universal health care without private health insurance? single payer: the only affordable, lifelong,...
TRANSCRIPT
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Universal Health Care without Private Health Insurance?
Single Payer: The Only Affordable, Lifelong, Comprehensive, Quality Health
Care Plan for Every American
Robert Zarr, MD, MPH, [email protected]
DC PNHPwww.pnhp.org
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MY STORY• Sept 22, 2007,at 1pm, I was assaulted
• Loss of consciousness
• Ambulance ride & ER visit
• NO in-network ambulance coverage for my insurance policy?
• Monthly bills from DC EMS
• After 5 months, insurance finally paid ONLY 75% of transport cost
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Best health care system in the world?
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18,314 Adult Deaths Annually Due to Uninsurance
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We are the best at spending the most
money to be ranked 37th in health outcomes by
WHO!
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Government Funds Most Academic Research
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Insurance Overhead 2001
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In summary, private insurance:
• Is wasteful ($350 billion a year)
• Reduces the buying power of 300 million American purchasers (decreased monopsony)
• Reduces transparency of health care system problems and solutions
• Does not provide lifetime comprehensive quality health care to any American
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Insanity:Try it the same way every time and expect different
results.
Individual & employer mandates, HSAs, High Deductible Plans, Free
Market models =MORE OF THE SAME
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SINGLE PAYER NATIONAL
HEALTH INSURANCE
READY FOR REAL CHANGE?
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House Resolution 676:http://thomas.loc.gov/cgi-bin/thomas
United States National Health Insurance Act
(Expanded and Improved Medicare for All Act)
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The 4 principles of single payer:
1. Access to comprehensive health care is a human right.
2. The right to choose and change one's physician is fundamental to patient autonomy.
3. No corporate profit and personal fortune.
4. In a democracy, the public should set overall health policies.
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Single Payer NHI guarantees:
• Comprehensive Care
• Quality
• Choice
• Affordability
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Single payer NHI would cover every American for all lifetime medically-necessary services:
acute, rehabilitative, long term and home care, mental health, dental services, occupational health care, prescription drugs and supplies, and preventive and public health measures
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Prescription Drugs and Supplies
• NHI would pay for all medically necessary prescription drugs and medical supplies, based on a national formulary
• Regional expert panels would establish and regularly update the formulary
• NHI would provide all Americans with full coverage for necessary drugs and supplies
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Payment for Physicians and Outpatient Care: 3 Options
1. fee-for-service, or
2. salaried positions in institutions receiving global budgets, or
3. salaried positions within group practices or HMOs receiving capitation payments
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How Do We Know It Can Be Done?
• Every other industrialized nation has a healthcare system that assures health care for all
• All spend less than we do; most spend less than half
• Most have lower death rates, more accountability, and higher satisfaction
• No country has ever adopted single payer, found it to be worse, and switched back
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But, can we afford NHI?
We can't afford NOT to have NHI!
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Projected 2010 Health Care Expenditure Comparison of:Current Health Care System to those of National Health Insurance (NHI, Improved and Expanded Medicare for All, HR 676)
Status Quo($ billions)
NHI($ billions)
Spending Federal spending (Medicare, Medicaid, DSH, etc.) 957 957
Spending State and Local spending 348 348
Spending Private Insurance spending (premiums) 950 0
Spending Out of pocket spending (co-pays, deductibles, over the counter drugs, etc.)
317 80
Spending Other private funds spending (foundations, etc.) 204 0
Savings Savings from reduced administrative cost (paperwork) 0 278
Savings Savings from bulk purchase of Rx DRUGS 0 87
Savings Savings from non-durable medical supplies 0 13
Savings Savings from durable medical supplies 0 9
Additional Revenue
Additional Payroll Tax 0 538 (3.3% increase over current 1.4%)
Additional Revenue
Stock transfer tax (0.25% on seller and buyer) 0 150
Additional Revenue
Corporate Welfare Reduction 0 100
Additional Revenue
Reversal of 2001 and 2002 Tax Cuts 0 251
Additional Revenue
Tax surcharge (5% on highest top 5% earners and 10% on top 1% earners)
0 200
Total ($billions) 2,776 3,011Surplus 0 235 (3,011-2,776)
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So, is this politically feasible?
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PNHP Total Membership
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
Year
Mem
bers
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Broad Support from:
• 92 US Congressional co-sponsors of HR 676 (more than any other bill)
• 59% of US physicians
• 70,000 medical students
• 75,000 nurses
• Faith organizations
• 2 state governments (Kentucky and N.H. House of Representatives)
• U.S. Conference of Mayors
• 452 union organizations