1. PHYSICIANS FOR A NATIONAL HEALTH PROGRAM
29 EAST MADISON SUITE 602 CHICAGO, IL TEL: (312)

2. The Uninsured

7. Financial Suffering Among the INSURED

10. Persistent Racial Inequalities

14. Rationing Amidst a Surplus of Care

15. Some Regions Already Spend at Canadian Level
Variation in Medicare Spending:
Some Regions Already Spend at Canadian Level

17. Half of Americans Live Where Population Is Too Low for Competition
A town’s only hospital will not compete with itself
Source: NEJM 1993;328:148

18. Profit-Driven HMOs: A Problem, Not a Solution

23. Medicare HMOs: A Cautionary Tale About Competition Between Public and Private Plans (AKA Public Plan Option)

25. Despite Medicare’s Lower Overhead, Enrollment of Medicare Patients in Private Plans Has Grown

27. Private Medicare Plans Have Prospered by Cherry Picking

33. Investor-Owned Care: Inflated Costs, Inferior Quality

34. For-Profit Hospitals’ Death Rates are 2% Higher
Source: CMAJ 2002;166:1399

35. For-Profit Hospitals Cost 19% More
Source: CMAJ 2004;170:1817

36. For-Profit Dialysis Clinics’ Death Rates are 9% Higher
Source: JAMA 2002;288:2449

38. High Deductible Insurance: Except for the Healthy and Wealthy, It’s Unwise

43. Mandate Model Reform: Keeping Private Insurers In Charge

44. “Mandate” Model for Reform
Proposed by Richard Nixon in 1971 to block Edward Kennedy’s NHI proposal

45. “Mandate” Model for Reform
Government uses its coercive power to make people buy private insurance.

46. “Mandate” Model for Reform
Expanded Medicaid-like program
Free for poor
Subsidies for low income
Buy-in without subsidy for others
Employer Mandate +/- Individuals
Managed Care / Care Management

47. “Mandate” Model - Problems
Absent cost controls, expanded coverage unaffordable
Computers, care management, prevention not shown to cut costs
Adds administrative complexity and cost; retains wasteful private insurers
Impeccable political logic, economic nonsense

48. The Massachusetts Reform: Headed Towards Failure

49. Massachusetts: Required Coverage (Income > $31k)
Premium: $4,800 Annually (56 year old)
$2000 deductible
20% co-insurance AFTER deductible is reached

50. Crimes and Punishments in Massachusetts
The Crime
The Fine
Violation of Child Labor Laws
$50
Employers Failing to Partially Subsidize a Poor Health Plan for Workers
$295
Illegal Sale of Firearms, First Offense
$500 max.
Driving Under the Influence, First Offense
$500 min.
Domestic Assault
$1000 max.
Cruelty to or Malicious Killing of Animals
Communication of a Terrorist Threat
$1000 min.
Being Uninsured In Massachusetts
$1068

51. How Many are Uninsured in Massachusetts?
State and Blue Cross Surveys – 2.6%
Phone survey, few non-english speakers
Census Bureau – 5.5%
Door-to-door survey, all local languages
Mass. Department of Revenue – 5%
of taxpayers, as of 1/1/2008 – based on tax
returns

56. Tried and Failed: State Experiments with Mandate Model and Other Incremental Reforms

57. Massachusetts 2006
“Every uninsured citizen in Massachusetts will soon have affordable health insurance and the costs of health care will be reduced.
Gov. Romney.”
“The bill does what health experts say no other state has been able to do: provide a mechanism for all of its citizens to obtain health insurance.”
Sources: Wall Street Journal 4/11/06 and New York Times 4/5/06.

58. Massachusetts 1988
“I am very proud of the fact that Massachusetts will be the first state in the country to enact universal health insurance.”
Gov. Dukakis`
“Massachusetts last week ventured where no state has gone before: it guaranteed health insurance for every resident.”
Sources: New York Times 4/14/88 and 4/26/88

60. Oregon 1992
“Today our dreams of providing effective and affordable health care to all Oregonians has come true.”
Gov. Roberts
“The most far-reaching health care reform in the nation.”
Sources:Washington Post 6/9/92 and 3/20/`93

62. Tennessee 1992
“The most radical health care plan in America.” “Tennessee will cover at least 95% of its citizens with health insurance by the end of 1994.”
Gov. Ned McWherter
Sources: Federal & State Insurance Week 4/12/93; and NY Times 9/16/94

64. Vermont 1992
“This is an incredibly exciting moment that should make all Vermonters proud.”
Gov. Dean
“Governor Howard Dean, the only governor who is a doctor, signed a law here today that sets in motion a plan to give Vermont universal healthcare by 1995.”
Source: New York Times 4/12/92

66. Minnesota 1992/1993
“Minnesota is enacting a program that will be the most sweeping effort yet to provide health insurance to people who lack it the first complete reform proposal in the U.S.”
“Minnesota is about to embark on a plan to solve the health-insurance crisis that could hold lessons for other states and the nation.”
Sources: New York Times 4/19/92; and Richard Reece, Medical World News 7/1/92.

68. Washington 1993
Washington state “passed one of the most aggressive health care experiments in the nation, a program that would extend medical benefits to all 5.1 million residents of the state ”
Source: New York Times 5/2/93

70. Maine 2003
“It’s bold and comprehensive, and it’s now the law of the state.”
Gov. Baldacci
“Maine has just become the first state in the union to approve a plan to provide universal access to affordable health insurance.”
Sources: AP Newswire 4/25/06 and Ellen Goodman, Washington Post Writers Group 7/7/03.

72. Public Plan Option: The Next Disappointment

73. In 1962 Republicans Jacob Javits and John Lindsay proposed a Public Plan Option (H.R and S. 2664) as an alternative to a public Medicare plan

74. Public Plan Option Saves Little Even if Half of Privately-Insured Switch
No savings on hospitals’ billing or internal cost tracking
Hospitals already use computerized uniform bill (UB-82)
Global budgeting could save $90 bil. annually
No savings on NH/home care bureaucracy ($24 bil. saved with single payer)
No savings on MD office bureaucracy
Single payer would save $85 bil. annually through simple, uniform fee schedule, eliminating prior-approval etc.
Insurance overhead reduced $38 bil. v $131 bil. under single payer
Private insurers retain significant market share
Hospital/NH payment can’t be simplified without global budgets
Need to collect premiums, track enrollment disenrollment etc.

75. Public Plan Option Cannot Solve Cost Problems
Achieves only a fraction (1/7th) of administrative savings possible through single payer – makes expanded coverage unaffordable
Medicare HMO experience shows private plans undermine fair competition despite regulations – avoid expensively ill
Public plan effectively serves as subsidy for private insurers, taking on many high cost patients and few profitable ones

76. The U.S. Trails Other Nations

84. Canada’s National Health Insurance Program

96. A National Health Program for the U.S.

101. Public Opinion Favors Single Payer National Health Insurance