Universal Health Care without Private Health Insurance?

Single Payer: The Only Affordable, Lifelong, Comprehensive, Quality Health

Care Plan for Every American

Robert Zarr, MD, MPH, FAAPRLZARR@yahoo.com

DC PNHPwww.pnhp.org

MY STORY• Sept 22, 2007,at 1pm, I was assaulted

• Loss of consciousness

• Ambulance ride & ER visit

• NO in-network ambulance coverage for my insurance policy?

• Monthly bills from DC EMS

• After 5 months, insurance finally paid ONLY 75% of transport cost

Best health care system in the world?

18,314 Adult Deaths Annually Due to Uninsurance

We are the best at spending the most

money to be ranked 37th in health outcomes by

WHO!

Government Funds Most Academic Research

Insurance Overhead 2001

In summary, private insurance:

• Is wasteful ($350 billion a year)

• Reduces the buying power of 300 million American purchasers (decreased monopsony)

• Reduces transparency of health care system problems and solutions

• Does not provide lifetime comprehensive quality health care to any American

Insanity:Try it the same way every time and expect different

results.

Individual & employer mandates, HSAs, High Deductible Plans, Free

Market models =MORE OF THE SAME

SINGLE PAYER NATIONAL

HEALTH INSURANCE

READY FOR REAL CHANGE?

House Resolution 676:http://thomas.loc.gov/cgi-bin/thomas

United States National Health Insurance Act

(Expanded and Improved Medicare for All Act)

The 4 principles of single payer:

1. Access to comprehensive health care is a human right.

2. The right to choose and change one's physician is fundamental to patient autonomy.

3. No corporate profit and personal fortune.

4. In a democracy, the public should set overall health policies.

Single Payer NHI guarantees:

• Comprehensive Care

• Quality

• Choice

• Affordability

Single payer NHI would cover every American for all lifetime medically-necessary services:

acute, rehabilitative, long term and home care, mental health, dental services, occupational health care, prescription drugs and supplies, and preventive and public health measures

Prescription Drugs and Supplies

• NHI would pay for all medically necessary prescription drugs and medical supplies, based on a national formulary

• Regional expert panels would establish and regularly update the formulary

• NHI would provide all Americans with full coverage for necessary drugs and supplies

Payment for Physicians and Outpatient Care: 3 Options

1. fee-for-service, or

2. salaried positions in institutions receiving global budgets, or

3. salaried positions within group practices or HMOs receiving capitation payments

How Do We Know It Can Be Done?

• Every other industrialized nation has a healthcare system that assures health care for all

• All spend less than we do; most spend less than half

• Most have lower death rates, more accountability, and higher satisfaction

• No country has ever adopted single payer, found it to be worse, and switched back

But, can we afford NHI?

We can't afford NOT to have NHI!

Projected 2010 Health Care Expenditure Comparison of:Current Health Care System to those of National Health Insurance (NHI, Improved and Expanded Medicare for All, HR 676)

Status Quo($ billions)

NHI($ billions)

Spending Federal spending (Medicare, Medicaid, DSH, etc.) 957 957

Spending State and Local spending 348 348

Spending Private Insurance spending (premiums) 950 0

Spending Out of pocket spending (co-pays, deductibles, over the counter drugs, etc.)

317 80

Spending Other private funds spending (foundations, etc.) 204 0

Savings Savings from reduced administrative cost (paperwork) 0 278

Savings Savings from bulk purchase of Rx DRUGS 0 87

Savings Savings from non-durable medical supplies 0 13

Savings Savings from durable medical supplies 0 9

Additional Revenue

Additional Payroll Tax 0 538 (3.3% increase over current 1.4%)

Additional Revenue

Stock transfer tax (0.25% on seller and buyer) 0 150

Additional Revenue

Corporate Welfare Reduction 0 100

Additional Revenue

Reversal of 2001 and 2002 Tax Cuts 0 251

Additional Revenue

Tax surcharge (5% on highest top 5% earners and 10% on top 1% earners)

0 200

Total ($billions) 2,776 3,011Surplus 0 235 (3,011-2,776)

So, is this politically feasible?

PNHP Total Membership

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

Year

Mem

bers

Broad Support from:

• 92 US Congressional co-sponsors of HR 676 (more than any other bill)

• 59% of US physicians

• 70,000 medical students

• 75,000 nurses

• Faith organizations

• 2 state governments (Kentucky and N.H. House of Representatives)

• U.S. Conference of Mayors

• 452 union organizations

Robert Zarr, MD, MPH, FAAP

RLZARR@yahoo.com