Title: Stephen Colbert on the Bush Health Plan
1Stephen Colbert on the Bush Health Plan
- It's so simple. Most people who can't afford
health insurance also are too poor to owe taxes.
But if you give them a deduction from the taxes
they don't owe, they can use the money they're
not getting back to buy the health care they
can't afford.
2US Health Care System Crisis A Single Payer
Solution
- Joshua Freeman, MD
- MASW Annual Conference
- Columbia, MO
- October 22, 2008
3What is the Problem?
- 47 Million Uninsured
- 75 Million un-or-underinsured
- Even having good insurance doesnt protect
- Inadequate health care outcomes and quality
- Extraordinary cost
- Health care primarily a business for making
profits rather than enhancing health
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5 JayDoc Student-run Free Clinic Patient
Population by Employment Status
618,314 Adult Deaths Annually Due to Uninsurance
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9Life Expectancy
Source OECD 2007, data from 2005
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15National Scorecard 2008
- Commonwealth Fund, July 2008
- US Scores 65 out of 100
- No improvement since 2006
- 42 (75M) adults uninsured or underinsured (up
from 35 2006) - 19th out of 19 countries on mortality amenable to
medical care (down from 15th, 2006) - Spends twice what other industrialized countries
do - Ref accessed 7/21/08
- http//www.commonwealthfund.org/publications/publi
cations_show.htm?doc_id692682
16National Health Spendingas a share of Gross
Domestic Product
Projected
Actual
Percentage GDP
Source Centers for Medicare Medicaid Services
17We spend twice as much on health care as other
nations do
Per person
OECD, 2006. Data for Japan is an estimate
18How are we paying for it now?
1,075 B
319B
286B
Based on 2003 National Health Spending of 1.68
trilllion (CMS)
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20COST SHIFTING NO END IN SIGHTThe Insurance
Death Spiral
21General Motors Health Care CostsA social
insurance system that sells cars to finance
itself
- 5 billion in 2003 (profits 1.7 billion)
- 1500 per car
- 9,000 per year/per employee
- -average firm (5758)
- 15,000 per year /per retiree under age 65
- 4,000 per year /per retiree on Medicare
Source New York Times 7/15/03
22Health Care Administrative Costs in the U.S.
Administrative Costs
31
Clinical Care
69
(2000 per person)
New England Journal of Medicine 8/03
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24Investor-Owned CareSummary of Evidence
- Hospitals Costs 3-11 higher, fewer nurses,
higher overhead, death rates 6-7 higher, fraud - HMOs Higher overhead, worse quality
- Dialysis Death rates 20 higher, less use of
transplants peritoneal dialysis. - Nursing Homes More citations for poor quality,
fraud - Rehab Hospitals Costs 19 higher
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26Financing 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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32How It Could Work
- Regional Health Board allocates resources
- Board accountable to patients rather than
stockholders - Private hospitals remain in tact
- Patients have ID that allow them to get care
wherever they wish - Physicians work fee-for-service
33Or Medicare for All
- Already covers majority of sickest
- Aged, Blind and Disabled
- Marginal Costs relatively low
- Overhead very low
34Covering Everyone and Saving Money through
Medicare for All
- Additional costs
- Covering the uninsured and poorly-insured
7.2 - Elimination of cost-sharing and co-pays
5.1 - Savings
- Bulk purchasing of drugs equipment
-2.8 - Reduced hospital administrative costs
-1.9 - Reduced physician office costs
- 3.6 - Reduced insurance administrative costs
-5.3 - Primary care emphasis reduce fraud
-2.2 - Net Savings
-4.3
Source Health Care for All Californians Plan,
Lewin Group, 2005
35NHI will save 5000 per capita by 2024
36Expansion of Universal Health
- 1973 Denmark
- 1974 Australia
- 1978 Italy
- 1979 Portugal
- 1986 Spain
- 1996 South Africa
- 2002 Taiwan
- 1883 Germany
- 1911 Switzerland
- 1938 New Zealand
- 1945 Belgium
- 1945 France
- 1946 United Kingdom
- 1966 Canada
None of these countries rely on private,
for-profit insurance companies
37Obamas Health Plan
- Expand Medicaid, SCHIP.
- National Health Insurance Exchange.
- Public plan for small business and individuals,
similar to FEHBP.
- Business tax credits
- Income based tax credits.
- Savings by IT, transparency, negotiated drug
prices for Medicare, tort reform. - Payment based on outcomes.
38McCain
- Tax credit for individuals
- Eliminate business tax deduction for employee
health insurance - Encourage HSAs
- Income related tax credits.
- Guaranteed Access Planpooled resources by states
for chronic illness and poor. - Reduce cost by IT, reimport drugs, tort reform,
transparency. - Payment based on outcomes.
39If 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
40Problems
- McCain
- Minimal cost containment
- HSAs lead to less preventive care
- Free market has failed to deliver quality and
efficiency.
- Obama
- Minimal cost containment
- No cost savings on administrative overhead
- Free market has failed to deliver quality and
efficiency.
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42Health Savings Accounts
- No savings globally
- No reduction of administrative costs
- Discourage preventive care
43Case Kansas Health Reform
- 2007 SB 13 Options (to KHPA)
- KHPA contracted with outside consultant
- Foundations paid the tab
- Consultant Steve Schramm
- Report on various options
- Presumed Premium Assistance
44Current KS (lt65 yo)
45Options vary on
- new people covered
- How covered / how paid
- Employer (private) vs. Medicaid expansion
(public) - Cost (and to whom)
464 Plans change in Uninsured
- Reference Decr. 144K
- Affordable Decr. 50K
- Universal Decr. 247K
- Single Payer Decr. 247K
475 Plans (Incl. Baseline) Cost
48Who Pays?
- Prevention saves lives, but maybe not money
- If it or any other intervention saves money,
who pays? Social good? - And how do we ensure quality?
49Sick Around the World
- PBS Frontline program T. R. Reid
- 5 Countries
- Britain
- Germany
- Japan
- Taiwan
- Switzerland
- http//www.pbs.org/wgbh/pages/frontline/sickaround
theworld/
50Annals of Internal Medicine April 1, 2008
51Single Payer NHI in the U.S.
- HR 676
- Congressional bill to establish Single Payer
National Health Insurance in the U.S. - Currently has more members of Congress signed on
than any other health reform bill (88)
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54Thank you!
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56Pascal Couchepin, Center-right President of the
Swiss Confederation
- Q But I can hear in what you're saying that that
concern that everyone get covered, everyone get
equal care, that's really important - A Oh, yes. ... For the Swiss, whether you are
right or left doesn't matter I think there is a
consensus on that. We want that every one of
our citizens can get the best medical treatment
when they need it. ...
57Couchepin (Switzerland) 2
- Q ... One of the problems we have in America is
that many people -- it's a huge number of people
-- go bankrupt because of medical bills some
studies say 700,000 people a year. How many
people in Switzerland go bankrupt because of
medical bills? - A Nobody. Doesn't happen. It would be a huge
scandal if it happens.
58Current KS (lt65 yo)
- Large Employer (gt50) 56
- Small Employer 9
- Medicaid 11
- Individual 8
- Military 3
- Medicare 1
- Prem. Assistance 1
- Uninsured 11
59- 2008 KHPA Recommendations
- Increased Health Coverage
- Combined plan
- Promote Medical Homes
- Promote Personal Responsibility
- Legislative Action 2008 None
- Not even premium assistance