1. Health Care for All Colorado Irene Aguilar, M.D. Vice President, Health Care for All Colorado Primary Care Physician Westside Health Center Denver Health and Hospitals

2. Health Care Spending in the U.S.  2006 - $2.1 trillion (16% GDP)  69% for health care  31% for other costs  Administrative overhead  Profits  2007 - $2.4 trillion (21% GDP) Colorado spending 2007 estimated at: $30.1 billion

3. Government Insurance 2006: 80.3 M 2007: 83.0 M  2.3 Million Government Insurance 2006: 80.3 M 2007: 83.0 M  2.3 Million 2007: 45.7 Million Uninsured 2007 Colorado: 801,000 uninsured 16.4% of population 2007 Colorado: 801,000 uninsured 16.4% of population

4. In Colorado, 70% of the uninsured are in the workforce or are dependents of a worker.

5. What is the cost of health insurance?  Over $10,000 for employer sponsored family policy*  Individual policy (if it can be purchased) more than $10,000 in after tax dollars Median income was $52,275 in 2006** Can the average worker afford health insurance? *The Lewin Group: Health Spending in Colorado June 2007 **Denver Business Journal August 2007

6. Average Total Employee Contribution per Enrolled Employee for Single Coverage at Private-Sector Establishments Offering Health Insurance in Colorado

7. Because of rising costs, the numbers of companies offering health benefits continues to decline 1995 – 67% 2000 – 51% 2007 – 41% National Small Business Association Survey - 2007 37.5% of Colorado’s uninsured work for firms that do not offer insurance; 21% are ineligible for their employer’s coverage 37.5% of Colorado’s uninsured work for firms that do not offer insurance; 21% are ineligible for their employer’s coverage

8. 37% of companies have taken cost cutting action  Instituting wellness programs  Changing insurance company  Decreasing covered benefits  Increasing deductibles and co-pays  Increasing employee contribution

13. Access Problems for Middle Class Families (Income $25,000-$49,999) NPR/Kaiser Survey, June2002

15. Who Pays for Health Care? Private health insurers Insure 59% of those with insurance  Pay 19% of total health care costs

16. Who Pays for Health Care? Government (taxpayers) – 66% Federal/State/Local Medicare - $440 billion (2006) Medicaid - $330 billion (2006) SCHIP Government Employee Insurance Premiums U.S. Public Health Services (IHS) U.S. Military VA System (235,000 employees) Prisoners (2 million incarcerated) Public hospitals and clinics Tax subsidies

17. Health Care Expenditure per Capita by Source of Funding in 2005 Adjusted for Differences in Cost of Living ab a 2004 b 2002 Source: OECD Health Data 2007

18. Average Length of Stay in Hospital in 2005 a 2004 b 2003 c Source: NZ Ministry of Health, 2004 aac Source: OECD Health Data 2007 (October 2007) Average Number of Physician Visits per Capita in 2005 Utilization of Health Care Services baaaa

21. In comparison to other countries, why do we:  Have 97 million uninsured or underinsured?  Spend far more per capita?  Have poorer outcomes?  In other words…  Where is the money?

23. Growth of Registered Nurses and Administrators, 1970-2002 Bureau of Labor Statistics & Himmelstein/Woolhandler/Lewontin Analysis of CPS data 0% 500% 1000% 1500% 2000% 2500% 1970197519801985199019952002 Growth since 1970 AdministratorsRNs

26. What role do medical liability costs play?  3% of total costs ($66 billion)  Majority of patients who are harmed are not compensated  Some not harmed are compensated  Tort reform is not the comprehensive solution to health care costs

27. MEDICAL MALPRACTICE INSURANCE 2000-2004 Gross Losses Paid Gross Premiums Written Falling Claims and Rising Premiums in the Medical Malpractice Insurance Industry, July 2005

29. Drug Companies’ Cost Structure

30. U.S. Drug Spending, 1990-2003 Source: HCFA, Office of the Actuary $40 $46$48 $51 $55 $61 $67 $75 $104 $122 $142 $161 $182 $85 »0»0 »20 »40 »60 »80 »100 »120 »140 »160 »180 »200 1990199219941996199820002002 »Prescription Drug Spending »(Billions of Dollars)

34. The Health Care Americans Want §Free choice of doctor §Guaranteed access §High quality §Affordability §Trust and Respect

35. The Health Care Americans Get §1/3 are uninsured or underinsured §Insurance companies deny care to millions more with expensive illnesses §Death rates higher than other wealthy nations §Costs exceed France, Germany and Sweden and rising faster §Executives and investors making billions §Destruction of the doctor/patient relationship

36. Medicare, Medicaid and Choice or Insurance does not = Access §Only 37% of Colorado Providers accept Medicaid (adult and children) §In 2002 only 37% of primary care physicians were accepting new Medicare patients

37. How do we achieve the ideal?  Dramatically reduce overhead costs. How?  Eliminate “for profit” entities in delivery of healthcare  Reduce costs of pharmaceuticals  Allow negotiation of bulk price  Create a single risk pool of all residents - makes health care available and affordable to all

38. Lewin Group Analysis of Colorado Proposals* COLORADO HEALTH SERVICES SINGLE PAYER PROGRAM Everyone insured with comprehensive benefits – No one without coverage $1.4 billion savings annually *Colorado Blue Ribbon Commission on Health Care Reform 1/31/2008

39. Single Payer Health Care §Universal – covers everyone §Comprehensive – all needed care, including dental, mental health, substance abuse § No or low co-pays §Simplified reimbursement §No for profit insurers, hospitals, etc §Improved health planning §Public accountability for quality and cost, with minimal bureaucracy

40. Single Payer Health Care: How do we know it can be done? §Every other industrialized nation has a healthcare system that assures medical care for all §All spend less than we do; many spend less than half §Most have lower death rates, more accountability and higher satisfaction

41. Single Payer Health Care Opponents  Insurance companies - lose business and lose profit  Pharmaceutical companies - lose profit  Many providers - fear change  Some small businesses - forced to pay a share  The insured – fear less coverage and more costs

42. Single Payer Health Care Supporters §The uninsured - all would be covered §The elderly & middle class - ends underinsurance and risk of bankruptcy §Medicaid & Medicare recipients - assures equal choice in care §Big business - contains costs §Health Care Providers - helps patients, curtails bureaucracy §Employees – bargain for salary increases instead of health benefits

44. Single-payer or National Health Insurance. U.S. Physicians Support for National Health Insurance among U.S. Physicians: 5 Years Later Carroll and Ackerman Ann Intern Med.2008; 148: 566-567

45. Elected leadership should work for taxpayers, not for special interests. Our healthcare dollars should be spent to guarantee access to comprehensive high quality health care. We need to advocate for REAL healthcare reform.

46. What can you do? §Write your federal legislators and ask them to endorse HR 676 – Improved Medicare for All §Talk to your state legislators and ask them to support Single Payer Health Care in Colorado §Educate yourself about the REAL ISSUES in health care reform §Join us : www.healthcareforallcolorado.org

47. “True compassion is more than flinging a coin to a beggar; it comes to see that an edifice which produces beggars needs restructuring. Martin Luther King, Jr.

48. Stephen Colbert on the Bush Health Plan “It’s so simple. Most people who can’t afford health insurance are also 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.”