Proposals for Universal Health Care or Back to the Health Care Future

1
Proposals for Universal Health Careor Back to
the Health Care Future

• Leonard Rodberg
• New York Metro Chapter
• Physicians for a National Health Program
• February 27, 2007

2
Why Health Is On the Agenda
3
A Declining Number of Firms Are Offering
Insurance
4
Firms Shift Health InsuranceCosts to Workers
5
HIGH COST OF HEALTH INSURANCE PREMIUMS

• National Average for Employer-provided
  Insurance
• Single Coverage 4,024 per year
• Family Coverage 10,880 per year
• Note Annual income at minimum wage
  10,300
• Annual income of average
  Wal-Mart worker 17,114
• Source Kaiser Family Foundation/HRET
  Survey, 2005

6
Rising Number of uninsured
Number of Uninsured Americans (Millions)
45
40
35
30
25
20
1980
1985
1990
1995
2000
Source U.S. Census Bureau
7
Bush Plan

• The problem Employers provide too much
  insurance, leading to excessive spending
• Bushs solution
• Tax employer-based insurance that is
  gold-plated
• Provide tax deductions (not credits) to allow
  people to buy their own insurance. No mandates on
  anyone.
• The impact (Lewin)
• 9 M fewer uninsured (12 M lose employer coverage,
  2 M would remain uninsured)
• Newly-insured are mainly upper-income
• 62 B in annual federal expenditures
• No reform of individual insurance market
  inaccessible to low- and middle-income families
  or pre-existing conditions

8
U.S .Out-of-Pocket Expenses are Greater than
Those of Other Countries
Source OECD 2006
9
Physician Visits Per Capita
10
Hospital Inpatient Days Per Capita
11
Stephen Colbert on the Bush Health Plan

• It's so simple. Most people who can't afford
  health insurance also are 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.

12
New Health Care Proposals (as of February 27,
2007)

• Americas Health Insurance Plans
• Better Health Care Together Campaign
• Health Coverage Coalition for the Uninsured
• Sen. Ron Wyden, SEIU, Safeway
• Federation of American Hospitals
• John Edwards

13
The Good News --and the Bad News

• Universal health care is accepted as the goal.
• This is defined to mean simply helping the
  uninsured buy private insurance.

14
Americas Health Insurance Plansthe private
insurance protection planand Federation of
American Hospitalsthe private hospital
protection plan

• Expand SCHIP and Medicaid eligibility for very
  low-income
• Provide federal and state subsidies and tax
  deductibility to encourage everyone else to buy
  private insurance

15
Better Health Care Together Campaigngrand
coalition

• Members ATT, Kelly Services, Wal-Mart
• SEIU, CWA
• Center for American Progress
• Principles but no Program
• Quality affordable insurance coverage for
  everyone
• Individuals are responsible for maintaining and
  protecting their health
• Improved value for health care dollar
• Shared Responsibility Businesses, government,
  individuals all contribute.

16
Health Coverage Coalition for the Uninsuredeven
grander coalition

• Members UnitedHealth, Blue Cross, Kaiser
• AHA, AMA
• Chamber of Commerce, NAM, Pfizer
• AFL-CIO, SEIU
• AARP, Families USA
• Could agree only on
• Expanding coverage as a goal
• Expansion of SCHIP
• Tax credits for childrens insurance

17
Wyden Healthy Americans Actslash and burn

• Supporters SEIU, Safeway, Families USA
• Eliminate the tax deductibility of
  employer-based insurance ? end employer benefit
• Require individual purchase of insurance
• Transitional payments by employers
• Subsidies to low-income individuals
• Relies on competition to contain costs

18
John Edwards Planindividual mandate with a
pretty face

• Medicaid and SCHIP expansion
• Employer mandate (play or pay)
• Individual mandate with community rating
• Government subsidies for low-income
• Regional purchasing plans (Health Markets)
• Government program (single payer?) as well as
  private plans. (cf Medicare Advantage)
• Note Jacob Hacker plan Identical content,
  different verbiage

19
Edwards Seductive Verbiage

• For everyone Shared responsibility
• For the fearful Lets people keep what they have
• For those worried about cost Everyone will work
  together to make the system more efficient
• For single payer advocates Individuals and
  businesses can choose if they want the government
  plan if so, the system will evolve toward a
  single-payer approach.
• (For more, see www.johnedwards.com)

20
Whats Wrong with an Individual Mandate (partial
list)?

• Will not lead to universal coverage
• Enforcement is anti-public health
• Affordable premium vs
• affordable health care
• Employers will drop coverage
• (crowd out)
• Insurance companies resist community rating

21
Whats Wrong with an Individual Mandate (partial
list cont.)?

• Health insurance a consumers nightmare
• (copays, deductibles, exclusions, denials,
  appeals)
• Complexity/humiliation of means testing
• More bureaucracy (Health Markets, etc.)
• High cost (120B Federal ???B for
• individuals)
• No cost control/continuing rising cost

22
Common Features of these Plans

• Identification of the problem too many
  uninsured.
• Their solution Require everyone to have
  insurance
• Employers should contribute but not necessarily
  offer insurance
• Their mission Save private insurers

23
None of These Plans Will Happen!

• They cost hundreds of billions of dollars
• They benefit only those with low incomes and
  those without insurance
• Note Half of middle- and lower-income adults
  experience serious problems paying medical bills
  or insurance premiums. (Commonwealth Fund 2006)
  These plans do nothing for them. 
• They dont solve any of the problems (especially
  rising costs) that concern everyone
• None envisions a real structural change.

24
A Familiar Headline But Its Wrong!

• It is the unaffordable, inefficient private
• insurance system that is collapsing.
• Employers should contribute their fair share,
• just not through private insurance.
• Going backwards to individual purchase of
• insurance is not the answer.

25
Some of the Problems created by private insurance
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SO HERES OUR REAL SINGLE PAYOR SOLUTION

• Expand Medicare to cover everyone
• Improve the coverage it offers
• Eliminate private insurance
• Automatic enrollment in Medicare for All
• Income-based financing through employers and
  employees (shared responsibility)
• Expand and Improve Medicare for All
• Conyers Bill - HR 676

27
Conclusion

• Instead of moving backwards, to a time before
  there was employer-based or group insurance, when
  everyone was on their own to get health care, we
  should be moving forward, to recognize health
  care as a necessary public good that should be a
  public responsibility. We should be expanding and
  improving the Medicare program, which we know
  provides reliable, cost-effective coverage and
  has been doing so for more than forty years.
  Public Medicare for All, not private for-profit
  insurance, is the only path to a future that will
  truly provide health care for all Americans.