"Of all the forms of inequality, injustice in health care is the most shocking and most inhumane" Martin Luther King Jr (March 25, 1966, National Convention of the Medical Committee for Human Rights, Chicago)

HEALTH CARE SECURITY FOR ALL A moral, ethical, social & religious good A family value An economic necessity

46+ Million Uninsured and Rising

COSTS SOARING TWO TRILLION DOLLARS AND STILL RISING 15% OF GNP

18,314 Adult Deaths Annually Due to Uninsurance

Illness and Medical Costs, A Major Cause of Bankruptcy Over 50% of all bankruptcies involve a medical reason or large medical debt 326,441 families identified illness/injury as the main reason for bankruptcy in 1999 An additional 269,757 had large medical debts at time of bankruptcy 7 per 1000 single women, and 5 per 1000 men suffered medical-related bankruptcy in 1999 Source: Norton's Bankruptcy Advisor, May, 2000

Who Pays for Nursing Home Care? Source: Health Affairs 2000; 19(3):44

Who Are The Uninsured? Source: Himmelstein & Woolhandler - Tabulation from 1999 CPS *Students>18, Homemakers, Disabled, Early retirees »Employed »50% »Children »25% »Unemployed »5% »*Out of labor »force »20%

The Eight Americas 1. Asians, 2. Northland low-income rural whites, 3. Middle America, 4. Low-income whites in Appalachia and the Mississippi Valley, 5. Western Native Americans, 6. Black Middle America, 7. Low-income southern rural blacks 8. High-risk urban blacks

Disparities in mortality across the eight Americas are enormous by all international standards. Policies aimed at reducing fundamental socioeconomic inequalities are currently practically absent in the US. Health disparities will have to be at least partly addressed through public health strategies that reduce risk factors for chronic diseases and injuries.

Probability of death between the ages of 15 and 59 years in the eight Americas from all causes.

Chronically Ill and Uninsured

Poverty Rates, 1997 U.S. and Other Industrialized Nations Source: Luxembourg Income Study Working Papers Note: U.S. figure for 1997, other nations most recent available year 6% 8% 9% 11% 17% 0%5%10%15%20% Netherlands France Sweden Canada UK Germany US % of Population Below Poverty Level

Life Expectancy For Women, 1999 Source: OECD, Data on Italy are for U.S. U.K. GERMANY ITALY CANADA SWEDEN FRANCE YEARS

Why Women Delay Prenatal Care When They Know They Are Pregnant Source: MMWR 5/12/2000; 49:393 Note: 11.1% of pregnant women failed to get timely prenatal care despite knowing they were pregnant

Health Care Administrative Costs in the U.S. 69% 31% Clinical Care Administrative Costs New England Journal of Medicine 8/03 $7 billion of the WI healthcare dollar is spent on administration

Health Care Financing Today The financing of health care is really a shell game with all the payers trying to avoid paying the fixed costs of health care

Cost shifting: No end in Sight Cost shiftHigher premiums Deficit More uninsured Bills not paid More underinsured Fixed costs of healthcare services not met Get Care

CEO Pay and Stockholdings, 1998 Source: Jenks Healthcare Business Report 7/24/99 CEOFirmPay (mill)Stock (mil) Wilson TaylorCigna$5.0$64.2 Norman PaysonOxford$3.3$44.7 Leonard ShaefferWellpoint$2.2$45.5 Richard HuberAetna$2.2$21.3 William McGuireUnited Hlthcr.$1.5$87.8 Melvin GoodesWarner Lambert$16.5$287 Paul OrmondManor Care$7.8$43.7 Peter NicholasBoston Scientific$0.8$1198 Thomas Frist Jr.Columbia/HCA$.025$445

Employers’ Health Benefit Costs US vs. Canada

Drug Companies’ Cost Structure

Percent of Population with Government-Assured Insurance Note: Germany does not require coverage for high-income persons, but virtually all buy coverage Source: OECD, Data are for 2000 or most recent year available 92% 100% 45% 0% 20% 40% 60% 80% 100% U.S.GermanyFranceCanadaAustraliaJapanU.K.

Who’s paying the Health Care bill? Source: NEJM 1999; 340:109; Health Affairs 2000; 19(3):150 60% 20% taxpayers Private employers Individuals In the end, we all pay the total bill, but we all don’t have coverage for our own care {Medicare, Medicaid. Public employees, tax subsidies}

We have the brains, resources and ability to resolve these problems so let’s do it.

THREE PROPOSALS WICONSIN HEALTH PLAN WISCONSIN HEALTH CARE PARTNERSHIP PLAN WISCONSIN HEALTH SECURITY ACT