Of all the forms of inequality injustice in

"Of all the forms of inequality, injustice in health care is the most shocking and most inhumane" Martin Luther King Jr (March 25, 1966, National Convention of the Medical Committee for Human Rights, Chicago)

HEALTH CARE SECURITY FOR ALL • A moral, ethical, social & religious good • A family value • An economic necessity

46+ Million Uninsured and Rising

COSTS SOARING TWO TRILLION DOLLARS AND STILL RISING 15% OF GNP

18, 314 Adult Deaths Annually Due to Uninsurance

Illness and Medical Costs, A Major Cause of Bankruptcy • Over 50% 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

Who Pays for Nursing Home Care? Source: Health Affairs 2000; 19(3): 44

Who Are The Uninsured? » Children » 25% » Employed » 50% » Unemployed » 5% » *Out of labor » force » 20% *Students>18, Homemakers, Disabled, Early retirees Source: Himmelstein & Woolhandler - Tabulation from 1999 CPS

The Eight Americas • • 1. Asians, 2. Northland low-income rural whites, 3. Middle America, 4. Low-income whites in Appalachia and the Mississippi Valley, 5. Western Native Americans, 6. Black Middle America, 7. Low-income southern rural blacks 8. High-risk urban blacks

Disparities in mortality across the eight Americas are enormous by all international standards. Policies aimed at reducing fundamental socioeconomic inequalities are currently practically absent in the US. Health disparities will have to be at least partly addressed through public health strategies that reduce risk factors for chronic diseases and injuries.

Probability of death between the ages of 15 and 59 years in the eight Americas from all causes.

Chronically Ill and Uninsured

Poverty Rates, 1997 U. S. and Other Industrialized Nations Netherlands 6% France 8% Sweden 9% Canada 11% UK 11% Germany 11% US 17% 0% 5% 10% 15% % of Population Below Poverty Level Source: Luxembourg Income Study Working Papers Note: U. S. figure for 1997, other nations most recent available year 20%

Life Expectancy For Women, 1999 83 YEARS 80. 7 81 80 82 81. 7 81. 6 82 82. 5 79. 8 79. 4 79 78 E NC FR A SW ED EN DA NA Y CA M ER G Source: OECD, 2002 - Data on Italy are for 1998 IT AL Y AN K. U. S. 77

Why Women Delay Prenatal Care When They Know They Are Pregnant Note: 11. 1% of pregnant women failed to get timely prenatal care despite knowing they were pregnant Source: MMWR 5/12/2000; 49: 393

Health Care Administrative Costs in the U. S. Clinical Care 31% Administrative Costs 69% New England Journal of Medicine 8/03 $7 billion of the WI healthcare dollar is spent on administration

Health Care Financing Today • The financing of health care is really a shell game with all the payers trying to avoid paying the fixed costs of health care

Cost shifting: No end in Sight Deficit Fixed costs of healthcare services. Billsmet paid not Cost shift Higher premiums More uninsured More underinsured Get Care

CEO Pay and Stockholdings, 1998 CEO Firm Pay (mill) Stock (mil) Wilson Taylor Norman Payson Leonard Shaeffer Richard Huber William Mc. Guire Cigna Oxford Wellpoint Aetna United Hlthcr. $5. 0 $3. 3 $2. 2 $1. 5 $64. 2 $44. 7 $45. 5 $21. 3 $87. 8 Melvin Goodes Paul Ormond Peter Nicholas Thomas Frist Jr. Warner Lambert Manor Care Boston Scientific Columbia/HCA $16. 5 $7. 8 $0. 8 $. 025 $287 $43. 7 $1198 $445 Source: Jenks Healthcare Business Report 7/24/99

Employers’ Health Benefit Costs US vs. Canada

Drug Companies’ Cost Structure

Percent of Population with Government-Assured Insurance 100% 92% 100% 100% Japan U. K. 80% 60% 45% 40% 20% 0% U. S. Germany France Canada Australia 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

Who’s paying the Health Care bill? Individuals 20% 60% Private employers taxpayers {Medicare, Medicaid. Public employees, tax subsidies} In the end, we all pay the total bill, but we all don’t have coverage for our own care Source: NEJM 1999; 340: 109; Health Affairs 2000; 19(3): 150

We have the brains, resources and ability to resolve these problems so let’s do it.

THREE PROPOSALS • WICONSIN HEALTH PLAN • WISCONSIN HEALTH CARE PARTNERSHIP PLAN • WISCONSIN HEALTH SECURITY ACT