President Trump’s Triple Aim “More coverage” “Better benefits” “Lower costs” “Something fabulous” Woolhandler, S, Himmelstein, D. Ann Intern Med. Feb. 21, 2017. doi:10.7326/M17-0302.

Paul Ryan’s Blueprint Shifts Costs Onto Patients and States Tax credits for anyone without job-based coverage More funds for the wealthy means less funds for low-income Mini-med plans Miniscule coverage Interstate sales Circumvents state-based consumer protections Augment Health Savings Accounts Boon for those in higher-tax brackets Woolhandler, S, Himmelstein, D. Ann Intern Med. Feb. 21, 2017. doi:10.7326/M17-0302.

Paul Ryan’s Blueprint Shifts Costs Onto Patients and States Block-grant Medicaid States could divert funds to non-medical purposes Delay Medicare eligibility to age 67 Turn Medicare into vouchers Eliminate guaranteed benefits of Medicare Tied to overall inflation, not to health care inflation Woolhandler, S, Himmelstein, D. Ann Intern Med. Feb. 21, 2017. doi:10.7326/M17-0302.

Economic Case for Single Payer Is Compelling Sector 2017 Spending Without Reform Savings with Single Payer 2017 Savings Insurance overhead and admin. of public programs $323.3 B 68.0% $220.0 B Billing and administration Hospitals $283.9 B 52.6% $149.3 B Physicians $187.6 B 40.1% $75.3 B Total Administration* $1091.7 B 46.1% $503.6 B Outpt Rx drugs $362.7 B 31.2% $113.2 B Total above $616.8 B Sector 2017 Spending Without Reform Savings with Single Payer 2017 Savings Insurance overhead and admin. of public programs $323.3 B 68.0% $220.0 B Billing and administration Hospitals $283.9 B 52.6% $149.3 B Physicians $187.6 B 40.1% $75.3 B Total Administration* $1091.7 B 46.1% $503.6 B *Note: “Total Administration” includes additional savings for nursing homes, home care agencies, non-physician practitioners, and employers Woolhandler, S, Himmelstein, D. Ann Intern Med. Feb. 21, 2017. doi:10.7326/M17-0302.

Fully cover the nation Plug the coverage gaps Fairness in fees 25 Studies (State and National) Confirm Savings Would Fund Full Coverage 26 million more covered people Eliminate copays and deductibles Fully cover the nation Cover missing services (dental, long term care, etc.) Plug the coverage gaps Bring Medicaid fees up to par Fairness in fees http://www.pnhp.org/facts/single-payer-system-cost Accessed 2/25/2017

Canadian Medicare Implemented in Montreal 1971 Did Not Overwhelm the Delivery System Annual visits per person per year http://www.nejm.org/doi/pdf/10.1056/NEJM197311292892206 Annual family income brackets: <$3,000; 3,000-4,999; 5,000-8,999; 9,000-14,999; 15,000+

Canadian Medicare Implemented in Quebec 1971 Care Shifted to Older and Lower Income Percentage change in annual visits 1969-70 to 1971-72 Age >65 years Age 17 – 65 years Age <17 years http://www.nejm.org/doi/pdf/10.1056/NEJM197311292892206 Annual family income brackets: Low income <$9,000; higher income >$9,000

USA Medicare and Medicaid Enactment in 1965 Did Not Overwhelm the Delivery System Total number of physician visits in USA MD + DO, in person or by telephone for civilian non-institutional USA population Wilder CS. Volume of physician visits. United States—July 1966-June 1967. Vital Health Stat 10. 1968;10:1-60. [PMID: 5303847] CDC_12947_DS1.pdf

Total physician visits across USA USA Medicare and Medicaid Enactment in 1965 Did Not Overwhelm the Delivery System Total physician visits across USA MD + DO, in person or by telephone for civilian non-institutional USA population Wilder CS. Volume of physician visits. United States—July 1966-June 1967. Vital Health Stat 10. 1968;10:1-60. [PMID: 5303847] CDC_12947_DS1.pdf