RStoneHealthcareForAll by 8V4xjYtD

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									HEALTH CARE FOR ALL

   Myths and Reality


      Rob Stone MD FACEP
     THE PROBLEM OF THE
         UNINSURED
• 46 Million is 16% of the
  population.
• Indiana has 800,000
  uninsured
• To get 46 million take all of
  Indiana, plus Texas,
  Florida, and Connecticut.
         Uninsured Americans




CPS and NHIS Data
Who are the uninsured?
                                 Children
                                  19%
                                            Unemployed
                                               5%



                                                *Out of
 Employed                                     labor force
   54%                                           22%



*Students>18, Homemakers,
Disabled, Early retirees

Source: Himmelstein & Woolhandler - Tabulation from CPS
     Lack of Insurance Increases
              Mortality
• 18,000 excess deaths per year due to lack of health
  coverage
• People without insurance:
      - Receive less care and receive it later
      - Have 25% higher mortality rates
      - Receive poorer care when they are in
  hospitals
• This is the fifth leading cause of death in the US
• The safety net is full of holes

Care Without Coverage, Institute of Medicine, May 2002
    Medical Bankruptcy in Indiana
•   2004 estimate: 55,000 bankruptcies
•   Almost 28,000 related to medical costs
•   Affecting 77,000 family members
•   75% had coverage at start of illness
•   Average out of pocket medical expenses
    leading to bankruptcy - almost $12,000.

Himmelstein et al, Health Affairs 2/2/05
           A Brief History
• Wage and price controls
  in WW II
• Truman pushes for
  National Health Insurance
  1949. AMA opposes.
                Red Baiting
“Would socialized medicine
 lead to socialization of other
 phases of life? Lenin thought
 so. He declared socialized
 medicine is the keystone to
 the arch of the socialist state.”


AMA Pamphlet 1949
    A Brief History (continued)

• The birth of the Blues
• The Great Society: Medicare
  and Medicaid 1965
• The Clinton Health Plan 1993
• The death of the not-for-profit
  Blues
  Anthem (formerly Blue Cross)
        Now Wellpoint
• CEO Larry Glassock is in
  Indianapolis
• The highest paid executive in
  Indiana
• Bonus announced in 2003 was
  $42.5 Million


Indianapolis Star 4/7/04
Where Does the Money Come From?




      And Where Does It Go?
               Per Capita National Health Spending
                     Reached $4,637 in 2000
                                                                                            $4637



                                                                                    $3637


                                                                            $2690


                                                                    $1733

                                                            $1052
                                                     $582
                                         $341
            $105      $141      $202
   $82

   1950     1955      1960      1965      1970       1975   1980    1985    1990    1995    2000
SOURCE: Centers for Medicare and Medicaid Services
         US Versus Other Countries
       Japan                  $2,080

        U.K.                   $2,160

      Sweden                      $2,520

      France                           $2,740

    Germany                             $2,820

      Canada                             $2,930

         U.S.                                           $5,270

                               $ Per Capita

OECD, 2004 & Health Affairs 2002; 21(4): 99
2004 data Health Affairs 1/06: $1.9 trillion or $6,280 per capita
      And Where Does It Go?

• The money is going to:
  - Overhead
  - Inefficiency
  - Waste
  - Profit
  - And graft
  Growth of Physicians, RNs &
   Administrators 1970-1998
          Percentage
2500
          Growth
2000

1500                                           Administrators
                                               RNs
1000                                           Physicians


500

   0
   1970     1975   1980   1985   1990   1998


                    Bureau of Labor Statistics, NCHS
   What Do Administrators Do?
         Cost Shifting.

• The $5 aspirin pill
• The $500 ER bill
• “Skimming the cream off the
  top”: Avoiding the costly, the
  very sick, and the uninsured

It’s called “GAMING THE SYSTEM” or “SURVIVOR”
    What Are We Paying for?
• A Very Complex System
• 7000+ private health plans
  – An army of people to deny health insurance
    coverage and payments
  – And an army of people to try to maximize
    and receive health insurance payments
  – An army of people to determine who is
    eligible for what program
         U.S. Overhead Spending
   30%
                                                        26.5%


                                          19.9%
   20%
                         16.3%



   10%



    0%
          Medicare   Non-Profit Blues   Commercial   Investor-Owned
                                         Carriers         Blues


International Journal of Health Services 2005; 35(1): 64-90
        U.S. Overhead Spending
  30%
                                                        26.5%


                                          19.9%
  20%
                         16.3%



  10%

           3.1%

   0%
          Medicare   Non-Profit Blues   Commercial   Investor-Owned
                                         Carriers         Blues


International Journal of Health Services 2005; 35(1): 64-90
    Health Care Administration
          US and Canada

• US administrative spending = $399.4
  Billion or 31% of total health care costs.
• Canada spends 17% on administrative
  overhead.
• Potential savings = $286 Billion, enough to
  cover the uninsured and then some.

Woolhandler et al. NEJM 349:768-75 8/21/2003, CBO, GAO
                 …. And Graft
“Investor ownership has been shown to
  compromise quality of care in hospitals,
  nursing homes, dialysis facilities, and
  HMO’s; for-profit hospitals are particularly
  costly. A wide array of investor-owned
  firms have defrauded Medicare and been
  implicated in other illegal activities.”

Journal of the American Medical Association, 8/13/03
              Columbia/HCA
• Fined $1.7 Billion in 2003 for Medicare
  fraud, the largest fine in Medicare history.
• No one went to jail.
• CEO Richard Scott left with a $10 million
  severance package and over $300 million in
  stock.

  Woolhandler, Canadian Medical Journal 6/8/04
       And What Do We Get
        For All Our Money?
• The most expensive health care in the
  world, no doubt.
• The best health care in the world?
• How would you measure the best health
  care in the world?



                   *
                  Life Expectancy
                                                            81.5

                                           79.7    79.9
  80                              79.4
                         78.5
                78.1
        77.1


  75




  70
        U.S.    U.K.   Germany   France   Canada   Italy   Japan

US ranked 27th, right after Barbados; OECD, 2004, (2001 Data)
     Infant Mortality per 1000 Births
 8
       6.8
 7

 6
               5.2        5
 5                                 4.7
                                             4.3        4.1
 4
                                                                 3.1
 3

 2

 1

 0
       U.S.   Canada   Australia   Italy   Germany     France   Japan


Ranked 36th, below Cuba and Taiwan                   OECD, 04
  WHO Global Health Rankings
• Based on outcomes AND fair
  distribution of care

• At the top: #1. France, #2. Italy

• US ranks 37th, between Costa Rica and Slovenia


  Bartlett and Steele, Critical Condition, 2004
Satisfaction with Health Systems
          in Ten Nations
• Harris Poll taken in US, Canada, UK,
  Germany, Australia, France, Sweden, Japan,
  Italy, and Holland.
• The U.S. had the lowest health care
  satisfaction rate (11 percent) of the 10
  nations.


      Blendon et al. Health Affairs, Summer 1990
How Can We Pay So Much and
       Get So Little?
          Inpatient Days per Capita
1.4
                                                                                1.2
1.2                                              1.1          1.1
                       1.0            1.0
1.0
0.8       0.7
0.6
0.4
0.2
0.0
                                    lia
         .




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OECD, 2004, (2001 Data)
   % Finding Difficulty in Receiving
                Care
    % finding it difficult to get care



                                         30   28

                                         25
                                                      21
                                         20
                                                                  15           15       15
                                         15

                                         10

                                         5

                                         0
                                              U.S.   Canada   New Zealand   Australia   U.K.


Commonwealth Fund Survey, 1998
Elderly as Percent of Total Population,
                 2000
       Percent of Population Older Than 65




                                             20%
                                                                                                    16.4%      17.1%
                                                                                  15.9%     16.0%
                                             15%
                                                   12.5%   12.1%        12.8%


                                             10%


                                             5%


                                             0%
                                                            Australia
                                                    U.S.




                                                                                             U.K.



                                                                                                     Germany



                                                                                                                Japan
                                                                         Canada



                                                                                   France




Source: Health Affairs 2000; 19(3):192
                                         Tobacco Smokers
                                35
                                                                             30.9
   % population smoking daily




                                30                                   28.6
                                                             27.0
                                25                   24.0

                                20    18.0    18.4

                                15

                                10

                                5

                                0
                                     Canada   U.S.   Italy   U.K.   France   Japan


OECD, 2004 (2002 Data, U.K is 2001)
   MRI Units per Million People
   40
                                                             35.3
   35
   30
   25

   20
   15
                                                     10.4
   10                               8.2      8.6
                            5.5
                  4.2
    5    2.7

    0
        France   Canada   Germany   U.S.   Denmark   Italy   Japan


OECD, 2004 (2002 Data, U.S., Canada, and Germany are 2001)
             Renal Transplants

40                                                    38
                         34       35       35
35
                31
30     29

25
20
15
10
 5
 0
      U.K.   Australia   U.S.   Sweden    Canada     France


OECD, 2004 (2002 Data, Canada and Sweden are 2001)
The Health Care System Dinosaur
  Stumbles Toward the Tar Pit




     Our non-system of illness care
                  Myths
• Our “system” is fine, it just
  needs adjustment
• There is a safety net
• We can’t afford to cover
  everyone
• We have the best health care system in the
  world
And the Myth of “Moral Hazard”
• “If you think health care is expensive now,
  just wait until it’s free.” PJ O’Roarke
• The “logic” of Health Savings Accounts
• The 80/20 rule
• Some things are best not left to the
  marketplace

 Gladwell, The New Yorker, 8/29/05
          Myth Versus Realty
• Every other industrialized country has come
  to the same conclusion, a national program
  to insure health care for all.

• We can learn from the Canadian
  experience:
  National health insurance (a “single payer”)
  Fee for service independent doctors just like our
  Medicare
  Not-for-profit independent hospitals
   International Timeline of Universal Health Care
Germany                     1883
Switzerland                 1911
New Zealand                 1938
Belgium                     1945
France              1945
United Kingdom              1946
Sweden                      1947
USA                         1948*
Greece                      1961
Japan                       1961
Canada                       1966
Denmark                      1973
Australia                    1974
Italy                        1978
Portugal                     1979
Spain                        1986
South Africa                 1996
           The Health Care We Get
•   1/3 are uninsured or underinsured

•   HMOs deny care to millions more with expensive illnesses

•   Death rates higher than other wealthy nations’

•   Costs double Canada's, Germany's, or Sweden's - and rising
    faster

•   Executives and investors making billions

•   Destruction of the doctor/patient relationship
    The Health Care We Want
•    Guaranteed access

•    Free choice of doctor

•    High quality

•    Affordability

•    Trust and respect
         We Have What it Takes

•   Excellent hospitals, empty beds
•   Enough well-trained professionals
•   Superb research
•   Current spending is sufficient
•   Polls show the people are ready for change
•   Large and small business are calling for
    change
Government Health Insurance for All, Even if
            Taxes Increase?
             No opinion
                5%

       No opinion 5%
                                Oppose
                                 30%




           Favor
           65%


 Pew Report, May 2005
Please indicate whether you support or oppose this
        policy: Universal Health Insurance
                 Unsure
                       8%


                       Unsure 8%
        Oppose
         17%




                                                    Strongly
                                                     Favor
                                                      52%




        Somewhat
          favor
           23%

Harris Poll, Wall Street Journal October 20, 2005
   Remember Columbia/HCA?

• Senate Majority Leader
  Dr. Bill Frist owns $25
  million in HCA stock.
• HCA is the Frist family
  business.
Why Health Care for
  Every Person,
  Young or Old,
  Rich or Poor?
“The care of human life
  and happiness, and not
  their destruction, is the
  first and only
  legitimate object of
  good government.”

Thomas Jefferson
“Never doubt that a small
 group of thoughtful,
 committed citizens can
 change the world.
 Indeed, it is the only
 thing that ever has. “

Margaret Mead
www.HCHP.info
PHYSICIANS FOR A NATIONAL HEALTH PROGRAM
29 EAST MADISON
SUITE 602
CHICAGO, IL 60602
TEL: (312) 782-6006

WWW.PNHP.ORG
Gallup pole 3/04: More Americans worried “a great deal” about
affordability and availability of health care than a terrorist attack,
60% vs. 42%.
          WHAT ABOUT
          MALPRACTICE?
• Democrats propose limiting “frivolous
  suits” thru something like the panels we
  have here in Indiana. Good idea.
• Republicans favor putting caps on non-
  medical settlements like we have here in
  Indiana. Good idea.
          WHAT ABOUT
          MALPRACTICE?
• Future medical payments themselves are
  about 25% of total payouts.
• Many suits are triggered by anger over bills
  for care received.
• Both of these factors would be taken care of
  by a single payer system.
          WHAT ABOUT
          MALPRACTICE?
• Malpractice costs account for ~1% of total
  health care spending.
• The real answer is for doctors and lawyers
  to come together and face their common
  enemy: the insurance industry.

								
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