1. PROPOSALS FOR HEALTH CARE REFORM: WHAT IS “REALISTIC”? Leonard Rodberg, PhD Urban Studies Dept., Queens College/CUNY and NY Metro Chapter Physicians for a National Health Program Presented to the DC Chapter, PNHP September 25, 2008

2. THE ARGUMENT 1. Americans are concerned about the high cost of health care and their access to it. 2. Our reliance on multiple private insurance companies is responsible for the high cost. 3. The Presidential candidates’ proposals will not solve the problems we face. 4. Single payer national health insurance will address these problems effectively.

3. Why Health Care Is On the Agenda Average Annual Premiums for Single and Family Coverage, 1999-2008 * Estimate is statistically different from estimate for the previous year shown (p<.05). Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 1999-2008.

4. ..And Costs Will Continue to Rise

5. A Declining Number of Firms Are Offering Insurance…

6. Rising Number of uninsured …Leading to a Rising Number of Uninsured

7. High Cost of Health Insurance Premiums: It’s Even Too Expensive for the Middle Class Today National Average for Employer-provided Insurance Single Coverage $4,704 per year Family Coverage $12,680 per year Note: Median household income = $50,233 Source: Kaiser Family Foundation/HRET Survey of Employee Benefits, 2008; U.S. Census Bureau, 2008

8. Lowest-cost – but Very Costly – Unsubsidized Insurance under the Massachusetts Plan Family Characteristics Annual Income Annual Cost Deductible* 30-year old individual $30,636 or more $2,348 $2,000 30-yr old couple w/2 children $61,956 or more $9,015 $3,000 55-year old couple $41,076 or more $6,303 $3,000 * Also MD co-pays & hospital co-insurance Source: www.mahealthconnector.org (Boston Area) February 2008

9. Medical costs create financial problems

10. …and they create health problems as well. Source: Health Tracking Poll, Kaiser Family Foundation, April 2008

11. U.S. Health Costs are 70% Greater than the Median of Other Countries United States

12. … and our Health Status is Worse

13. The Outlier Nation: Our Public System Covers Fewer… Source: F. Colombo and N. Tapay, Private Health Insurance in OECD Countries, OECD 2004 United States

14. While Private Insurance Dominates Source: F. Colombo and N. Tapay, Private Health Insurance in OECD Countries, OECD 2004 United States

15. Private Insurers’ High Overhead International Journal of Health Services 2005; 35(1): 64-90

16. Profits 5% of revenues The insurance industry is highly concentrated and profitable

17. Billing Costs: Nearly 20% of All Health Care Spending

18. Everybody’s Got a Health Plan!

19. 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)?

20. The Mandate Model Clinton/Obama Jacob Hacker Commonwealth Fund The problem: Too many uninsured The solution: Require everyone to have insurance, employers to contribute Continued reliance on private insurance Control costs through market competition, computerization, chronic disease management No regulation of insurance company premiums or reimbursement practices

21. Will Mandates Lead to Universal Coverage? Source: Sherry Glied et al, “Consider It Done? The Likely Efficacy of Mandates for Health Insurance,”, Health Affairs, 26(6), Nov/Dec 2007; Insurance Research Council, June 2006 below 65 yrs

22. The Mandate Model Won’t Work Will not lead to universal coverage Private health insurance will be a continuing consumer’s nightmare (copays, deductibles, denials) Does not address widespread underinsurance Increases the cost of the system by hundreds of billions of dollars Will not control rising costs It treats the symptom – the uninsured – and ignores the disease – private insurance.

23. These Plans Offer a Public Plan along with Private Plans. What’s Wrong with That? Private plans avoid sick people leading to “adverse selection” and high cost for the public plan. Many payers remain, so costs are increased. The savings from a single funding source cannot be achieved. There is no way to control costs.

24. These Plans Are Not Politically Realistic! They cost hundreds of billions of dollars Little public support, since they benefit only those without insurance Insurance companies will resist regulation They don’t solve any of the problems -- especially rising costs -- that concern everyone

25. 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.

26. Conyers HR 676 Expanded and Improved Medicare for All “single payer national health insurance” Automatic enrollment Comprehensive benefits Free choice of doctor and hospital Doctors and hospitals remain independent Financed through progressive taxes Costs contained through capital planning, budgeting, quality reviews, primary care

27. Paying for Health Care Today

28. How Single Payer Could Be Paid For: One Example from a Recent Study of a California Plan

29. Covering Everyone with No Additional Spending Additional costs Covering the uninsured and poorly-insured +6.4% Elimination of cost-sharing and co-pays +5.1% Savings Reduced insurance administrative costs -5.3% Reduced hospital billing costs -1.9% Reduced physician office costs -3.6% Bulk purchasing of drugs & equipment -2.8% Primary care emphasis & reduce fraud -2.2% Source: Health Care for All Californians Plan, Lewin Group, January 2005 Total Costs +11.5% Total Savings -15.8% Net Savings - 4.3%

30. It’s Not Only the Cost, it’s the Growth in Costs that Must be Addressed Single payer offers 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.

31. Why a National Health Insurance Program is Possible Today Everyone benefits: the uninsured, the underinsured, and everyone else who is insecurely insured. Employers will no longer face rising costs and competition from those who don't offer insurance. Limited reforms have been tried and failed. Every other advanced country has done it.

32. “Would you prefer the current system or Universal Health Insurance…like Medicare…run by Government…financed by Taxpayers” Source: Washington Post/ABC News Poll, 10/20/03 Current Don’t know Universal Health Insurance

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

34. Physicians for a National Health Program For more information: www.pnhp.org www.pnhpnymetro.org