Transcript The Real Facts!! - PNHP California

Healthcare Reform – The Real
Facts!!
Paul Y. Song, MD
Physicians for a National Health Program
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”.
The Problem

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.

The CBO estimates it will grow to 25% of our GDP by 2025.

The average family premium is $14,000 a year.

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?

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.

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
 50,000
annual deaths are
attributed simply to a lack of
coverage.
The For-Profit Insurance Industry
is Not Your Friend!

Only recession proof industry that consistently
raises prices 10-15% every year regardless of the
economy. Far outpacing inflation.

Take 30 cents out of every dollar away from
actual patient care.

1/6 of all policies are actually grossly inadequate
to cover a serious illness.

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!

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)
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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 McAllister – Humana - $ 4,764,309
Jay Gellert – Health Net - $ 4,425,355
Steven Helmsley – United Health Group - $ 3,241,042
Billy Tauzin – CEO PhRMA - $2,000,000
Karen Ignani – Amer. Health Insurance Plans - $ 1,580,000
Medical Related Bankruptcies

Number of medical related bankruptcies
increased 50% during the last 9 years.

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!

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.

Ford spent $3.2 Billion on health premiums; Prior
to the bailout, GM spent more on health
premiums than on steel.

It is estimated that health care costs add $15002000 to the sticker price of a US made car.
What Do Americans Want?

40% believe the recently passed health
care reform did not go far enough.

20% believe that the federal government
should not be involved in health care at all.

30% neither favor nor oppose the new
health care law.
AP Poll – Washington Post 9/26/10
Insurance Industry Efforts

4525 lobbyists for the 535 Congressional
members (8:1) – 450 lobbyists are former
congressional staffers and 12 were former Max
Baucus Staffers.

$1.4 Million was spent each day!!

$260+ Million was spent by the health insurance
industry and big Pharma – more than on the 2004
Bush-Kerry presidential campaign.

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…

The Democrats had a supermajority for most of
the debate.

60% of all money went to Democrats.

Max Baucus (Chairman of the Senate Finance
Committee) received over $2 million.

Ben Nelson received more money from the health
insurance industry than any other industry.

Joe Lieberman received over $1 million and his
wife was employed by several healthcare and
Pharma companies.
So What Did We End Up With?

The Patient Protection and Affordable Care Act,
not Obamacare.

It is not socialized medicine or a government
takeover of medicine.

There are no death panels.

CBO estimates it will cost $940 Billion over the
first 10 years.

Majority of the provisions will not begin until
2014.
What’s Been Implemented?

$727 Million to upgrade and expand community
health centers providing health care to 745,000
uninsured patients.

Medicare beneficiaries will receive a $250 rebate
to help fill the prescription drug donut.
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Primary care doctors will get a 10% raise.

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).

Insurers must now offer coverage to kids on their
parent’s policies up to the age of 26.
What’s Been Implemented?

Insurers must now cover recommended
preventative care and immunizations without
charging cost sharing amounts.

Insurers will be forced to spend 85 cents out of
every dollar for actual patient care.

$350 Million to crack down on Medicare fraud.

Small businesses (< 25 full time employees with
annual wages less than $50K ($25K in 2014) will
get a 35% tax credit to help pay for premiums.
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A high risk pool will be established for the sickest
patients who are currently uninsurable.
What Happens in 2014?

Medicaid will be expanded to cover 133%
of poverty (currently $29K for a family of
four).

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

$475 Billion subsidy to the insurance industry
that forces 30 Million Americans to buy coverage
from these companies that do not care about
patients!

23 Million people will still be uninsured nine years
from now.

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.
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Fee-For-Service
Problems With the Reform Bill

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.

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.

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

“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

“Will explode the deficit!”
 “This is the largest government run health care
program ever”.
Originally passed in 2004 at a projected cost of
$400B 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 PhRMA.
Arguments Against Reform

“Will explode the deficit!”
 “This is the largest government run health care
program ever”.
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“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!

There currently is no free market! Only two industries in the
US have antitrust exemptions – Major League Baseball and
The Health Insurance Industry.

There has been heavy consolidation and near monopolies
established in the past 10 years.

One or two insurers generally control the top 94
metropolitan areas in the US.
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In some states like Alabama, 90% have Blue Cross.

By allowing insurers to sell across state lines, patient
protections will be reduced due to variations between
states.
Single Payer System = Medicare

Established in 1965 when only 56% of adults over 65 years of age
were insured.

Prior to Medicare, 1/3 of all seniors were living in poverty.

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.
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Kaiser Family foundation study showed greater overall satisfaction
and much more cost efficiency than private insurance companies.
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Patients have greater choice and do not need pre-authorizations.
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The government does not tell doctors how to practice, what tests
to order, which hospitals to go to, or what medications to
prescribe.
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It is the private insurance companies that tell patients who to see,
where to go, and what doctors can do.
Single Payer System

Private insurers waste 31 cents of every dollar on overhead,
sales and marketing, lobbying, billing, underwriting, and
exorbitant executive compensation.

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.

Would be financed by eliminating private insurance and
recapturing their administrative waste.
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Modest new taxes would replace premiums and costs would
be controlled through negotiated fees, global budgeting,
and bulk purchasing.
Single Payer System

Physicians would still be able to practice medicine the way
they think is best.
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Would lead to higher wages as employers would not have to
pay for healthcare premiums.
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Would lead to more capital investments by companies.
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CA Nurses Association study found it would create 2.6
Million new jobs and infuse $317 Billion in new business
revenue.
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Patients would not feel trapped in their current jobs due to
the fear of losing their health care coverage.
Single Payer System
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HR 676 – Expanded and Improved
Medicare Act for All - Conyers
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Senate Amendment 2837 – Medicare for
All –
Sanders, Brown, Burris.
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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