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					PHYSICIANS FOR A NATIONAL HEALTH PROGRAM 29 EAST MADISON SUITE 602 CHICAGO, IL 60602 TEL: (312) 782-6006
WWW.PNHP.ORG

Who Are The Uninsured?
deyolpmE %05
Source: Himmelstein & Woolhandler - Tabulation from 1999 CPS

*Students>18, Homemakers, Disabled, Early retirees

robal fo tuO* ecrof %02 deyolpmenU %5 nerdlihC %52

Chronically Ill and Uninsured

Unmet Health Needs of the Uninsured

18,314 Adult Deaths Annually Due to Uninsurance

Full Time Jobs Provide Little Protection for Hispanics
ni ylredle-non fo tnecreP oh w rekro w e mit-lluf a hti w seili maf derusninu era
cinapsiH kcalB etihW %0 %01 %02 %03

Source: Commonwealth Fund, 3/2000

Rising Out-of-Pocket Costs for Seniors
Voucher/Premium Support Proposals Would Worsen
%34
Percent of Income
Source: Senate Select Committee on Aging; AARP 4/95 & 3/98; and Commonwealth Fund May, 1999 projections (adjusted to include nursing home costs)

%53 %52 %32 %12 %41 %21

0002

7991

4991

4891

7791

)wal tnerruc( 5202

)troppus muimerp( 5202

Who Pays for Nursing Home Care?
Medicaid 44%

Other 5% Out of pocket 31% Private 7%

Medicare 14%

Source: Health Affairs 2000; 19(3):44

Illness and Medical Costs, A Major Cause of Bankruptcy
• 45.6% of all bankruptcies involve a medical reason or large medical debt

•
• •

326,441 families identified illness/injury as the main reason for bankruptcy in 1999
An additional 269,757 had large medical debts at time of bankruptcy 7 per 1000 single women, and 5 per 1000 men suffered medical-related bankruptcy in 1999

Source: Norton's Bankruptcy Advisor, May, 2000

Many With Insurance Lack Choice 42% Are Offered Only 1 Plan
-000,05$ 999,99$ -000,03$ 999,94$

eciohC oN hti W tnecreP

Note: Those without choice were 70% more likely to give their plan a low rating
Source: Health Affairs 1998; 17(5):184

%53

%93

puorG emocnI
-000,02$ 999,92$

%94

-000,01$ 999,91$

%35

K01$<

%56

%0 %02 %04 %06

Patients Refused Authorization for ER Care
• 8% to 12% of HMO patients presenting to 2 ERs were
denied authorization

• Authorization delayed care by 20 to 150 minutes • Of those denied:
47% had unstable vital signs or other high risk indicators 40% of children were not seen in f/u by primary MD
Eventual diagnoses included: meningococcemia (2), ruptured ectopic (2),shock due to hemorrhage (2), septic hip, PE, MI (2), ruptured AAA, pancreatitis, peritonsillar abscess, small bowel obstruction, unstable angina, pneumothorax, appendicitis, meningitis(3)
Source: J Emerg Med 1997; 15:605; Acad Emerg Med 1997; 4:1129; Ann Emerg med 1990; 19:59

Financial Suffering at the End of Life
gnitropeR llI yllanimreT fo % smelborP detaleR-tsoC lacideM
**.cte tessA dloS ylimaF %01> *emocnI ereveS/doM melborP
%0

Source: Ann Int Med 2000; 132:451 - Study of 988 terminally ill patients * Out-of-pocket medical costs > 10% of household income ** Patient or family sold assets, took out mortgage, used savings or took extra job

%21 %12 %93
%01 %02 %03 %04

Why Women Delay Prenatal Care When They Know They Are Pregnant
47%

31% 22%

No money or insurance Other reason

Unable to get appointment

Note: 11.1% of pregnant women failed to get timely prenatal care despite knowing they were pregnant
Source: MMWR 5/12/2000; 49:393

Distribution of Wealth, 1976 & 1998
1976
19% 30%

1998
34% 35%

51%

Wealthiest 1% Next 9% Bottom 90%

31%

Poverty Rates, 1997 U.S. and Other Industrialized Nations
%02 leveL ytrevoP woleB noitalupoP fo %
Source: Luxembourg Income Study Working Papers Note: U.S. figure for 1997, other nations most recent available year

%51

%01 %71

%11

%11

%11

%5 %9 %8 %6

%0 ecnarF adanaC SU KU sdnalrehteN nedewS ynamreG

9931 0651 6561 1371 9881 3881 6691 0002 0571 0051 0521 0001 057 005 052 0

7991 - raey-rekrow/sruoH

Source: International Labor Organization, 1999

yawroN ynamreG ecnarF .K.U napaJ )0891( .S.U )7991( .S.U

Americans Lead the World in Hours Worked

Causes Of Excess Deaths Among African Americans
H/amuarT sgurD /VI %92 rehtO %71 tnafnI %6 setebaiD %3 recnaC %02

Cardiovascular 39%

Source: Himmelstein & Woolhandler - Analysis of data from NCHS

ELAM

rehtO %71

VIH/amuarT sgurD / %21

ELAMEF

tnafnI %21 setebaiD %8 recnaC %31

Cardiovascular 25%

Racial Disparity in Access to Kidney Transplants

Pharmacies in Minority Neighborhoods Fail to Stock Opioids
%06>

htiw seicamrahP fo % ylppuS dioipO etauqedA

Source: N Engl J Med 2000; 242:1023

%52

doohrobhgieN ni stnediseR ytironiM %
%06-12

%35

%12<

%27

%0 %52 %05 %57 %001

Minority Physicians Provide More Care for the Disadvantaged
rooP %13 %02 %81 derusninU %41 %21 kcalB

Ethnicity of Physician

ecitcarP fo tnecreP

Source: AJPH 1997;87:817

cinapsiH

%01

%42 %22

etihW

diacideM %41 %0 %01 %02 %03 %04

Are Emily and Brendan More Employable than Lakisha and Jamal?

Growth of Registered Nurses and Administrators 1970-2002
1002 5991 0991
sNR

0791 ecnis htworG

Source: Bureau of Labor Statistics & Himmelstein/Woolhandler/Lewontin Analysis of CPS data

srotartsinimdA

5891

0891

5791

0791 %0001 %0051 %0002 %0052 %005 %0

Growth of Physicians and Administrators 1970-2002
0791 ecnis htworG

Source: Bureau of Labor Statistics & NCHS

%0 0002 5991 0991 5891 0891 5791 0791
snaicisyhP srotartsinimdA

%005 %0001 %0051 %0002 %0052

High Risk HMO Patients Fared Poorly in the Rand Experiment
Relative Risk of Dying
1.5

Diastolic Blood Pressure
90 85 80

1

0.5

1.21

1

87.8

82.9
75 70

0 HMO FFS

HMO

FFS

Source: Rand Health Insurance Experiment, Lancet 1986; i:1017 Note: High Risk = 20% of population with lowest income + highest medical risk

The Elderly and Sick Poor did Worse in HMOs
Changes in Physical Health at 4 Years
%06 esroW retteB %04 esroW/retteB stneitaP fo %
Source: Medical Outcomes Study - JAMA 1996;276:1039

%02

%0

%02

%04

%06 ylredlE - OMH rooP kciS - OMH ylredlE - SFF rooP kciS - SFF

Elderly HMO Stroke Patients Get Less Specialist Neurology Care
eraC tsilaicepS rof oitaR sddO stneitaP OMH-noN ot evitaleR

Source: Medical Care 1999; 37:1186 Note: Patients receiving specialist neurology care had 23% lower 1 year mortality

47> 4.0

47-56 15.0

46-55 45.0

60.1

55<

segA llA 25.0 0 1 5.0 5.1

HMOs' Stroke Patients:
Fewer Go Home or to Rehab, More to Nursing Homes
emoH gnisruN
%82 %24

segrahcsiD fo tnecreP

Source: JAMA 1997; 278:119

S-F-F eracideM

tinU baheR
%32 %61

OMH eracideM

%94

emoH
%24 %0 %01 %02 %03 %04 %05

HMOs Push Heart Surgery Patients to High-Mortality Hospitals
-hgiH gnisU stneitaP *GBAC fo % slatipsoH ytilatroM
eracideM OMH etavirP OMH eracideM SFF etavirP SFF
Source: JAMA 2000; 283:1976 *CABG = coronary artery bypass graft surgery

%46

%95

%94

%54

%0 %02 %04 %06

Depressed Patients: Fee-for Service Vs. Managed Care
Fee-For-Service Primary Care Patients Managed Care

Depression Detected Appropriately Treated Patients Seeing Psychiatrist
# Functional Limitations - Baseline # Functional Limitations - 2 Years

53.7% 60.7%

41.8% 46.4%

1.3 1.2

1.5 2.0

SOURCE: Medical Outcomes Study - JAMA 1989;262:3298 & Arch Gen Psych 1993; 50:517

Managed Mental Health: Audit Report
• • • •
• • •
Plans overstated utilization by 45%
Delay from initial call to starting care > contractor's written standard by 97%-347%

Plans rarely site-visited or interviewed providers
No providers in 15% of counties "covered"; no child provider in 25% of counties Quality problem in 30-58% of charts reviewed Criteria for inpatient care dangerously restrictive (eg. requiring DTs prior to detox admit) Overhead + profit NEVER consumed < 45% of premiums

Source: J. Wrich - Audit findings submitted to CBO, 3/98

Primary Care Physicians: Patients Can't Get Quality Mental Health Services
How often can you obtain high quality mental health services for your patients?
Always/Almost always 32% Sometimes 29%

Frequently 19%

Never/rarely 20%

Source: Center for Studying Health System Change, 1997 - survey of 5,160 primary care physicians Note - Data shown are for inpatient care; responses regarding outpatient care were similar

States that Limit New Heart Surgery Programs: Higher Volumes, Lower Mortality

Unnecessary Procedures

Seniors Without Drug Coverage Forego Cardiac Medications

Out-of-Pocket Costs for Medicare HMO Enrollees, 1999-2002

Can Seniors Make Informed HMO Choices?
Proportion with Knowledge of How HMOs Work
Inadequate knowledge 59%

No knowledge 30%

Adequate knowledge 11%

Source: AARP Survey - Health Affairs 1998; 17(6):181

Medicare HMOs: The Healthy Go In, The Sick Go Out
eracideM SFF fo % sa stsoc tneitapnI

* Data are for 12 month period before joining HMO ** Data are for 3 month period after leaving HMO Source: N Engl J Med 1997; 337:169

retfA **OMH gnivaeL

%081

erofeB *OMH gninioJ

%66

eracideM SFF

%001

%0 %05 %001 %051 %002

tiforp-roF

tiforp-noN
%001 %57 %05 %52 %0

9991

7991

5991

3991

1991

9891

7891

5891

Source: Interstudy

tnemllornE OMH fo %

For-Profit HMOs’ Increasing Dominance, 1985-2000

Investor-Owned HMOs Provide Lower Quality Care
I m um B te a D ai b ite c aM m m o rg B ol c ek r n zi de O ev r la l aP p

E ey

oT dd

P so t

em a sr

E ax sm

)tnecrep( etar egarevA

y

IM

Source: Himmelstein, Woolhandler, Hellander & Wolfe - JAMA 1999; 282:159

26

45

a itc no

l re s

pa h

ita fs

S

84

S

tiforP-roF-toN tiforP-roF

53

17

95

77

96

57

96

27

46

52 05 57 001

0

“Productive” Physicians, Worse Care
ygolomlahthpO larrefeR "wolS" airunietorP gnitseT "tsaF"
:oitaR doohilekiL stneitaP citebaiD rof gniredrO
Note: Fast physicians = those seeing more pts./hour than average Slow Physicians = those seeing fewer pts./hour than average Source: Arch Int Med 1999; 159:294

Physician Practice Style

1

52.0

1

35.0

1

LDH gnitseT

6.0

0 1 5.0 57.0 52.0

Doctors Urged to Shun the Sick
“[We can] no longer tolerate patients with complex and expensive-to-treat conditions being encouraged to transfer to our group.”
-Letter to faculty from University of
California Irvine Hospital Chief

Source: Modern Healthcare, 9/21/95:172.

Corporate Social Responsibility?
“Few trends could so thoroughly undermine the very foundations of our free society as the acceptance by corporate officials of a social responsibility other than to make as much money for their shareholders as possible.” Milton Friedman, 1962
Source: Milton Friedman - Capitalism & Freedom, 1962.

Health Insurers' Tobacco Habit Stock Holdings in 1999 - $ Millions
Prudential MetLife/ Travelers Cigna

RJ Reynolds
Philip Morris Loews (Kent etc.)

$137.2
$435.2

$55.3

$38.6

$319.6

$6.8

$4.1

Source: Boyd, Himmelstein & Woolhandler - JAMA 8/9/2000

Milliman & Robertson Pediatric Length of Stay Guidelines
• • •
1 Day for Diabetic Coma 2 Days for Osteomyelitis 3 Days for Bacterial Meningitis

“They're outrageous. They’re dangerous. Kids could die because of these guidelines.”
Thomas Cleary, M.D. Prof. of Pediatrics, U. Texas, Houston Listed as "Contributing Author" in M&R manual

Source: Modern Healthcare May 8, 2000:34

Milliman & Robertson
“We do not base our guidelines on any randomized clinical trials or other controlled studies, nor do we study outcomes before sharing the evidence of most efficient practices with colleagues.”

Wall Street Journal 7/1/98

Medicare Costs Rose Faster in Communities with For-Profit Hospitals
atipac rep tsoc eracideM
tiforp-roF 5991 tiforp-noN 5991 tiforp-roF 9891 tiforp-noN 9891 latipsoH 0$ 000,1$

$5,148 $4,427 $3,990 $3,556

Note: For-profit=HSA with only for-profit hospitals (n=208) Non-profit=HSA with only non-profit hospitals (n=2860)
Source: Silverman, Fisher & Skinner - NEJM 1999;341:420

scvS rehtO

htlaeH emoH

naicisyhP

000,2$ 000,3$ 000,4$ 000,5$ 000,6$

Why Are For-Profit Hospitals Costlier? Higher Administrative and Non-Personnel Costs
$8,115 $6,507
661,2$ 909,2$ 234,1$ 692,3$ cilbuP noitartsinimdA -roF-toN tiforP tiforP-roF 0$

yats latipsoh rep tsoC

$7,490

Source: Woolhandler & Himmelstein - NEJM 3/13/97 - Analysis of data from 5201 acute care hospitals Note: Costs are for FY 1994, adjusted for hospital case mix and local wages

stsoC rehtO llA

583,2$

908,1$

lennosreP lacinilC

459,2$ 278,2$ 982,2$ 005,2$ 000,5$ 005,7$ 000,01$

Death Rates are Higher at For-Profit Hospitals
fo tnecreP sA etaR htaeD detsujdA slatipsoH tiforP-roF ta etaR

* 85.5% Non-Profit, 14.3% Government, 0.2% For-Profit
Source: NEJM 1999; 340:293

rojaM *gnihcaeT

%57

tiforP-noN gnihcaeT oN

%39

tiforP-roF gnihcaeT oN

%001

%05 %57 %001

Death Rates Were Higher at For-Profit Hospitals in 1989
tnecreP sA etaR htaeD detsujdA slatipsoH tiforP-roF ta etaR fo
tiforP-noN *gnihcaeT %98 stiforP-noN llA %49 tiforP-roF
*Member of Council of Teaching Hospitals
Source: NEJM 1989; 321:1720

%001

%05 %57 %001

VA Quality of Care for MI Patients: Better than Other Hospitals

More Nurses, Fewer Complications A Study of 589 Hospitals in 10 States
• A 1 hour increase in RN hours/patient day was associated with:

8.4% decrease in post-op pneumonia 5.2% decrease in post-op thrombosis 3.6% decrease in post-op pulmonary compromise 8.9% decrease in post-op UTIs
• For-profit hospitals had higher rates of post-op pneumonia, pulmonary compromise & UTI, even after control for their lower RN staffing
Source: Kovner & Gergen - Image: J Nurs Schol 1998;30:315

Fewer Nurses, Worse Hospital Outcomes

Nursing Home Staffing Low Standards, Poor Working Conditions
• • Required: 1 RN - 8 hrs/day, 1 LPN - 24 hrs/day RNs + LPNs = only 30% of nursing staff

•
•

Pay = 15-20% below hospitals
Turnover rates = 80-100%/year

Source: C. Harrington, UCSF - 1997

For-Profit Dialysis: More Deaths, Fewer Transplants
tnalpsnarT ot derrefeR %7 %5 tiforP-noN tiforP-roF etaR htaeD %71 %12 %01 %51 %02 %52 %0
Note: Figures are adjusted for demographic factors and co-morbidities Source: NEJM 1999; 341:1653

%5

For Profit Dialysis For Children: Less Use of Peritoneal Dialysis
.sv tiforP-roF ,esU DP rof oitaR sddO tiforP-noN
detsujdA 2.2 detsujdanU
Source: Pediatrics 104:519

9.2

0 1 2 3 4

End Stage Renal Disease Care 85% of U.S. Providers are For-Profit, Outcomes are Worse than Canada's
• U.S. death rates for dialysis patients are 47% higher after control for age, sex, race & comorbidities Canadians get more transplants (35% vs. 17%) 57% of U.S. patients were treated with reprocessed dialyzers, 0% in Canada Costs lower in Canada by $503/patient/month Fresenius (a German firm) controls 24% of U.S. market; profit = $225/patient/month

• • • •

Source: Med Care 1997; 35:686 & Fresenius SEC filings, 2000

Investor-Owned Care Summary of Evidence
• Hospitals: Costs 3%-11% higher, fewer nurses, higher overhead, death rates 6%-7% higher, fraud HMOs: Higher overhead, worse quality, collaboration with tobacco industry Dialysis: Death rates 20% higher, less use of transplants & peritoneal dialysis, fraud Nursing Homes: More citations for poor quality, fraud Rehab Hospitals: Costs 19% higher

• • •

•

Crime Pays: CEOs Who Cook the Books Earn More

U.S. Seniors Paying More for Ten Top Selling Drugs*
Vermont $129.33

Canada

$75.54

Mexico

$69.35

Source: U.S. GAO – www.house.gov/bernie/legislation/pharmbill/international.html

*Zocor, Ticlid, Prilosec, Relafen, Procardia XL, Zoloft, Vasotec, Norvasc, Fosamax, Cardizem CD

Millions Can’t Afford Prescriptions

%72 %32 %82 %82 %33 emocnI latoT fo tnecreP a sa sexaT .S.U

Source: Congressional Research Service, 12/13/1999 Note: Figures are industry-wide averages for 1993-1996

%61

smriF gurD seirtsudnI llA gnirutcafunaM noitcurtsnoC secivreS /tropsnarT seitilitU

yrtsudnI

Drug Firms Avoid Taxes

Drug Company Marketing, 19962001

Drug Company Sponsored Miseducation
•
• • •

•

Spending for drug promotion (>$10 billion/yr.) exceeds total medical student teaching costs The average MD meets with one of the 56,000 drug reps once a week Attending drug company-sponsored CME predicts worse prescribing 11% of drug reps’ factual claims are false (all favorable) - 26% of MDs recognize even one falsehood 30% of journal drug ads falsely claim "drug of choice", 40% omit key side effect info

Source: JAMA 283:373 & 273:1296, Ann Int Med 116:919, and www.nofreelunch.org

Percent of Population with Government-Assured Insurance
.K.U %001 napaJ %001 ailartsuA adanaC %001 %001 ecnarF ynamreG %001 %29 .S.U %54 %0
Note: Germany does not require coverage for high-income persons, but virtually all buy coverage Source: OECD, 2002 - Data are for 2000 or most recent year available

%001

%02 %04 %06 %08

Federal Tax Subsidies for Private Health Spending, 1998
2$ 0 4$ 0 7 -5 $ $ $ $ > 1$ 0

1 -5

3 -0

5 -0

<

1$

-

-

03 K

05 K

K5

K0

K0

K5

00 K

2

4

7

1

ylimaF reP ydisbuS xaT emocnI yB

Note: Total federal tax subsidy = $111.2 billion
Source: Health Affairs 1999; 18(2):176

7532$

K0

1791$

4861$

emocnI ylimaF 5911$ 748$ 535$ 692$ 17$ 0003$ 0052$ 0002$ 0051$ 0001$ 005$ 0$

Elderly as Percent of Total Population, 2000
ailartsuA adanaC ecnarF ynamreG .S.U .K.U napaJ

56 nahT redlO noitalupoP fo tnecreP

Source: Health Affairs 2000; 19(3):192

%1.71

%4.61

%0.61

%9.51

%8.21

%1.21

%5.21

%0 %5 %01 %51 %02

tahwemos ro yrev ,ylemertxe ti gnidnif % dedeen nehw erac teg ot tluciffid

53

03

52

02

51 5

01 0
U S. . C na a ad eZ la

12

81

51

51

Source: Commonwealth Fund Survey, 1998

82

eN w na d

la ai

A su rt

Difficulties Getting Needed Care

U K. .

rotcod emas htiw tnecreP sraey 5 naht erom
%06 %04 %02 %0

%54

U S. . eZ a al dn eN w

%25

%75

%95

%95

Source: Commonwealth Fund Survey, 1998

C na da a A su rt la ai

Continuity of Care

U K. .

Medical Journal Articles per Capita

Minimum Standards For Canada's Provincial Programs
1. Universal coverage that does not impede, either directly or indirectly, whether by charges or otherwise, reasonable access. 2. Portability of benefits from province to province 3. Coverage for all medically necessary services 4. Publicly administered, non-profit program

% Of People With Serious Sx Seeing A Doctor Before And After Passage Of NHP In Quebec
PHN RETFA RAEY 1 %37 PHN EROFEB

TISIV ROTCOD HTIW %

Source: NEJM 1973; 289:1174

%26

Infant Deaths by Income, Canada 1996 Even the Poor Do Better than U.S. Average
9 8 7 6 5 4 3 2 1 0 7.8 6.5 4.7 3.9 5.1 5.2

Infant Mortality

Wealthiest 20%

Middle 20%

Poorest U.S. 20% Average

Depression Management: Better in Canada
*eraC etairporppA %51
* Antidepressant prescribed + 4 or more visits
Source: JGIM 1998; 13:77

%7 adanaC .S.U %55 %13

lanoisseforP waS %0 %02 %04 %06

Waits for Publicly-Paid Cataract Surgery, Manitoba Longer When Surgeon Also Operates Privately
6991 etavirP & cilbuP htoB 5991 4991 ylnO rotceS cilbuP 3991 2991 0

noitatlusnoc tsrif morf skeeW yregrus ot

Source: Medical Care 1999; 37(6-supplement):JS187

01 02
Surgeon Operates in:

Physician Services For The Elderly: Canadians Get More of Most Kinds of Care
stseT 81.1 serudecorP 57.0 /noitaulavE tnemeganaM 44.1 secivreS llA
etaR .S.U/etaR naidanaC
Source: JAMA 1996; 275:1410

71.1

0 1 2 5.0 5.1

Applicants per Medical School Place
6.0 5.0 4.0 3.0 2.0 1.0 0.0 United States Canada 2.4 5.5

: JAMA; 282:892; Canadian Medical Education Statistics, 1999:150

Few Canadian Physicians Emigrate

What's OK in Canada? Compared to the U.S….
• • Life expectancy 2 years longer Infant deaths 25% lower

•
• • • •

Universal comprehensive coverage
More MD visits, hospital care; less bureaucracy Quality of care equivalent to insured Americans’ Free choice of doctor/hospital Health spending half U.S. level

Who Pays For Canada's NHP? Province Of Alberta
erahS/stnemyaP htlaeH fo erahS emocnI fo
K 521 3.1 K 001 3.1 000,57 2.1 EMOCNI YLIMAF
Source: Premier's Common Future Of Health, Excludes Out-of-Pocket Costs

000,05 1

000,53 58.0

000,52 77.0

000,51 47.0 0 1 2 5.1 5.0

Who Pays For Health Care? Regressivity Of U.S. Health Financing
fo erahS/stnemyaP htlaeH fo erahS emocnI
TSEHCIR 46.0 99.0 70.1 ELICED EMOCNI 1.1 72.1 13.1 51.1 32.1 0 TSEROOP
Source: Oxford Rev Econ Pol 1989;5(1):89

57.1

3

5.0 5.1 5.2 5.3 2 3 1

Employers’ Health Benefit Costs US vs. Canada

Number of Insurance Products

Private insurers’ High Overhead

The Healthcare Americans 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 Healthcare Americans Want
• Guaranteed access

•
•

Free choice of doctor
High quality

•
•

Affordability
Trust and respect

How Do We Know It Can Be Done?
• Every other industrialized nation has a healthcare system that assures medical care for all All spend less than we do; most spend less than half Most have lower death rates, more accountability, and higher satisfaction

• •

We Have What it Takes
• Excellent hospitals, empty beds

•
• •

Enough well-trained professionals
Superb research Current spending is sufficient

Medical Savings Accounts: No Savings
•
•

• • •

Sickest 10% of Americans use 72% of care. MSA's cannot lower these catastrophic costs The 15% of people who get no care would get premium “refunds”, removing their cross-subsidy for the sick but not lowering use or cost Discourages prevention Complex to administer - insurers have to keep track of all out-of-pocket payments Congressional Budget Office projects that MSAs would increase Medicare costs by $2 billion.

What's Wrong with Tax Subsidies and Vouchers?
• Taxes go to wasteful private insurers, overhead • •
>13% Amounts too low for good coverage, especially for the sick High costs for little coverage - much of subsidy replaces employer-paid coverage Encourages shift from employer-based to individual policies with overhead of 35% or more Costs continue to rise (e.g. FEHBP) Many are unable to purchase wisely - e.g. frail elders, severely ill, poor literacy

•
• •

puorG-noN

puorG %05 %04

%53

%31

deM/latipsoH srerusnI

htlaeH/efiL srerusnI

Source: J Health Policy, Pol & Law 2000;25:19

%04 %03 %71 %02 %01 %0

rof smuimerP fo tnecreP daehrevO

Non-Group Plans, High Overhead

Vouchers by Any Other Name…

Harris Poll: “Government Should Provide Quality Medical Coverage to All Adults . . .”
lanoissergnoC sediA %74 etatS srotalsigeL %25 sreyolpmE %35 lareneG cilbuP %0

gnieerga tnecreP

Source: USA Today/Harris Poll - 11/23/98

%77

%02 %04 %06 %08

Even Many Small Business Owners Favor NHI

Wealth Buys Political Power
•
• • • •
The 107,000 residents of zip code 10021 gave $1.5 million to 1999 presidential campaigns, and $9.3 million to 1996 congressional races
The residents of New Hampshire gave $333,000 to presidential candidates in 1999 The 9.5 million people in communities that are > 90% minority gave $5.5 million in 1996 congressional races In 1996, 91% of Congressional races were won by the candidate who spent the most Since 1984, the candidate with the most money on January 1 of the election year always wins his party’s nomination

Source: www.publicampaign.org;

Who Votes? Voter Turnout by Income, 2000

56% of Medical Students & Faculty Favor Single Payer, Majority of Med School Deans Concur
“What is the best health care system for the most people?”
56%

22%

3% 19% Managed Care No Preference
Source: NEJM 1999; 340:928

Single Payer Fee-for-service


				
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