1. Speaking To Physicians About Single Payer Matt Hendrickson, MD MPH PNHP California

2. P-PACA Patient Protection and Affordability Care Act President Obama set out 3 goals Universal Quality Affordable Let’s add one more goal Physician Quality of Life

3. Universal Universal Emergency Care! “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.” This was the old paradigm for Universal care, it’s called Universal Emergency Care. Congress passed a law in 1997, EMTALA which stated their firm support of the principle of healthcare as a right of all Americans. The problem was they didn’t come up with a way to pay for it. Rather than implement fundamental reform by removing the 400 billion dollar surcharge that the private insurance industry imposes on our system which could pay for first dollar coverage for all Americans. Instead, congress passed a law which mandates emergency rooms and hospitals to care for all Americans without funding, you ER doctors and hospitalists figure out how to deal with it. Once again Doctors getting stuck with the hot potato without the control to find a sustainable solution. We will return to this topic in the future! Back to the question of why 1% of the uninsured die every year due to lack of insurance. This was the old paradigm for Universal care, it’s called Universal Emergency Care. Congress passed a law in 1997, EMTALA which stated their firm support of the principle of healthcare as a right of all Americans. The problem was they didn’t come up with a way to pay for it. Rather than implement fundamental reform by removing the 400 billion dollar surcharge that the private insurance industry imposes on our system which could pay for first dollar coverage for all Americans. Instead, congress passed a law which mandates emergency rooms and hospitals to care for all Americans without funding, you ER doctors and hospitalists figure out how to deal with it. Once again Doctors getting stuck with the hot potato without the control to find a sustainable solution. We will return to this topic in the future! Back to the question of why 1% of the uninsured die every year due to lack of insurance.

4. Physician Quality of Life Physicians in 1997 were less satisfied in every aspect of their professional life than those asked similar questions in 1986. They were dissatisfied with the time they have with individual patients and their lack of incentives for high-quality care. 1. Murray A, Montgomery JE, Chang H, et al. Doctor discontent: a comparison of physician satisfaction in different delivery system settings, 1986 and 1997. J Gen Intern Med. 2001;16:451-459.

5. Burnout Malpractice ACOs/HMOs control our practice EMTALA Salaries stagnant Growing underinsurance

6. Burnout causes sense of control over the practice environment Freeborn DK. Satisfaction, commitment, and psychological well-being among HMO physicians. West J Med. 2001;174:13-18. Physician Quality of Life

7. Physician Salary

8. Specialty USCanada Family Medicine $164,952$167,064 Internal Medicine $170,889$248,721 Ob/Gyn $253,160$261,412 General Surgery $278,433$247,375 Anesthesia $309,019$205,441 Urology $317,778$279,982

9. P-PACA Cut Costs?= Doctors Fees Source - The Advisory Board Company

10. P-PACA The long term goal- Capitation

11. Cost Control PPACA Medicare Payment Reform Delivery Reform Fight fraud and abuse Coordination of care Electronic records Comparat effect. research NHP No more private insurance No more for-profit hospitals Bulk Savings on Drugs/Devices Global planning Malpractice settlements cut

12. Universal PPACA Guaranteed coverage! Unless you lose your job Unless you don’t pay your premium Unless you don’t pay your copay Unless it’s not included Unless you don’t pay your deductible Unless you’re undocumented NHP Everyone First dollar full coverage For Life

13. Quality PPACA Choice of insurance co. Provider network Copayment reduces basic care For profit hospital reduces quality 24 million uninsured NHP Free choice of MD Free choice of hospital No financial barrier to care No for profit hospital/ surgicenters. Global budgeting reduces financially incentivized overtreatment

14. Physician Quality of Life PPACA Accountable Care Organiz- ations designed to control physician practice Physicians quality control measures 50 million in demonstration grants to explore alternatives to tort litigation 24 million uninsured Referral problems for under- insured Administrative overhead con- sumes 10% of income Medicare SGR Unsustainable NHP No insurance industry No more HMOs the way we know them Physicians and pts in charge Malpractice settlement costs cut in half Dramatic reduction in admin. overhead Canada Primary Care Makes More $