1. Disclosure No financial conflicts
Dr. Woolhandler served as an unpaid advisor to Bernie Sanders’ presidential campaign
She served as a staff member in Mr. Sanders’ Congressional office in , supported by a Robert Wood Johnson Foundation Fellowship at the Institute of Medicine

5. Rising Mortality For US Non-Hispanic Whites, 45-54
Source: Case & Deaton, PNAS 2016

11. Medicare’s “Software” 18.9 Million Seniors Enrolled Within11 Months

12. Washington Revolving Door

15. The uninsured

17. Did ObamaCare Fix it

18. 28,949 Deaths in 2015 Due to Lack Of Insurance
9.4% of the U.S. population had no health insurance in 2015, and an estimated 28,949 persons died as a result.
7.1% of Illinois residents lacked insurance in 2015 of whom 900 died.

25. Many Specialists Won’t See Kids With Medicaid
Figure 2 Clinics Scheduling Specialty Care Appointments for Children, According to Type of Insurance. Public insurance was reported by callers as the Illinois Medicaid–Children's Health Insurance Program (CHIP) umbrella program; private insurance was reported by callers as Blue Cross Blue Shield. Each of the 273 clinics was called twice (for a total of 546 calls) by the same caller, with only insurance coverage varying between the two calls: once reporting Medicaid–CHIP coverage and once reporting private coverage. Calls were made 1 month apart, and the order of the reported insurance status was randomly assigned. Asthma clinics included 38 allergy–immunology clinics and 6 pulmonary disease clinics.
Bisgaier J, Rhodes KV. N Engl J Med 2011;364:

26. Narrow Networks

28. Medication CoPays Increased Post-MI Vascular Events in Minorities – An RCT
No Co-Pay
Source: Health Aff 2014:33:863

33. Medical Education to Ameliorate Racism

37. Bureaucratization of Medicine

43. Single Payer

48. “Costs Don’t Add Up” –based on Thorpe analysis that was covertly coordinated with (and probably commissioned by) Clinton campaign (per Podesta wikileaks)
“Costs Don’t Add Up”

54. Medicare’s Value-Based Payment Reforms Have Flopped
ACOs – No savings after accounting for bonuses
Bundled Payment – No savings
P4P – No quality improvement
Medical Homes – No savings, no quality improvement

58. Medicare’s Bundled Payment Program: No Savings
“For most clinical episodes, there were no statistically significant differences in the change in Medicare standardized allowed payments between BPCI [Bundled Care Payments Improvement] participants and comparison providers”
Source: Lewin Group report prepared for CMS. CMS Bundled Payments for Care Improvement Initiative Models 2-4: Year 2 Evaluation & Monitoring Annual Report

60. Medicare’s “Value-Based Purchasing” Program Hasn’t Cut Mortality Rates
Source: BMJ 2016;353:i2214 – Data is for the three incentivized conditions – CHF, AMI & Pneumonia
Note: Program rewards hospitals based on process, outcome, patient experience and cost measures

63. Adverse Selection: Why the ACA Insurance Coops (and Other Good Guys) Can’t Compete
In Utah’s (failed) coop, 200 enrollees (0.3% of all enrollees) accounted for 50% of claims.
When Wisconsin’s coop “went live”, 19 people requested transplants within the first month.
New York’s (failed) coop was the only ACA plan that included New York City’s major cancer center (Memorial Sloan Kettering).
Source: Modern Healthcare 5/16/2016 & Politico 11/8/15

64. 64

65. Public Plan Option Cannot Solve Cost Problems
Achieves only a fraction (~1/7th) of administrative savings possible through single payer since no savings on providers’ administrative costs.
Medicare HMO experience shows private plans undermine fair competition despite regulations – avoid expensively ill.
Public plan effectively serves as subsidy for private insurers, taking on many high cost patients (or regions) and few profitable ones.

66. Mr. Trump’s Likely Health Policies
Repeal ACA
Shrink the generosity of Medicaid coverage via block grants or per-enrollee caps
Voucherize Medicare via “premium support”
End state-based consumer protections in private insurance plans by “allowing plans to be sold across state lines”
?? Measures to deny access to immigrant

70. Extras