an intro to single payer health care molly tavella, mph shearer student fellow 2010-2011 pnhp...

An Intro to Single Payer Health Care

Molly Tavella, MPHShearer Student Fellow 2010-2011

PNHP California

Who am I?

• Shearer Student Fellow• PNHP California

• CaHPSA – California Health Professional Student Alliance

Health care is a right

What is a Single-Payer System?

Publicly Funded, Privately Delivered

Improved and Expanded Medicare for All

Single Plan with Same Benefits

An Actual System Run by a Public Entity

The Public Option for Everyone

Current Financing

Individuals/Businesses

direct/out-of-pocket payments Health Service

Providers

Government

Private Insurers

Subsidies

Taxes

Public Employees’ Premiums

Payment to providers

Medicare, Medicaid, SCHIP, VA, IHS

Premiums

Single Payer Financing

Medicare $

Medi-Cal $

EmployerPayrollTax $

Single PayerHealthcare

Fund

$$$$$$

Rx

Healthcare Providers

Lewin 2004

Integrated Health Systems

Income tax $

So… For-Profit Insurers…

• Would not be allowed to offer any services that the single payer covers

• Could offer non-necessary services (like plastic surgery insurance) although there would be no medical need to have this insurance

What are the goals of Single Payer Care?

• Universal• Comprehensive• Continuous• Equitable• Affordable• Sustainable

What about 2010 Reform?

BOTTOM LINE: REFORM DOESN’T MEET OUR GOALS

Still 23 million uninsured, millions more will be underinsured because the plans are not comprehensive, still not attached to the person, still unfair, still no proven cost controls

What do we get for $938 Billion?• Segregation of Sick and Healthy• Medicaid Expansion • Private Insurance Mandate• Public Subsidies • Regulation of Private Insurance?

No Accountability

Ethical?

WHAT ARE THE EFFECTS?

Health Care Ranking by Country

Infant Mortality Rates, 2010 OECDPer 1000 live births

Maternal Mortality, 2010 OECDPer 100,000 live births

Life Expectancy in Years: 2010 OECD

Underinsured

Uninsured• People without health insurance:– Receive less medical care and receive it later– Are sicker when diagnosed– Have 25% higher mortality rates– Earn less because of poorer health

“Health Insurance and Mortality in US Adults”, A. Wilper et al, Am. Journal of Public Health, Dec 09“Care Without Coverage”, Institute of Medicine, May 2007

“Sicker and Poorer”, Medical Care Research and Review, June 2003

Unsustainable Cycle

Choose Policy with fewer benefits, higher deductible, lower premium

Increases Out-Of-Pocket Spending if you needed to get health care

Decrease use of health care because you can’t afford it

Increased Illness/Disability, as you put off needed care

When it becomes an Emergency, More Economic Resources go towards medical care / decreases take home pay

Become Uninsured

More Americans Opt for a High Deductible Insurance Plan

High Cost

We spend more public dollars than other countries spend in totalOECD

The High Cost of Overhead…

http://www.health-insurance-2008.org/united-states-vs-canada.php

The For-Profit Insurance Industry

• Over the past 9 years:

– Average premiums have increased nearly 120%

– Profits at the 10 largest publicly traded insurance companies have risen 428% (reported).

– Average annual CEO salary was $11.9 Million, 468 times what the average US worker makes.

HOW DO WE FIX THIS?

Why is Single Payer Better?

• Stop segregation of healthy and sick• Everybody in, nobody out• Single plan• Emphasize prevention• Non-profit• Bulk-buying power• Streamline administration

THE HISTORY OF SB810

Myths About Single Payer

• It will cost too much!• We need to pay high prices for drug R&D.• I have insurance, I’m happy with it.• It’s SOCIALISM!

Myth: “It will cost too much”Additional costsCovering the uninsured and poorly-insured +6.4%Elimination of cost-sharing and co-pays +5.1%

SavingsReduced insurance administrative costs -5.3%Reduced hospital billing costs -1.9%Reduced physician office costs -3.6%Bulk purchasing of drugs & equipment -2.8%Primary care emphasis & reduce fraud -2.2%

31

Total Costs +11.5%

Total Savings -15.8% Net Savings: 11.5% + -15.8% = -

4.3% Source: Lewin Group, January 2005

How will we save money?California will save $29 billion in the first year

$20 billion in administrative costs through streamlining our system to one payer

$5.2 billion in bulk purchase of pharmaceuticals and medical equipment

$3.4 billion through emphasis of primary care and preventive medicine

$900 million in spending on health benefits for government employees

Lewin Group, 2005

Single-Payer Savings

Source: Lewin Group, 2005

Myth: “We need to pay high drug prices to fund research and development”

• Out of $222 billion dollar budget– $32 billion = Research and Development– $39 billion = Profit (16% profit margin)• Profit Margin for other Fortune 500 Companies =

<6%

– $71 billion = Marketing and Administration

Source: Health, Money and Fear DVD, Paul Hochfeld, MD

It’s really not funny…

Myth: “I have insurance, I’m happy”

Source: August 2009 issue of the American Journal of Medicine

Myth: “It’s SOCIALISM!”

• It is Socialistic like:–Public Schools –Police Department– Fire Department–911 Services

Will Businesses Lead the Way?

• AT&T revealed that they currently pay $2.4 billion annually to cover their employees.

• Under PPACA, if they did not cover their employees, the fine would be $600 million.

How do we know this will work?

Why is it good for Physicians?

• Eliminate the role of insurance companies• Stop arguing over compensation

• Lower overhead costs in your practice• Lower the cost of malpractice fees• Negotiate fair and timely reimbursement

• Patient centered care• Increase continuity of care for patients• Increase access for new patients

Physician Shortages

• SB810 provides an opportunity to restructure our physician workforce:– Reimbursement reform

– Loan forgiveness programs for primary care

– Increase funding for graduate medical education in primary care

– Reallocate graduate medical education by specialty

Physician Salaries

Specialty US Average Malpractice Canada Average Malpractice

OB/GYN $64,000 $35,000

Ref: US General Accounting Office/National Bureau of Economic Research

Why should Nursing Students Care?

• Patients have greater choice

• Focus on prevention, education and public health

• Providers spend time with patients not paper

• Providers can effectively coordinate care across disciplines and specialties

• Single Payer systems eliminates profits made from pain, suffering, and illness

SB810 and Nursing

SB 810 will help address the nursing crisis.

– Mandates to establish a budget to support the development and training of a health system workforce that is sufficient to meet the health care needs of the population.

– This would include assuring that adequate numbers of nurses were trained and available to maintain quality of care standards.

Why is it good for OT students?

• All have the right to engage in meaningful activities that provide each individual with a sense of identity and self efficacy

• Being able to engage in occupations is based on the ability to access basic healthcare.

• Rehabilitation services and OT/PT/SLP would be covered under single payer under the category of coverage of all "medically necessary” outpatient and inpatient care.

• All licensed providers would be covered, and there would be no arbitrary caps on utilization.

Why is this important to Public Health?

The TRIFECTA!–Increase Access–Increase Prevention–Reduce Disparities

And… it saves money!

Who will Run the Single Payer?

The Public – Through a vote would elect: The California Healthcare Agency: A public body with

representatives of patients and medical experts▪ Commissioner▪ Chief Medical Officer▪ Health Planning, Quality, Funding, Payments▪ Patient Advocate

All meetings would be openAll documents (except privacy-protected

documents) would be publicAll officers may be impeached for malfeasance

How will SB810 protect the California Health Care Agency?

SB 810 has provisions to protect the health care system from some of the problems that governments face– Strong conflict of interest rules– No partisan activity or collusion with for-profit firms – Health system officers protected from special

interests– The health care system is exempted from oversight

by other government agencies

WHAT CAN YOU DO?

Join CaHPSA: cahpsa.org

Start a CaHPSA Chapter

Attend Lobby Day!

Lobby Day 2010

www.cahpsa.org/CaHPSA/Lobby_Day.html

Building a Movement

• Believe!!!• Be Active!!!• Tell Your

Friends!!!

Thank You!• Questions?• Contact:– molly@pnhpcalifornia.org– Phone: 408-892-1255

• Resources

Get For-Profit

Ins.OUT

of my healthcare!