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Internal Medicine Residency Program Columbia University Medical Center NewYork-Presbyterian Hospital February 3, 2012
PRESENTATION OUTLINE
1. History of recent U.S. Health Reform 2. Challenges facing U.S. Health Care System 3. Comparison of Single Payer and 2010 Health Reform (P-PACA)
DISCLOSURES
Dr. Oliver Fein has no relevant financial relationships with commercial interests Dr. Oliver Fein is immediate past President of Physicians for a National Health Program (PNHP), a non-profit educational and advocacy organization. He receives no financial compensation from PNHP.
Disclosure Information
A) Relationship with companies who manufacture products used in the treatment of the subjects under discussion Yes____ No __X__ If "Yes," list company(ies) with the relationship(s) below. Relationship Research Support Speaker's Bureau Consultant Share Holder Other Financial Support Large Gift(s) Manufacturer(s) ________________________________ ________________________________ ________________________________ ________________________________ ________________________________ ________________________________
HEALTH REFORM:
OBAMAS FATEFUL CHOICE
He did not want to start from scratch He had two fundamental choices:
Individual mandate*
Public option**
** you can choose to enroll in the new public plan
3. Necessary for the survival of private HI. Private HI lost 3.2% (6.3 million) enrollees in 2009 and more than 15 million in the last decade.
CHALLENGE #1
DECLINING ACCESS
Number of people spending more than 10% of income on health care (Millions)
Insured
Uninsured
Note: The uninsured include about 5 million undocumented immigrants. Source: Congressional Budget Office.
CHALLENGE #2
ESCALATING COSTS
Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 2000-2008. Bureau of Labor Statistics, Consumer Price Index
High Cost of Health Insurance Premiums: Its Even Too Expensive for the Middle Class Today
National Average for Employer-provided Insurance
$400 billion* redirected to cover the uninsured and to expand coverage for the underinsured
* NEJM 2003:349;768-775 updated to 2010
Total Costs
Savings Reduced insurance administrative costs Reduced hospital administrative costs Reduced physician office costs Bulk purchasing of drugs & equipment Primary care emphasis & reduce fraud
-21 -76 -59 -46 Total Savings -15.8% -313 Net Savings - 4.3% - 72
Source: Health Care for All Californians Plan, Lewin Group, January 2005
Penalties under P-PACA Individuals $695 per year Families $2,085 per year Employers $2,000 per employee
States choose a benchmark plan that reflects the scope of services offered by a typical employer plan Four benchmark options: One of the three largest small group plans in the state by enrollment; One of the three largest state employee health plans by enrollment; One of the three largest federal employee health plan options by enrollment; The largest HMO plan offered in the states commercial market by enrollment. If states choose not to select a benchmark, HHS intends to propose that the default benchmark will be the small group plan with the largest enrollment in the state.
CHALLENGE #7
2.
3.
5. 6.
7.
Funding: Excise tax on high cost (comprehensive coverage) private HI and Medicare cutbacks
MEDICARE 2.0
Sanders (& McDermott): American Health Security Act S 915 (HR 1200)
1.Automatic enrollment 2.Comprehensive benefits 3.Operated by States using Federal standards 4.Free choice of doctor and hospital 5.Doctors and hospitals remain independent 6.Public agency processes and pays bills 7.Financed through payroll taxes
5 6
Summary
A system based on private insurance plans -- will not lead to universal coverage -- will not create affordable insurance A Medicare for All System -- can lead to universal, comprehensive coverage without costing more -- has the greatest potential to increase choice, improve quality and expand primary care -- can be financed fairly
Will We Get Real Health Care Reform Before the Premium Takes All our Income?
Today
OBrien ME, Livingston M (editors), 10 Excellent Reasons for National Health Care. New Press, 2008
Potter W, Deadly Spin: An Insurance Company Insider Speaks Out on How Corporate PR Is Killing Health Care and Deceiving Americans. Bloomsbury Press, 2010