Health Care Reform Health Care Reform A Crash Course for ConsumersA Crash Course for Consumers

Susan Wildin, M.D.Ken Kenegos, R.N.

Margaret Nosek, Ph.D.

Health Care for All-Texaswww.hcfat.org

Topics Topics 1. Status of health care financing in the US2. Patient Protection and Affordable Care Act

(ACA)3. How do other countries compare with the

U.S.?4. What is the real support for single-payer?5. HR 676: The U.S. National Health Care Act

"Expanded & Improved Medicare for All"6. What you can do

““Our systems are perfectly Our systems are perfectly designed to attain the results designed to attain the results we are currentlywe are currently achieving.” achieving.”

W. Edwards Deming

Status of Health Care Status of Health Care in the USin the US

Number of Uninsured Americans: Number of Uninsured Americans: 1976 - 20061976 - 2006

Source: Himmelstein, Woolhandler, and Carasquillo, tabulation from CPS and NHIS data

Who Are the Uninsured?Who Are the Uninsured?

• 80% are employed

• 75% are U.S. citizens

• People losing private health insurance at the fastest rate are those earning $75,000 or more

Source: 2007 US Census Bureau and Institute of Medicine

Source: NEJM 1999; 340:109; Health Affairs 2000; 19(3):150

Most Health Care is Most Health Care is Publicly FinancedPublicly Financed

60%20%

20%

Taxpayers

Private employers

Individuals

(Medicare, Medicaid, VA Public employees,tax subsidies}

100% Financed by People!

Medicare versus MedicaidMedicare versus Medicaid

• Medicare =– an insurance program– paid into by all people who work– beneficiaries -- people who have worked and are

over age 65 or work disabled (high-end healthcare users)

• Medicaid =– safety net (charity) program– paid for by taxpayers (state with federal match)– beneficiaries -- people who are poor

One-Third of Health Spending is One-Third of Health Spending is Consumed by AdministrationConsumed by Administration

AdministrationAll Other

31%

Potential Savings: $350 billion per Potential Savings: $350 billion per yearyear

Enough to Provide Comprehensive Coverage to Everyone

Source: Woolhandler, et al, New England Journal of Medicine, August 2003 & Int. Jrnl. Of Hlth. Services, 2004

69%

Here's what we're paying for now Here's what we're paying for now with with $.31$.31 on every health care dollar on every health care dollar

• Exorbitant salaries for private insurance company executives

• Lobbying by private insurers (over $26 million in 2007, a non-election year)

• Insurance bureaucrats paid to find ways to deny treatment

• Dividends to stock holders • Advertising

Growth of Physicians and Growth of Physicians and Administrators 1970-2004Administrators 1970-2004

Source: Bureau of Labor Statistics; NCHS; and analysis of CPS

……and Health Insurance Costs Keep Risingand Health Insurance Costs Keep Rising

Beware of Insurance Company Beware of Insurance Company DoubletalkDoubletalk

• "consumer-driven" = sky-high deductibles • "medical management" = deny coverage for

doctor-ordered care • "if you have to choose, you take margin and

you sacrifice the growth line" =

profits over people

Patient Protection and Patient Protection and Affordable Care ActAffordable Care Act

The PositivesThe Positives

• Small business tax credits

• Elimination of pre-existing conditions for children (adults in 2014)

• Elimination of lifetime caps

• Some required preventative care without payment

• Strengthened community health centers

• Improved drug coverage for Medicare

• Investment in medical education

What is Missing?What is Missing?

• About 23 million people will remain uninsured nine years out, which translates to…

• An estimated 23,000 unnecessary deaths annually and an incalculable toll of suffering

What are the Costs?What are the Costs?

• Pressure on middle-income families to buy commercial health insurance policies means– Costs as high as 9.5% of household income

– Coverage for an average of only 70% of medical expenses

– Threat of financial ruin if people become seriously ill

– Insurance is unaffordable because of the high co-pays and deductibles

Does it Offer Cost-Control?Does it Offer Cost-Control?

• Health care costs will continue to skyrocket, as the experience with the Massachusetts plan (after which this bill is patterned) demonstrates

• Employer-based coverage locks people into their plan's limited network of providers

• Families and individuals will face ever-rising costs and erosion of their health benefits

• With the rising cost of premiums, most people will be in the "Cadillac" category with mediocre coverage

• In 2018, “Cadillac” plans will be subject to an excise tax*

*"Health Policy Brief" Health Affairs 3-9-11

Is it Equitable?Is it Equitable?

• Insurance regulations are riddled with loopholes, thanks to the central role that insurers played in crafting the legislation

• People 50 years and older can be charged up to three times more than their younger counterparts

• Large companies with a predominantly female workforce can be charged higher gender-based rates at least until 2017

What’s Wrong with Subsidy What’s Wrong with Subsidy and Individual Mandate and Individual Mandate

SchemesSchemes• Substandard Coverage:

– only policies that underinsure are affordable

• Unaffordable: – Amount people are presumed to be able to afford is

unrealistic– Increase in taxes to pay for subsidies for low income to

buy private health insurance - costing taxpayers even more

• No Realistic Cost Control: – Continues to use for-profit private health plans which

raise premiums every year; no system reform to control costs

But don't despairBut don't despair!!

• Progress to date:– Victory in Vermont– More pundits admit single-payer is inevitable– Health insurance industry is scrambling– Reemergence of the public option in state

insurance exchanges

How Do Other Countries How Do Other Countries Compare with the U.S.?Compare with the U.S.?

How Do Other Countries How Do Other Countries Compare with the U.S.?Compare with the U.S.?

• They have as good or better health outcomes• They use the same medical technology• They have better access / same wait times• They have universal coverage from birth to death• They spend half the amount we spend per capita

(average cost per person)

What Other Countries What Other Countries Have Have

that the U.S. Doesn’t that the U.S. Doesn’t HaveHave

• More preventive care• More nurses, more doctor visits, longer inpatient

stays• More cost control with same or better health care

quality as U.S.• Fewer out-of-pocket costs• Most offer free medical and nursing education

• Sickness funds – France, Germany

• highly regulated non-profit insurance companies– No model in US

• Social insurance (U.K., Spain)– VA model

• Single-payer • Canada, Australia, Taiwan, Sweden

– Medicare model

How Other Countries Finance How Other Countries Finance Health CareHealth Care

What is the Real Support What is the Real Support for Single-payer?for Single-payer?

65% of the public and

59% of physicians

support single-payer

(CNN Poll May 4-6 2007; : A Carroll and R Ackerman, Support for National Health Insurance Among American Physicians: Five Years Later. Annals of Internal Medicine April, 2008)

“… “… the government should provide an the government should provide an NHI program for all Americans even if NHI program for all Americans even if

this would require higher taxes.”this would require higher taxes.”

Source: CNN poll May 4-6, 2007

HR 676: The U.S. National HR 676: The U.S. National Health Care ActHealth Care Act

• Privately delivered, high quality• Everybody in, nobody out• Choice of provider & hospital• Uniform, comprehensive benefits, portable• Prevention, full mental health parity• Cost control through “economies of scale”

Source: http://thomas.loc.gov/cgi-bin/thomas

HR 676: The U.S. National HR 676: The U.S. National Health Care ActHealth Care Act

• Reduced administrative waste & overhead• Common sense budgeting, affordable, sustainable• Public oversight and input/control• Ending insurance industry interference

Source: http://thomas.loc.gov/cgi-bin/thomas

HR 676: The U.S. National HR 676: The U.S. National Health Care ActHealth Care Act

• For those whose jobs are eliminated due to reduced administration – Retraining and Job Placement – 2 Years of Salary Parity Benefits – Medicare For All Employment Transition Fund – Annual Appropriations to Medicare For All Employment

Transition Fund – Retention of Right to Unemployment Benefits

Source: http://thomas.loc.gov/cgi-bin/thomas

HR 676: The U.S. National HR 676: The U.S. National Health Care ActHealth Care Act

What You Can DoWhat You Can Do

ActionsActions

1. Talk about it!– Speak truth to the lies– Spread the HCFAT message of

" Expanded and Improved Medicare for All“" Expanded and Improved Medicare for All“• Elevator talk• Spread HCFAT literature ● Letters to the editor or op-eds● Invite us to talk to your organizations

ActionsActions

2. Express your support to the power brokers• Attend Town Hall meetings● Contact State and Federal Representatives● Work with HR 676 sponsors to make

improvements and to pass the bill

ActionsActions

3. Join us• Health Care for All-Texas (HCFAT.org)● Physicians for a National Health Program

(PNHP.org)● sign on to our listserv● come to our monthly meetings● come to our rallies

“Never doubt that a small group of thoughtful, committed citizens can change the world; indeed it's the

only thing that ever has.”

Margaret Mead