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

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Regional purchasing plans ('Health Markets') Offers government/public program ('single payer' ... future health needs no basis for choosing a plan or accepting ... – PowerPoint PPT presentation

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Title: 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
  • Urban Studies Dept., Queens College/CUNY
  • and
  • NY Metro Chapter
  • Physicians for a National Health Program
  • May 29, 2007

2
Everybodys Got a Health Plan!
3
Why Health Care Is On the Agenda
4
A Declining Number of Firms Are Offering
Insurance
5
Firms Shift Health InsuranceCosts to Workers
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
U.S. Health Costs are 70 Greater than the Median
of Other Countries
United States
8
The Outlier Nation Our Public System Covers
Fewer
United States
Source F. Colombo and N. Tapay, Private Health
Insurance in OECD Countries, OECD 2004
9
While Private Insurance Dominates
United States
Source F. Colombo and N. Tapay, Private Health
Insurance in OECD Countries, OECD 2004
10
THE MAJORITY OF AMERICANS HAVE PRIVATE INSURANCE
  • Total Population
  • Private health insurance
  • - Employer-provided
  • - Individual
  • Public health insurance
  • Medicare
  • Medicaid
  • Uninsured
  • Million
  • 288 100.0
  • 174 60.5
  • 160 55.6
  • 14 4.9
  • 72 25.0
  • 41 14.2
  • 31 10.8
  • 42 14.6

Source National Center for Health Statistics,
2003
11
BUT IT PAYS MUCH LESS THAN HALF THE COST
  • 2004
  • Personal Health Expenditures
  • Private Funds
  • Private health insurance
  • - Self-funded plans
  • - Insurance company plans
  • Out-of-pockets payments
  • Other private funds
  • Public Funds
  • Medicare
  • Medicaid
  • Other public expenditures
  • Billion
  • 1,753 100
  • 965 54
  • 658 37
  • 340 19
  • 318 18
  • 236 13
  • 70 4
  • 789 46
  • 309 18
  • 293 17
  • 187 11

Does not include tax subsidy for private
insurance. See Woolhandler Himmelstein,
HealthAffairs 2002
Source Centers for Medicare and Medicaid
Services, 2006
12
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

13
The Good News
  • Universal health care is accepted as a goal by
    many mainstream politicians.
  • The Bad News
  • Universal health care is defined simply as
    everyone having some kind of insurance, not
    everyone having access to care.
  • This wont solve the problem!

14
Common Features of the New Plans
  • The problem Too many uninsured.
  • The solution Require everyone to have insurance
  • Employers contribute but dont necessarily offer
    insurance
  • These plans dont reform the structure at all
  • Their true objective appears to be to preserve
    the private insurance industry, even though it
    adds cost but no value to our health care system.

15
Wyden Healthy Americans Actslash and burn
  • Eliminate the tax deductibility of employer-based
    insurance ? end employer benefit
  • Require individual purchase of private
    insurance
  • Transitional payments by employers
  • Subsidies to low-income individuals
  • Relies on insurance company competition to
    contain costs

16
Stark/Edwards/Hacker Planindividual mandate
with a pretty face
  • Employer mandate (play or pay)
  • Individual mandate with community rating
  • Subsidies for low-income
  • Regional purchasing plans (Health Markets)
  • Offers government/public program (single
    payer?) as well as private insurance plans.

17
Stark/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 public plan

18
Ten Top Reasons Why Individual Mandate is Poor
Public Policy
  • 10. Enforcement is bad for public health
  • 9. Insurance companies will resist and
    undermine community rating and guaranteed
    issue
  • 8. Financing through premium payments requires
    complex and intrusive means testing
  • 7. Will not lead to universal coverage
  • 6. If premium is affordable, health care is
    not (copays, deductibles)

19
Ten Top Reasons Why Individual Mandate is Poor
Public Policy
  • 5. Even more bureaucracy (Health Markets)
  • 4. Private health insurance will be a continuing
    consumers nightmare (copays, deductibles,
    exclusions, denials, appeals)
  • 3. Increases the cost of the system, most going
    to private insurance companies
  • 2. No cost control continually rising cost

20
And the Top Reason Why Individual Mandate is Poor
Public Policy
  • 1. It doesnt reform the system at all. It would
    not help those of us who think were insured.
  • -- Half of middle- and lower-income adults
    experience serious problems paying medical bills
    or insurance premiums. (Commonwealth Fund 2006)
  • -- Three-fourths of those who declare
    medical bankruptcy had insurance (D.Himmelstein
    et al, Health Affairs, 2005)
  • It doesnt solve any of the problems --
    especially rising costs -- that concern everyone.
  • It is not a real structural change.

21
Kennedy-Dingell Medicare for All Medicare for
most people
  • Automatic enrollment phased in by age over 5
    years
  • Tax-based financing
  • Public Medicare-like program is the default
  • Option of Federal Employees Health Benefit Plan,
    i.e., private insurance
  • Retains Medicaid for the poor, Medicare for
    elderly
  • Some savings through public programs efficiencies

22
Whats Wrong With Offering a Public Plan vs. a
Private Plan?
  • Consumer cannot predict future health needs ? no
    basis for choosing a plan or accepting limits.
  • Advertising can mislead consumer.
  • Private plans avoid sick people and paying for
    illness ? adverse selection for public plan.
  • A level playing field is impossible (Private
    insurance companies require subsidies to stay in
    the game).
  • Most important, theres no way to control costs.

23
THERE IS A SOLUTION
  • Expand the existing Medicare program to cover
    everyone
  • Improve the coverage it offers
  • Eliminate private insurance

24
Conyers/Kucinich/et al Expanded and Improved
Medicare for Allsingle payer national health
insurance
  • Everyone receives a Medicare card assuring
    payment for all needed care
  • Free choice of doctor and hospital
  • Doctors and hospitals remain independent,
    negotiate fees and budgets with Medicare
  • Financed through progressive taxes
  • Public agency processes and pays bills

25
Some Implications of True Medicare for All
  • The same coverage for everyone No means
    testing coverage would not depend on income,
    employment or age
  • Medicaid would no be longer needed
  • Hundreds of billions of dollars in administrative
    costs would be saved
  • Costs would be controlled through capital
    planning, budgeting, and quality reviews
    conducted through the single insurer

26
Covering Everyone and Saving Money through
Medicare for All
  • Additional costs
  • Covering the uninsured and poorly-insured
    6.4
  • 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
27
How Would It Be Paid For?One Example
28
Why Such a National Health Insurance Program is
Possible Today
  • Everyone is affected the uninsured, the
    underinsured, and everyone else who is insecurely
    insured.
  • Employers who offer insurance want to be relieved
    of the burden of rising costs and unfair
    competition from employers who don't offer
    insurance.
  • Small businesses want to offer insurance to their
    employees but cant afford it.
  • Limited reforms that keep private insurance in
    place have been tried and failed.

29
More Reasons Why Such a National Health Insurance
Program is Possible Today
  • Private insurance cant solve the fundamental
    problem of cost and access.
  • If we bypass the insurance companies, we can have
    a Medicare for All system that is simpler, less
    costly, and provides access to health care for
    everyone.
  • Every other industrialized country has done it.
  • Lets move forward with it!

30
RESOURCES
  • Physicians for a National Health Program
  • www.pnhp.org
  • PNHP New York Metro Chapter www.pnhpnyc.org.
  • HealthCare-NOW
  • www.healthcare-now.org
  • Commonwealth Fund
  • www.cmwf.org
  • Kaiser Family Fund
  • www.kff.org
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