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Stephen Colbert on the Bush Health Plan

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You might even save money.' -Joseph Antony, CNBC / MSN Money, Winter 2003. CNBC / MSN Money ... Prevention saves lives, but maybe not money ... – PowerPoint PPT presentation

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Title: Stephen Colbert on the Bush Health Plan


1
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.

2
US Health Care System Crisis A Single Payer
Solution
  • Joshua Freeman, MD
  • MASW Annual Conference
  • Columbia, MO
  • October 22, 2008

3
What is the Problem?
  • 47 Million Uninsured
  • 75 Million un-or-underinsured
  • Even having good insurance doesnt protect
  • Inadequate health care outcomes and quality
  • Extraordinary cost
  • Health care primarily a business for making
    profits rather than enhancing health

4
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5
JayDoc Student-run Free Clinic Patient
Population by Employment Status
6
18,314 Adult Deaths Annually Due to Uninsurance
7
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9
Life Expectancy
Source OECD 2007, data from 2005
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15
National Scorecard 2008
  • Commonwealth Fund, July 2008
  • US Scores 65 out of 100
  • No improvement since 2006
  • 42 (75M) adults uninsured or underinsured (up
    from 35 2006)
  • 19th out of 19 countries on mortality amenable to
    medical care (down from 15th, 2006)
  • Spends twice what other industrialized countries
    do
  • Ref accessed 7/21/08
  • http//www.commonwealthfund.org/publications/publi
    cations_show.htm?doc_id692682

16
National Health Spendingas a share of Gross
Domestic Product
Projected
Actual
Percentage GDP
Source Centers for Medicare Medicaid Services
17
We spend twice as much on health care as other
nations do
Per person
OECD, 2006. Data for Japan is an estimate
18
How are we paying for it now?
1,075 B
319B
286B
Based on 2003 National Health Spending of 1.68
trilllion (CMS)
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20
COST SHIFTING NO END IN SIGHTThe Insurance
Death Spiral
21
General Motors Health Care CostsA social
insurance system that sells cars to finance
itself
  • 5 billion in 2003 (profits 1.7 billion)
  • 1500 per car
  • 9,000 per year/per employee
  • -average firm (5758)
  • 15,000 per year /per retiree under age 65
  • 4,000 per year /per retiree on Medicare

Source New York Times 7/15/03
22
Health Care Administrative Costs in the U.S.
Administrative Costs
31
Clinical Care
69

(2000 per person)
New England Journal of Medicine 8/03
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24
Investor-Owned CareSummary of Evidence
  • Hospitals Costs 3-11 higher, fewer nurses,
    higher overhead, death rates 6-7 higher, fraud
  • HMOs Higher overhead, worse quality
  • Dialysis Death rates 20 higher, less use of
    transplants peritoneal dialysis.
  • Nursing Homes More citations for poor quality,
    fraud
  • Rehab Hospitals Costs 19 higher

25
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26
Financing Single-Payer
Medicare
Single-Payer Health Care Fund
Medicaid
Payroll Tax
Income Tax
Bonus Negotiated formulary with physicians,
global budget for hospitals, increased primary
and preventive care, reduction in unnecessary
high-tech interventions, bulk purchasing of drugs
and medical supplies long term cost control.
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32
How It Could Work
  • Regional Health Board allocates resources
  • Board accountable to patients rather than
    stockholders
  • Private hospitals remain in tact
  • Patients have ID that allow them to get care
    wherever they wish
  • Physicians work fee-for-service

33
Or Medicare for All
  • Already covers majority of sickest
  • Aged, Blind and Disabled
  • Marginal Costs relatively low
  • Overhead very low

34
Covering Everyone and Saving Money through
Medicare for All
  • Additional costs
  • Covering the uninsured and poorly-insured
    7.2
  • Elimination of cost-sharing and co-pays
    5.1
  • Savings
  • Bulk purchasing of drugs equipment
    -2.8
  • Reduced hospital administrative costs
    -1.9
  • Reduced physician office costs
    - 3.6
  • Reduced insurance administrative costs
    -5.3
  • Primary care emphasis reduce fraud
    -2.2
  • Net Savings
    -4.3

Source Health Care for All Californians Plan,
Lewin Group, 2005
35
NHI will save 5000 per capita by 2024
36
Expansion of Universal Health
  • 1973 Denmark
  • 1974 Australia
  • 1978 Italy
  • 1979 Portugal
  • 1986 Spain
  • 1996 South Africa
  • 2002 Taiwan
  • 1883 Germany
  • 1911 Switzerland
  • 1938 New Zealand
  • 1945 Belgium
  • 1945 France
  • 1946 United Kingdom
  • 1966 Canada

None of these countries rely on private,
for-profit insurance companies
37
Obamas Health Plan
  • Expand Medicaid, SCHIP.
  • National Health Insurance Exchange.
  • Public plan for small business and individuals,
    similar to FEHBP.
  • Business tax credits
  • Income based tax credits.
  • Savings by IT, transparency, negotiated drug
    prices for Medicare, tort reform.
  • Payment based on outcomes.

38
McCain
  • Tax credit for individuals
  • Eliminate business tax deduction for employee
    health insurance
  • Encourage HSAs
  • Income related tax credits.
  • Guaranteed Access Planpooled resources by states
    for chronic illness and poor.
  • Reduce cost by IT, reimport drugs, tort reform,
    transparency.
  • Payment based on outcomes.

39
If done right, health care in America could be
dramatically better with true single-payer
coverage. -Ben Brewer, WSJ, April 18, 2006
  • single-payer is an idea that's so easy to slam
    politically yet so sensible for business that
    only Republicans can sell it! it may take a
    Republican President to bless the socialization
    of health spending we need.
  • -Matt Miller, Fortune, April 18, 2006

CNBC / MSN Money
  • Think, as a small business, how you could
    benefit from a single-payer system you wouldnt
    lose potential employees to larger firms that
    offer more attractive health benefits health
    insurance costs would cease to be a line item in
    your budget. A serious illness befalling you or
    an employee wouldnt be a company-wide financial
    crisis. You might even save money.
  • -Joseph Antony, CNBC / MSN Money, Winter 2003

40
Problems
  • McCain
  • Minimal cost containment
  • HSAs lead to less preventive care
  • Free market has failed to deliver quality and
    efficiency.
  • Obama
  • Minimal cost containment
  • No cost savings on administrative overhead
  • Free market has failed to deliver quality and
    efficiency.

41
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42
Health Savings Accounts
  • No savings globally
  • No reduction of administrative costs
  • Discourage preventive care

43
Case Kansas Health Reform
  • 2007 SB 13 Options (to KHPA)
  • KHPA contracted with outside consultant
  • Foundations paid the tab
  • Consultant Steve Schramm
  • Report on various options
  • Presumed Premium Assistance

44
Current KS (lt65 yo)
45
Options vary on
  • new people covered
  • How covered / how paid
  • Employer (private) vs. Medicaid expansion
    (public)
  • Cost (and to whom)

46
4 Plans change in Uninsured
  • Reference Decr. 144K
  • Affordable Decr. 50K
  • Universal Decr. 247K
  • Single Payer Decr. 247K

47
5 Plans (Incl. Baseline) Cost
48
Who Pays?
  • Prevention saves lives, but maybe not money
  • If it or any other intervention saves money,
    who pays? Social good?
  • And how do we ensure quality?

49
Sick Around the World
  • PBS Frontline program T. R. Reid
  • 5 Countries
  • Britain
  • Germany
  • Japan
  • Taiwan
  • Switzerland
  • http//www.pbs.org/wgbh/pages/frontline/sickaround
    theworld/

50
Annals of Internal Medicine April 1, 2008
51
Single Payer NHI in the U.S.
  • HR 676
  • Congressional bill to establish Single Payer
    National Health Insurance in the U.S.
  • Currently has more members of Congress signed on
    than any other health reform bill (88)

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54
Thank you!
55
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56
Pascal Couchepin, Center-right President of the
Swiss Confederation
  • Q But I can hear in what you're saying that that
    concern that everyone get covered, everyone get
    equal care, that's really important
  • A Oh, yes. ... For the Swiss, whether you are
    right or left doesn't matter I think there is a
    consensus on that. We want that every one of
    our citizens can get the best medical treatment
    when they need it. ...

57
Couchepin (Switzerland) 2
  • Q ... One of the problems we have in America is
    that many people -- it's a huge number of people
    -- go bankrupt because of medical bills some
    studies say 700,000 people a year. How many
    people in Switzerland go bankrupt because of
    medical bills?
  • A Nobody. Doesn't happen. It would be a huge
    scandal if it happens.

58
Current KS (lt65 yo)
  • Large Employer (gt50) 56
  • Small Employer 9
  • Medicaid 11
  • Individual 8
  • Military 3
  • Medicare 1
  • Prem. Assistance 1
  • Uninsured 11

59
  • 2008 KHPA Recommendations
  • Increased Health Coverage
  • Combined plan
  • Promote Medical Homes
  • Promote Personal Responsibility
  • Legislative Action 2008 None
  • Not even premium assistance
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