Single Payer 101 Training Universal Health Care for Massachusetts

What’s Wrong With Our Health Care System? (the easy part)

U.S. Has Lowest Life Expectancy in the Industrialized World OECD, 2011

U.S. Has Among Highest Infant Mortality Rates Health, United States, 2007

U.S. Has Among Highest Maternal Mortality Rates OECD, 2011

Rising Uninsured Population

Human Toll of Uninsurance 1987 = Uninsured 25% more likely to die than the insured 2005 = Uninsured 40% more likely to die than the insured United States = 45,000 deaths due to lack of insurance in 2005

Insurance Coverage Better in Massachusetts, but Unsustainable

Rapid Growth of “Underinsured” Households

Insurance Not Protection Against Health Care Costs (2010)

Most Medically Bankrupt Had Insurance at Onset of Illness

No Change in Mass. Medical Debt and Medical Bankruptcies

Rising Share of Mass. Residents with High Deductibles ($1,000+)

Large Inequities Remain in Mass. Insurance Coverage

Little Change in Mass. Inequities in Cost Barriers to Care

U.S. Spends Almost Double Next Highest Spending Country

U.S. Health Care System the Sixth Largest Economy in the World Country2010 GDP United States$14,447,100 China$5,739,358 Japan$5,458,873 Germany$3,280,334 France$2,559,850 U.S. Health Care System$2,542,690 United Kingdom$2,253,552

Health Care Spending Will Consume the Entire Economy by 2052

Health Care Costs Responsible for the Federal Deficit

State Health Spending is Edging Out All Other Public Programs

City of Boston Salaries Falling, Health Care & Pension Costs Rising

1,105 (6.5%) jobs cut from January 2009 to 2012

100% of Minimum Wage Salary to Pay for a Family Health Plan

Growing % of Mass. Families with Unaffordable Health Care Costs

Over Half of Home Foreclosures Due to Medical Causes

Why Are U.S. Health Care Costs So High? (the hard part)

Common Explanations for High Health Care Costs Inadequate Prevention Behavioral factors – High obesity rate – High smoking rate – High levels of drinking Racial and Ethnic Makeup of the U.S. Aging population End of life care Chronic Illnesses – High cancer rates – High diabetes rates – High heart disease rates Overuse of technology (e.g. MRIs, CT scans, etc) Use more prescription drugs Fee-for-service: overuse of tests and procedures Lower cost transparency More third party insurance payers More physician visits More ER and hospitals visits More Medical Malpractice lawsuits Worse electronic health records Higher Cost of drugs Higher cost of medical devices Too much hospital bargaining power More profits More administration/paperwork Higher physician/nurse pay

Common Explanations for High Health Care Costs Inadequate Prevention Behavioral factors – High obesity rate – High smoking rate – High levels of drinking Racial and Ethnic Makeup of the U.S. Aging population End of life care Chronic Illnesses – High cancer rates – High diabetes rates – High heart disease rates Overuse of technology (e.g. MRIs, CT scans, etc) Use more prescription drugs Fee-for-service: overuse of tests and procedures Lower cost transparency More third party insurance payers More physician visits More ER and hospitals visits More Medical Malpractice lawsuits Worse electronic health records Higher Cost of drugs Higher cost of medical devices Too much hospital bargaining power More profits More administration/paperwork Higher physician/nurse pay

Common Explanations for High Health Care Costs Inadequate Prevention Behavioral factors – High obesity rate – High smoking rate – High levels of drinking Racial and Ethnic Makeup of the U.S. Aging population End of life care Chronic Illnesses – High cancer rates – High diabetes rates – High heart disease rates Overuse of technology (e.g. MRIs, CT scans, etc) Use more prescription drugs Fee-for-service: overuse of tests and procedures Lower cost transparency More third party insurance payers More physician visits More ER and hospitals visits More Medical Malpractice lawsuits Worse electronic health records Higher Cost of drugs Higher cost of medical devices Too much hospital bargaining power More profits More administration/paperwork Higher physician/nurse pay

Common Explanations for High Health Care Costs Inadequate Prevention Behavioral factors – High obesity rate – High smoking rate – High levels of drinking Racial and Ethnic Makeup of the U.S. Aging population End of life care Chronic Illnesses – High cancer rates – High diabetes rates – High heart disease rates Overuse of technology (e.g. MRIs, CT scans, etc) Use more prescription drugs Fee-for-service: overuse of tests and procedures Lower cost transparency More third party insurance payers More physician visits More ER and hospitals visits More Medical Malpractice lawsuits Worse electronic health records Higher cost of drugs Higher cost of medical devices Too much hospital bargaining power More profits More administration/paperwork Higher physician/nurse pay

Disease Prevalence: U.S. vs. Peer Countries

Disease prevalence = $57 to $70 billion savings

What’s Driving U.S. Prices? (the easy part that’s hard to win)

Nations With Universal Health Care Coverage

How Single Payer Health Care Is Paid For You Government Fund Health Care Providers Fixed Payroll TaxNegotiated Budget

How U.S. Health Care Is Paid For You Health Care Providers Medicaid Tufts Medical Insurance Blue Cross Medicare Out-of-Pocket Costs Premiums Taxes Separate contracts

OECD Data, 2010 Insurance Administration Costs

Hospital Administration Costs OECD, 2010

Brox. et. al. Arch Internal Medicine, 2003 Aortic Aneurysm Repair Costs

U.S. Pays Higher Prices for the Same Drugs mt.gov.com, 2010