For Patients, Not for Profits A Single-Payer National Health Insurance Program (HR 676) .

For Patients, Not for For Patients, Not for ProfitsProfits

A Single-Payer National A Single-Payer National Health Insurance ProgramHealth Insurance Program

(HR 676)(HR 676)

www.SiCKOCure.orgwww.SiCKOCure.org

www.pnhp.orgwww.pnhp.org

United States:United States:

46 Million Uninsured46 Million Uninsured

But simply covering them But simply covering them with existing policies is with existing policies is notnot a a solution.solution.

America’s Underinsured

28

60 59

0

10

20

30

40

50

60

70

Insured Insured, Gap in Coverage Uninsured

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

Medical Bankruptcy

• Illness and Medical Bills Contribute to HALF of all Bankruptcies.

Source: Himmelstein, Health Affairs 2005 (state estimates provided by author)

24.3%

75.7%

Uninsured Had Insurance

• Of those, more than three-quarters had insurance when they got sick.

Insurance Status at Onset of Illness

Rising Costs = Fewer Benefits = Under/UninsuranceProportion of Americans Covered by Employer Insurance

Source: US Census

55.0%

57.0%

59.0%

61.0%

63.0%

65.0%

2000 2001 2002 2003 2004 2005

What Does This Mean?What Does This Mean?

Lesson #1: Simply Expanding Existing Lesson #1: Simply Expanding Existing Private Insurance Policies Is Not a Private Insurance Policies Is Not a Solution.Solution.

Current Private Insurance Policies Offer Inadequate Protection.

Any Gains in Coverage Will Be Quickly Offset as Costs Rise and Employers Shed Benefits.

What Does This Mean?

Lesson #2: Any Real Solution to the Health Crisis Must Do Two Things:

1) 1) Offer Coverage More Offer Coverage More Comprehensive than that Comprehensive than that Currently Currently Available on the Private Market.Available on the Private Market.

2) 2) Control Costs so that Benefits are Control Costs so that Benefits are Sustainable.Sustainable.

78.1 78.4

79.4 79.7 79.9 80.2

77.2

U.S. U.K. Germany France Canada Italy Sweden

Life Expectancy, 2003Life Expectancy, 2003(Data in Years)

Source: Organization for Economic Cooperation and Development (OECD)

5.4

4.84.3 4.2

3.9

3.1

7

0

4

8

U.S. Canada Australia Italy Germany France Sweden

Infant Mortality, 2003Infant Mortality, 2003(Deaths in first year of life per 1,000 live (Deaths in first year of life per 1,000 live

births)births)

Source: Organization for Economic Cooperation and Development (OECD)

$0

$2,000

$4,000

$6,000

Japan

*U.K

.Ita

ly

Sweden

France

Germ

any*

Canad

aU.S

.

International Health SpendingU.S. Public Spending is Greater than Other Nations’ U.S. Public Spending is Greater than Other Nations’

Public/Private Spending CombinedPublic/Private Spending Combined

Per Capita Health Spending, 2004Per Capita Health Spending, 2004

Source: OECD 2004; Japan and Germany data are from 2003

Insurance Companies = Insurance Companies = Paperwork WastePaperwork Waste

•Billing

•Marketing

•Underwriting

•Co-Payment Processing

•Eligibility Determinations

•Utilization Reviews

•Provider Administrative Staff

•Employer Benefit Administration

0%

500%

1000%

1500%

2000%

2500%

3000%

1970 1975 1980 1985 1990 1995 2000

Physicians Administrators

Growth of Physicians and Growth of Physicians and Administrators Administrators 1970-20051970-2005

Source: Bureau of Labor Statistics and NCHS

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

Administration

All Other

31%

Potential Savings: $350 billion Potential Savings: $350 billion per yearper year

Enough to Provide Comprehensive Coverage Enough to Provide Comprehensive Coverage to Everyoneto Everyone

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

MedicareMedicare

MedicaidMedicaid

Payroll TaxPayroll Tax

Income TaxIncome Tax

Single-Payer Single-Payer Health Care Health Care

FundFund

$$$$$$

Financing Single-PayerFinancing Single-Payer

Bonus: Negotiated formulary with physicians, global budget for Bonus: Negotiated formulary with physicians, global budget for hospitals, increased primary and preventive care, reduction in hospitals, increased primary and preventive care, reduction in unnecessary high-tech interventions, bulk purchasing of drugs and unnecessary high-tech interventions, bulk purchasing of drugs and medical supplies = medical supplies =

long term cost control.long term cost control.

Single-Payer BenefitsSingle-Payer Benefits

Comprehensive CoverageComprehensive Coverage for all medically for all medically necessary services necessary services (doctor, hospital, long-term care, mental (doctor, hospital, long-term care, mental

health, vision, dental, drug, etc.) health, vision, dental, drug, etc.) in a in a single-tier systemsingle-tier system..

Free Choice Free Choice of doctor and hospital.of doctor and hospital.

Health Workers Unleashed Health Workers Unleashed from corporate from corporate dictates over patient care.dictates over patient care.

Hospitals Hospitals guaranteed a secure, regular guaranteed a secure, regular budget.budget.

OnlyOnly Two Paths to Two Paths to ReformReform

1.1. Preserve Private Preserve Private Insurance Insurance Companies and Companies and their Wastetheir Waste

2.2. Create a Create a National Health National Health Insurance Insurance SystemSystem

““Save the Insurance Save the Insurance Companies”Companies”

A A BipartisanBipartisan Consensus ConsensusPrivate Insurance Private Insurance

Tax CreditsTax CreditsNational Health

Program

Subsidy and Individual Mandate Subsidy and Individual Mandate SchemesSchemes

(The Edwards and Obama Plans)(The Edwards and Obama Plans) Substandard CoverageSubstandard Coverage: forces the uninsured to buy : forces the uninsured to buy

defective insurance industry products that are already defective insurance industry products that are already causing families to face bankruptcy and go without causing families to face bankruptcy and go without needed care.needed care.

UnaffordableUnaffordable:: Without the savings achievable with Without the savings achievable with single-payer, taxes must raised or funds diverted from single-payer, taxes must raised or funds diverted from other needy programs. other needy programs.

Micro-coverage, Macro-costsMicro-coverage, Macro-costs: Preserves wasteful : Preserves wasteful private insurers and adds yet another layer of state private insurers and adds yet another layer of state administrative waste. Rather than provide care to the administrative waste. Rather than provide care to the uninsured through a relatively efficient program like uninsured through a relatively efficient program like Medicare, the plan launders tax dollars through Medicare, the plan launders tax dollars through wasteful private insurers.wasteful private insurers.

No Realistic Cost ControlNo Realistic Cost Control: Any gains in public : Any gains in public coverage will be unsustainable due to rising costs.coverage will be unsustainable due to rising costs.

““Sounds Great, Sounds Great, but it’s not but it’s not politically politically feasible”feasible”2/3rds of population want it2/3rds of population want it

Many (probably most) Many (probably most) physicians want itphysicians want it

Business community is now Business community is now realizing the need for itrealizing the need for it

““If done right, health care in America could be dramatically better If done right, health care in America could be dramatically better with true single-payer coverage.”with true single-payer coverage.”

--Ben Brewer, WSJ, April 18, 2006Ben Brewer, WSJ, April 18, 2006

““[single-payer] is an idea that's so easy to slam politically yet so [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 sensible for business that only Republicans can sell it! …it may take a Republican President to bless the socialization of health spending we Republican President to bless the socialization of health spending we need.”need.”

-Matt Miller, Fortune, April 18, 2006-Matt Miller, Fortune, April 18, 2006

““Think, as a small business, how you could benefit from a single-payer Think, as a small business, how you could benefit from a single-payer system: you wouldn’t lose potential employees to larger firms that system: you wouldn’t lose potential employees to larger firms that offer more attractive health benefits; health insurance costs would offer more attractive health benefits; health insurance costs would cease to be a line item in your budget. A serious illness befalling you cease to be a line item in your budget. A serious illness befalling you or an employee wouldn’t be a company-wide financial crisis. You might or an employee wouldn’t be a company-wide financial crisis. You might even save money.”even save money.”

-Joseph Antony, CNBC / MSN Money, Winter 2003-Joseph Antony, CNBC / MSN Money, Winter 2003

CNBC / MSN MoneyCNBC / MSN Money

““A Step Towards Universal A Step Towards Universal Coverage”Coverage”

or The Definition of Insanity?or The Definition of Insanity?Other States That Have Taken Other States That Have Taken

“Steps”“Steps”Hawaii (1974)Hawaii (1974) 82,00082,000

116,000116,000

Massachusetts (1988)Massachusetts (1988) 494,000494,000617,000617,000

Oregon (1989)Oregon (1989) 400,000400,000578,000578,000

Tennessee (1992)Tennessee (1992) 687,000687,000 835,000835,000

Minnesota (1992)Minnesota (1992) 350,000350,000 430,000430,000

Maine (2003)Maine (2003) 133,000133,000 142,000142,000

Uninsured 2005Uninsured at Time

Is “The Perfect the Enemy of Is “The Perfect the Enemy of the Good?”the Good?”

The Radical and the RepublicanThe Radical and the Republican

“Many of Lincoln’s admirers have painted him as a man who wanted exactly what the abolitionists did but cannily waited for a perfect moment to achieve it. [In fact], radicals like Douglass set an agenda Lincoln gradually adopted as his own. Without abolitionists, there would have been no Lincoln.”

- James Oakes, Historian, UC Berkeley

Single-Payer: “Politically Single-Payer: “Politically Feasible?”Feasible?”

Abolition of Human Abolition of Human Slavery Slavery (1600s)(1600s)

Women’s Suffrage Women’s Suffrage MovementMovement

(1840-1920)(1840-1920)

Civil Rights ActCivil Rights Act(1964)(1964)

Other “Politically Infeasible” Movements

What What YouYou Can Do Can Do•Join Up with the campaign for HR 676 at www.sickocure.org. Use the resources on the site to educate yourself, your family and your friends about the single-payer solution.

•Sign the Citizens’ Petition for single-payer national health insurance (on the website).

•Contact your Members of Congress to tell them you support HR 676, and they should too.

•Write an Op-Ed or Letter to the Editor of your local paper. You can find tips, templates and examples at www.sickocure.org.

•Bring Materials and Talk to your church, labor, community or other group about the single-payer solution. The SickoCure website includes sample resolutions that your group can endorse and a copy of this slideshow you can use.