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HEALTH CARE FOR ALL Myths and Reality Rob Stone MD FACEP.

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Presentation on theme: "HEALTH CARE FOR ALL Myths and Reality Rob Stone MD FACEP."— Presentation transcript:

1 HEALTH CARE FOR ALL Myths and Reality Rob Stone MD FACEP

2 THE PROBLEM OF THE UNINSURED 46 Million is 16% of the population. Indiana has 800,000 uninsured To get 46 million take all of Indiana, plus Texas, Florida, and Connecticut.

3 Uninsured Americans CPS and NHIS Data

4 Who are the uninsured? *Students>18, Homemakers, Disabled, Early retirees Source: Himmelstein & Woolhandler - Tabulation from CPS

5 Lack of Insurance Increases Mortality 18,000 excess deaths per year due to lack of health coverage People without insurance: - Receive less care and receive it later - Have 25% higher mortality rates - Receive poorer care when they are in hospitals This is the fifth leading cause of death in the US The safety net is full of holes Care Without Coverage, Institute of Medicine, May 2002


7 Medical Bankruptcy in Indiana 2004 estimate: 55,000 bankruptcies Almost 28,000 related to medical costs Affecting 77,000 family members 75% had coverage at start of illness Average out of pocket medical expenses leading to bankruptcy - almost $12,000. Himmelstein et al, Health Affairs 2/2/05

8 A Brief History Wage and price controls in WW II Truman pushes for National Health Insurance AMA opposes.

9 Red 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

10 A Brief History (continued) The birth of the Blues The Great Society: Medicare and Medicaid 1965 The Clinton Health Plan 1993 The death of the not-for-profit Blues

11 Anthem (formerly Blue Cross) Now Wellpoint CEO Larry Glassock is in Indianapolis The highest paid executive in Indiana Bonus announced in 2003 was $42.5 Million Indianapolis Star 4/7/04

12 Where Does the Money Come From? And Where Does It Go?


14 US Versus Other Countries OECD, 2004 & Health Affairs 2002; 21(4): data Health Affairs 1/06: $1.9 trillion or $6,280 per capita

15 And Where Does It Go? The money is going to: - Overhead - Inefficiency - Waste - Profit - And graft

16 Growth of Physicians, RNs & Administrators Bureau of Labor Statistics, NCHS Percentage Growth

17 What Do Administrators Do? Cost Shifting. The $5 aspirin pill The $500 ER bill Skimming the cream off the top: Avoiding the costly, the very sick, and the uninsured Its called GAMING THE SYSTEM or SURVIVOR

18 What Are We Paying for? A Very Complex System private health plans –An army of people to deny health insurance coverage and payments –And an army of people to try to maximize and receive health insurance payments –An army of people to determine who is eligible for what program

19 U.S. Overhead Spending International Journal of Health Services 2005; 35(1): 64-90

20 U.S. Overhead Spending International Journal of Health Services 2005; 35(1): 64-90

21 Health 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. 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 HMOs; for-profit hospitals are particularly costly. A wide array of investor-owned firms have defrauded Medicare and been implicated in other illegal activities. Journal of the American Medical Association, 8/13/03

24 Columbia/HCA Fined $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. Woolhandler, Canadian Medical Journal 6/8/04

25 And 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? *

26 Life Expectancy US ranked 27th, right after Barbados ; OECD, 2004, (2001 Data)

27 Infant Mortality per 1000 Births Ranked 36th, below Cuba and Taiwan OECD, 04

28 WHO Global Health Rankings Based on outcomes AND fair distribution of care At the top: #1. France, #2. Italy US ranks 37th, between Costa Rica and Slovenia Bartlett and Steele, Critical Condition, 2004

29 Satisfaction 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. Blendon et al. Health Affairs, Summer 1990

30 How Can We Pay So Much and Get So Little?

31 Inpatient Days per Capita OECD, 2004, (2001 Data)



34 % Finding Difficulty in Receiving Care Commonwealth Fund Survey, 1998

35 Elderly as Percent of Total Population, 2000 Source: Health Affairs 2000; 19(3):192

36 Tobacco Smokers OECD, 2004 (2002 Data, U.K is 2001)

37 MRI Units per Million People OECD, 2004 (2002 Data, U.S., Canada, and Germany are 2001)

38 Renal Transplants OECD, 2004 (2002 Data, Canada and Sweden are 2001)

39 The Health Care System Dinosaur Stumbles Toward the Tar Pit Our non-system of illness care


41 Myths Our system is fine, it just needs adjustment There is a safety net We cant afford to cover everyone We have the best health care system in the world

42 And the Myth of Moral Hazard If you think health care is expensive now, just wait until its free. PJ ORoarke The logic of Health Savings Accounts The 80/20 rule Some things are best not left to the marketplace Gladwell, The New Yorker, 8/29/05

43 Myth Versus Realty Every 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 hospitals


45 International Timeline of Universal Health Care Germany 1883 Switzerland1911 New Zealand1938 Belgium1945 France1945 United Kingdom1946 Sweden1947 USA1948* Greece 1961 Japan 1961 Canada 1966 Denmark 1973 Australia 1974 Italy 1978 Portugal 1979 Spain 1986 South Africa 1996

46 The Health Care We Get 1/3 are uninsured or underinsured HMOs deny care to millions more with expensive illnesses Death rates higher than other wealthy nations Costs double Canada's, Germany's, or Sweden's - and rising faster Executives and investors making billions Destruction of the doctor/patient relationship

47 The Health Care We Want Guaranteed access Free choice of doctor High quality Affordability Trust and respect

48 We Have What it Takes Excellent hospitals, empty beds Enough well-trained professionals Superb research Current spending is sufficient Polls show the people are ready for change Large and small business are calling for change

49 Government Health Insurance for All, Even if Taxes Increase? Pew Report, May 2005 No opinion 5%

50 Please indicate whether you support or oppose this policy: Universal Health Insurance Harris Poll, Wall Street Journal October 20, 2005 Unsure 8%

51 Remember Columbia/HCA? Senate Majority Leader Dr. Bill Frist owns $25 million in HCA stock. HCA is the Frist family business.

52 Why Health Care for Every Person, Young or Old, Rich or Poor?

53 The care of human life and happiness, and not their destruction, is the first and only legitimate object of good government. Thomas Jefferson


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 Mead




59 Gallup pole 3/04: More Americans worried a great deal about affordability and availability of health care than a terrorist attack, 60% vs. 42%.




63 WHAT 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.

64 WHAT 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.

65 WHAT 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.


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