Answering Difficult Questions about Single Payer Healthcare SNaHP Annual Summit February 2015 Xin Guan Albany Medical College M3 Danny Ash Ohio State U College of Medicine M4 The most important thing is to show people that change is ID: 553038
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Myth Busters:
Answering Difficult Questions about Single Payer Healthcare
SNaHP
Annual Summit
February 2015
Xin Guan
Albany Medical College, M3
Danny Ash
Ohio State U. College of Medicine, M4Slide2
“The most important thing is to show people that change is
possible.” Gerald Friedman
Professor of Economics
University of Massachusetts, AmherstSlide3
MYTH…
“The uninsured get free health care. They can just go to the emergency room.”Slide4
MYTH…
REALITYAmong families with at least one uninsured member, less than ¼ report getting free or discounted care in any given year.
Financial pressures
to provide charity care are reducing the ability of private physicians to provide charity care. Emergency department care is not free! Hospitals
bill the uninsured at higher prices than insurance companies
pay
EDs are ill-suited to provide primary careSlide5
MYTH…
“Single payer is fundamentally anti-American because America is a capitalist and individualistic society.”Slide6
MYTH…
REALITYAnti‐American: our current system that discourages entrepreneurship because health insurance is tied to employment
Anti-American
: our current system that leaves Americans vulnerable to skyrocketing healthcare costs, so that 78% of all bankruptcies are related to medical billsSingle payer will boost our economy, reduce healthcare expenditures in the long run and help us remain
a strong nation.Slide7
MYTH…
“Single payer is socialized medicine.”Slide8
MYTH…
REALITYA single payer national health program is NOT socialized medicineSocialized medicine: a
system in which doctors and hospitals work for and draw salaries from the
government. American examples: VA, Armed Services. Other examples: Great Britain and SpainSingle payer: the government pays for most healthcare (hence single payer) but does not own or manage medical practices or hospitals
American examples: Medicare
Other examples: Canada, Australia, Japan
This
is why our motto for single payer is
“improved Medicare for all
”Slide9
MYTH…
“We have the best health care system in the world! Why change it
?”Slide10
MYTH…
REALITYOur life expectancy and infant mortality rates are worse than that of many
countries
International rankings: 19th out of 19 nations in deaths from medically-treatable causesWHO: 37th on overall performance and 24th on health attainment
We spend
more than any other nation in the world per capita on health
care
Only
a select few who can afford it get some of the best care in the world. Americans get less of most kinds of care (doctor, hospital, surgery, etc.) than the citizens of other industrialized nations. Slide11
Our current system: worse outcomes…
Female life expectancy at birth
Figure: Gerald Friedman from data at http
://www.oecd.org/els/health-systems/oecdhealthdata2013-frequentlyrequesteddata.htm Slide12
… for a LOT more money!
Per capita healthcare spending (2011 USD, PPP)
Figure: Gerald Friedman from data at http
://www.oecd.org/els/health-systems/oecdhealthdata2013-frequentlyrequesteddata.htm Slide13
Paying more… for less!
Annual per Capita Doctor Visits
Figure: Gerald Friedman from data at http
://www.oecd.org/els/health-systems/oecdhealthdata2013-frequentlyrequesteddata.htm Slide14
MYTH…
“We already have healthcare reform. The ACA will cover everybody who is uninsured.”Slide15
MYTH…
REALITYThe ACA will cover some uninsured Americans… but the job’s not finished!CBO projections for 2019: 23 million Americans still without coverage
CBO estimates do not include the underinsured, who are still vulnerable to financial ruin due to growing out-of-pocket costs
Underinsurance will worsen under ACASlide16
MYTH…
“Single payer will restrict provider choice.”Slide17
MYTH…
REALITYProvider choice is already restricted under current system!Many private insurers severely limit patients’ ability to choose their health care provider
Single payer would
promote increased patient autonomy and choice of providers by removing all “network” restrictionsSlide18
MYTH…
“Quality of care will suffer under single payer.”Slide19
MYTH…
REALITYSingle payer provides the most effective financial structure for increasing the quality and efficiency of care Facilitates large-scale
adoption of quality improvement initiatives such as surgical
checklistsMakes it possible to identify "outliers" who are practicing outside community normsSlide20
Perverse incentives and fragmented payment system: a recipe for troubleSlide21
MYTH…
“Doctors will never buy into single payer because it will interfere with their autonomy and decrease their salaries.”Slide22
MYTH…
REALITYMore than 60% of physicians already support a single payer system Canada
is experiencing a net influx of
physicians – both Canadian and AmericanPrivate companies currently restrict physicians’ ability to practice medicine (network restrictions, precert, etc
)
Under single payer, decision
making will be returned to healthcare providers and their
patients
Based on Canadian experience, average
physician incomes should change
little, though income
disparity between specialties is likely to
shrinkSlide23
Healthcare job growth since 1970...
Physicians
Administrators
3000%
2500%
2000%
1500%
1000%
500%
0
1970
1980
1990
2000
2010
Figure: Gerald Friedman from data provided by Bureau
of Labor Statistics, Occupational Employment Statistics, at bls.org
.Slide24
… a uniquely American phenomenon!
Per capita administrative spending (2014 USD)
Figure: Gerald Friedman from
Woolhandler
/
Himmelstein
/Campbell
NEJM 2003;349:769 (updated 2013)Slide25
MYTH…
“Single payer is politically unfeasible – look what happened in Vermont
!”Slide26
MYTH…
REALITYThere are still single payer bills in many state legislatures and a national bill, HR 676Single payer has growing support from health professional, labor, business, and faith-based
groups
Vermont’s plan had veered away from a true single payer model, so is not representative of single payer’s political prospectsEffective grassroots organizing got real healthcare reform on the political radar screen in Vermont, and can get it back on the radar
elsewhere!Slide27
MYTH…
“Health care is not a right.”Slide28
MYTH…
REALITYEven if healthcare is not a right, single payer might still be the wisest public policy because of its moral and economic benefits. Moral benefits - tens
of thousands of Americans die each year because they do not have adequate access to
healthcareEconomic benefits - The United States spends 50% more as a percentage of its GDP than most other developed countries, but we insure a lower percentage of our population. Under single payer, the average taxpayer would have thousands of dollars more in discretionary income.Slide29
We die young because we lack access to careAnd it is getting worse!
Slide by Gerald Friedman
Source:
Commonwealth
Fund survey reported in Cathy Schoen, et al., "Access, Affordability, and Insurance Complexity" Health Affairs, Nov. 18, 2013Slide30
Cost of health insurance
, Ohio private-sector workers with health insurance and single payer savings
Cost of health insurance, Ohio private-sector workers with health insurance and single payer savings
Average premium worker with health insurance
$ 9,584
Average deductible
$ 1,777
Total
:
$ 11,361
Average wages
$ 43,170
ratio
26.3%
Savings under single-payer
$
7,044
Slide by Gerald FriedmanSlide31
MYTH…
“Single payer will create waiting lists.”
“Single
payer would result in rationing of care.”Slide32
MYTH…
REALITYWe are already rationing healthcare in the United States.All scarce goods are rationed. The only choice we have is how.
Rationing in single payer system: according to need
Rationing in the current system: according to income This is an inefficient allocation of healthcare resources.
In
European-style single-payer systems, some elective procedures have waiting lists, but there are rarely, if ever waiting lists for medically necessary or emergent proceduresSlide33
MYTH…
“How can we possibly transition from our current system to single payer? It seems impossible!”Slide34
MYTH…
REALITYThe payment and provider structures already exist within the Medicare program to permit a relatively smooth transition to a single payer health care system in this countryMany
people now working in the insurance industry are, in fact, already health professionals (e.g. nurses) who will be able to find work in the healthcare field
againMany insurance and health administrative workers will need a job retraining and placement program. Cost: ~$20B/yr
during transition (a
small fraction of the administrative
savings
from transition)Slide35
THANK YOU!
Photos © Ian
Hayhurst
, Bob Estremera
, and Joe Newman