Proposals for Universal Health Care or Back to the Health Care Future Leonard Rodberg New York Metro Chapter Physicians for a National Health Program February 27, 2007

Why Health Is On the Agenda

A Declining Number of Firms Are Offering Insurance…

Firms Shift Health Insurance Costs to Workers

HIGH COST OF HEALTH INSURANCE PREMIUMS National Average for Employer-provided Insurance Single Coverage $4,024 per year Family Coverage $10,880 per year Note: Annual income at minimum wage = $10,300 Annual income of average Wal-Mart worker = $17,114 Source: Kaiser Family Foundation/HRET Survey, 2005

Number of Uninsured Americans (Millions) Source: U.S. Census Bureau Rising Number of uninsured

Bush Plan The problem: Employers provide too much insurance, leading to excessive spending Bushs solution: –Tax employer-based insurance that is gold-plated –Provide tax deductions (not credits) to allow people to buy their own insurance. No mandates on anyone. The impact (Lewin): –9 M fewer uninsured (12 M lose employer coverage, 2 M would remain uninsured) –Newly-insured are mainly upper-income –$62 B in annual federal expenditures No reform of individual insurance market: inaccessible to low- and middle-income families or pre-existing conditions

U.S.Out-of-Pocket Expenses are Greater than Those of Other Countries Source: OECD 2006

Physician Visits Per Capita

Hospital Inpatient Days Per Capita

Stephen 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.

New Health Care Proposals (as of February 27, 2007) Americas Health Insurance Plans Better Health Care Together Campaign Health Coverage Coalition for the Uninsured Sen. Ron Wyden, SEIU, Safeway Federation of American Hospitals John Edwards

The Good News -- and the Bad News Universal health care is accepted as the goal. This is defined to mean simply helping the uninsured buy private insurance.

Americas Health Insurance Plans the private insurance protection plan and Federation of American Hospitals the private hospital protection plan Expand SCHIP and Medicaid eligibility for very low-income Provide federal and state subsidies and tax deductibility to encourage everyone else to buy private insurance

Better Health Care Together Campaign grand coalition Members: ATT, Kelly Services, Wal-Mart SEIU, CWA Center for American Progress Principles but no Program: Quality affordable insurance coverage for everyone Individuals are responsible for maintaining and protecting their health Improved value for health care dollar Shared Responsibility: Businesses, government, individuals all contribute.

Health Coverage Coalition for the Uninsured even grander coalition Members: UnitedHealth, Blue Cross, Kaiser AHA, AMA Chamber of Commerce, NAM, Pfizer AFL-CIO, SEIU AARP, Families USA Could agree only on: Expanding coverage as a goal Expansion of SCHIP Tax credits for childrens insurance

Wyden Healthy Americans Act slash and burn Supporters: SEIU, Safeway, Families USA Eliminate the tax deductibility of employer- based insurance end employer benefit Require individual purchase of insurance Transitional payments by employers Subsidies to low-income individuals Relies on competition to contain costs

John Edwards Plan individual mandate with a pretty face Medicaid and SCHIP expansion Employer mandate (play or pay) Individual mandate with community rating Government subsidies for low-income Regional purchasing plans (Health Markets) Government program (single payer?) as well as private plans. (cf Medicare Advantage) Note: Jacob Hacker plan: Identical content, different verbiage

Edwards Seductive Verbiage For everyone: Shared responsibility For the fearful: Lets people keep what they have For those worried about cost: Everyone will work together to make the system more efficient For single payer advocates: Individuals and businesses can choose if they want the government plan; if so, the system will evolve toward a single-payer approach. (For more, see

Whats Wrong with an Individual Mandate (partial list)? Will not lead to universal coverage Enforcement is anti-public health Affordable premium vs affordable health care Employers will drop coverage (crowd out) Insurance companies resist community rating

Whats Wrong with an Individual Mandate (partial list cont.)? Health insurance: a consumers nightmare (copays, deductibles, exclusions, denials, appeals) Complexity/humiliation of means testing More bureaucracy (Health Markets, etc.) High cost ($120B Federal + ???B for individuals) No cost control/continuing rising cost

Common Features of these Plans Identification of the problem: too many uninsured. Their solution: Require everyone to have insurance Employers should contribute but not necessarily offer insurance Their mission: Save private insurers

None of These Plans Will Happen! They cost hundreds of billions of dollars They benefit only those with low incomes and those without insurance Note: Half of middle- and lower-income adults experience serious problems paying medical bills or insurance premiums. (Commonwealth Fund 2006) These plans do nothing for them. They dont solve any of the problems (especially rising costs) that concern everyone None envisions a real structural change.

A Familiar Headline – But Its Wrong! It is the unaffordable, inefficient private insurance system that is collapsing. Employers should contribute their fair share, just not through private insurance. Going backwards to individual purchase of insurance is not the answer.

Some of the Problems created by private insurance

SO HERES OUR REAL SINGLE PAYOR SOLUTION: Expand Medicare to cover everyone Improve the coverage it offers Eliminate private insurance Automatic enrollment in Medicare for All Income-based financing through employers and employees (shared responsibility) Expand and Improve Medicare for All Conyers Bill - HR 676

Conclusion Instead of moving backwards, to a time before there was employer-based or group insurance, when everyone was on their own to get health care, we should be moving forward, to recognize health care as a necessary public good that should be a public responsibility. We should be expanding and improving the Medicare program, which we know provides reliable, cost-effective coverage and has been doing so for more than forty years. Public Medicare for All, not private for-profit insurance, is the only path to a future that will truly provide health care for all Americans.