Healthcare Reform – The Real Healthcare Reform – The Real Facts!!Facts!!

Paul Y. Song, MDPaul Y. Song, MD

Physicians for a National Health ProgramPhysicians for a National Health Program

Hippocratic OathHippocratic Oath

““I will follow that system of regimen, which I will follow that system of regimen, which according to my ability and judgment, I according to my ability and judgment, I consider for the benefit of my patients, and consider for the benefit of my patients, and abstain from whatever is deleterious and abstain from whatever is deleterious and mischievous”.mischievous”.

The ProblemThe Problem

The US spends $2.5 Trillion a year which is 17.3% of The US spends $2.5 Trillion a year which is 17.3% of our GDP on healthcare and more than any other our GDP on healthcare and more than any other industrialized country in the world by far. industrialized country in the world by far.

The CBO estimates it will grow to 25% of our GDP by The CBO estimates it will grow to 25% of our GDP by 2025.2025.

The average family premium is $14,000 a year.The average family premium is $14,000 a year.

The number of uninsured in the US now exceeds 50.7 The number of uninsured in the US now exceeds 50.7 million and has actually increased since the passage million and has actually increased since the passage of the healthcare bill.of the healthcare bill.

Broken System??Broken System??

The Commonwealth Fund 6/23/10

Who Are the Uninsured?Who Are the Uninsured?

Of the 50.7 million, over 20 million are fully Of the 50.7 million, over 20 million are fully employed and 70% of all uninsured are from employed and 70% of all uninsured are from families with one or more full-time workers.families with one or more full-time workers.

One of out every five Asians in the US are One of out every five Asians in the US are uninsured.uninsured.

– 31% of Koreans, 24% Native Hawaiian 31% of Koreans, 24% Native Hawaiian Islanders, 20% of Vietnamese, 16% Islanders, 20% of Vietnamese, 16% Chinese, 14% Filipinos, 12% Indian and Chinese, 14% Filipinos, 12% Indian and JapaneseJapanese

Uninsured DeathsUninsured Deaths

50,000 annual deaths are 50,000 annual deaths are attributed simply to a lack of attributed simply to a lack of coverage.coverage.

The For-Profit Insurance The For-Profit Insurance Industry is Not Your Friend!Industry is Not Your Friend!

Only recession proof industry that Only recession proof industry that consistently raises prices 10-15% every consistently raises prices 10-15% every year regardless of the economy. Far year regardless of the economy. Far outpacing inflation.outpacing inflation.

Take 30 cents out of every dollar away from Take 30 cents out of every dollar away from actual patient care.actual patient care.

1/6 of all policies are actually grossly 1/6 of all policies are actually grossly inadequate to cover a serious illness.inadequate to cover a serious illness.

They encourage higher deductibles and co-They encourage higher deductibles and co-pays by increasing premiums to insure they pays by increasing premiums to insure they cover very little.cover very little.

The For-Profit Insurance The For-Profit Insurance Industry is Not Your Friend!Industry is Not Your Friend!

Over the past 9 years:Over the past 9 years:

– Average premiums have increased nearly Average premiums have increased nearly 120%120%

– Profits at the 10 largest publicly traded Profits at the 10 largest publicly traded insurance companies have rose 428% insurance companies have rose 428% (reported).(reported).

– Average annual CEO salary at these Average annual CEO salary at these companies was $11.9 Million which is 468 companies was $11.9 Million which is 468 times what the average US worker makes.times what the average US worker makes.

– In CA, the six largest insurers denied over In CA, the six largest insurers denied over 45.7 million claims in a six year period.45.7 million claims in a six year period.

CEO Salaries (2008)CEO Salaries (2008)

Roy Williams – CEO Aetna - Roy Williams – CEO Aetna - $ 24,300,122$ 24,300,122 H. Edward Hanway – Cigna - H. Edward Hanway – Cigna - $ 12,236740$ 12,236740 Angela Bray – Wellpoint - Angela Bray – Wellpoint - $ 9,844,212$ 9,844,212 Dale Wolf – Coventry Healthcare - Dale Wolf – Coventry Healthcare - $ 9,047,469$ 9,047,469 Michael Niedorff –Centene - Michael Niedorff –Centene - $ 8,744, 483$ 8,744, 483 James Carlson – Amerigroup - James Carlson – Amerigroup - $ 5,292,546$ 5,292,546 Michael McAllister – Humana - Michael McAllister – Humana - $ 4,764,309$ 4,764,309 Jay Gellert – Health Net - Jay Gellert – Health Net - $ 4,425,355$ 4,425,355 Steven Helmsley – United Health Group - Steven Helmsley – United Health Group - $ 3,241,042$ 3,241,042

Billy Tauzin – CEO PhRMA - Billy Tauzin – CEO PhRMA - $2,000,000$2,000,000 Karen Ignani – Amer. Health Insurance Plans - Karen Ignani – Amer. Health Insurance Plans - $ $

1,580,0001,580,000

Medical Related BankruptciesMedical Related Bankruptcies

Number of medical related Number of medical related bankruptcies increased 50% during bankruptcies increased 50% during the last 9 years.the last 9 years.

In 2010, it is estimated that there will In 2010, it is estimated that there will be over 4 million bankruptcies.be over 4 million bankruptcies.

- 2/3 are due to a medical illness.2/3 are due to a medical illness.

- 75% will be insured.- 75% will be insured.

Hard for Employers Too!Hard for Employers Too!

For every For every $100$100 that US companies spend on that US companies spend on health care, companies in Japan, Germany, health care, companies in Japan, Germany, France, and Canada spend France, and Canada spend 6363 cents which cents which leads to more off-shoring of jobs and less leads to more off-shoring of jobs and less job creation.job creation.

Ford spent $3.2 Billion on health premiums; Ford spent $3.2 Billion on health premiums; Prior to the bailout, GM spent more on Prior to the bailout, GM spent more on health premiums than on steel.health premiums than on steel.

It is estimated that health care costs add It is estimated that health care costs add $1500-2000 to the sticker price of a US $1500-2000 to the sticker price of a US made car.made car.

What Do Americans Want?What Do Americans Want?

40%40% believe the recently passed believe the recently passed health care reform did not go far health care reform did not go far enough.enough.

20%20% believe that the federal believe that the federal government should not be involved in government should not be involved in health care at all.health care at all.

30%30% neither favor nor oppose the new neither favor nor oppose the new health care law.health care law.

AP Poll – Washington Post 9/26/10

Insurance Industry EffortsInsurance Industry Efforts

4525 lobbyists for the 535 Congressional 4525 lobbyists for the 535 Congressional members (8:1) – 450 lobbyists are former members (8:1) – 450 lobbyists are former congressional staffers and 12 were former congressional staffers and 12 were former Max Baucus Staffers.Max Baucus Staffers.

$1.4 Million was spent each day!!$1.4 Million was spent each day!!

$260+ Million was spent by the health $260+ Million was spent by the health insurance industry and big Pharma – more insurance industry and big Pharma – more than on the 2004 Bush-Kerry presidential than on the 2004 Bush-Kerry presidential campaign.campaign.

Insurance stocks hit a 52 week high once Insurance stocks hit a 52 week high once there was no public option.there was no public option.

June 17, 2009 – As 22 Senators began hearings and work on healthcare reform, the room was full of registered healthcare Lobbyists.

Easy to Blame the GOP, but…Easy to Blame the GOP, but…

The Democrats had a supermajority for most of The Democrats had a supermajority for most of the debate.the debate.

60%60% of all money went to Democrats. of all money went to Democrats.

Max Baucus (Chairman of the Senate Finance Max Baucus (Chairman of the Senate Finance Committee) received over $2 million.Committee) received over $2 million.

Ben Nelson received more money from the health Ben Nelson received more money from the health insurance industry than any other industry.insurance industry than any other industry.

Joe Lieberman received over $1 million and his Joe Lieberman received over $1 million and his wife was employed by several healthcare and wife was employed by several healthcare and Pharma companies.Pharma companies.

So What Did We End Up With?So What Did We End Up With?

The Patient Protection and Affordable Care The Patient Protection and Affordable Care Act, not Obamacare.Act, not Obamacare.

It is not socialized medicine or a It is not socialized medicine or a government takeover of medicine.government takeover of medicine.

There are no death panels.There are no death panels.

CBO estimates it will cost $940 Billion over CBO estimates it will cost $940 Billion over the first 10 years.the first 10 years.

Majority of the provisions will not begin Majority of the provisions will not begin until 2014.until 2014.

What’s Been Implemented?What’s Been Implemented? $727 Million to upgrade and expand community $727 Million to upgrade and expand community

health centers providing health care to 745,000 health centers providing health care to 745,000 uninsured patients.uninsured patients.

Medicare beneficiaries will receive a $250 rebate to Medicare beneficiaries will receive a $250 rebate to help fill the prescription drug donut.help fill the prescription drug donut.

Primary care doctors will get a 10% raise.Primary care doctors will get a 10% raise.

Insurers can no longer carry out rescissions when Insurers can no longer carry out rescissions when insured use policies, set lifetime benefit limits, set insured use policies, set lifetime benefit limits, set annual benefit limits, deny coverage to children annual benefit limits, deny coverage to children with pre-existing conditions (2014 for everyone).with pre-existing conditions (2014 for everyone).

Insurers must now offer coverage to kids on their Insurers must now offer coverage to kids on their parent’s policies up to the age of 26.parent’s policies up to the age of 26.

What’s Been Implemented?What’s Been Implemented? Insurers must now cover recommended Insurers must now cover recommended

preventative care and immunizations without preventative care and immunizations without charging cost sharing amounts.charging cost sharing amounts.

Insurers will be forced to spend 85 cents out of Insurers will be forced to spend 85 cents out of every dollar for actual patient care.every dollar for actual patient care.

$350 Million to crack down on Medicare fraud.$350 Million to crack down on Medicare fraud.

Small businesses (< 25 full time employees Small businesses (< 25 full time employees with annual wages less than $50K ($25K in with annual wages less than $50K ($25K in 2014) will get a 35% tax credit to help pay for 2014) will get a 35% tax credit to help pay for premiums.premiums.

A high risk pool will be established for the A high risk pool will be established for the sickest patients who are currently uninsurable.sickest patients who are currently uninsurable.

What Happens in 2014?What Happens in 2014?

Medicaid will be expanded to cover Medicaid will be expanded to cover 133% of poverty (currently $29K for a 133% of poverty (currently $29K for a family of four).family of four).

Establishment of a health insurance Establishment of a health insurance exchange for those who do not have exchange for those who do not have work sponsored coverage and work sponsored coverage and subsidize insurance premiums for subsidize insurance premiums for individuals up to 400% of poverty individuals up to 400% of poverty line.line.

Problems With the Reform BillProblems With the Reform Bill $475 Billion subsidy to the insurance $475 Billion subsidy to the insurance

industry that forces 30 Million Americans to industry that forces 30 Million Americans to buy coverage from these companies that do buy coverage from these companies that do not care about patients!not care about patients!

23 Million people will still be uninsured nine 23 Million people will still be uninsured nine years from now.years from now.

Millions of middle income people will be Millions of middle income people will be forced to buy commercial policies costing up forced to buy commercial policies costing up to 9.5% of their income, but covering only to 9.5% of their income, but covering only 70% of their medical expenses, leaving them 70% of their medical expenses, leaving them still very vulnerable to medical related still very vulnerable to medical related bankruptcies due to high deductibles and co-bankruptcies due to high deductibles and co-pays which will still be permitted.pays which will still be permitted.

Fee-For-ServiceFee-For-Service

Problems With the Reform BillProblems With the Reform Bill While Insurers will no longer be able to While Insurers will no longer be able to

deny coverage or set maximum caps, they deny coverage or set maximum caps, they will still be able to increase co-pays, will still be able to increase co-pays, deductibles, and premiums which will only deductibles, and premiums which will only serve to preclude access to healthcare.serve to preclude access to healthcare.

Enforcement of new regulations such as Enforcement of new regulations such as ending denials on the basis of pre-existing ending denials on the basis of pre-existing conditions are riddled with loopholes and conditions are riddled with loopholes and waivers, and there is nothing to prevent waivers, and there is nothing to prevent older people or women from being charged older people or women from being charged more based on age or gender until 2017.more based on age or gender until 2017.

People with employer based coverage will People with employer based coverage will remain locked in their plans and have no remain locked in their plans and have no choice of providers or hospitals. No choice of providers or hospitals. No competition for most of us!competition for most of us!

Arguments Against ReformArguments Against Reform

““Will explode the deficit!”Will explode the deficit!”

Nixon/Ford: Nixon/Ford: 6.8% per year6.8% per year

Carter: 2.0% per Carter: 2.0% per yearyear

Reagan: -1.3% Reagan: -1.3% per yearper year

Bush 1: 4.0% Bush 1: 4.0% per yearper year

Clinton: 2.5% Clinton: 2.5% per yearper year

Bush Jr: 8.2% Bush Jr: 8.2% per yearper year

Arguments Against ReformArguments Against Reform

““Will explode the deficit!”Will explode the deficit!”

““This is the largest government run health This is the largest government run health care program ever”.care program ever”.

Originally passed in 2004 at a projected cost of

$400B over 10 years, some estimates suggest it will cost over $900 Billion.

Passed by a GOP controlled house and senate led by then Rep. Billy Tauzin (R-

La) who left immediately after its passage to become the head of PhRMA.

Arguments Against ReformArguments Against Reform

““Will explode the deficit!”Will explode the deficit!”

““This is the largest government run health care This is the largest government run health care program ever”.program ever”.

““Socialized medicine”Socialized medicine”

Socialized Medicine was popularized by a public relations firm working for the American Medical Association in 1947 to disparage President Truman's proposal for a national health care system.

It was a label, at the dawn of the cold war, meant to suggest that anybody advocating universal access to health care must be a communist.

And the phrase has retained its political power for six decades.

“If you don’t stop Medicare and I don’t do it, one of These Days, you and I are going to spend our sunset years telling our children, and our children’s children

what it once was like In America when men were free”

- Ronald Regan 1961

The original meaning of “socialized medicine” was confined to systems in which the government owns and operates health care facilities and employs health care professionals, support staff, and all ancillary workers.

England, Germany, Israel, Sweden, Finland, New Zealand, France, Canada, Taiwan, Japan all have “socialized medicine”.

October 22, 2009 - Veterans Health Care Budget Reform And Transparency Act

More than 1400 hospitals, clinics and nursing homes, 14,800 doctors, 61,000 nurses , and 5 million patients.

Rand Corporation found that 67% of veterans received appropriate care compared to 55% for the general public.

University of Michigan study found 83% satisfaction for Veterans compared to 73% for general public.

Let the Free Market Let the Free Market Rule!Rule!

There currently is no free market! Only two There currently is no free market! Only two industries in the US have antitrust exemptions – industries in the US have antitrust exemptions – Major League Baseball and The Health Insurance Major League Baseball and The Health Insurance Industry.Industry.

There has been heavy consolidation and near There has been heavy consolidation and near monopolies established in the past 10 years.monopolies established in the past 10 years.

One or two insurers generally control the top 94 One or two insurers generally control the top 94 metropolitan areas in the US.metropolitan areas in the US.

In some states like Alabama, 90% have Blue Cross.In some states like Alabama, 90% have Blue Cross.

By allowing insurers to sell across state lines, By allowing insurers to sell across state lines, patient protections will be reduced due to variations patient protections will be reduced due to variations between states.between states.

Single Payer System = MedicareSingle Payer System = Medicare Established in 1965 when only 56% of adults over 65 years of Established in 1965 when only 56% of adults over 65 years of

age were insured.age were insured.

Prior to Medicare, 1/3 of all seniors were living in poverty.Prior to Medicare, 1/3 of all seniors were living in poverty.

Commonwealth Fund Study (5/09) – Medicare patients had much Commonwealth Fund Study (5/09) – Medicare patients had much greater satisfaction, better access to care, and fewer billing greater satisfaction, better access to care, and fewer billing problems than those with employer sponsored plans.problems than those with employer sponsored plans.

Kaiser Family foundation study showed greater overall Kaiser Family foundation study showed greater overall satisfaction and much more cost efficiency than private satisfaction and much more cost efficiency than private insurance companies.insurance companies.

Patients have greater choice and do not need pre-Patients have greater choice and do not need pre-authorizations.authorizations.

The government does not tell doctors how to practice, what The government does not tell doctors how to practice, what tests to order, which hospitals to go to, or what medications to tests to order, which hospitals to go to, or what medications to prescribe.prescribe.

It is the private insurance companies that tell patients who to It is the private insurance companies that tell patients who to see, where to go, and what doctors can do.see, where to go, and what doctors can do.

Single Payer SystemSingle Payer System

Private insurers waste 31 cents of every dollar on Private insurers waste 31 cents of every dollar on overhead, sales and marketing, lobbying, billing, overhead, sales and marketing, lobbying, billing, underwriting, and exorbitant executive underwriting, and exorbitant executive compensation.compensation.

Single payer financing is the only way to recapture Single payer financing is the only way to recapture this wasted money (estimated to be over $350 Billion this wasted money (estimated to be over $350 Billion a year) and provide comprehensive coverage to a year) and provide comprehensive coverage to everyone without paying more than we already do.everyone without paying more than we already do.

Would be financed by eliminating private insurance Would be financed by eliminating private insurance and recapturing their administrative waste. and recapturing their administrative waste.

Modest new taxes would replace premiums and costs Modest new taxes would replace premiums and costs would be controlled through negotiated fees, global would be controlled through negotiated fees, global budgeting, and bulk purchasing.budgeting, and bulk purchasing.

Single Payer SystemSingle Payer System Physicians would still be able to practice medicine the Physicians would still be able to practice medicine the

way they think is best.way they think is best.

Would lead to higher wages as employers would not Would lead to higher wages as employers would not have to pay for healthcare premiums.have to pay for healthcare premiums.

Would lead to more capital investments by companies.Would lead to more capital investments by companies.

CA Nurses Association study found it would create 2.6 CA Nurses Association study found it would create 2.6 Million new jobs and infuse $317 Billion in new Million new jobs and infuse $317 Billion in new business revenue.business revenue.

Patients would not feel trapped in their current jobs Patients would not feel trapped in their current jobs due to the fear of losing their health care coverage.due to the fear of losing their health care coverage.

Single Payer SystemSingle Payer System

HR 676 – Expanded and Improved HR 676 – Expanded and Improved Medicare Act for All - Conyers Medicare Act for All - Conyers

Senate Amendment 2837 – Medicare Senate Amendment 2837 – Medicare for All – Sanders, Brown, Burris.for All – Sanders, Brown, Burris.

California SB 810 – Mark LenoCalifornia SB 810 – Mark Leno

                                                                

“Prayer and fasting" will help defeat health care reform.

- Michele Bachmann 8/25/09

“I tell you the truth, whatever you did for one of the least of these brothers of mine, you did for me.”

- Jesus Christ – Matthew 25:40