29 East Madison, Suite 602 Chicago, Il Single Payer Basics and the Effect of P-PACA Margaret Flowers, M.D. Congressional Fellow

Health Care History in 2 Slides: 1940’s:  Europe: The destruction of WWII required the restoration of security through social institutions. Created a system based on human rights.  The US retained an employment-based system of health care. 1960s belief:  Private insurance industry would respond quickly to a changing medical economy and cover everybody within 10 years.

Health Care History in 2 Slides: 1980’s:  Fundamental shift occurred to private investor-owned health corporations.  Health care was perceived as a fertile field for profit seeking businesses. In this new environmen t, Health became a commodity Health became a commodity Patients became consumers

US Public Spending is More than Total Spending in other Nations Sources: OECD 2008; Health Affairs 2002;21(4)88 – Data are for 2006

51 Million Americans Without Insurance Today Source: Himmelstein, Woolhandler, Carrasquilo – Tabulation from CPS and NHIS data Millions of Uninsured Americans

Who are the Un-insured? FULL-TIME WORKER 66.5% PART-TIME WORKER 14% Urban Institute and Kaiser Commission on Medicaid and the Uninsured estimates based on the Census Bureau's March 2008 and 2009 Current Population Survey (CPS: Annual Social and Economic Supplements). NON-WORKER 19.5%

Highest Number of Preventable Deaths Measuring The Health Of Nations: Updating An Earlier Analysis: Ellen Nolte and C. Martin McKee Health Affairs, 27, no. 1 (2008): 58-71

A Few People Drive Most Costs Decile of privately insured Percentage of total health spending in 2001 Source: MEPS data, from Thorpe and Reinhart Top two deciles account for 78.3% of spending

Administrators are Growing Faster than Physicians Source: Bureau of Labor Statistics; NCHS; Himmelstein/Woolhandler analysis of CPS 3,000% 2,000% 1,000% Physicians Administrators

Consumer-directed Health Care = Under-insurance Plans with very high deductibles ($2,000 to $15,000 per family) and often high co-insurance rates thereafter (25 to 35%). Tax-free savings accounts (HSA and MSA) from which deductible and co-insurance can be paid. Only “covered services” count toward deductible.

Unsustainable Cycle! Insurance premiums increase Choose policy with fewer benefits, higher deductible Increase out of pocket spending Decrease use of health services Increase illness and disability UNINSURED

Most of the Medically Bankrupt had Insurance Coverage Source: Himmelstein et al. Am J Med, Aug Insurance at onset of illness

What did we get for $938 b? Based on the “mandate model” of reform: Medicaid expansion Private insurance mandate Public dollar subsidies Regulation of private insurers The result = more of the same!

Impact of Health Reform on the Un-insured 46 million today; ~23 million in 2019 Less uninsured Americans Medicare funding cut by $36 billion through 2019 Less funding for safety net hospitals Increased by $1 billion annually Community health center funding enhanced

Impact of Health Reform on the Under-insured If you like your current coverage, you can keep it If you don’t like your current job-based coverage, you have to keep it Policies will be required to cover at least 60% of expected health costs e.g. $7,000 premium $2,000 deductible + 20% co-insurance for next $15,000 of care

Health Care Reform, We are still for it! Patient Protection and Affordable Care Act: continues to leave tens of millions uninsured. increases total health spending. likely to continue upward trend of underinsured. mandates coverage without health security. restricts choice.

Market Failure: Expensive Poor outcomes Increasing disparities Preventable deaths Losing (esp. primary care) doctors Under-insurance/Un-insurance

Role Played by Health Industry in Health Reform Insurance donations to both Democrats & RepublicansInsurance company ads both favoring and opposing reformPharma spent over $100 million on ads supporting reform Senate framework written by Liz Fowler, former VP of Public Policy for WellPoint/Anthem

What are the Lessons? We still have a health care crisis in the United States and we need the I.C.U. I = Independence C= Clarity U = Uncompromising

DO YOU HAVE YOUR FIRE INSURANCE CARD?

Unified risk pool – everybody in, nobody out. Everybody contributes to fund health care based on ability to pay. No financial barriers. All medically necessary care is covered. Simplified administration saves money. Choice of physician and treatment. Focused on preventative and timely care. Transparency and Accountability to the public What is Single Payer? Improved Medicare for All

Funding for the NHP Sources of Revenue Medicare & Medicaid State, local government Employers Private insurance revenues New Taxes Recipients of Money Hospitals, operating Hospitals, capital HMOs Fee-for- service MDs Home Care Agencies Long Term Care NHP Fund Source: NEJM 1989:320:102

Covering Everyone and Saving Money Additional costs Covering the uninsured and poorly-insured +7.2% Elimination of cost-sharing and co-pays +5.1% Savings Bulk purchasing of drugs & equipment -2.8% Reduced hospital administrative costs -1.9% Reduced physician office costs - 3.6% Reduced insurance administrative costs -5.3% Primary care emphasis & reduce fraud -2.2% Net (Savings) -4.3% Source: Health Care for All Californians Plan, Lewin Group, 2005

We have what it takes! Excellent hospitals Well-trained professionals Superb research Current spending is sufficient

Where is the Single Payer Movement Now? State Single Payer Efforts National improved Medicare for All

State Single Payer Efforts 20 states and growing! California, Colorado, Delaware, Hawaii, Illinois, Iowa, Maryland, Massachusetts, Minnesota, Missouri, New Hampshire, New Mexico, New York, North Carolina, Ohio, Oregon, Pennsylvania, Vermont, Washington, Wisconsin. For a summary, see: lead-the-way-on-single-payer /

Vermont Passed legislation to design 3 universal health systems – 1 is single payer Contract with William Hsaio New Governor campaigned on SP Plan to pass in 2011 Sen. Sanders to request waivers

National Improved Medicare for All Education! Education! Education! Building coalitions at the congressional district level Reaching out to state grassroots groups Reaching out to organizations that advocate for social and economic justice

National Improved Medicare for All Pressure on insurance corporations Wellpoint shareholder actions Divestment campaigns Expose health injustice Hospital/clinic closings Denied care Health professional firings/strikes

A HEALTH SYSTEM THAT WE CAN BE PROUD OF! NATIONALIMPROVEDMEDICARE FOR ALL! A HEALTH SYSTEM THAT WE CAN BE PROUD OF: