PHYSICIANS FOR A NATIONAL HEALTH PROGRAM

PHYSICIANS FOR A NATIONAL HEALTH PROGRAM

29 EAST MADISONSUITE 602CHICAGO, IL 60602TEL: (312) 782-6006

WWW.PNHP.ORG

The Uninsured

18,314 Adult Deaths Annually Due to Uninsurance

Financial Suffering Among the INSURED

Persistent Racial Inequalities

Rationing Amidst a Surplus of Care

Variation in Medicare Spending:Some Regions Already Spend at Canadian Level

Half of Americans Live Where Population Is Too Low for Competition

Source: NEJM 1993;328:148

A town’s only hospital will not compete with itself

Profit-Driven HMOs: A Problem, Not a Solution

Investor-Owned Care:Inflated Costs, Inferior Quality

For-Profit Hospitals’ Death Rates are 2% HigherSource: CMAJ 2002;166:1399

For-Profit Hospitals Cost 19% MoreSource: CMAJ 2004;170:1817

For-Profit Dialysis Clinics’ Death Rates are 9% Higher

Source: JAMA 2002;288:2449

High Deductible Insurance:Except for the Healthy and

Wealthy, It’s Unwise

Mandate Model Reform:Keeping Private Insurers

In Charge

“Mandate” Model for Reform

• Proposed by Richard Nixon in 1971 to block Edward Kennedy’s NHI proposal

“Mandate” Model for Reform

• Government uses its coercive power to make people buy private insurance.

“Mandate” Model for Reform

1. Expanded Medicaid-like program Free for poor Subsidies for low income Buy-in without subsidy for others

2. Employer Mandate +/- Individuals3. Managed Care / Care Management

“Mandate” Model - Problems

• Absent cost controls, expanded coverage unaffordable

• Computers, care management, prevention not shown to cut costs

• Adds administrative complexity and cost; retains wasteful private insurers

• Impeccable political logic, economic nonsense

The Massachusetts Reform: Headed Towards Failure

Massachusetts: Required Massachusetts: Required CoverageCoverage(Income > $30k)(Income > $30k)

Premium: $4,080 Annually (56 Premium: $4,080 Annually (56 year old)year old)

$2000 deductible$2000 deductible

20% co-insurance AFTER 20% co-insurance AFTER deductible is reacheddeductible is reached

Crimes and Punishments in Crimes and Punishments in MassachusettsMassachusettsThe CrimeThe Crime The The

FineFineViolation of Child Labor LawsViolation of Child Labor Laws $50$50

Employers Failing to Partially Employers Failing to Partially Subsidize a Poor Health Plan for Subsidize a Poor Health Plan for WorkersWorkers

$295$295

Illegal Sale of Firearms, First OffenseIllegal Sale of Firearms, First Offense $500 max.$500 max.

Driving Under the Influence, First Driving Under the Influence, First OffenseOffense

$500 min.$500 min.

Domestic AssaultDomestic Assault $1000 $1000 max.max.

Cruelty to or Malicious Killing of Cruelty to or Malicious Killing of AnimalsAnimals

$1000 $1000 max.max.

Communication of a Terrorist ThreatCommunication of a Terrorist Threat $1000 $1000 min.min.

Being Uninsured In MassachusettsBeing Uninsured In Massachusetts $982$982

Tried and Failed:State Experiments with Mandate Model

and Other Incremental Reforms

Massachusetts 2006

“Every uninsured citizen in Massachusetts will soon have affordable health insurance and the costs of health care will be reduced.

Gov. Romney.”

Sources: Wall Street Journal 4/11/06 and New York Times 4/5/06.

“The bill does what health experts say no other state has been able to do: provide a mechanism for all of its citizens to obtain health insurance.”

Massachusetts 1988

“I am very proud of the fact that Massachusetts will be the first state in the country to enact universal health insurance.”

Gov. Dukakis`

Sources: New York Times 4/14/88 and 4/26/88

“Massachusetts last week ventured where no state has gone before: it guaranteed health insurance for every resident.”

Sources:Washington Post 6/9/92 and 3/20/`93

Oregon 1992

“Today our dreams of providing effective and affordable health care to all Oregonians has come true.”

Gov. Roberts

“The most far-reaching health care reform in the nation.”

Sources: Federal & State Insurance Week 4/12/93; and NY Times 9/16/94

“The most radical health care plan in America.” “Tennessee will cover at least 95% of its citizens with health insurance by the end of 1994.”

Gov. Ned McWherter

Tennessee 1992

Vermont 1992

“This is an incredibly exciting moment that should make all Vermonters proud.”

Gov. Dean

Source: New York Times 4/12/92

“Governor Howard Dean, the only governor who is a doctor, signed a law here today that sets in motion a plan to give Vermont universal healthcare by 1995.”

Sources: New York Times 4/19/92; and Richard Reece, Medical World News 7/1/92.

“Minnesota is enacting a program that will be the most sweeping effort yet to provide health insurance to people who lack it . . . the first complete reform proposal in the U.S.”

“Minnesota is about to embark on a plan to solve the health-insurance crisis that could hold lessons for other states and the nation.”

Minnesota 1992/1993

Washington 1993

Source: New York Times 5/2/93

Washington state “passed one of the most aggressive health care experiments in the nation, a program that would extend medical benefits to all 5.1 million residents of the state . . . .”

Sources: AP Newswire 4/25/06 and Ellen Goodman, Washington Post Writers Group 7/7/03.

“It’s bold and comprehensive, and it’s now the law of the state.”

Gov. Baldacci

Maine 2003

“Maine has just become the first state in the union to approve a plan to provide universal access to affordable health insurance.”

The U.S. Trails Other Nations

Canada’s National Health Insurance Program

A National Health Program for the U.S.

Public Opinion Favors Single Payer National Health Insurance