A Single-Payer Statewide Health System for All Illinoisans The Only Solution for Illinois

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A Single-Payer Statewide Health System for All
IllinoisansThe Only Solution for Illinois

• Nicholas Skala
• Senior Research Associate
• Physicians for A National Health Program
• Co-Founder, Health Care for All Illinois
• www.healthcareil.org
• nick_at_healthcareil.org

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Illinois 1.7 Million Uninsured Institute of
Medicine 18 Illinoisans Die Every Week Due to a
Lack of Health Insurance
But simply helping them buy private insurance is
not a solution.
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Meet Thomas Wilkes

• Born in 2003 with Severe Hemophilia A.
• Dad Senior Engineer at a high-tech computer firm
  with good benefits.
• 2004 Develops an inhibitor to his hemophilia
  treatment.
• 750,000 annual claims.

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Private Insurance for Thomas

• Company faces 40 to 55 increase in premiums.
• Only insurer that will cover them requires
  10,000 out-of-pocket and a 1 million cap.
• Thomas is projected to reach the 1 million
  benefit cap in summer 2007

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Options for Thomas Family

1. Thomas father can quit the job he loves and go
   to work for a mega-firm that will take longer to
   be affected by high claims.
2. Thomas mother can stop raising the children and
   go to work for a mega-firm.
3. Thomas father can divorce his mother to leave
   her and Thomas legally destitute and eligible for
   public programs.

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Americas Underinsured
Proportion of Americans Going Without Care due to
Costs, 2005 (skipping doctor visit, specialist
appointment, treatment or prescription when
needed)
Source Commonwealth Fund Biennial Health
Insurance Survey, 2005
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Medical Bankruptcy

• Illness and Medical Bills Contributed to 40,000
  Personal Bankruptcies in Illinois in 2004. (Half
  of All Illinois Bankruptcies)

Insurance Status at Onset of Illness

• Of those, more than three-quarters had insurance
  when they got sick.

Source Himmelstein, Health Affairs 2005 (state
estimates provided by author)
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Rising Costs Less Benefits Under/Uninsurance
Proportion of Illinoisans Covered by Employer
Insurance
Source US Census
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Expansion of Public ProgramsAn SCHIP Math
Problem!
8 Million Uninsured Kids (1995)

5 Million get coverage through SCHIP
-
5 Million more become uninsured
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Expansion of Public ProgramsA Zero Sum Game
Number of Uninsured Kids (0-18 yrs.) 1988 - 2005
Source U.S. Census Bureau
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What Does This Mean?
Lesson 1 Simply Expanding Existing Private
Insurance Policies Is Not a Solution.
Current Private Insurance Policies Offer
Inadequate Protection. Any Gains in Coverage
Will Be Quickly Offset as Costs Rise and
Employers Shed Benefits.
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What Does This Mean?
Lesson 2 Any Real Solution to the Health Crisis
Must Do Two Things
1) Offer Coverage More Comprehensive than that
Currently Available on the Private Market.
2) Control Costs so that Benefits are
Sustainable.
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Life Expectancy, 2005
(Data in Years)
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Infant Mortality, 2005
(Deaths in first year of life per 1,000 live
births)
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International Health Spending, 2005
U.S. Public Spending is Greater than Other
Nations
Public/Private Spending Combined
Source OECD 2007 Japan data are from 2004
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If you were in an insurance CEO, who would you
want to insure?
73
Percent of health Care Costs
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6
4
1 1 2
0 0 0
SourceAgency for Healthcare Research and
Quality MEPS
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The Health and Profitable to the Market, the
Sick and Poor to the Taxpayer
73
Government Programs
Percent of health Care Costs
Private Insurers
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6
4
1 1 2
0 0 0
SourceAgency for Healthcare Research and
Quality MEPS
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Growth of Physicians and Administrators 1970-2005
Source Bureau of Labor Statistics and NCHS
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One-Third of Health Spending is Consumed by
Administration
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Potential Savings 350 billion per year Enough
to Provide Comprehensive Coverage to Everyone
Source Woolhandler, et al, New England Journal
of Medicine, August 2003 Int. Jrnl. Of Hlth.
Services, 2004
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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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Single-Payer Benefits

• Comprehensive Coverage for all medically
  necessary services (doctor, hospital, long-term
  care, mental health, vision, dental, drug, etc.)
  in a single-tier system.
• Free Choice of doctor and hospital.
• Health Workers Unleashed from corporate dictates
  over patient care.
• Hospitals guaranteed a secure, regular budget.

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Only Two Paths to Reform

• Preserve Private Insurance Companies and their
  Waste
• Create a National Health Insurance System

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Blagojevich Illinois Covered

• Modest Expansion of Public Coverage (Expand
  Medicaid to destitute people up to 100 of
  poverty).
• Tax Credits to Buy Coverage (Those up to 400 of
  poverty will get subsidies, if people dont buy
  plans the stat will probably force them to).
• State Risk Pool (Pool uninsured, ostensibly to
  bargain down health costs).

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Single-Payer
Blagojevich Plan
All Illinois Residents Covered
As many as two-thirds of uninsured stay that way.

• Coverage
• Benefits
• Coverage Method
• Costs / Savings
• Sustainability

Full coverage for all medically necessary needs.
Skimpy policies which restrict access and
protection.
Expand Medicare to all Illinoisans.
If they dont buy insurance, punish them.
Redirect gt17 billion in waste no net cost
increase.
Raise 2.1 billion to waste on private insurers.
Effective cost control to ensure sustainable
benefits.
Gains in coverage quickly erased by rising costs.
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Individual Mandate

• Let them buy insurance.

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Criminalizing the UninsuredA Massachusetts
Punitive Index
The Crime The Fine
1 Violation of Child Labor Laws 50
2 Illegal Sale of Firearms, First Offense 500 max.
3 Driving Under the Influence, First Offense 500 min.
4 Domestic Assault 1000 max.
5 Cruelty to or Malicious Killing of Animals 1000 max.
6 Communication of a Terrorist Threat 1000 min.
7 Being Uninsured 1500 min.
Note Original version of House Bill would have
suspended individuals driving licenses for
uninsurance as well.
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Subsidy and Individual Mandate Schemes

• Substandard Coverage forces the uninsured to buy
  defective insurance industry products that are
  already causing families to face bankruptcy and
  go without needed care.
• Unaffordable Without the savings achievable with
  single-payer, taxes must raised or funds diverted
  from other needy programs.
• Micro-coverage, Macro-costs Preserves wasteful
  private insurers and adds yet another layer of
  state administrative waste. Rather than provide
  care to the uninsured through a relatively
  efficient program like Medicare, the plan
  launders tax dollars through wasteful private
  insurers.
• No Realistic Cost Control Any gains in public
  coverage will be unsustainable due to rising
  costs.

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Sounds Great, but its not politically feasible

• 2/3rds of population want it
• Many (probably most) physicians want it
• Business community is now realizing the need for
  it

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Single-Payer
Glen BartonFormer CEO, Caterpillar Inc. (Fortune
100)Past Chairman, Health and Retirement Task
Force Business RoundtableRepresents 150 Largest
EmployersTotal Assets 4.0 Trillion
The quickest and simplest solution is to go
to a single-payer system- Written Testimony to
AHCTF, Feb. 1 2006
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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

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A Step Towards Universal Coverageor The
Definition of Insanity?Other States That Have
Taken Steps
Uninsured 2005
Uninsured at Time

• Hawaii (1974) 82,000 116,000
• Massachusetts (1988) 494,000 617,000
• Oregon (1989) 400,000 578,000
• Tennessee (1992) 687,000 835,000
• Minnesota (1992) 350,000 430,000
• Maine (2003) 133,000 142,000

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Is The Perfect the Enemy of the Good?The
Radical and the Republican
Many of Lincolns admirers have painted him as a
man who wanted exactly what the abolitionists did
but cannily waited for a perfect moment to
achieve it. In fact, radicals like Douglass set
an agenda Lincoln gradually adopted as his own.
Without abolitionists, there would have been no
Lincoln. - James Oakes, Historian, UC Berkeley
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Single-Payer Politically Feasible?
Other Politically Infeasible Movements

• Abolition of Human Slavery
• (1600s)
• Womens Suffrage Movement
• (1840-1920)
• Civil Rights Act
• (1964)