“It's so simple. Most people who can't afford health insurance also are too poor to owe taxes. But if you give them a deduction from the taxes they don't owe, they can use the money they're not getting back to buy the health care they can't afford.”

Joshua Freeman, MD MASW Annual Conference Columbia, MO October 22, 2008

 47 Million Uninsured  75 Million un-or-underinsured  Even having “good” insurance doesn’t protect  Inadequate health care outcomes and quality  Extraordinary cost  Health care primarily a business for making profits rather than enhancing health

JayDoc Student-run Free Clinic Patient Population by Employment Status

Source OECD 2007, data from 2005

 Commonwealth Fund, July 2008  US Scores 65 out of 100  No improvement since 2006  42% (75M) adults uninsured or underinsured (up from 35% 2006)  19 th out of 19 countries on mortality amenable to medical care (down from 15 th, 2006)  Spends twice what other industrialized countries do Ref:: accessed 7/21/08

Source: Centers for Medicare & Medicaid Services Projected Actual Percentage GDP

OECD, Data for Japan is an estimate $ Per person

$1,075 B$319B$286B Based on 2003 National Health Spending of $1.68 trilllion (CMS)

COST SHIFTING: NO END IN SIGHT The “Insurance Death Spiral” Bills not paid Fixed costs of healthcare services not met Fixed costs of healthcare services not met Deficit! Cost shift Higher premiums More uninsured More underinsured More uninsured More underinsured Get Care

 $5 billion in 2003 (profits $1.7 billion)  $1500 per car  $9,000 per year/per employee -average firm ($5758)  $15,000 per year /per retiree under age 65  $4,000 per year /per retiree on Medicare Source: New York Times 7/15/03

69% 31% Clinical Care Administrative Costs New England Journal of Medicine 8/03 ($2000 per person)

 Hospitals: Costs 3%-11% higher, fewer nurses, higher overhead, death rates 6%-7% higher, fraud  HMOs: Higher overhead, worse quality  Dialysis: Death rates 20% higher, less use of transplants & peritoneal dialysis.  Nursing Homes: More citations for poor quality, fraud  Rehab Hospitals: Costs 19% higher

Medicare Medicaid Payroll Tax Income Tax Single-Payer Health Care Fund $$$ Bonus: Negotiated formulary with physicians, global budget for hospitals, increased primary and preventive care, reduction in unnecessary high-tech interventions, bulk purchasing of drugs and medical supplies = long term cost control.

 Regional Health Board allocates resources  Board accountable to patients rather than stockholders  Private hospitals remain in tact  Patients have ID that allow them to get care wherever they wish  Physicians work fee-for-service

 Already covers majority of sickest  Aged, Blind and Disabled  Marginal Costs relatively low  Overhead very low

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

1973 – Denmark 1974 – Australia 1978 – Italy 1979 – Portugal 1986 – Spain 1996 – South Africa 2002 – Taiwan None of these countries rely on private, for- profit insurance companies 1883 – Germany 1911 – Switzerland 1938 – New Zealand 1945 – Belgium 1945 – France 1946 – United Kingdom 1966 – Canada

 Expand Medicaid, SCHIP.  National Health Insurance Exchange.  Public plan for small business and individuals, similar to FEHBP.  Business tax credits  Income based tax credits.  Savings by IT, transparency, negotiated drug prices for Medicare, tort reform.  Payment based on outcomes.

 Tax credit for individuals  Eliminate business tax deduction for employee health insurance  Encourage HSA’s  Income related tax credits.  Guaranteed Access Plan—pooled resources by states for chronic illness and poor.  Reduce cost by IT, reimport drugs, tort reform, transparency.  Payment based on outcomes.

“If done right, health care in America could be dramatically better with true single-payer coverage.” - Ben Brewer, WSJ, April 18, 2006 “[single-payer] is an idea that's so easy to slam politically yet so sensible for business that only Republicans can sell it! …it may take a Republican President to bless the socialization of health spending we need.” -Matt Miller, Fortune, April 18, 2006 “Think, as a small business, how you could benefit from a single-payer system: you wouldn’t lose potential employees to larger firms that offer more attractive health benefits; health insurance costs would cease to be a line item in your budget. A serious illness befalling you or an employee wouldn’t be a company- wide financial crisis. You might even save money.” -Joseph Antony, CNBC / MSN Money, Winter 2003 CNBC / MSN Money

 McCain  Minimal cost containment  HSA’s lead to less preventive care  Free market has failed to deliver quality and efficiency.  Obama  Minimal cost containment  No cost savings on administrative overhead  Free market has failed to deliver quality and efficiency.

 No savings globally  No reduction of administrative costs  Discourage preventive care

 2007 SB 13 – Options (to KHPA)  KHPA contracted with outside consultant  Foundations paid the tab  Consultant: Steve Schramm  Report on various options  Presumed Premium Assistance

 # new people covered  How covered / how paid  Employer (private) vs. Medicaid expansion (public)  Cost (and to whom)

 Reference: Decr. 144K  Affordable: Decr. 50K  Universal: Decr. 247K  Single Payer: Decr. 247K

 Prevention saves lives, but maybe not money  If it – or any other intervention – saves money, who pays? Social good?  And how do we ensure quality?

 PBS “Frontline” program – T. R. Reid  5 Countries:  Britain  Germany  Japan  Taiwan  Switzerland  sickaroundtheworld/

Annals of Internal Medicine: April 1, 2008

 HR 676  Congressional bill to establish Single Payer National Health Insurance in the U.S.  Currently has more members of Congress signed on than any other health reform bill (88)

 Q: But I can hear in what you're saying that that concern that everyone get covered, everyone get equal care, that's really important  A: Oh, yes.... For the Swiss, whether you are right or left doesn't matter; I think there is a consensus on that. We want that every [one] of our citizen[s] can get the best medical treatment when they need it....

 Q:... One of the problems we have in America is that many people -- it's a huge number of people -- go bankrupt because of medical bills; some studies say 700,000 people a year. How many people in Switzerland go bankrupt because of medical bills?  A: Nobody. Doesn't happen. It would be a huge scandal if it happens.

 Large Employer (>50):56%  Small Employer: 9%  Medicaid:11%  Individual 8%  Military 3%  Medicare 1%  Prem. Assistance* 1%  Uninsured11%

 2008 KHPA Recommendations:  Increased Health Coverage  Combined plan  Promote Medical Homes  Promote Personal Responsibility  Legislative Action 2008: None  Not even premium assistance