1. Healthcare for Everyone?
Like the rest of the civilized world
START THE TIMER!!
Rob Stone MD
Director, Hoosiers for a Commonsense Health Plan
Director, Palliative Care, IU Health Bloomington
Assistant Clinical Professor of Medicine, IUSM

2. Slides can be downloaded at: HCHP.info/Presentations
DISCLOSURES
Dr. Rob Stone has no relevant financial relationships with commercial interests.
Slides can be downloaded at: HCHP.info/Presentations

3. Mary F is 49 yo, first noted to be diabetic during her 2nd pregnancy, and for the past 3 years has required insulin injections. She was laid off from her job as a secretary 1 year before I saw her, and, like so many she was forced to join the ranks of the uninsured quickly thereafter. To continue her insurance by COBRA would have cost her over $700/month, she was uninsurable in the private insurance market, and she was not eligible for Medicaid. She was able to afford her metformin pills and her insulin injections, with difficulty, but as time went on, finances kept getting tighter. What could she cut? Her test strips. Although she had 3 different glucose meters at home, the strips were almost $1 apiece, and she simply couldn’t afford them and keep food on the table.
When she started getting sick, with nausea and vomiting, she didn’t know if her sugar was high or low, but since she couldn’t keep anything down, she decided she’d better not take her insulin. She’d almost died from a hypoglycemic reaction when she first started the shots and was justifiably scared of low blood sugar. After 3 days she was too weak to get out of bed or even make a phone call. Luckily, her son stopped by to check on her and called 911.
When I walked in the room, I saw a woman so pale and breathing so hard, she looked near death. She was so dehydrated that when she tried to open her mouth for me to examine it, at first her tongue stuck to the roof of her mouth. Our rapid bedside blood sugar monitor simply read “HI”. Indicating that the actual reading was over 500 (normal is around 100).
After lots of intravenous fluids and an insulin infusion, she started to stabilize, and was admitted to the ICU. Luckily, she bounced back quickly and was able to return home the next afternoon. Her bill for not quite 24 hours in the hospital? $20,000. All for the lack of a few dollars worth of glucose test strips.

4. Countries with Universal Healthcare

9. What Are We Paying For? An incredibly complex system
Thousands of plans
Armies of people to:
-deny coverage and payments
- collect payments
- determine eligibility
And what do those armies of people look like?…

10. What Do We Get For Our Money?
The most expensive health care in the world
The best health care in the world?

13. WHO Global Health Rankings
At the top: France is #1
US ranks 37th, between Costa Rica and Slovenia
No matter how you slice and dice it, our healthcare statistics are embarrassingly bad

17. Tobacco Smokers OECD, 2004 (2002 Data, U.K is 2001)
Drinking would be the same. Maybe that’s why they live longer.
OECD, 2004 (2002 Data, U.K is 2001)

18. Why spend so much AND get so little?
Reason # 1: Our profit-driven insurance system
AND
As long as millions are left out, everyone will suffer
Understand that the way insurance companies make a profit for their stockholders is by taking in your
premiums, but figuring out ways to not pay out when people get sick. That is their model. I went to
Medical school to TAKE CARE of sick people. My motivation is exactly the opposite of theirs.

19. Health Insecurity Indiana
800,000 to 900,000 Hoosiers uninsured
Hoosier bankruptcy filings because of medical bills:
> 27,000 annually
Uninsured Rates Comparison: MA 5.6%, TX 24.6%
108 bankruptcy filings every business day in Indiana
US Census Dept, “Income, Poverty, and Health Insurance Coverage” Sept 2012
Himmelstein et al, American Journal
of Medicine, August 2009

20. Is the ACA Going in the Right Direction?
What’s wrong with this picture?
Is the ACA Going in the Right Direction?

24. Affordable Care Act Original projection: 30-35 million newly covered
Half thru Health Insurance Exchanges (Mandate)
Half thru Medicaid expansion
Supreme Court Decision Summer 2012

25. The map of states with poor health statistics overlaps with this map.

26. Two Very Different Public Programs
Medicare
Pre-paid health insurance
Who
Age >65, dialysis, disability
How
100% federally funded, the same in every state
Medicaid
The only safety net
Low-income people with additional eligibility criteria
60% federal, 40% state funded

27. Medicaid 101 What Who Established in 1965 with Medicare
Administered by states within broad federal parameters
What
73% Caucasian, 19% African American, 5% Hispanic
Largest numbers covered – children
Largest expense – care of frail elderly, esp in nursing homes
Who

28. HIP Indiana Medicaid 2014 400% ($95,400) 300% ($71,550) 200% ($47,700)
100% ($23,850)
FPL
250%
200%
Premium No
HIP
19%
Children
Pregnant
Parents
Childless Adults
Y-axis is % of Federal Poverty Level; Example of a family of four

29. ACA as Planned 100% - 400% of poverty level 400% ($95,400)
300% ($71,550)
200% ($47,700)
100% ($23,850)
Sliding scale premium subsidies:
100% - 400% of poverty level
% poverty: patient’s choice
Medicaid in all states: up to 138% of poverty
Y-axis is % of Federal Poverty Level; Example of a family of four

30. Medicaid Expansion Would Help People We All Rely On

31. Hoosier Medicaid Expansion
Estimated 350 – 450 thousand lives covered, ~ half the uninsured
Largest increase in coverage in >50 years
$11.50 a day versus $30,000 a year eligibility

32. Medicaid Expansion – Good for All of Us
Traditional Medicaid 60/40 Federal/State
ACA Medicaid 100% tapering to 90% Federal
Cost to Indiana taxpayers: $ million
Federal subsidy: $1.7 billion a year

33. A Deal Too Good to Refuse
HIP cigarette taxes - $121 million
High risk pool - $48 million
Savings from prisons and jails

34. “I’m just here for the dental.”

35. A Deal Too Good to Refuse
HIP cigarette taxes - $121 million
High risk pool - $48 million
Savings from prisons and jails
Hospitals avoid $345 M/year unpaid care
30,000 new jobs
>$100 million new tax revenues
Indiana Hospital Association Report 2/11/13

36. Indiana Is Being Taxed For a Program We’re Turning Down
Federal responsibility for cost of expansion population
Our federal tax dollars are
paying for Medicaid but IN is
not getting the benefits

37. Losing $5 Million a Day

38. Michigan Chamber Applauds Passage of Medicaid Reform Legislation
“Make no mistake, the Michigan Chamber remains strongly opposed to Obamacare,” said Jim Holcomb, Senior Vice President for the Michigan Chamber. “However, our Board of Directors believes Medicaid reform makes sense for our state and the business community.”
June 13, 2013

39. Governor Pence has called Medicaid a “broken program”
Is Medicaid worse than no insurance at all?

40. Oregon: Expand Medicaid, Increase ER Usage by 40%
A 40% relative increase means
one extra visit per person
every four years
Annual emergency room visits per person
Taubman, S. Science Magazine. Jan 2, 2014.

42. Medicaid Expansion Is About Life and Death In Indiana
Better women’s health
5,893 more mammograms
14,246 more Pap smears
Better treatment of chronic diseases
14,225 more diabetics receiving medications
23,971 less adults with depression
Fewer preventable deaths
Between 240 and 758 preventable deaths avoided
Consistent with the “Culture of Life”
Annual data for Indiana from Dickman S, Himmelstein D, McCormick D, and Woolhandler S. Opting out of Medicaid Expansion: The Health and Financial Impacts. Health Affairs Blog. January 30, 2014

43. International Timeline of Universal Healthcare
Germany Switzerland
New Zealand
France
United Kingdom 1946
Sweden
USA *
Japan
Canada
Australia
Italy
Spain
Taiwan
No matter how you slice and dice it, our healthcare statistics are embarrassingly bad
*President Truman proposed but failed to pass National Health Insurance

45. Why Health Care for All - Young and Old, Rich and Poor?
You’ve seen the data, now let’s talk heart to heart.
Growing up in Evansville. Conservative parents, fairness and caring. These are core American values.
“If religion were a thing that money could by, then the rich would live and the poor would die.” That’s the reality of healthcare in this country, and it’s not good for any of us, rich or poor
When did the denial of sympathy and charity become patriotic American values?

46. What Can We Do? Educate Ourselves Find Our Voices Join In
Our Commonsense solution: Medicare Part E – E is for Everyone.

48. PNHP.org