1. Single Payer Presentation to Leadership Greater Chicago Christopher Masi, MD, Ph.D. Assistant Prof. – General Internal Medicine University of Chicago Illinois Single-Payer Coalition ilcoalition.pnhp.org

3. Illinois: 1.8 Million Uninsured But simply covering them with existing policies is not a solution.

4. Illinois’ Underinsured Proportion of Americans Going Without Care due to Costs, 2005 (skipping doctor visit, specialist appointment, treatment or prescription when needed) Source: Commonwealth Fund Biennial Health Insurance Survey, 2005

5. Medical Bankruptcy in Illinois  Illness and Medical Bills Contributed to 40,000 Illinois Personal Bankruptcies in 2004. (Half of All Illinois Bankruptcies) Source: Himmelstein, Health Affairs 2005 (state estimates provided by author) Of those, more than three- quarters had insurance when they got sick. Insurance Status at Onset of Illness

6. Rising Costs = Less Benefits = Under/Uninsurance Proportion of Illinoisans Covered by Employer Insurance Source: US Census

7. What Does This Mean? Lesson #1: Simply Expanding Existing Private Insurance Policies Is Not a Solution. Current Private Insurance Policies Offer Inadequate Protection. Any Gains in Coverage Will Be Quickly Offset as Costs Rise and Employers Shed Benefits. An Example: State Children's’ Health Insurance Program (S-CHIP) Largest Coverage Expansion in a GenerationLargest Coverage Expansion in a Generation 5 million children added to S-CHIP / Medicaid rolls since 1997, but the number of uninsured children has decreased by only 2 million. Government can barely keep up with drops in employer coverage. Now 9 million children uninsured.5 million children added to S-CHIP / Medicaid rolls since 1997, but the number of uninsured children has decreased by only 2 million. Government can barely keep up with drops in employer coverage. Now 9 million children uninsured. Even those benefits are probably unsustainable.Even those benefits are probably unsustainable.

8. What Does This Mean? Lesson #2: Any Real Solution to the Health Crisis Must Do Two Things: 1) Offer Coverage More Comprehensive than that Currently Available on the Private Market. 2) Control Costs so that Benefits are Sustainable.

9. Life Expectancy, 2003 (Data in Years)

10. Infant Mortality, 2003 (Deaths in first year of life per 10,000 live births)

11. International Health Spending U.S. Public Spending is Greater than Other Nations’ Public/Private Spending Combined Per Capita Health Spending, 2004 Source: OECD 2004; Japan and Germany data are from 2003

12. Growth of Physicians and Administrators 1970-2005 Source: Bureau of Labor Statistics and NCHS

13. One-Third of Health Spending is Consumed by Administration 31% Potential Savings in Illinois: $13 billion Enough to Provide Comprehensive Coverage to Everyone Source: Woolhandler, et al, New England Journal of Medicine, August 2003 & Int. Jrnl. Of Hlth. Services, 2004

14. Medicare Medicaid Payroll Tax Income Tax Single-Payer Health Care Fund $$$ Financing Single-Payer 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.

15. Single-Payer Benefits Comprehensive Coverage for all medically necessary services (doctor, hospital, long-term care, mental health, vision, dental, drug, etc.) Comprehensive Coverage for all medically necessary services (doctor, hospital, long-term care, mental health, vision, dental, drug, etc.) Free Choice of doctor and hospital. Free Choice of doctor and hospital. Doctors Unleashed from corporate dictates over patient care. Doctors Unleashed from corporate dictates over patient care. Hospitals guaranteed a secure, regular budget. Hospitals guaranteed a secure, regular budget.

16. State Consultant’s Analysis Single-Payer85.4 “Hybrid”76.3 Campaign Better HC75.4 Hospital Assoc.70.0 Healthy Illinois69.4 Insurance Industry65.3

17. Employer-Sponsored Health Plan: “Play” Mandate *Required for those with certain # of employees Employer Assessment Individual Mandate Standard Package or Equivalent Coverage Criminalize Uninsurance Medicaid / SCHIP Expansion Parents 185-200% FPL (SCHIP) Childless adults (Medicaid) Subsidies up to 400% of poverty with special provisions to support small and low-wage firms. The Illinois “Hybrid” Plan “Pay” Fee for Non-play per Employee Punishment via State Income Taxes $ State Premium and Deductible Subsides to Individuals Standard Benefit Package: Comprehensive Coverage for low premiums? IHERC – Administrative Body and Oversight Board Manage Standard Benefit Package Serve as clearinghouse for coverage options, etc Provide information to consumers about premium rates of return

18. First, Do No Harm? A Massachusetts Punitive Index # The Crime The Fine 1 Violation of Child Labor Laws $50 2 Illegal Sale of Firearms, First Offense $500 max. 3 Driving Under the Influence, First Offense $500 min. 4 Domestic Assault $1000 max. 5 Cruelty to or Malicious Killing of Animals $1000 max. 6 Communication of a Terrorist Threat $1000 min. 7 Being Uninsured* $1500 min. *Note: Original version of House Bill would have suspended individuals’ driving licenses for uninsurance as well.

19. The Illinois “Hybrid” Plan Substandard Coverage: forces the uninsured to buy defective insurance industry products that are already causing Illinois families to face bankruptcy and go without needed care. Substandard Coverage: forces the uninsured to buy defective insurance industry products that are already causing Illinois families to face bankruptcy and go without needed care. No Funding: Of the estimated $3.6 billion cost to the state, 77 percent ($2.8 billion) has no identified source of funding. No Funding: Of the estimated $3.6 billion cost to the state, 77 percent ($2.8 billion) has no identified source of funding. Micro-coverage, Macro-costs: Preserves wasteful private insurers and adds yet another layer of state administrative waste. Rather than provide care to the uninsured through a relatively efficient program like Medicare, the plan launders tax dollars through wasteful private insurers. Micro-coverage, Macro-costs: Preserves wasteful private insurers and adds yet another layer of state administrative waste. Rather than provide care to the uninsured through a relatively efficient program like Medicare, the plan launders tax dollars through wasteful private insurers. No Realistic Cost Control: Any gains in public coverage will be unsustainable due to rising costs. No Realistic Cost Control: Any gains in public coverage will be unsustainable due to rising costs.

20. “Sounds Great, but it’s not politically feasible” 2/3rds of population want it Many (probably most) physicians want it Business community is now realizing the need for it

21. Single-Payer: Glen Barton Former CEO, Caterpillar Inc. (Fortune 100) Past Chairman, Health and Retirement Task Force Business Roundtable Represents 150 Largest Employers Total Assets: $4.0 Trillion “The quickest and simplest solution… is to go to a single-payer system” - Written Testimony to AHCTF, Feb. 1 2006

22. “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

23. Single-Payer: “Politically Feasible?” Other “Politically unfeasible” movements: Abolition of Human Slavery (1600s) Women’s Suffrage Movement (1840-1920) Civil Rights Act (1964)