Health Care for All Fiscally conservative Socially responsible Rob Stone MD Director, Hoosiers for a Commonsense Health Plan Assistant Professor of Emergency Medicine, IUSM

DISCLOSURES Dr. Rob Stone has no relevant financial relationships with commercial interests. Slides can be downloaded at: HCHP.info/Presentations

Lack of Insurance Kills 1 every 12 minutes 120 every day 45,000 a year People without insurance:  Live sicker and die younger  The safety net is full of holes American Journal Public Health, Wilper et al, Dec 2009

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

Bankruptcy 2009 $ 62% caused by illness and medical bills $ Most were middle class $ 78% were insured when they became ill Himmelstein et al, American Journal of Medicine, August 2009

Health Spending Per Capita Rampel, US Health Spending Breaks From the Pack, NYT 7/8/09

What Are We Paying For?  An incredibly complex system  Thousands of plans  Armies of people to: -deny coverage and payments - collect payments - determine eligibility

Where is the bureaucratic nightmare?

U.S. Overhead Spending International Journal of Health Services 2005; 35(1): 64-90

Medicare’s Efficiency: 3% Overhead $2003, 31% health spending on overhead – could save $286 Billion 1 $1993, CBO: “The net cost of Single Payer would be negative.” 2 $1991, GAO: “If US shifted to coverage like Canada, savings would offset the expense of universal coverage” 3 1 New England Journal of Medicine 8/21/ Congressional Budget Office, 1993, 3 separate reports 3 General Accounting Office, 06/91 ref: T-HRD-91-35

“Kids, your mother and I have spent so much money on health insurance this year that instead of vacation, we’re all going in for elective surgery.”

Brief History  WWII: Wage and price controls  1947: Truman pushes for National Health Insurance  AMA and Southern legislators oppose

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

Hospital Inpatient Days per Capita Rationing?

Physician Visits per Capita

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)

Kidney Transplants OECD, 2004 (2002 Data, Canada and Sweden 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

Obama on Single Payer  “A single payer plan is what I would like to see.” - addressing an AFL-CIO group in Chicago, 2003  “If I were starting from scratch, if we didn't have a system in which employers had typically provided health care, I would go with a single payer system.” - January 22, 2008, and many times after that

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

The Best Democracy Money Can Buy? $Health industry spending - $280 million on lobbying first half of $13 health lobbyists per member of Congress 2 1 The Center for Responsive Politics 2 American League of Lobbyists

Public Support – Single Payer Polls from April, Kaiser Family Foundation 2 January, Grove Insight Opinion Research 3 January, New York Times/CBS News ☤ 49% favor coverage from a single govt. plan 1 ☤ 59% prefer a system like Medicare for all 2 ☤ 59% say government should provide national health insurance 3

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

Our Non-System of Illness Care

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

What Can We Do? ✔ Educate Ourselves ✔ Find Our Voices ✔ Join In

HCHP.info

PHYSICIANS FOR A NATIONAL HEALTH PROGRAM PNHP.org

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

Waiting in Canada ☤ Fewer Canadians report unmet health needs 1 ☤ 96% prefer their system to ours 2 ☤ No waits for cancer care or emergency surgery 3 ☤ Americans without insurance wait forever 1 O’Neill and O’Neill, Forum for Health Economics & Policy Vol 10 (2007) 2 Gallup Poll, Toronto Star 5/12/99 3 Commonwealth Fund 7/16/07

Waiting for Medicare? ☤ Americans’ health improves at age 65 1 ☤ Americans are happier with Medicare than private insurance 2 ☤ US Medicare – no waiting 3 1 Journal of the AMA 12/26/07 2 Health Affairs 5/12/09 3 Self evident, no reference needed

Choice ? Employer Health Benefit Plans Offered Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 2008.

Some Choices Don’t Really Matter!

Partisan Reaction – Single Payer Indiana University Center for Health Policy and Professionalism Research 8/5/09

Partisan Reaction – Public Option Indiana University Center for Health Policy and Professionalism Research 8/5/09

Single Payer vs Public Option

Schoen, Health Affairs 6/10/08 Already ☠ 1 in 3 with insurance defer needed care now

Source: “Measuring the Health of Nations: Updating an Earlier Analysis”. Health Affairs, Jan./Feb

Health Care Expenditures Source: The Commonwealth Fund, calculated from OECD Health Data Per Capita, Adjusted for Differences in Cost of Living

Rampel, US Health Spending Breaks From the Pack, NYT 7/8/09 National Health Spending % GDP