Health Care Reform Post-Election : What is “Realistic”? Leonard Rodberg, PhD Urban Studies Dept., Queens College/CUNY and NY Metro Chapter, Physicians for a National Health Program November 18, 2008

Parasitical middleman - American Way cartoon

Wall Street Bailout

NYTimes Editorial re international comparisons

Three Possibilities for the Non-elderly Non-poor Private insurance Private insurance with a public option Public plan/national health program

McCain/Wyden-Bennett: Individual Responsibility “You’re On Your Own” End employer-based insurance by eliminating the employers’ tax deduction for health insurance Make individuals more cost-conscious consumers Use tax credits to help low-income individuals Control costs through market competition No evidence - “Faith-based health policy” Will Mom & Pop do better than GM and the Federal Government (FEHBP)?

The problem : Too many uninsured The solution: Everyone should buy insurance Employers should contribute or offer insurance Continued reliance on private insurance, with the option of a public plan “Keep what you have” Expansion of Medicaid/SCHIP No regulation of insurance company premiums or reimbursement and denial practices “Mainstream”Mandate/ Building Blocks Model Obama/Baucus/Ted Kennedy(?) Commonwealth/Hacker/HCAN

The Mandate/Building Blocks Model Won’t Work It won’t lead to 100% coverage Private health insurance will be a continuing consumers nightmare (copay, deductible, denials) Doesn’t address widespread underinsurance Increases cost of the system by billions of dollars Many payers remain, so the savings from a single funding source can’t be achieved. There is no way to control costs. It treats the symptom – the uninsured – while ignoring the disease – private insurance.

Even Its Supporters Recognize the Superiority of Single Payer “Compared to a Medicare-for-All approach, the Building Blocks framework would not achieve the simplicity, consolidated risk, administrative overhead, and provider payment net savings of covering nearly everyone through Medicare.” -- Cathy Schoen, Karen Davis and Sara R. Collins, “Building Blocks For Reform: Achieving Universal Coverage with Private and Public Group Health Insurance, Health Affairs, May-June 2008

Conyers/Kucinich/et al Expanded and Improved Medicare for All “single payer national health insurance” HR 676 Automatic enrollment - everyone receives a card assuring payment for all needed care Doctors and hospitals remain independent, negotiate fees, budgets with public agency Public agency processes and pays bills Financed through progressive taxes

Where the Private Insurance Dollar Goes: Nearly 30% for Billing

Covering Everyone and Saving Money through Single Payer Additional costs Covering the uninsured and poorly-insured +6.4% Elimination of cost-sharing and co-pays +5.1% Savings Reduced hospital administrative costs -1.9% Reduced physician office costs -3.6% Reduced insurance administrative costs -5.3% Bulk purchasing of drugs & equipment -2.8% Primary care emphasis & reduce fraud -2.2% Source: Health Care for All Californians Plan, Lewin Group, January $ B Total Costs +11.5% Total Savings -15.8%

Obama on Single Payer 2003

Obama on Single Payer 2007

Obama on Single Payer 2008

A FALSE POLICY CHOICE Assertion: “Let’s first cover everybody. Then we can deal with the system’s inefficiencies.” Fact: We will never have enough money to provide everyone with decent coverage until we eliminate the principal sources of waste and inadequate coverage.

Why Health Care Is On the Agenda: Escalating Cost Average Annual Premiums for Single and Family Coverage, * Estimate is statistically different from estimate for the previous year shown (p<.05). Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits,

The Growth in Cost Must be Addressed if Any Plan is to Succeed Single payer offers real tools to contain costs – Budgeting, especially for hospitals Investment planning Emphasis on primary care and coordination of care Mandate plans offer only hopes – Computerization Chronic disease management Insurance company competition There is no data or experience to suggest that these will cut costs or limit the rise in cost.

The Bottom Line The Mandate/Building Block model will – Make the world’s most costly health system even costlier. Not improve insurance coverage for the average person. Not make affordable insurance available. Not address the problem of underinsurance. Not contain the continuing growth in cost. In other words, they won’t work! Only national health insurance will – Cover everyone for comprehensive services. Cost no more than we are now spending. Provide mechanisms for containing the growth in cost.

Leadership Conference for Guaranteed Health Care – The National Single Payer Coalition Meeting in Washington, DC Nov at AFL- CIO Headquarters, but limited involvement of labor Sponsors: California Nurses Association, PNHP, Healthcare NOW, Progressive Democrats of America, faith groups Health care reform = Economic and moral issue Media campaign: Need to “Start from Scratch” Congressional visits “the train is moving”

Strategic Questions in this Post-election Period Should “mainstream” health reform be passed quickly, perhaps providing an economic stimulus? Should we oppose early action, urging limited reforms (SCHIP, Medicare reforms, IT) while the country engages in a lengthy debate towards real reform? Our Rodney Dangerfield problem: How do we get respect and visibility for the single payer option? How do we mobilize latent majority public support?

Will We Get Real Health Care Reform Before the Premium Takes All our Income? Source: American Family Physician, November 14, 2005 Today

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