Health care is an essential safeguard of human life and dignity, and there is an obligation for society to ensure that every person be able to realize this right.

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• "Health care is an essential safeguard of human
  life and dignity, and there is an obligation for
  society to ensure that every person be able to
  realize this right."
• Cardinal Joseph Bernardin

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Universal Health Care An American Dream or
Reality?
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Goals for Presentation

• CONSEQUENCES OF BEING UNINSURED
• US VS OTHER DEVELOPED COUNTRIES
• WHERES THE WASTE?
• WHAT IS SINGLE PAYER?

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• CONSEQUENCES OF BEING UNINSURED

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Who Are The Uninsured?
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18,314 Adult Deaths Annually Due to Uninsurance
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Unmet Health Needs of the Uninsured
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• US vs. OTHER DEVELOPED COUNTRIES

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The next several slides show data from the
recently-released US./Canada Health Survey - a
bi-national study carried out jointly by the two
nations health statistics agencies. The point
here, is that the average Canadian gets care very
similar to that received by insured Americans.
On average (with the uninsured included),
Canadians receive better care than Americans,
despite spending far less.
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The U.S. continues to trail most other developed
nations in key health indicators, despite
spending far more on care.
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Despite spending far more on health care than any
other nation, Americans do not get large amounts
of care.
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Number of Nurses per 1000 Population
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Percent of Population withGovernment-Assured
Insurance
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• WHERES THE WASTE?

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US Drug Spending
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Drug Company Profits
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While drug firms have trumpeted their research
innovations, they have developed few important
new drugs in recent years. Indeed, drug stocks
have slumped recently because investors fear that
the pipeline of new drugs is largely empty.
Among important new drugs that have been
introduced in recent years, most were the
products of either NIH-funded research, or were
discovered at small firms and sold to the major
drug firms at a late stage in their development.
It appears that the evolving model of commercial
domination of science, with many scientists and
research universities scrambling to cut deals
with drug firms, may be leading down a
scientific dead end.
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Government Funds Most Academic Research
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Drug Companies Cost Structure
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Administrative Cost

• 375 Billion per year
• 1 million Americans pushing paper rather than
  delivering direct health services
• Private health insurers and HMOs consume 13.6
  percent of premiums for overhead, while both the
  Medicare program and Canadian NHI have overhead
  costs below 3 percent

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Private insurers High Overhead
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Insurance Overhead 2001
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Who Pays for Health Care? Regressivity of US
Health Financing
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Is there any mystery why many Blue Cross
executives are anxious to turn for-profit and
join Anthem (a former Blue Cross plan).
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Health Costs as of GDP US Canada
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• WHAT IS SINGLE PAYER?

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The Healthcare Americans Get

• 1/3 are uninsured or underinsured
• HMOs deny care to millions more with expensive
  illnesses
• Death rates higher than other wealthy nations
• Costs double Canada's, Germany's, or Sweden's -
  and rising faster
• Executives and investors making billions
• Destruction of the doctor/patient relationship

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The Healthcare Americans Want

• Guaranteed access
• Free choice of doctor
• High quality
• Affordability
• Trust and respect

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The 4 principles of single payer

1. Access to comprehensive health care is a human
   right.
2. The right to choose and change one's physician is
   fundamental to patient autonomy.
3. Pursuit of corporate profit and personal fortune
   have no place in caregiving and they create
   enormous waste.
4. In a democracy, the public should set overall
   health policies.

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Single public plan would cover every American for
all medically-necessary services

• acute, rehabilitative, long term and home care,
  mental health, dental services, occupational
  health care, prescription drugs and supplies, and
  preventive and public health measures

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Private insurance would be proscribed because

• Private insurers would continually lobby for
  underfunding of the public system
• If the wealthy could turn to private coverage,
  their support for adequate funding of NHI would
  also wane
• Private coverage would encourage doctors and
  hospitals to provide two classes of care
• A fractured payment system would subvert quality
  improvement efforts, e.g. the monitoring of
  surgical death rates and other patterns of care
• Eliminating multiple payers is essential to cost
  containment

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Payment for Hospital Services

• NHI would pay each hospital a monthly lump sum to
  cover all operating expenses - that is, a global
  budget.
• Global budgeting would simplify hospital
  administration and virtually eliminate billing,
  freeing up substantial resources for enhanced
  clinical care

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Payment for Physicians and Outpatient Care 3
Options

1. fee-for-service
2. salaried positions in institutions receiving
   global budgets
3. salaried positions within group practices or HMOs
   receiving capitation payments

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Capital Allocation, Health Planning, and Profit

• Funds for the construction or renovation of
  health facilities, and for major equipment
  purchases would be appropriated from the NHI
  budget.
• Regional health planning boards of both experts
  and community representatives would allocate
  these capital funds.

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Prescription Drugs and Supplies

• NHI would pay for all medically necessary
  prescription drugs and medical supplies, based on
  a national formulary
• An expert panel would establish and regularly
  update the formulary
• NHI would provide all Americans with full
  coverage for necessary drugs and supplies
• NHI would contain drug costs as a monopsony
  purchaser, by exerting substantial pressure on
  pharmaceutical companies to lower prices

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Funding for NHI

• Disburse virtually all payments for health
  services
• Total expenditures would be set at approximately
  the same proportion of the Gross National Product
  as in the year preceding the establishment of NHI
  
• Funding would be based on an income or other
  progressive tax because this is fairest and most
  efficient solution

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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 most spend less than
  half
• Most have lower death rates, more accountability,
  and higher satisfaction
• Not a single one has gone to that system, found
  it to be worse, and switched back
• NONE

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We Have What it Takes

• Excellent hospitals
• Enough well-trained professionals
• Superb research
• Current spending is sufficient