Greg Henry MD “Medicare… should have been called the ‘Savior of Internal Medicine Act.’” Emergency Physician Monthly October ‘09

History (continued)  The birth of the Blues  1965: Medicare and Medicaid  1993: Clinton Health Plan  Death of not-for-profit insurance

Anthem /WellPoint (formerly Blue Cross)  CEO Larry Glasscock in Indianapolis, just retired  Bonus in $42.5 Million Indianapolis Star 4/7/04

What Do We Get For Our Money?  The most expensive health care in the world  The best health care in the world?

WHO Global Health Rankings ☤ At the top: France is #1 ☤ US ranks 37th, between Costa Rica and Slovenia

Elderly as Percent of Total Population

Tobacco Smokers OECD, 2004 (2002 Data, U.K is 2001)

MRI Units per Million People OECD, 2004 (2002 Data, U.S., Canada, and Germany are 2001)

Why spend so much AND get so little? Reason # 1: Our profit- driven insurance system AND As long as millions are left out, everyone will suffer

Myths  Our “system” is fine, just needs band-aids  The safety net  We can’t afford to cover everyone  The best health care system in the world

International Timeline of Universal Healthcare Germany 1883 Switzerland1911 New Zealand1938 France 1945 United Kingdom1946 Sweden1947 USA1947* Japan1961 Canada1966 Australia1974 Italy1978 Spain1986 Taiwan1995 *President Truman proposed but failed to pass National Health Insurance

Myth Versus Reality  Every wealthy democracy has A National Program of Health Care For All  Socialized Medicine versus Single Payer

The Medical-Industrial Complex “Remember that what the rest of us call health care costs, they call income.” - Paul Krugman, Nobel Laureate New York Times 5/10/09

Physician Support – NHI 1 Ann Int Med, Carroll, Nov 18, Ann Int Med, Carroll, Apr 1, NEJM, Keyhani, Sept 14, 2009 ☤ 2003: 49% favor establish NHI 1 ☤ 2008: 59% now in favor 2 ☤ 2009: 58% expand Medicare 3

Physician Support for NHI by Specialty Ackermann R T, Carroll A E Ann Intern Med 2003;139: ©2003 by American College of Physicians

“It is time for our nation to extend coverage to everyone.” - Institute of Medicine, 2004

Why Health Care for All - Young and Old, Rich and Poor?

Insurance Premiums Workers’ Earnings Inflation Kaiser/HRET Survey of Employer-Sponsored Health Benefits, Bureau of Labor Statistics, Consumer Price Index

1 Hewitt Associates The Road Ahead: 2009 Our Broken System: ☁ 1 in 5 employers to drop health benefits in next 3-5 years