Planning Committee in Boston for a Single-Payer System in Vermont Happy New Year everyone! Recently, there's been a buzz in the Boston Globe about VT having the chance to form a state wide single-payer system. Peter Shumlin, a single- payer supporting governor won the election and is leading an effort to get single-payer. Physicians and single-payer advocates in VT have asked that medical and health professional students come to VT to show our support. So....we're organizing a trip to show our support in Montpelier, VT at 1 pm on March 26th. We're expecting Senator Bernie Sanders, Gov. Shumlin, and hopefully Howard Dean at the big event. The goal is to get 100 people from the area medical and health professional schools to trek up. Come help make this happen. We'll start planning over brunch this Saturday. Information about where and when is below. Just let me know if you'll be able to make it, so I know how much food to make. Please pass this along to other individual people --- medical students, nursing students, social work students, public health students etc who you think would be interested in spearheading a group to join us. Onward, Sim VT Action Planning Meeting 11 AM Saturday, January 8th 36 Goodrich Rd. Apt at the end of the block Jamaica Plain, Boston BUS: Right off the 39 Bus line (get off at Lakeville Rd and walk one block further to Goodrich) Train: Or, take the orange line to Green St. Left out of the station on to Green St. Take a right on Centre St. Left on Goodrich. simeon.kimmel [at] gmail [dot] com if you are interested in attending or have any questions.simeon.kimmel [at] gmail [dot] com

Pillars of medical ethics Beneficence: Do what is good, what is needed Nonmaleficence: Don’t do harm Autonomy: Respect a patient’s choice Justice: Do what is right, what is just

Pillars of medical ethics: crumbling?! Beneficence: Do what is good, what is needed  Doctors can’t afford to treat everyone Nonmaleficence: Don’t do harm  It’s hard not to do harm when you can’t treat patients Autonomy: Respect a patient’s choice  Insurance status limits treatment options, choice of provider Justice: Do what is right, what is just  Difficult in our current system

Our whole system is crumbling

New Figures? In 2009:  50.7 million uninsured  That’s 16.7% of all Americans Source: U.S. Census Bureau

Our whole system is crumbling

There must be a better way…

Source: American Family Physician, November 15, 2005 Today There must be a better way… Will premiums surpass income??

There must be a better way…

What is single payer? “Expanded and improved medicare for all” Everybody in, nobody out All necessary medical care Option to buy supplementary insurance Choose any provider, any medical center Progressively funded through payroll or income taxation  With current national spending, we could cover everyone for all necessary care This is not a radical idea – many Western countries have something similar  Generally with better health outcomes than we have!

Canadian Physicians’ Incomes 2004/2005 SpecialtyAnnual Income Family Medicine$202,219 Internal Medicine$284,641 Pediatrics$186,040 Psychiatry$152,916 Dermatology$311,507 Ob/GYN$334,016 General Surgery$323,639 Thoracic Surgery$463,880 Ophthalmology$436,488 All Physicians$233,617 Source: Canadian Institute for Health Information And don’t worry, salaries are comparable!

Advantages of single payer for patients All necessary care is paid for Everyone gets the same benefits Choose any doctor Never lose your coverage Enjoy preventive care before getting sick Pay the same or less for better care in a better system

Advantages of single payer for doctors Gain the ability to care for everyone  Social justice – fight disparities Do less paperwork  One payer, not hundreds See the end of insurance company claim denials! Practice in a friendlier litigation climate Get a real health system in place  Structures in place for mandating electronic records  Enabling health database research  All patients with equal access to primary care

Advantages of single payer for doctors Practice in a system with a sound structure

Advantages of single payer for the budget Cover everyone for less than we are currently paying

Advantages of single payer for everyone Everybody in, nobody out

MEDICAL PHYSICIANS FOR A NATIONAL HEALTH PROGRAM JANUARY, 2011 What’s the situation in Vermont ?

Vermont… not just Maple Syrup!

Vermont: Background Long tradition of independent thought Bernie Sanders (I-VT Senator) is a long-time supporter Authored the Senate single payer bill The stars aligned…  Governor Shumlin ran on a single payer platform  Other legislators (Welch, Leahy) support single payer  After ACA’s passage, health reform is still on everyone’s minds

Vermont in early 2011 William Hsiao, Harvard Economist:  To provide Vermonters with 3 state health reform options:  1. Single payer  2. Public option  3. Plan of Hsiao’s choice  “a viable and practical single payer plan”

Who is William Hsiao?  Born in China, emigrated to NYC as a child  Worked for predecessor to CIGNA  Chief Actuary of the Social Security Administration in 1960’s  Helped design the Resource-Based Relative Value Scale  Professor of Economics at Harvard School of Public Health  Key player in designing Taiwan’s single payer system  Memberships  National Academy of Sciences  Institute of Medicine  Society of Actuaries  National Academy of Social Insurance

Why not go with a public option? Adverse selection.  Only those who can’t find affordable insurance will buy in  Cherry-picking by private companies  These are high risk patients that are expensive to insure  Public option rates skyrocket to keep up with costs  The public option becomes unaffordable to everyone Lack of administrative savings.  Makes expanded coverage unaffordable

Another plan… A new creation of William Hsiao’s? ?

The best path: Single payer  Hsiao already helped create Taiwan’s single payer system  Incredibly successful In 1995, 41% of population uninsured 4.8% of GDP spent on healthcare Now, National health insurance 6.1% of GDP spent on healthcare (2009)  The US is not Taiwan  However, those are stunning results! Source: Cheng, T. (2009). Lessons from Taiwan's universal national health insurance: A conversation with taiwan's health minister ching-chuan yeh. Health Affairs, 28(4),

Call to action!! Come to Vermont to meet with legislators One day, and one day only!  A Saturday in March 2011 (date TBA) Show your enthusiasm for practicing in a single payer system  Rally for social justice in health care  Meet doctors passionate about healthcare for all  Hang out with like-minded students  Optional: declare your intention to move to Vermont if single payer is enacted  Afterparty??

Can’t come? Sign our statement! A quick and easy way to show your support