1. Will We Ever Have Healthcare for Everyone? Like in the rest of the civilized world. Rob Stone MD Director, Hoosiers for a Commonsense Health Plan Assistant Clinical Professor of Medicine, IUSM

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

4. Click to edit the outline text format Second Outline Level Third Outline Level Fourth Outline Level Fifth Outline Level Sixth Outline Level Seventh Outline Level Eighth Outline Level Ninth Outline LevelClick to edit Master text styles Second level Third level Fourth level » Fifth level Lack of Insurance Kills 49,000 deaths a year 1 death every 11 minutes People without insurance : Live sicker and die younger The safety net is full of holes American Journal Public Health, Wilper et al, Dec 2009

5. 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

6. US Census Dept, Income, Poverty, and Health Insurance Coverage Sept 2012 Himmelstein et al, American Journal of Medicine, August 2009 Health Insecurity Indiana 800,000 to 900,000 Hoosiers uninsured Hoosier bankruptcy filings because of medical bills: > 27,000 annually

7. Click to edit the outline text format Second Outline Level Third Outline Level Fourth Outline Level Fifth Outline Level Sixth Outline Level Seventh Outline Level Eighth Outline Level Ninth Outline LevelClick to edit Master text styles Second level Third level Fourth level » Fifth level Hoosier Medicaid Expansion Estimated 300 – 450 thousand lives covered, ~ half the uninsured Largest increase in coverage in >50 years $11 a day versus $30,000 a year

9. Hoosier Medicaid Expansion Traditional Medicaid 60/40 Federal/State ACA Medicaid 100% tapering to 90% Federal Cost to Indiana taxpayers: $50-150 million Federal subsidy: $1.7 billion a year At least $11 return for every $1 invested

10. A Deal Too Good to Refuse HIP cigarette taxes - $121 million High risk pool - $48 million Savings from prisons and jails Effects on hospitals Job creation

13. Im afraid well have to remove your wallet.

15. Click to edit the outline text format Second Outline Level Third Outline Level Fourth Outline Level Fifth Outline Level Sixth Outline Level Seventh Outline Level Eighth Outline Level Ninth Outline LevelClick to edit Master text styles Second level Third level Fourth level » Fifth level What Are We Paying For? An incredibly complex system Thousands of plans Armies of people to: -deny coverage and payments - collect payments - determine eligibility

16. Efficiency and Overhead $ 2003, 31% of US health spending on overhead $ Medicares overhead – 3% $ Cover everyone at Medicare rate: savings = $286 B [400 B in 2011 dollars] 1 $ 1991-93,GAO, CBO: The net cost of Single Payer would be negative.2,3 1New England Journal of Medicine 8/21/2003 2Congressional Budget Office, 1993, 3 separate reports 3General Accounting Office, 06/91 ref: T-HRD-91-35

17. Click to edit the outline text format Second Outline Level Third Outline Level Fourth Outline Level Fifth Outline Level Sixth Outline Level Seventh Outline Level Eighth Outline Level Ninth Outline LevelClick to edit Master text styles Second level Third level Fourth level » Fifth level What Do We Get For Our Money? The most expensive health care in the world The best health care in the world?

22. WHO Global Health Rankings At the top: France is #1 US ranks 37th, between Costa Rica and Slovenia

28. Click to edit the outline text format Second Outline Level Third Outline Level Fourth Outline Level Fifth Outline Level Sixth Outline Level Seventh Outline Level Eighth Outline Level Ninth Outline LevelClick to edit Master text styles Second level Third level Fourth level » Fifth level 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

30. Click to edit the outline text format Second Outline Level Third Outline Level Fourth Outline Level Fifth Outline Level Sixth Outline Level Seventh Outline Level Eighth Outline Level Ninth Outline LevelClick to edit Master text styles Second level Third level Fourth level » Fifth level Myths Our system is fine, just needs band-aids The safety net We cant afford to cover everyone The best health care system in the world

31. International Timeline of Universal Healthcare Germany 1883Switzerland1911 New Zealand1938 France 1945 United Kingdom1946 Sweden1947 USA1947* Japan1961 Canada1966 Australia1974 Italy1978 Spain1986 Taiwan1995 *President Truman proposed but failed to pass National Health Insurance

32. Our Non-System of Illness Care A Dinosaur Stumbling Toward a Tar Pit

33. Why Health Care for All - Young and Old, Rich and Poor?

34. What Can We Do? Educate Ourselves Find Our Voices Join In

36. PNHP.org