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Health Care Reform PostElection: What is Realistic

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Three Possibilities for the Non-elderly Non-poor. Private insurance. Private insurance with a public ... Obama/Baucus/Ted Kennedy(?) Commonwealth/Hacker/HCAN ... – PowerPoint PPT presentation

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Title: Health Care Reform PostElection: What is Realistic


1
Health Care Reform Post-ElectionWhat is
Realistic?
  • Leonard Rodberg, PhD
  • Urban Studies Dept., Queens College/CUNY
  • and
  • NY Metro Chapter, Physicians for a National
  • Health Program
  • November 18, 2008
  • len_at_infoshare.org

2
Parasitical middleman - American Way cartoon
3
Wall Street Bailout
4
NYTimes Editorial re international comparisons
5
Three Possibilities for the Non-elderly Non-poor
  • Private insurance
  • Private insurance with a public option
  • Public plan/national health program

6
McCain/Wyden-Bennett Individual
ResponsibilityYoure 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)?

7
MainstreamMandate/Building Blocks
ModelObama/Baucus/Ted Kennedy(?)Commonwealth/Hac
ker/HCAN
  • The problem Too many uninsured
  • The solution Everyone should buy insurance
  • Employers should contribute or offer insurance
  • Continued reliance on private insurance, with the
    option of a public plan Keep what you have
  • Expansion of Medicaid/SCHIP
  • No regulation of insurance company premiums or
    reimbursement and denial practices

8
The Mandate/Building Blocks Model Wont Work
  • It wont lead to 100 coverage
  • Private health insurance will be a continuing
    consumers nightmare (copay, deductible, denials)
  • Doesnt address widespread underinsurance
  • Increases cost of the system by billions of
    dollars
  • Many payers remain, so the savings from a single
    funding source cant be achieved.
  • There is no way to control costs.
  • It treats the symptom the uninsured
  • while ignoring the disease private insurance.

9
Even Its Supporters Recognize the Superiority of
Single Payer
  • Compared to a Medicare-for-All approach, the
    Building Blocks framework would not achieve the
    simplicity, consolidated risk, administrative
    overhead, and provider payment net savings of
    covering nearly everyone through Medicare.
  • -- Cathy Schoen, Karen Davis and Sara R.
    Collins, Building
  • Blocks For Reform Achieving Universal
    Coverage with Private
  • and Public Group Health Insurance,
    Health Affairs, May-June 2008

10
Conyers/Kucinich/et al Expanded and Improved
Medicare for Allsingle payer national health
insurance HR 676
  • Automatic enrollment - everyone receives a card
    assuring payment for all needed care
  • Doctors and hospitals remain independent,
    negotiate fees, budgets with public agency
  • Public agency processes and pays bills
  • Financed through progressive taxes

11
Where the Private Insurance Dollar Goes Nearly
30 for Billing
12
Covering Everyone and Saving Money through Single
Payer
  • Additional costs
  • Covering the uninsured and poorly-insured
    6.4
  • Elimination of cost-sharing and co-pays
    5.1
  • Savings
  • Reduced hospital administrative costs
    -1.9
  • Reduced physician office costs
    -3.6
  • Reduced insurance administrative costs
    -5.3
  • Bulk purchasing of drugs equipment
    -2.8
  • Primary care emphasis reduce fraud
    -2.2

B
134 107 241
Total Costs 11.5
-21 -76 -111 -59 -46 -313
Total Savings -15.8
Source Health Care for All Californians Plan,
Lewin Group, January 2005
13
Obama on Single Payer 2003
14
Obama on Single Payer 2007
15
Obama on Single Payer 2008
16
A FALSE POLICY CHOICE
  • Assertion Lets first cover everybody. Then we
    can deal with the systems 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.

17
Why Health Care Is On the Agenda Escalating Cost
Average Annual Premiums for Single and Family
Coverage, 1999-2008
Estimate is statistically different from
estimate for the previous year shown
(pEmployer-Sponsored Health Benefits, 1999-2008.
18
The Growth in Cost Must be Addressed if Any Plan
is to Succeed
  • Single payer offers real 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.

19
The Bottom Line
  • The Mandate/Building Block model will
  • Make the worlds most costly health system even
    costlier.
  • Not improve insurance coverage for the average
    person.
  • Not make affordable insurance available.
  • Not address the problem of underinsurance.
  • Not contain the continuing growth in cost.
  • In other words, they wont work!
  • Only national health insurance will
  • Cover everyone for comprehensive services.
  • Cost no more than we are now spending.
  • Provide mechanisms for containing the growth in
    cost.

20
Leadership Conference for Guaranteed Health Care
The National Single Payer Coalition
  • Meeting in Washington, DC Nov. 10-11 at AFL-CIO
    Headquarters, but limited involvement of labor
  • Sponsors California Nurses Association, PNHP,
    Healthcare NOW, Progressive Democrats of America,
    faith groups
  • Health care reform Economic and moral issue
  • Media campaign Need to Start from Scratch
  • Congressional visits
  • the train is moving

21
Strategic Questions in this Post-election Period
  • Should mainstream health reform be passed
    quickly, perhaps providing an economic stimulus?
  • Should we oppose early action, urging limited
    reforms (SCHIP, Medicare reforms, IT) while the
    country engages in a lengthy debate towards real
    reform?
  • Our Rodney Dangerfield problem How do we get
    respect and visibility for the single payer
    option?
  • How do we mobilize latent majority public support?

22
Will We Get Real Health Care Reform Before the
Premium Takes All our Income?
Today
Source American Family Physician, November 14,
2005
23
  • Physicians for a
  • National Health Program
  • For more information
  • www.pnhp.org
  • www.pnhpnymetro.org
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