Transcript Healthcare Reform – The Real Facts!!

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

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%
Of
FULL-TIME
WORKER 66.5%
the 50.7 million, over 20 million are fully employed.
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
with
one
or and
more
full-time
workers.
Population
Survey (CPS:
Annual
Social
Economic
Supplements).
Medical Related Bankruptcies

Number of medical related bankruptcies
increased 50% during the last 9 years.

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, UnitedHealth was up 33%, Wellpoint 50%, Aetna 46%, and
Cigna 60%.
This year stock prices have hit all time highs!
But...
Inconvenient Truth

Family premiums already are at $16,800 per year
and rising, with employees having to contribute
more every year.

Premiums, copays, and out-of-pocket costs will
continue to increase as insurance companies
continue to maximize their profits under the ACA.

36 million will remain uninsured in 2015.

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

Kaiser Family Foundation estimates that the
refusal of 25 states to expand Medicaid will result
in 5 million without affordable coverage.

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

Healthcare benefits has become the
biggest area of labor negotiation
strife!!

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!

In 2011 – 159 Million Americans had
employer sponsored healthcare coverage.

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!!

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.

Commonwealth Fund - Medicare patients
continue to have much greater
satisfaction, better access to care, and
fewer billing problems than those with
employer sponsored plans.

Kaiser Family foundation study showed
greater overall satisfaction and much more
cost efficiency than private insurance
companies.
Medicare – A Single Payer System!!

Medicare spends approximately 2% on
administrative costs.

Patients have greater choice and do not
need pre-authorizations.

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

A much bigger government run healthcare program than
“Obamacare”.

It is illegal for Medicare, the nation’s biggest health plan, to
use its market power to negotiate for lower prescription drugs
prices.

Medicare is also banned importation of cheaper drugs and
gave drug companies stronger protections against their
generic competitors.

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.

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

Identify and acknowledge wasteful
spending within the program – Medicare
Advantage and Part D.

Eliminate these indefensible subsidies for
big corporations.

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

Too many existing federal restrictions.

Medicaid and limited Medicare waivers are not clearly
enough to assemble a single payer system.

ERISA prevents the state from moving self-funded employer
sponsored health plans into a state system.

Control of Medicare or Military Tri-care could not be
transferred to a state.

Big multi-state employers cannot be forced into the program.
Strengthen, Preserve, and Expand Medicare

Allow everyone to buy into Medicare
instead of private insurance with
premiums based on their ability to pay.

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

Healthcare costs will continue to climb for the
federal government, states, cities, companies,
and individuals which are simply unsustainable.

This will lead to fewer overall benefits and more
“skin in the game” by everyone who is insured.

Ideology will eventually be replaced by reality
once a critical mass of people experience the
looming dramatic change in their healthcare.