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

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

5. Single-Payer No-Brainer ☝ EMTALA – We already live with healthcare as a human right ☝ We come out ahead financially ☝ Best way to get everyone covered = less primary care done in ED and fewer hassles making referrals

6. Single-Payer Downside ☟ If you practice in a tony suburb ☟ If you fear the power of big government more than the power of big corporations

7. Our Non-System of Illness Care

9. 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

10. President G W Bush “I mean, people have access to health care in America. “I mean, people have access to health care in America. After all, you just go to an emergency room.” After all, you just go to an emergency room.” Cleveland, Ohio, July 10, 2007

11. Indiana Governor Mitch Daniels “We already have universal health care in this state – anyone can go to the emergency room and get care 24/7.”

12. September 10, 2001

13. ED’s Feel the Pinch ☤ AMI and other urgent patients have increased wait times due to overcrowding by patients unable to obtain non-urgent care elsewhere 1 ☤ Uninsured children over 3X more likely to die from trauma-related injuries than children with commercial insurance 2 1” Waits To See An Emergency Department Physician: 1997– 2004” Wilper et al, Health Affairs 27, no. 2 (2008) 2 "Lack of Insurance Negatively Affects Trauma Mortality in U.S. Children” Rosen et al, Journal of Pediatric Surgery, 10/09

15. Insurance Premiums Workers’ Earnings Inflation 1999-2008 Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 2000-2008. Bureau of Labor Statistics, Consumer Price Index

16. 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

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

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

20. Where is the bureaucratic nightmare?

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

22. 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 8/21/2003 2 Congressional Budget Office, 1993, 3 separate reports 3 General Accounting Office, 06/91 ref: T-HRD-91-35

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

24. History (continued)  The birth of the Blues  1965: Medicare and Medicaid

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