Healthcare Reform Beyond the ACA Paul Y Song

Healthcare Reform: Beyond the ACA Paul Y. Song, MD

“Of all the forms of inequality, injustice in health care is the most shocking and inhumane. ” — Martin Luther King Jr. In a speech to the Medical Committee for Human Rights, 1966

Hippocratic Oath n. I will follow that system of regimen, which according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous.

Now estimated to be $ 3. 13 Trillion in 2014.

Who are the Uninsured? NON-WORKER 19. 5% PART-TIME WORKER 14% n. Of FULL-TIME WORKER 66. 5% the 50. 7 million, over 20 million are fully employed. n 70% of all uninsured are Urban Institute and Kaiser Commission on Medicaid and the Uninsured estimates based on the Census Bureau's March 2008 and 2009 Current from families(CPS: Annual Social and Economic Supplements). Population Survey with one or more full-time workers.

Medical Related Bankruptcies n Number of medical related bankruptcies increased 50% during the last 9 years. n In 2013, there were over 1. 7 million medical related bankruptcies. - 75% were insured. - 10 million insured are projected to accumulate medical bills they cannot pay off in 2015.

The six largest insurers denied over 45. 7 million claims over the past nine years in CA alone.

Between 2003 and 2010 median incomes increased by only 10% - The Commonwealth Fund

www. opensecrets. org

$475 Billion subsidy to the private insurance industry that mandates 15 Million Americans to buy coverage from an industry that only makes money by denying people care.

United Health Group stock price is up 263% since Obamacare became law! In 2013, United. Health was up 33%, Wellpoint 50%, Aetna 46%, and Cigna 60%. This year stock prices have hit all time highs!

But. . .

Inconvenient Truth n Family premiums already are at $16, 800 per year and rising, with employees having to contribute more every year. n Premiums, copays, and out-of-pocket costs will continue to increase as insurance companies continue to maximize their profits under the ACA. n 36 million will remain uninsured in 2015. n No provisions to regulate excessive insurance premium hikes.

Anything But Universal Health Care!!

Many patients enrolled in the exchange are finding less and less providers who will see them.

Medicaid Expansion n Kaiser Family Foundation estimates that the refusal of 25 states to expand Medicaid will result in 5 million without affordable coverage. n A NEJM study found that for every 500, 000 adults newly covered by Medicaid, 2, 840 fewer deaths would be prevented.

The foreigner residing among you must be treated as your native-born. Love them as yourself, for you were foreigners in Egypt. I am the Lord your God. - Leviticus 19: 34

Too Much Dependence on Employer Based Healthcare Coverage n Healthcare benefits has become the biggest area of labor negotiation strife!! n Too many Americans are stuck in jobs they hate simply because they receive coverage through their employers.

Kaiser Family Foundation 2012 In the past 12 years, Premiums have increased 160% while wages have only Increased 35% and inflation has increased 35%.

Hard for Employers Too! n In 2011 – 159 Million Americans had employer sponsored healthcare coverage. n For every $1. 00 that US companies spend on health care, companies in Japan, Germany, France, and Canada spend 63 cents which leads to more off-shoring of jobs and less job creation.

So why are we spending so much and getting so little? !!!

Prior to the ACA, private insurers wasted 31 cents of every dollar on administrative overhead, sales and marketing, lobbying, billing, underwriting, and exorbitant executive compensation. This waste is now estimated to be over $475 Billion a year!!

1965

Medicare – A Single Payer System!! n Established in 1965 when only 44% of adults over 65 years of age were uninsured and 1/3 of all seniors were living in poverty. n Commonwealth Fund - Medicare patients continue to have much greater satisfaction, better access to care, and fewer billing problems than those with employer sponsored plans. n Kaiser Family foundation study showed greater overall satisfaction and much more cost efficiency than private insurance companies.

Medicare – A Single Payer System!! n Medicare spends approximately 2% on administrative costs. n Patients have greater choice and do not need pre-authorizations. n The government does not tell doctors how to practice, what tests to order, which hospitals to go to, or what medications to prescribe.

Source: Kaiser Family Foundation; Centers for Medicare and Medicaid Services

GOP pledged that by placing at least 20% of Medicare beneficiaries in private HMOs would save $270 Billion over seven years.

Medicare has overpaid private insurers by $282. 6 billion, or 24. 4% of all Medicare payments, since 1985. In 2012 alone, we find that MA plans are being overpaid by $34. 1 billion, or 6. 2% of total Medicare spending. - Hellander, Woodhandler, Himmelstein – Int. J. of Health Services (2012)

Pharmaceutical costs are rising

In 2006, the first year of Medicare Part D, the combined profits of the largest drug Companies soared 34% to $ 76. 3 Billion.

Medicare Part D n A much bigger government run healthcare program than “Obamacare”. n It is illegal for Medicare, the nation’s biggest health plan, to use its market power to negotiate for lower prescription drugs prices. n Medicare is also banned importation of cheaper drugs and gave drug companies stronger protections against their generic competitors. n The per capita spending on drugs in the US is 40% higher than in Canada and 75% greater than in Japan and 300% higher than the amount spent in Denmark. n Administrative costs are almost 10%.

Private Medicare Drug Plans – US Congressional Committee on Oversight and Government Reform Report 2007

How to Best Strengthen and Preserve Medicare n Identify and acknowledge wasteful spending within the program – Medicare Advantage and Part D. n Eliminate these indefensible subsidies for big corporations. n Rid the program of all very expensive and inefficient private solutions.

Single Payer – Friedman U. Mass Study 2013 An estimated $592 Billion would be saved annually. – $476 Billion would be saved by slashing administrative waste associated with the private insurance industry. – $116 Billion would be saved by reducing pharmaceutical prices to European levels. $1. 8 Trillion (inflation adjusted) will be saved over the next 10 years.

Challenges of Setting up a State Only Single Payer System n Too many existing federal restrictions. n Medicaid and limited Medicare waivers are not clearly enough to assemble a single payer system. n ERISA prevents the state from moving self-funded employer sponsored health plans into a state system. n Control of Medicare or Military Tri-care could not be transferred to a state. n Big multi-state employers cannot be forced into the program.

Strengthen, Preserve, and Expand Medicare n Allow everyone to buy into Medicare instead of private insurance with premiums based on their ability to pay. n Bringing in a younger and healthier pool with spread out risk and provide a strong financial infusion to further strengthen Medicare.

Why Single Payer is Inevitable n Healthcare costs will continue to climb for the federal government, states, cities, companies, and individuals which are simply unsustainable. n This will lead to fewer overall benefits and more “skin in the game” by everyone who is insured. n Ideology will eventually be replaced by reality once a critical mass of people experience the looming dramatic change in their healthcare.