1. Single Payer Health Care
Philip Madvig, MD
Associate Executive Director

2. What is single payer health care?
Government run healthcare like the NHS?
Government provided health insurance like Canada?
US Medicare
Multi-payer models like Germany?
Obama Care

3. The Healthy California Act
SB 562
The Healthy California Act
Senator Sanders
Medicare for All
All California residents, without respect to immigration status
All U.S. residents

4. The Healthy California Act
SB 562
The Healthy California Act
Senator Sanders
Medicare for All
BENEFITS
All medical care deemed medically appropriate by the provider.
Hospital services, ambulatory services, primary and preventative services, prescription drugs and devices, mental health and substance abuse services, lab/diagnostic services, reproductive and maternity care, pediatrics, oral health, audiology and vision and habilitative services. Much broader than 10 categories of ACA Essential Health Benefits, and inclusive of long-term care services.
PROVIDER CHOICE
Any willing California-licensed provider.
Any willing provider. Balance billing prohibited.
OVERSIGHT
Government-appointed Healthy California board to be governed by 9-person board
(5 appointed by Governor, 4 by legislature).
HHS Secretary and Congress.

5. The Healthy California Act
SB 562
The Healthy California Act
Senator Sanders
Medicare for All
FINANCING
No specific mechanism. Intent language to repurpose existing federal funds for individual, Medicare and Medicaid markets. Dependent upon necessary waiver approval.
No specific mechanism. Staff has suggested a 7.5% payroll tax, 4% income tax increase and capital gains tax modifications would suffice, but the bill presently contains no funding mechanism. Even if all funding mechanisms suggested were adopted, only about $16 trillion (roughly half the program’s 10-year cost) would be funded.
COST
Approximately $400 billion annually. Existing federal funds about half, other half would require additional tax revenue through new, 15% payroll tax.
The CBO has not officially scored the Sanders proposal, but a prior Urban Institute estimate pegged the tab at $32 trillion over 10 years.

6. PREMIUMS/COST-SHARING PROVIDER COMPENSATION
SB 562
The Healthy California Act
Senator Sanders
Medicare for All
PREMIUMS/COST-SHARING
Premiums and cost-sharing prohibited.
Cost-sharing prohibited, except for prescription drugs under certain circumstances that doesn’t exceed $200 annually. Premiums barred outside of transitional period.
PROVIDER COMPENSATION
Pure fee-for-service “until and unless another payment methodology is established by the Healthy California board.”
Fee-for-service, but payment demonstration methodologies under other markets could be retained.

7. COMPETITIVE/MA-LIKE MODEL
SB 562
The Healthy California Act
Senator Sanders
Medicare for All
COMPETITIVE/MA-LIKE MODEL
Does not permit Medicare Advantage/Part C-like model.
Only permits such plans during 4-year transitional period. Public option through Exchanges would be instituted for the transitional period.
KP ROLE
Sale of private insurance benefits illegal. Care coordination services can be provided that include administrative tracking and medical recordkeeping.
Unlawful to sell private insurance benefits duplicative of program (through employer market or otherwise) beginning on effective date, four years after becoming law. Theoretically could exist for provision of some elective services.

8. What problems are we trying to solve?

9. Changing costs over time
Trend in Health Care Costs, Percent of GDP
COSTS, % GDP
1929
2014
$3.7 Billion
$3.021 Trillion

10. Quality Questioned: IOM reports
To Err is Human
100,000 deaths/year from harm
Crossing the Quality Chasm
“Between the health care that we now have and the health care that we could have lies not just a gap, but a chasm”.

11. What would it take to enact single payer?
Corollary: What happened in Vermont?

12. Trump, Republicans “Who knew healthcare was this complicated?”
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