Single Payer Presentation to Leadership Greater Chicago

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Single Payer Presentation to Leadership Greater
Chicago

• Christopher Masi, MD, Ph.D.
• Assistant Prof. General Internal Medicine
• University of Chicago
• Illinois Single-Payer Coalition
• ilcoalition.pnhp.org

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(No Transcript)
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Illinois 1.8 Million Uninsured
But simply covering them with existing policies
is not a solution.
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Illinois 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 in Illinois

• Illness and Medical Bills Contributed to 40,000
  Illinois Personal Bankruptcies 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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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.

• An Example State Children's Health Insurance
  Program (S-CHIP)
• Largest Coverage Expansion in a Generation
• 5 million children added to S-CHIP / Medicaid
  rolls since 1997, but the number of uninsured
  children has decreased by only 2 million.
  Government can barely keep up with drops in
  employer coverage. Now 9 million children
  uninsured.
• Even those benefits are probably unsustainable.

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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, 2003
(Data in Years)
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Infant Mortality, 2003
(Deaths in first year of life per 10,000 live
births)
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International Health Spending
U.S. Public Spending is Greater than Other
Nations
Public/Private Spending Combined
Per Capita Health Spending, 2004
Source OECD 2004 Japan and Germany data are
from 2003
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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 in Illinois 13 billion 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.)
• Free Choice of doctor and hospital.
• Doctors Unleashed from corporate dictates over
  patient care.
• Hospitals guaranteed a secure, regular budget.

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State Consultants Analysis

• Single-Payer 85.4
• Hybrid 76.3
• Campaign Better HC 75.4
• Hospital Assoc. 70.0
• Healthy Illinois 69.4
• Insurance Industry 65.3

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The Illinois Hybrid Plan
Medicaid / SCHIP Expansion Parents 185-200 FPL
(SCHIP) Childless adults (Medicaid) Subsidies up
to 400 of poverty with special provisions to
support small and low-wage firms.
Standard Benefit Package Comprehensive Coverage
for low premiums?
Employer-Sponsored Health Plan Play Mandate
Required for those with certain of
employees Employer Assessment
Individual Mandate Standard Package or Equivalent
Coverage Criminalize Uninsurance
IHERC Administrative Body and Oversight
Board Manage Standard Benefit Package Serve as
clearinghouse for coverage options, etc Provide
information to consumers about premium rates of
return
Pay Fee for Non-play per Employee
Punishment via State Income Taxes
State Premium and Deductible Subsides to
Individuals
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First, Do No Harm?A 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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The Illinois Hybrid Plan

• Substandard Coverage forces the uninsured to buy
  defective insurance industry products that are
  already causing Illinois families to face
  bankruptcy and go without needed care.
• No Funding Of the estimated 3.6 billion cost to
  the state, 77 percent (2.8 billion) has no
  identified source of funding.
• 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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Single-Payer Politically Feasible?

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