich or Poor? I want to tell you one last story, about myself, about a young boy who grew up in Southern Indiana in a family of lawyers, the third of 4 boys. My father wasHarvard trained and a conservative Republican, but he believed that government had some important functions, and he believed in the rule of law. The term“rule of law” was a bit too abstract for young boys, and so he emphasized fairlness, equality, and responsibility. Brother’s Keeper. Life, Liberty, and the Pursuitof Happiness. Which is tough if you are sick and can’t get help. It is really from that foundation he gave me that I come to this issue. I don’t see it as a leftwing social justice issue or a right wing economic issue, I just see it as fairness, equality, and freedom, basic American principles. I think our health care isan essential part of the fabric of our communities, part of the infrastructure, like schools and bridges, like clean air and water. This is the real national securityissue. And this is an issue to unite us, not divide us, to come together around, An idea whose time has come.
53“The care of human life and happiness, and not their destruction, is the first and only legitimate object of good government.”Thomas JeffersonSo I claim TJ would support me today if he were alive.
54There are some tough issues we face. Global warming, world peace There are some tough issues we face. Global warming, world peace. This one is do-able.I see this as a long road, but not a long shot.In fact, I see it as inevitable.
55“Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has. “Margaret MeadPlease join me in this effort.
59Gallup pole 3/04: More Americans worried “a great deal” about Gallup pole 3/26/04: More that 60% of Americans say they worry a “great deal” about the affordability and availability of healt care, more than express a “great deal” of concern about crime (46%), illegal drug use (46%), the possibility of a terrorist attack (42%), or the economy (41%).Gallup pole 3/04: More Americans worried “a great deal” aboutaffordability and availability of health care than a terrorist attack,60% vs. 42%.
63WHAT ABOUT MALPRACTICE? Democrats propose limiting “frivolous suits” thru something like the panels we have here in Indiana. Good idea.Republicans favor putting caps on non-medical settlements like we have here in Indiana. Good idea.
64WHAT ABOUT MALPRACTICE? Future medical payments themselves are about 25% of total payouts.Many suits are triggered by anger over bills for care received.Both of these factors would be taken care of by a single payer system.
65WHAT ABOUT MALPRACTICE? Malpractice costs account for ~1% of total health care spending.The real answer is for doctors and lawyers to come together and face their common enemy: the insurance industry.