National Health Insurance Has Its Time Come Walter

National Health Insurance: Has Its Time Come? Walter Tsou, MD, MPH Physicians for a National Health Program NASW-PA October 17, 2005

Two Questions? ¨ What is the health policy of the United States of America? ¨ How much will the US spend this year for health care?

“Iron Triangle of Health Policy” Access to Care Cost Containment Quality of Care

Looking at Costs

Health Care Costs at $1. 9 Tr in 2005 and almost doubles in 9 years. Total for Decade? $27 Trillion!! 2005 06 07 08 09 10 11 12 13 2014 Source: Projected from Natl Health Expenditures, Health Affairs, Feb. 23, 2005

National Health Expenditures (NHE) Share of Gross Domestic Product (GDP) and Private and Public Shares of NHE Private funds Public funds Source: Heffler, et al. 2005. U. S. Health Spending Projections For 2004 -2014. Health Affairs, web-exclusive: w 5 -74 – w 5 -85.

Private insurance is covering less Source: Sept. 23, 2004, AP

People under 65 with catastrophic health costs despite health insurance, 2004 Source: Families USA, Sept 2004

Our Current Health System is Absurdly Inefficient

Growth of Physicians and Administrators 1970 -1998 Source: Bureau of Labor Statistics & NCHS

US spends far more than other countries on health care OECD, Health Expenditures per capita, 1998

U. S. Public Spending Per Capita for Health is Greater than Total Spending in Other Nations Note: Public includes benefit costs for govt. employees & tax subsidy for private insurance Source: NEJM 1999; 340: 109; Health Aff 2000; 19(3): 150

Looking at Quality

Primary Care Physicians: Patients Can't Get Quality Mental Health Services 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

Life Expectancy For Women, 1999 Source: OECD, 1999 & NCHS

Life Expectancy For Men, 1999 Source: OECD, 1999 & NCHS

US Health Expenditures vs Female Life Expectancy by country-not a good deal! Health Expenditure L if e E x p e c t a n c y Source: OECD 2004

Looking at Access

45. 8 Million Uninsured Source: US Census, 2004

Growing number of uninsured in PA 10, 724, 000 insured (88%) ¨ 1, 454, 000 uninsured over one year (12%) ¨

Number of uninsured is actually worse than census statistics ¨ ¨ Pennsylvania uninsured at any given time - 2, 820, 000 or 27. 4% of the state’s population United States uninsured at any given time - 85, 216, 000 or 33. 3% Source: Families USA, Sept 2004

Looking at Malpractice

Rex Morgan, MD on Malpractice

Philadelphia Malpractice Rates, 2004 by specialty Source: PA Medical Society, 2004

Malpractice ¨ Economic vs. Non economic damages

Economic Damages ¨ Lost wages – Huge loss in high wage earners ¨ Current and future health care costs – Huge loss without universal coverage

Non economic damages ¨ To cap or not to cap? That is the question

Phila vs. Ontario malpractice premiums, 2004 Source: PA Medical Society, Canadian Medical Protective Assoc, US Dollars, 2004

Phila vs. Ontario by high malpractice specialties, 2004 Source: PA Medical Society, Canadian Medical Protective Assoc, US Dollars, 2004

Possible Reasons for Less Malpractice Fees in Canada Much less money is spent on health care ¨ Access to preventive services for all ¨ Under universal coverage, all future health care costs covered by health care system ¨ 95% of docs covered by Canadian Medical Protective Association, a non profit entity ¨ Malpractice fees paid for by provinces ¨

Perspectives on Health Care Reform Managed Competition ¨ Managed Care ¨ Health Savings Accounts ¨ National Health Insurance ¨

Balanced and Comprehensive Health Care Reform Act of 2005

Highlights of the State Reform proposal Comprehensive health, dental, mental health and Rx drug benefits for all ¨ Free choice of private doctors, dentists, hospitals ¨ No deductibles, co-pays, caps ¨ Can opt out if bargaining agreement as comprehensive as Reform proposal ¨

Choice of “no fault” malpractice vs. current tort remedies No-fault malpractice assures payment to victims ¨ Funding for electronic medical record system ¨ Investigations of medical errors ¨ Sufficient savings with single payer will fund all malpractice premiums for doctors, NPs ¨

Added incentives $1000 tax credit for certified volunteer firemen, EMTs, paramedics ¨ Restoration of certificate of need ¨ K-12 health education and phys ed funding ¨ Transitional funding for displaced workers ¨

Public financing, Private delivery

Funding of Reform proposal 10% Health Care levy on payroll ¨ 3% wellness tax on personal income ¨ 1% tax on personal income for qualifying bargaining agreement plans ¨

Physician Proposal in JAMA, Aug. 2003 www. physiciansproposal. org

Congress introduces Physician Proposal Angell Himmelstein House Judiciary Committee Room, Feb 4, 2003 Conyers

US National Health Insurance Act

Simplified flow of funds Public Private

Universal Health Care will cost less now

Economies of Scale Saves Money

Sources of Revenue for NHI

NHI will save $5000 per capita by 2024

How can we get there? Business community ¨ American public ¨

Government is the “swing” vote Business People Government

Health care and Big Business Rising insurance premiums (10 -30%) ¨ Limited choices with managed care ¨ Subsidizing small businesses and uninsured ¨

Less workers covered by private health insurance

Health benefit will eclipse corporate profits between 2005 -2008 Source: Mc. Kinsey Quarterly, Sept 2004

Corporate Dilemma on Health High health care costs have "created a competitive gap that's driving investment decisions away from the U. S. , " Ford Vice Chairman Allan Gilmour said in a speech at a recent auto industry conference. "If we cannot get our arms around this issue as a nation, our manufacturing base and many of our other businesses are in danger, " Source: Washington Post, March 6, 2004

Jobless recovery due to health care ¨ “For every new hire, health insurance costs each employer as much as payroll taxes. ” - Helen Darling, Natl Business Group on Health Source: Wall St. Journal, March 11, 2004

GM retiree cost is $60 Billion! Source: Wall St. Journal, March 11, 2004

Ideology trumps rationality “But while the Big Three automakers told Canadians that their nationalized health insurance system helped preserve jobs, and lobbied the Canadian government last year to maintain the program, their corporate executives are not willing to go that far when it comes to health care in the United States. ” Source: Washington Post, March 6, 2004

Ideology vs. Rational thinking? ¨ ¨ ¨ Government incompetent Marketplace can solve everything Privately financed, privately “run” ¨ ¨ ¨ Gov’t does some things well Essential goods respond poorly to markets Publicly financed, privately “run”

WSJ survey of Business Leaders “But if managed care fails to contain health care costs over the next few years, 53% of corporate executives said they might accept national health care” (Louis Harris poll of 2, 048 business leaders)

Two Myths about National Health Insurance We can’t afford it. ¨ We don’t have the “political will” ¨

Political feasibility and cost containment “Here is the ultimate paradox of US health politics. . . The more likely a reform proposal is to control costs, the less likely it is to be politically viable. ” - Jonathan Oberlander, Health Affairs, Aug. 27, 2003

American Public Want quality, affordable health care for all Americans ¨ Not concerned about health care unless ill ¨ Economy and health care becoming the same ¨

Most Important Issues for 2005 Congress?

Within health care, what do people care about? Source: NEJM, Sept. 23, 2004

Do We Have the Political Will?

Congress is debating whether to cut MA and Medicare by $32 billion Current thoughts are $12 billion cut in MA ¨ $20 billion cut in Medicare ¨

Balanced Budget Amendment, 1997 Cuts to “DSH” hospitals ¨ Cost to DV hospitals=$1 B ¨

Philadelphia Hospitals are cutting

Penn

12 hospitals have closed from 1994 -2003 Year Closed Hospital Beds Outcome 1994 Sacred Heart Hospital & Rehab. Ctr 234 Closed 1995 Community Hospital of Chester 179 Converted to Outpt Clinics 1995 Thomas Jefferson UH Ford Road 38 Converted to Outpt Clinics 1997 Allegheny Univ Hospitals, Mt Sinai 1997 Institute of Pennsylvania 91 Sold to become Kirkbride Center 1999 Germantown Hospital 88 Converted to Outpt Clinics 1999 Neumann Medical Center 133 Converted to Outpt Clinics 2000 John F. Kennedy Memorial Hospital 103 Converted to Outpt Clinics 2000 City Avenue Hospital 2002 Mercy Community Hospital 113 Converted to Outpt Clinics 2003 Parkview Hospital 149 Closed 2003 Elkins Park Hospital 114 Purchased by Einstein 141 44 Closed Number of Beds removed from Inpatient Use (excl. s Elkins Park, some or all of whose bed capacity will be used by Einstein/Moss. Rehab) 1, 222 25. 3% Bed Capacity Reduction At Hospitals Remaining open 3, 615 74. 7%

Philadelphia Hospitals are Closing

“Iron Triangle of Health Policy” Access to Care Cost Containment Quality of Care

Political Willpower: New Iraqi Constitution Article 31 ¨ “Every Iraqi has the right to health service, and the state is in charge of public health and guarantees the means of protections and treatment by building different kinds of hospitals and health institutions. ”

Will Iraq get universal health care before America? ?

Rex Morgan, MD on NHI

PHYSICIANS FOR A NATIONAL HEALTH PROGRAM 29 EAST MADISON STREET SUITE 602 CHICAGO, IL 60602 -4404 TEL: (312) 554 -0382 WWW. PNHP. ORG

Questions?