Healthcare Reform The Real Facts Paul Y

Healthcare Reform – The Real Facts!! Paul Y. Song, MD Physicians for a National Health Program

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”.

The Problem n The US spends $2. 5 Trillion a year which is 17. 3% of our GDP on healthcare and more than any other industrialized country in the world by far. n The CBO estimates it will grow to 25% of our GDP by 2025. n The average family premium is $14, 000 a year. n The number of uninsured in the US now exceeds 50. 7 million and has actually increased since the passage of the healthcare bill.

Broken System? ? The Commonwealth Fund 6/23/10

Who Are the Uninsured? n Of the 50. 7 million, over 20 million are fully employed and 70% of all uninsured are from families with one or more full-time workers. n One of out every five Asians in the US are uninsured. – 31% of Koreans, 24% Native Hawaiian Islanders, 20% of Vietnamese, 16% Chinese, 14% Filipinos, 12% Indian and Japanese

Uninsured Deaths n 50, 000 annual deaths are attributed simply to a lack of coverage.

The For-Profit Insurance Industry is Not Your Friend! n Only recession proof industry that consistently raises prices 10 -15% every year regardless of the economy. Far outpacing inflation. n Take 30 cents out of every dollar away from actual patient care. n 1/6 of all policies are actually grossly inadequate to cover a serious illness. n They encourage higher deductibles and co-pays by increasing premiums to insure they cover very little.

The For-Profit Insurance Industry is Not Your Friend! n Over the past 9 years: – Average premiums have increased nearly 120% – Profits at the 10 largest publicly traded insurance companies have rose 428% (reported). – Average annual CEO salary at these companies was $11. 9 Million which is 468 times what the average US worker makes. – In CA, the six largest insurers denied over 45. 7 million claims in a six year period.

CEO Salaries (2008) n n n n n Roy Williams – CEO Aetna - $ 24, 300, 122 H. Edward Hanway – Cigna - $ 12, 236740 Angela Bray – Wellpoint - $ 9, 844, 212 Dale Wolf – Coventry Healthcare - $ 9, 047, 469 Michael Niedorff –Centene - $ 8, 744, 483 James Carlson – Amerigroup - $ 5, 292, 546 Michael Mc. Allister – Humana - $ 4, 764, 309 Jay Gellert – Health Net - $ 4, 425, 355 Steven Helmsley – United Health Group - $ 3, 241, 042 Billy Tauzin – CEO Ph. RMA - $2, 000 n Karen Ignani – Amer. Health Insurance Plans - $ 1, 580, 000 n

Medical Related Bankruptcies n Number of medical related bankruptcies increased 50% during the last 9 years. n In 2010, it is estimated that there will be over 4 million bankruptcies. - 2/3 are due to a medical illness. - 75% will be insured.

Hard for Employers Too! n For every $100 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. n Ford spent $3. 2 Billion on health premiums; Prior to the bailout, GM spent more on health premiums than on steel. n It is estimated that health care costs add $15002000 to the sticker price of a US made car.

What Do Americans Want? n 40% believe the recently passed health care reform did not go far enough. n 20% believe that the federal government should not be involved in health care at all. n 30% neither favor nor oppose the new health care law. AP Poll – Washington Post 9/26/10

Insurance Industry Efforts n 4525 lobbyists for the 535 Congressional members (8: 1) – 450 lobbyists are former congressional staffers and 12 were former Max Baucus Staffers. n $1. 4 Million was spent each day!! n $260+ Million was spent by the health insurance industry and big Pharma – more than on the 2004 Bush-Kerry presidential campaign. n Insurance stocks hit a 52 week high once there was no public option.

June 17, 2009 – As 22 Senators began hearings and work on healthcare reform, the room was full of registered healthcare Lobbyists.

Easy to Blame the GOP, but… n The Democrats had a supermajority for most of the debate. n 60% of all money went to Democrats. n Max Baucus (Chairman of the Senate Finance Committee) received over $2 million. n Ben Nelson received more money from the health insurance industry than any other industry. n Joe Lieberman received over $1 million and his wife was employed by several healthcare and Pharma companies.

So What Did We End Up With? n The Patient Protection and Affordable Care Act, not Obamacare. n It is not socialized medicine or a government takeover of medicine. n There are no death panels. n CBO estimates it will cost $940 Billion over the first 10 years. n Majority of the provisions will not begin until 2014.

What’s Been Implemented? n $727 Million to upgrade and expand community health centers providing health care to 745, 000 uninsured patients. n Medicare beneficiaries will receive a $250 rebate to help fill the prescription drug donut. n Primary care doctors will get a 10% raise. n Insurers can no longer carry out rescissions when insured use policies, set lifetime benefit limits, set annual benefit limits, deny coverage to children with pre-existing conditions (2014 for everyone). n Insurers must now offer coverage to kids on their parent’s policies up to the age of 26.

What’s Been Implemented? n Insurers must now cover recommended preventative care and immunizations without charging cost sharing amounts. n Insurers will be forced to spend 85 cents out of every dollar for actual patient care. n $350 Million to crack down on Medicare fraud. n Small businesses (< 25 full time employees with annual wages less than $50 K ($25 K in 2014) will get a 35% tax credit to help pay for premiums. n A high risk pool will be established for the sickest patients who are currently uninsurable.

What Happens in 2014? n Medicaid will be expanded to cover 133% of poverty (currently $29 K for a family of four). n Establishment of a health insurance exchange for those who do not have work sponsored coverage and subsidize insurance premiums for individuals up to 400% of poverty line.

Problems With the Reform Bill n $475 Billion subsidy to the insurance industry that forces 30 Million Americans to buy coverage from these companies that do not care about patients! n 23 Million people will still be uninsured nine years from now. n Millions of middle income people will be forced to buy commercial policies costing up to 9. 5% of their income, but covering only 70% of their medical expenses, leaving them still very vulnerable to medical related bankruptcies due to high deductibles and co-pays which will still be permitted. n Fee-For-Service

Problems With the Reform Bill n While Insurers will no longer be able to deny coverage or set maximum caps, they will still be able to increase co-pays, deductibles, and premiums which will only serve to preclude access to healthcare. n Enforcement of new regulations such as ending denials on the basis of pre-existing conditions are riddled with loopholes and waivers, and there is nothing to prevent older people or women from being charged more based on age or gender until 2017. n People with employer based coverage will remain locked in their plans and have no choice of providers or hospitals. No competition for most of us!

Arguments Against Reform n “Will explode the deficit!”

Nixon/Ford: 6. 8% per year Carter: 2. 0% per year Reagan: -1. 3% per year Bush 1: 4. 0% per year Clinton: 2. 5% per year Bush Jr: 8. 2% per year

Arguments Against Reform n “Will explode the deficit!” n “This is the largest government run health care program ever”.

Originally passed in 2004 at a projected cost of $400 B over 10 years, some estimates suggest it will cost over $900 Billion. Passed by a GOP controlled house and senate led by then Rep. Billy Tauzin (R-La) who left immediately after its passage to become the head of Ph. RMA.

Arguments Against Reform n “Will explode the deficit!” n “This is the largest government run health care program ever”. n “Socialized medicine”

“If you don’t stop Medicare and I don’t do it, one of These Days, you and I are going to spend our sunset years telling our children, and our children’s children what it once was like In America when men were free” - Ronald Regan 1961 Socialized Medicine was popularized by a public relations firm working for the American Medical Association in 1947 to disparage President Truman's proposal for a national health care system. It was a label, at the dawn of the cold war, meant to suggest that anybody advocating universal access to health care must be a communist. And the phrase has retained its political power for six decades.

The original meaning of “socialized medicine” was confined to systems in which the government owns and operates health care facilities and employs health care professionals, support staff, and all ancillary workers. England, Germany, Israel, Sweden, Finland, New Zealand, France, Canada, Taiwan, Japan all have “socialized medicine”.

October 22, 2009 - Veterans Health Care Budget Reform And Transparency Act More than 1400 hospitals, clinics and nursing homes, 14, 800 doctors, 61, 000 nurses , and 5 million patients. Rand Corporation found that 67% of veterans received appropriate care compared to 55% for the general public. University of Michigan study found 83% satisfaction for Veterans compared to 73% for general public.

Let the Free Market Rule! n There currently is no free market! Only two industries in the US have antitrust exemptions – Major League Baseball and The Health Insurance Industry. n There has been heavy consolidation and near monopolies established in the past 10 years. n One or two insurers generally control the top 94 metropolitan areas in the US. n In some states like Alabama, 90% have Blue Cross. n By allowing insurers to sell across state lines, patient protections will be reduced due to variations between states.

Single Payer System = Medicare n Established in 1965 when only 56% of adults over 65 years of age were insured. n Prior to Medicare, 1/3 of all seniors were living in poverty. n Commonwealth Fund Study (5/09) – Medicare patients had 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. 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. n It is the private insurance companies that tell patients who to see, where to go, and what doctors can do.

Single Payer System n Private insurers waste 31 cents of every dollar on overhead, sales and marketing, lobbying, billing, underwriting, and exorbitant executive compensation. n Single payer financing is the only way to recapture this wasted money (estimated to be over $350 Billion a year) and provide comprehensive coverage to everyone without paying more than we already do. n Would be financed by eliminating private insurance and recapturing their administrative waste. n Modest new taxes would replace premiums and costs would be controlled through negotiated fees, global budgeting, and bulk purchasing.

Single Payer System n Physicians would still be able to practice medicine the way they think is best. n Would lead to higher wages as employers would not have to pay for healthcare premiums. n Would lead to more capital investments by companies. n CA Nurses Association study found it would create 2. 6 Million new jobs and infuse $317 Billion in new business revenue. n Patients would not feel trapped in their current jobs due to the fear of losing their health care coverage.

Single Payer System n HR 676 – Expanded and Improved Medicare Act for All - Conyers n Senate Amendment 2837 – Medicare for All – Sanders, Brown, Burris. n California SB 810 – Mark Leno

“Prayer and fasting" will help defeat health care reform. - Michele Bachmann 8/25/09 “I tell you the truth, whatever you did for one of the least of these brothers of mine, you did for me. ” - Jesus Christ – Matthew 25: 40