Universal Health Care without Private Health Insurance? Single Payer: The Only Affordable, Lifelong, Comprehensive, Quality Health Care Plan for Every American Robert Zarr, MD, MPH, FAAP DC PNHP

MY STORY Sept 22, 2007,at 1pm, I was assaulted Loss of consciousness Ambulance ride & ER visit NO in-network ambulance coverage for my insurance policy? Monthly bills from DC EMS After 5 months, insurance finally paid ONLY 75% of transport cost

Best health care system in the world?

18,314 Adult Deaths Annually Due to Uninsurance

We are the best at spending the most money to be ranked 37 th in health outcomes by WHO!

Government Funds Most Academic Research

Insurance Overhead 2001

In summary, private insurance: Is wasteful ($350 billion a year) Reduces the buying power of 300 million American purchasers (decreased monopsony) Reduces transparency of health care system problems and solutions Does not provide lifetime comprehensive quality health care to any American

Insanity: Try it the same way every time and expect different results. Individual & employer mandates, HSAs, High Deductible Plans, Free Market models = MORE OF THE SAME

SINGLE PAYER NATIONAL HEALTH INSURANCE READY FOR REAL CHANGE?

House Resolution 676: United States National Health Insurance Act (Expanded and Improved Medicare for All Act)

The 4 principles of single payer: 1.Access to comprehensive health care is a human right. 2.The right to choose and change one's physician is fundamental to patient autonomy. 3.No corporate profit and personal fortune. 4.In a democracy, the public should set overall health policies.

Single Payer NHI guarantees: Comprehensive Care Quality Choice Affordability

Single payer NHI would cover every American for all lifetime medically-necessary services: acute, rehabilitative, long term and home care, mental health, dental services, occupational health care, prescription drugs and supplies, and preventive and public health measures

Prescription Drugs and Supplies NHI would pay for all medically necessary prescription drugs and medical supplies, based on a national formulary Regional expert panels would establish and regularly update the formulary NHI would provide all Americans with full coverage for necessary drugs and supplies

Payment for Physicians and Outpatient Care: 3 Options 1.fee-for-service, or 2.salaried positions in institutions receiving global budgets, or 3.salaried positions within group practices or HMOs receiving capitation payments

How Do We Know It Can Be Done? Every other industrialized nation has a healthcare system that assures health care for all All spend less than we do; most spend less than half Most have lower death rates, more accountability, and higher satisfaction No country has ever adopted single payer, found it to be worse, and switched back

But, can we afford NHI? We can't afford NOT to have NHI!

Projected 2010 Health Care Expenditure Comparison of: Current Health Care System to those of National Health Insurance (NHI, Improved and Expanded Medicare for All, HR 676) Status Quo ($ billions) NHI ($ billions) SpendingFederal spending (Medicare, Medicaid, DSH, etc.)957 SpendingState and Local spending348 Spending Private Insurance spending (premiums) SpendingOut of pocket spending (co-pays, deductibles, over the counter drugs, etc.) SpendingOther private funds spending (foundations, etc.)2040 SavingsSavings from reduced administrative cost (paperwork)0 278 SavingsSavings from bulk purchase of Rx DRUGS087 SavingsSavings from non-durable medical supplies013 SavingsSavings from durable medical supplies09 Additional Revenue Additional Payroll Tax0538 (3.3% increase over current 1.4%) Additional Revenue Stock transfer tax (0.25% on seller and buyer)0150 Additional Revenue Corporate Welfare Reduction0100 Additional Revenue Reversal of 2001 and 2002 Tax Cuts0251 Additional Revenue Tax surcharge (5% on highest top 5% earners and 10% on top 1% earners) 0200 Total ($billions) 2,7763,011 Surplus0235 (3,011-2,776)

So, is this politically feasible?

Broad Support from: 92 US Congressional co-sponsors of HR 676 (more than any other bill) 59% of US physicians 70,000 medical students 75,000 nurses Faith organizations 2 state governments (Kentucky and N.H. House of Representatives) U.S. Conference of Mayors 452 union organizations

Robert Zarr, MD, MPH, FAAP