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The Three Myths of a Single-Payer Healthcare Delivery System

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1 The Three Myths of a Single-Payer Healthcare Delivery System
NAHU The Three Myths of a Single-Payer Healthcare Delivery System <SLIDES: This version is ‘animated’ with a click required to advance to each bullet on most slides. If you want the slides to come up all at once with just a single click, use the other version, entitled “NAHU SinglePayer Jan07 Standard.ppt” > <PRESENTATION GOAL: After this presentation the audience should have a clearer understanding of the arguments used to push Single-Payer Legislation, and how to counteract those points. They should understand enough about other countries’ systems to be able to interpret comments made about them. They should be willing & able to take these materials & tell this story to others – coworkers, peers, clients, etc.> <INTENDED PRESENTER: Any member at local & state AHU chapters who is willing to study this topic & present it.> <TARGET AUDIENCE: Foremost: NAHU members. Additionally: Other healthcare stakeholders.> <TO THE PRESENTER: Make use of as much of the Presentation Notes as you care to. They are written so that you can read them, or take what you want and add in more local or personal stories (if you have some). We believe we’ve put enough detail here that anyone could take this and capture an audience with the information!>

2 A Single-Payer System Could Be Closer Than You Think
This year, an unprecedented number of universal coverage initiatives were debated in the states & in the city councils of several major municipalities. Single-payer legislation was debated in California, & passed both chambers of their legislature by large margin. It was only stopped by the Governor’s veto. Most of the state and local measures are “universal access” initiatives, not true single-payer plans (where the government would be the only provider of health benefits). A number of jurisdictions are adopting the plans. Most of these measures are unfavorable to the private market. Some may represent a back-door approach to implementing a single-payer system. All make dramatic changes to our current system of health care delivery. <Speaker note: Some audience members might discount what California did because “It’s California, they are radical. It could never happen here.” However, California is a policy innovator state. What they pass now that is perceived as radical gets national press attention. And in a few years it becomes the norm and every state is trying to pass it. Also, single payer bills are introduced each year a in a number of state legislatures and every year they get more and more attention. In just the past 5 years citizens in MA and OR overturned single-payer ballot initiatives. States like IL, NM, WA, MI and PA have active commissions appointed by the Governor studying universal healthcare options, including single-payer.> In talking with agents around the country, it’s interesting to hear how many really don’t believe that the Single Payer system is a threat to their livelihood. Or, more realistically, maybe they are just too focused on making that next sale to recognize that this idea is becoming more mainstream over the past 15 years. 19 states currently have legislation that is pushing for either a single-payer system, or else just more government control over our healthcare system. With that, plus the recent shift in federal control due to the November 2006 election, this is going to continue to build as a political issue. It is definitely a threat…

3 Public Poll Supports Dramatic Change
80% Unhappy with U.S. health care spending 75% Like expanding Medicare to cover uninsured ages 55-64 68% Prefer Universal Coverage system to Private marketplace This comes from a set of USA Today articles in October 2006, done in conjunction with Kaiser Family Foundation & ABC News. It shows that the public is happy with the care they are getting, but unhappy with recent cost increases, and just plain frustrated with the whole process. Take note: don’t think that “people aren’t going to vote in a Single-Payer system”. <The public’s confusion is proven with the other questions highlighted on a slide toward end of presentation – where most clearly said they support Single-Payer measures unless it would mean a reduction in access to services or increased costs. But we’ll come back to that later.> 56% Happy with the quality of care provided in U.S. 44% Coverage for everyone more important than keeping taxes down Source: USA Today/Kaiser Family Foundation/ABC News Poll, October 2006

4 Policy “Experts” Favor a Single-Payer System
Such quotes are common & often repeated: “A large sum might be saved in the United States if administrative costs could be trimmed by implementing a Canadian-style healthcare system.” “Hundreds of billions are squandered each year on healthcare bureaucracy, more than enough to cover all of the uninsured, pay for full drug coverage for seniors, and upgrade coverage for the tens of millions who are underinsured.” - Dr. Steffie Woolhandler - Harvard Medical School Professor, The New England Journal of Medicine, September 2003 This quote sums up the argument from the Single-Payer camp. Later in the article she said that this statement might not be exactly correct. So why did she say it? Because the media runs from sound bites, so this one was quoted dozens of times over the following 15 months during the Kerry Health Plan period. How many of you believe this quote? <you’ll get almost no hands> Who could debate this subject with a Harvard University Professor? <possibly a few more hands> Who could at least explain to a client why they ought not believe this person when they say tell you that they are willing to vote-in a single-payer system next time it comes around? <you have their attention right here> To all the people who know us, WE ARE the healthcare experts. So if we can’t answer this challenge, then why would any of us expect them to think any differently? This is the type of information going around in the media. If we don’t address it, people will start believing this, and vote us all out of business… because every one of us is included in the “healthcare bureaucracy” mentioned here. <Use this slide to challenge the audience to learn what you are going to tell them in the next few minutes.>

5 What If the U.S. Implemented Canada’s Single-Payer Plan?
Scrap most technological equipment, including: 330 Lithotripters 6,000 MRIs 23,750 CAT Scanners Stop covering prescriptions outside Hospitals Make 1/2 drugs approved by FDA in past 5 years illegal Give 10% more of your Gross Income to government Cut national Research & Development by $77 Billion (25%) Stop covering mental-health care Never again be allowed to visit a specialist or even get a test without first having a visit & referral from a family doctor Put 7,730,000 people on waiting lists for everything: doctor visits, tests, surgeries, etc. <The Organization for Economic Comparative Data (OECD) is a group that studies data at a macro-economic (country) level, and compares them amongst most of the free countries around the world (ie: US, Canada, Western & Eastern Europe, Asia, etc). They are the Gold Standard for comparing health care, economic and demographic information between countries.> <The Fraser Institute is a Think Tank in Canada. Their data is most often used when studying Canada’s hospital and Dr wait times.> There are big gaps in Canadian coverage, compared to what Americans have come to expect. If we implemented Canada’s health care system here in America, here are a few of the things that would change overnight. This is because Canadian health insurance covers significantly less things than what American health insurance includes. Don’t you think that in the past 15 years, more of this comparative information should have made it into the media’s discussion of healthcare? Yet, that’s not what comes up. Let’s look again at the kind of quotes <This is the short version, and is intended as another ‘shocker’.> Source: OECD Statistics 2005; & The Fraser Institute’s Waiting Times Survey 2006

6 3 Great Myths of Single-Payer Systems
A common promise: “The Canadian system manages to cover the country’s entire population while spending a third less of the country’s gross domestic product than the US system… and produces better outcomes such as lower infant mortality and greater life expectancy.” - John Whiteside, Reuters Author, Consultant & Blogger - #1- Everyone Has Access. #2- They Have Better Outcomes. #3- It Costs Less. This quote is common among proponents of a Single-Payer system. It sounds a lot like the Harvard professor’s, doesn’t it? It’s almost an exact quote most of the time you hear it. You have to admit – they have gotten very focused. In a single sentence they are completely discrediting a 2.2 trillion dollar industry. Almost every time, these same three issues get brought up. We call them myths, and will explain to you why we do. Let’s look at each in more detail…

7 Myth #1—Everyone Has Access
Everyone might have a base level of coverage, but they don’t necessarily have access to care. Single-payer systems are giant HMOs. Since users of the system don’t pay for care directly, the only way to control costs is to limit utilization & access to medical technology. A single-payer system’s economic success is dependent on rationing the access to services. Bullet # 1 - This is partly an error in semantics. In a Single-Payer system, everyone has an EQUAL access to insurance coverage. And that might even give them an EQUAL level of access to care. But it doesn’t mean that everyone is able to access all the care that they want or even believe they need. It is often said in America that “there is a health care access crisis.” This is not true. Everyone in America has full access to all the healthcare services they want. The only question is who will pay for it – the government, an insurance carrier, or the individual themselves. In some Socialized Medicine countries, people are not even free to have private insurance or private funds pay for medical care; for example, this is the case in Canada. In some other countries, they don’t even have the level of specialist care that we have here. These are both examples of a true access problem. Bullet #2 – …but an HMO without competitor options for people to switch to. When a single-payer participant has a problem with their care, they have no options for recourse. There is no appeals process or the opportunity to initiate legal action against the single-payer. You cannot sue your provider for malpractice. In some countries, you don’t even have the right to a second opinion, or a right to see what’s written in your medical record. Bullet #3 & 4 - In virtually every country with a single-payer system, the governments are not able to keep up with the increased demand for services, and the increased cost of services. They can only afford so many resources, so the only other option is to limit access to services. This results in waiting lists in every country with this kind of system. And therefore, it also results in increased sales of supplemental policies (and private-pay patients) in most of these markets. Rationing occurs under all systems.

8 Myth #1—Everyone Has Access
What does rationing care mean in reality? “If you have a cold and are willing to wait in your family doctor’s office for three hours, this is the best health care system in the world.” David Henderson, Canadian Economist However, if you don’t just have a cold… Everything is “free,” but nothing is readily available. Countries with single-payer systems spend less on their health care but their citizens get less. Access to the newest technologies and drug therapies is limited. There are significant wait-times for any extensive level of care. Most people understand this, even if it’s not what we’ve been promised in recent years. No country’s system is able to keep up with an unlimited demand for all of the latest technology and medical expertise available. So resources are available for the emergencies, and people wait for most other services. In some cases or countries, they are allocated on a first-come, first-served basis. In others, they are allocated based upon the greatest need or the greatest chance of success. There are some more detailed examples of this coming up. Let’s start by looking at their access to surgeries in a couple well-known countries…

9 Myth #1—Everyone Has Access
Canada’s Wait-Times Are Drastic Americans are not used to having to wait very long for services. There is no Socialized system in the world that meets that kind of standard. Let’s start by looking at Canada – This is becoming a huge issue for them: waiting for everything. This annual national survey tracks wait-times from when a Family Doctor refers patients to a specialist, to when they finally get their surgery. In 1993 it was a 9.3 week wait-time, and has grown every year since… now they wait an average 17.7 weeks. That’s 4.5 months! Why is it that since single-payer first hit the national scene in the early 1990, that we never heard about this in the media? You would never sell your clients a health-plan that had these wait-times! Now, let’s look at Great Britain, too… 17.7 Weeks: Canada’s 2006 wait-times from referral to surgery Canada 9.3 Weeks: Canada’s 1993 wait-times from referral to surgery (Weeks Wait Times) Source: The Fraser Institute’s Wait Time Survey, 2006

10 Myth #1—Everyone Has Access
Britain’s Wait-Times Are Even Worse 13 Weeks: Britain’s 2007 goal – Diagnostic tests Great Britain 18 Weeks: Britain’s 2007 goal – wait-time from referral to surgery 25 Weeks: Britain’s 2005 wait-time for Cancer & Cardiac tests Their results are similar. This first bar shows results from a September 2005 study. It shows that currently the British wait 25 weeks for tests that are “routine tests critical to cancer and cardiac care”. It’s also their wait time for getting an MRI. Not surprisingly, even there the people are complaining over these results. So the government looked at it, agreed that it was inappropriate, and set some targets regarding reasonable wait times for them to get to by 2007 / That’s what these top two bars represent. The next bar shows a goal similar to Canada’s here – that they get down to an average wait time of 18 weeks for the time between when a person is referred by their family Dr to when they get a surgery. The top bar represents a 13 week average wait time for diagnostic tests. There was a series on the Norwich Evening News in England on November 2, 2006 discussing the country’s physicians’ reaction to these new standards. They were quite skeptical that anything would change. Which of course is a perfect example of what happens when there is only one entity paying the bills – there is no real recourse if they don’t follow through on a promise. Unless the government puts a lot more money in the system, or else they take it from elsewhere, this will have just been an exercise to set a standard that they can’t meet. It will be interesting to watch over the next couple years. Nobody who wants a Single-Payer system in America believes that they will end up with this, but what else does one do when there is an almost unlimited demand? It’s one of the shockers that people need to recognize is inherent in this kind of system, but it’s not something that is being discussed by those promising an easy solution. 17.7 Weeks: Canada’s 2006 wait-times from referral to surgery Canada 9.3 Weeks: Canada’s 1993 wait-times from referral to surgery (Weeks Wait Times) Source: The Fraser Institute’s Wait Time Survey, 2006; British Wait Time Study, 2005

11 Myth #1—Everyone Has Access
Problems accessing the latest technologies, too: In September 2006 in Scotland, more than 200 hip fracture operations were cancelled (among many other types of surgeries) because of lack of operating room space. News In September 2006 a woman in Cheltenham, Gloucestershire, England found out she was #582 on a waiting-list to replace her analog hearing aid with a more sophisticated digital one. News In 2006, in 5 out of 6 European countries surveyed, access to new cancer drugs is by “post-code lottery”. Euro Health Consumer Index On a per-capita basis, Canada has 20% the number of MRIs as America, & 14% the number of CAT Scans. The Fraser Institute “Access to Technology”; OECD Health Statistics, 2006 More statistics from Europe – this time showing that technology is also an expensive category that gets rationed. Bullet #2 – As best this lady could tell, she has a 14 year wait. The government told her that it would certainly not take that long, although they couldn’t explain how that wouldn’t happen, or tell her when she would get it. Bullet #3 – Rationing comes in various ways. This is a unique method: hold a lottery to pick which addresses get drugs. Then watch the Real Estate industry boom for the next 11 months in those areas. Bullet #4 – Also, older technology means that their quality of readings isn’t the same as we’re used to. <This is the last slide for Myth #1. Closing comment:> So all of this proves that while single-payer systems give people ‘equal access’, it’s not at the level of quality or quantity that any of us are used to!

12 Myth #2: They Have Better Outcomes
Life Expectancy: A Lifestyle Issue European Union 15 78.1 Canada 79.3 As you saw in the earlier quote, two outcomes (Life Expectancy & Infant Mortality) are held up to prove that Single-Payer systems are better than free markets. But you really need to study a wide variety of outcomes to get a proper picture. Let’s look at Life Expectancy from birth. These are the most recent numbers; Canadians live 2.5 years longer than Americans; and Europeans live a little more than a year longer than us. By the way, this data is for the “European Union 15”, which includes the first 15 countries that came together as the European Union between 1993 and <The E.U.15 are: Austria, Belgium, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Luxembourg, the Netherlands, Portugal, Spain, Sweden, & the United Kingdom.> <The E.U. expanded in 2004 to include Cyprus, the Czech Republic, Estonia, Hungary, Latvia, Lithuania, Malta, Poland, Slovakia & Slovenia. These countries are not included here.> While Life Expectancy might be a good indicator of the health care system when comparing America to a third-world country, it isn’t necessarily valid when comparing two modernized countries. How old we live is not so much an indicator of the quality of what happens when that 75 year old man is in the Emergency Room being treated for a heart attack. It is much more about how he had been living over the past 75 years. This is really an issue of Lifestyle. And that’s the kicker: because socially, Americans just eat a little more, & move a little less than many people in other countries. USA 76.8 (Average Age in Years) Source: Life Expectancy: OECD Health Statistics 2006, per the 2000 Census

13 Myth #2: They Have Better Outcomes
Life Expectancy: Obesity is a Big Factor 15.1% European Union 15 78.1 23.5% Canada 79.3 Here are some numbers on this. More than 60% of Americans are overweight, and more than 30% are obese. There are multiple sources for this data, and they are each a little different, but they all point to these same common issues. These green bars show data from the World Health Organization. They define Obese as a Body Mass Index of greater than or equal to 30%. <BMI is the weight of a person’s fat stores, as compared to their entire body weight. The E.U.15 number seems significantly low; the W.H.O. admits that some of this is because weight numbers were self-reported.> Even though this is just one factor that affects Lifespan, it helps us understand why we don’t live as long as other countries. It’s not so much about our insurance coverage, it’s about taking responsibility for our own health. <You might choose to add this next argument…> If you still question this - to prove this point a little more, we can look back at life expectancy as far back as While at that time we were expected to live as much as the Europeans, the telling point is with Canada. Canadians didn’t even implement their nationalized healthcare until 1967, and they have always lived two years longer than us. So that didn’t even affect it. 39.2% USA 76.8 (% BMI >= 30%) (Average Age in Years) Source: Obesity: World Health Organization, 2006

14 Myth #2: They Have Better Outcomes
Infant Mortality – A Socio-Economic Issue European Union 15 4.2 Canada 5.3 Infant Mortality is similar – certainly between first-world countries. This is the measure of the number of deaths of babies in their first year, that occur for every 1000 live births. It isn’t so much about what happens that day of the birth, as it is about what that Mom has been doing for the prior 9 months, and how she treats the child in that first year. The first factor is that this is largely a a Socio-Economic issue, as the worst infant mortality occurs amongst the poorest Moms… has she been eating properly; did she smoke or drink during pregnancy; did she actually get on the bus and go to her Dr appointments; did she know to put the baby to sleep on their back; etc. If you want to improve this rate, go find this group of expectant mothers as soon as they know they are pregnant, and hand them a thousand dollars. Or else force them to follow some basic rules of health and child rearing. With that in mind, recognize why this graph looks like it does – because in Canada and Europe, the governments tax the wealthy and middle class more, and give more money to the poorest citizens. The other contributing factor is stated in the OECD study itself. America, Canada & a few of the Nordic European countries count births differently from the rest of the world. We consider and include some very difficult births (which later pass away) that many other countries don’t even count. It doesn’t reason away all of the difference, but it certainly is a major issue with why the European Union 15’s number is this significantly low. <See notes on Slide 12 regarding the “European Union 15”.> So the next time you hear about another country having better health care outcomes, take a step back and consider whether they have chosen an appropriate set of indicators to compare. USA 6.9 (Deaths per 1000 Live Births) Source: OECD Health Statistics 2006, per the 2000 Census.

15 Myth #2: They Have Better Outcomes
Frustrations Drive Another Outcome: Consumerism In Europe: - 26 single-payer countries were surveyed. In 25, majority of respondents identified health system reform as an “urgent priority.” - The overall rating of their system by consumers was 6. - In Great Britain, in a November 2006 survey, over half the respondents rated the NHS worse than in 1996. In Canada: -Canadian Supreme Court ruling in June 2005 proves their system is unable to serve all people. - “…prohibiting…ordinary Canadians to access health care…the government is failing to deliver health care in a reasonable manner, thereby increasing the risk of complications and death…” - Private-pay clinics & diagnostic centers are on the rise. While American frustrations have us considering single-payer health care, it’s interesting to see that opinion surveys from Canadians & Europeans show that they are demanding change in their systems, too. They want more control and involvement in their care. Bullet #1 – Even in that outlying 26th country (which was Spain) - while ‘most of the respondents’ didn’t rate healthcare this way, a full 46% of respondents did. Bullet #2 – This was from a survey by “Stockholm Network Studies”, that was explained in two reports: “Inpatient for Change” and “Poles Apart.” It’s actually interesting that they rated as high as a 6. <France rated the highest – at 6.9> Bullet #3 – This recent study regarding Britain’s National Health Service (NHS) was reported online at the news-site: Canadians have been very proud that for years their system worked for all citizens. They have been okay with giving up control – as long as it was “fair” across the board. Until recently. Wait times in Canada have driven public & legal opinion to drastically move toward consumerism. We just talked about wait times that have doubled. This drove a lawsuit that reached the Supreme Court of Canada in June A businessman from the province of Quebec who waited 12 months for a hip surgery wanted to pay out of his own pocket to get it done in Canada – but that’s not allowed. The Supreme Court agreed that the system wasn’t working. In fact the full quote was: <read it here. Edited on slide for space & focus> “We conclude, based on the evidence, that prohibiting health insurance that would permit ordinary Canadians to access health care, in the circumstances where the government is failing to deliver health care in a reasonable manner, thereby increasing the risk of complications and death, interferes with life and security of the person as protected by Section 7 of the Charter.” In Canada, this was a BIG DEAL. This effectively said that Canada’s system isn’t able to meet the demand. Now they are changing a lot - - allowing individuals more control & private spending in their healthcare. And while it hasn’t cut down their whole system, there are many reforms coming in all Provinces. People don’t want the government controlling ALL of the access to ALL their care. Of course, the problem is that the government doesn’t want to give up what they have controlled for 40 years, either. <Close out Myth #2> So I think we’ve covered this fallacy that other countries have Better Outcomes. We can’t just look at a couple of outcomes and judge an entire system by them. Some of them don’t even directly relate to our system structure. But how about the economic question – that It Costs Less? Let’s look into that…

16 Myth #3 – It Costs Less Health insurance is expensive because medical treatment is increasingly more expensive. Under every single-payer system in the world, costs are high & rising due to medical inflation. Significant savings in single-payer systems come from limiting the supply of medical services to curb demand (rationing of treatment and technology). “American Coverage” is different from every other country’s “Single-Payer Coverage”. Most Americans think others get more. Myth #3 – Is this promise that when the government pays for all health care, that costs drop dramatically. Bullet #1 – This is true whether public or private. The following slides will show some of this. Bullet #2 – Inflation in healthcare costs plays out differently depending on the delivery system. In America, this shows up as increased costs & a reduction of the percentage of those services being included in insurance plans. But in other countries inflation often shows up as a longer waiting list. We’ve already talked about some of these examples. Bullet #3 – We have been told so many times that this kind of system is free, that even we forget to challenge it. A quote from H.L.Mencken says it strongly: “The urge to save humanity is almost always only a false front for the urge to rule it.” Bullet #4 – This is a big point. It has to do with perceptions. Think about your clients, coworkers and friends. When they hear that under single-payer systems “Everyone has access and it costs less”, what do you think that means to them? I believe that they think about all the care they weren’t able to get an insurance company to pay for (like a certain test, or a higher-level payment – such as an out-of-network charge); and they think about that story they heard four years ago where an insurance company wouldn’t pay for “experimental” surgery on a premature baby; or they think about that time when they believed they needed a certain treatment, but a provider wouldn’t refer them for it… Don’t you think that people believe that when they hear the promises of Single-Payer, they believe that ALL of these things are made available? They think it means that their level of care is going to go WAY UP! No wonder they say that they would be happy with a system like that. I’m saying that it’s a myth that “It Costs Less” because there isn’t a single country in the world that covers what we do under the name of ‘insurance’. But most people believe it’s an equal comparison. Economic data shows people under a single-payer systems pay much more in taxes & suffer from lower worker productivity (& the associated economic costs) due to slower recoveries. Let’s look at some graphs that draw this out for us…

17 Total Tax Revenue as % of GDP
Myth #3 – It Costs Less Total Tax Revenue as % of GDP European Union 15 Canada (% of GDP) The question often comes up about how much these systems cost. It’s tough to get an accurate comparison, because it’s such a huge entity, and it’s rolled in with government-based accounting. This graph attempts to show one view of this with total taxes, as a % of Gross Domestic Product. This graph tracks America and Canada back to As an additional comparison, this also shows the “European Union 15” data – although just back to 1990 (that’s why it looks like taxes rose out of nowhere in 1990). <See notes on Slide 12 regarding the “European Union 15”.> So, here are some facts to ponder: * Canada implemented their nationalized healthcare system in Prior to that, Canada’s and America’s taxes were very similar. Almost immediately, Canada’s taxes rose drastically, & for 35 years they have paid significantly more of their gross income in taxes. * This means that Canadians are paying 40% more taxes than Americans, and Europeans are paying 60% more than we are! USA Shortly after Canada implemented nationalized health, taxes rose drastically. Source: OECD Revenue Statistics, 2006 (Year)

18 Public/Private Health Care $ as % of GDP
Myth #3 – It Costs Less Public/Private Health Care $ as % of GDP Total: 9.9 % Private: 3.0% Public: 6.9% Total: 15.3% This is the most recent comparison of health care spending – comparing Canada & America. It shows the total healthcare dollars as a % of Gross Domestic Product. Also, it shows the split between dollars from public sources (taxes - - light blue), and private sources (dark blue). Private sources in Canada: out of pocket expenses for things not covered by insurance, such as mental health, non-hospital based pharmaceuticals, some lab/xray/testing expenses, etc. Private sources in America: insurance premiums, co-pays, deductibles, coinsurances, etc. Two points regarding this: 1. The Single-Payer proponents always quote this statistic: “America spends 15.3% of it’s GDP on healthcare – more than any other country in the world!”. And they always say it in a tone of voice that says this is a bad thing. Let me express this another way – America spends more on healthcare than any other country because we are the WEALTIEST country in the world, and BECAUSE WE CAN! For example, Canadians aren’t even allowed to pay for services that are paid for under the government system – it’s illegal! Heck, if this 15.3% is a PROBLEM, then we could reduce the number very quickly by just making many services illegal. But that doesn’t fit with American values of freedom, does it. 2. How about the light-blue portion of this graph, showing how many funds come from Public sources – taxes. Isn’t this amazing?! How many of you would have ever guessed that Canadians & Americans spend virtually the same amount of taxes on healthcare? <Virtually Nobody!> Canadians use those funds to provide a medium-level of care for every Canadian, while Americans focus those dollars on the groups that need it more: Medicare & Medicaid – the poor and the elderly. Americans completely forget about these versions of single-payer healthcare systems in America. Plus, Medicare & Medicaid only reimburse Drs & Hospitals about 40% of what it really costs to provide services… so if it weren’t for Private Insurance subsidizing them, then this 6.8% of GDP would go up, too. Public: 6.8% Private: 8.5% Source: OECD Health, 2006 (% of GDP)

19 Workforce Productivity: GDP Per Capita
Myth #3 – It Costs Less Workforce Productivity: GDP Per Capita USA There is a cost: lost productivity Canada European Union 15 (Thousands) This shows Gross Domestic Product on a Per Capita basis – as a way to compare productivity of America with Canada and Europe. Decreased productivity can be attributed (at least in part) to missed days and unproductive days at work due to delayed medical treatment. It is also a reality of taking away the incentive to succeed. Since 1967, when Canada implemented their government-run healthcare system, the gap in productivity has continued to widen. This can at least partially be attributed to a workforce that needs to wait longer for most healthcare services. Another reason is the lack of motivation when taxes are raised drastically. The difference is even greater in Europe, although not a surprise. For this comparison, we are looking at Europe’s data rolled together back to <See notes on Slide 12 regarding the “European Union 15”.> One of the most specific studies was by Britain’s “Prime Minister’s Strategy Unit”. They found falling productivity of the country’s workforce of up to 20% since Their Office of National Statistics confirmed at least a 1% drop in productivity per year since 1997. <This is the end of Myth #3> So you can see why I’m saying that it is a Myth that single-payer systems cost less. First of all, they aren’t getting what we get; and secondly, there is a significant cost in taxes & productivity! So we’ve covered the 3 Myths of Single-Payer Systems. Now that we actually know more about how these systems work, let’s look a little deeper at Americans opinions, which we started discussing earlier… (Year) Source: OECD Economics, 2006

20 Look Past the Public’s Desire For Change:
80% Unhappy with U.S. health care spending 75% Like expanding Medicare to cover uninsured ages 55-64 68% Prefer Universal Coverage system to Private marketplace <Now we’re moving to close> Remember this slide showing the USA Today survey? <Yes, it’s the same as Slide #3> Let’s take a step back & look again at this very same survey. It is a good example of what we are hearing from people these days. On one had they will say loud and clear that they want change… : 80% Are unhappy with US Health Care spending, and : 68% State they prefer a Universal Coverage system to the Private marketplace. But let’s we need to look at the rest of the story… 56% Happy with the quality of care provided in U.S. 44% Coverage for everyone more important than keeping taxes down Source: USA Today/Kaiser Family Foundation/ABC News Poll, October 2006

21 Americans Value Freedom of Choice & Access Too Much for Single-Payer Limits
76% Opposed if treatments covered by insurance no longer paid for 68% Opposed if it limits doctor choice …Three other questions later in that same study show that Americans value freedom of choice & freedom of access way too much for the limits of Single Payer health care systems: Bar #1 – 76% Opposed any changes that would mean that any treatments currently covered by insurance would no longer be covered. Bar #2 – 68% Opposed any changes if it meant that they would be limited in which Drs they could visit. Bar #3 – 60% Opposed any changes if it would result in either higher taxes or higher health premiums. As you would likely agree from what we’ve just covered by looking at the 3 Myths: every single-payer system limits access to providers &/or services. And there is no proven way to even do that without increasing taxes. So the results of the survey could be interpreted that Americans are just frustrated with the high increase in the cost of healthcare, and are grasping at solutions – as long as it gives them at least as much access to care as they currently get… they just want to pay less for it. It comes back to a core value of Americans: Freedom of Choice. I don’t believe any of your clients would be happy with a system with access levels like we’ve just talked about… right? 60% Opposed if it means higher taxes or health premiums Source: USA Today/Kaiser Family Foundation/ABC News Poll, October 2006

22 So - -What Can We Do? Educate about single-payer realities.
Educate about how other, incremental reform proposals could lead to a single-payer approach. Individual Mandate (Massachusetts) Employer Mandate (California, Maryland) Government Competition with the Private Insurance Market (Maine—Dirigo) Medicaid Expansion Optional Federal Charter of Insurance/Federal Insurance Regulation Learn & promote consumerism. So - - where does that leave us as an industry? Bullet # 1 - First of all, we need to educate people about the realities of Single-Payer healthcare. Most of us are seen as absolute experts in Healthcare, to the people that know us. And we didn’t even know most of what was discussed in the last hour. So we need to tell people about it more… so that when politicians & special interest groups try to convince them that: * Everyone Has Access * They Have Better Outcomes, and * It’s Free …they won’t fall for it. Bullet # 2 - Secondly, we need to teach that other advances of government control in healthcare aren’t a solution either. They put more dollars in the government’s hands, keep the insurance industry from being able to develop creative market-based solutions, and they further separate consumers from the real cause of inflation in health insurance: the cost of current & advancing healthcare. This is a large part of what The Health Underwriters Association is doing, but we need everyone’s help. Bullet # 3 – Thirdly, we all need to learn what Consumerism looks like. And how to develop products for it. And how to sell those products. Consumerism is the only way to quell the unlimited demand for services, while honoring people’s freedom of choices, and at the same time – bringing people back to a realization of the real costs of the best healthcare available in the world today. And that’s worth fighting for!

23 If You Don’t Want the Limitations of Single-Payer
NAHU If You Don’t Want the Limitations of Single-Payer <Last Slide> So if you now clearly know that you don’t want the realities of limitations of a Single-Payer health care plan, then you need to GET INVOLVED! This means different things: To Brokers: Take this story out over the next 12 months and tell it to all those people that are in your ‘sphere of inflluence’ – your clients and their employees. To Carrier Representatives: Take this out to your other brokers, as well as your other industry contacts. To Employers & Clients <if in audience>: Take more time this year than you have in recent years planning your Benefits. Discuss more creative ways to get your people engaged in their own healthcare. There’s no magic solution, but we need to continually work at being on top of this. If your Broker doesn’t answer these issues to your liking, go get another Broker. And to all: Join NAHU, and keep supporting your local & state chapters. Get to know your State & Federal Representatives, & ask the local Legislative Chair what to do next. Do something – if nothing else, get a set of these materials & tell somebody about it. <Re-Evaluate the PRESENTATION GOAL: After this presentation the audience should have a clearer understanding of the arguments used to push Single-Payer Legislation, and how to counteract those points. They should understand enough about other countries’ systems to be able to interpret comments made about them. They should be willing & able to take these materials & tell this story to others – coworkers, peers, clients, etc.> Get Involved!

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