Health Care for

All Colorado

Irene Aguilar, M.D.

Vice President,

Health Care for All Colorado

Primary Care Physician

Westside Health Center

Denver Health and Hospitals

Health Care Spending in the U.S.

2006 - $2.1 trillion (16% GDP)69% for health care31% for other costs

Administrative overheadProfits

2007 - $2.4 trillion (21% GDP)Colorado spending 2007 estimated at: $30.1 billion

Colorado spending 2007 estimated at: $30.1 billion

Government Insurance

2006: 80.3 M 2007: 83.0 M

2.3 Million

Government Insurance

2006: 80.3 M 2007: 83.0 M

2.3 Million

2007: 45.7 Million Uninsured2007: 45.7 Million Uninsured

2007 Colorado:

801,000 uninsured

16.4% of population

2007 Colorado:

801,000 uninsured

16.4% of population

In Colorado, 70% of the uninsured are in the workforce or are dependents of a worker.

In Colorado, 70% of the uninsured are in the workforce or are dependents of a worker.

What is the cost of health insurance?

Over $10,000 for employer sponsored family policy*

Individual policy (if it can be purchased) more than $10,000 in after tax dollars

Median income was $52,275 in 2006**

Can the average worker afford health insurance?

*The Lewin Group: Health Spending in Colorado June 2007**Denver Business Journal August 2007

0

100

200

300

400

500

600

700

800

$$

Average Total Employee Contribution per Enrolled Employee for Single Coverage at Private-Sector

Establishments Offering Health Insurance in Colorado

Average Total Employee Contribution per Enrolled Employee for Single Coverage at Private-Sector

Establishments Offering Health Insurance in Colorado

Because of rising costs, the numbers of companies

offering health benefits continues to decline

1995 – 67%2000 – 51%2007 – 41%

National Small Business Association Survey - 2007

37.5% of Colorado’s uninsured work for firms that do not offer insurance;

21% are ineligible for their employer’s coverage

37.5% of Colorado’s uninsured work for firms that do not offer insurance;

21% are ineligible for their employer’s coverage

37% of companies have taken

cost cutting action

Instituting wellness programs Changing insurance company Decreasing covered benefits Increasing deductibles and co-pays Increasing employee contribution

Access Problems for Middle Class Families

(Income $25,000-$49,999)

22% 23%

13% 12%

0%

5%

10%

15%

20%

25%

Postponed Needed Care Problem Paying Bills

Didn't Get Needed Drug Collection Agency Call

NPR/Kaiser Survey, June2002

Who Pays for Health Care?

Private health insurers

Insure 59% of those with insurancePay 19% of total health care costs

Who Pays for Health Care?Government (taxpayers) – 66%Federal/State/Local

Medicare - $440 billion (2006)Medicaid - $330 billion (2006)SCHIPGovernment Employee Insurance PremiumsU.S. Public Health Services (IHS)U.S. MilitaryVA System (235,000 employees)Prisoners (2 million incarcerated) Public hospitals and clinicsTax subsidies

Health Care Expenditure per Capitaby Source of Funding in 2005Adjusted for Differences in Cost of Living

$2,884 $2,693 $2,527 $2,337 $2,064 $2,110 $1,829

$2,676

$448$328 $507 $832

$390

$121

$842

$233$431 $482

$392

$2,110

$352$0$250

$627

$0

$1,000

$2,000

$3,000

$4,000

$5,000

$6,000

$7,000

United

States

France Germany Canada Netherlands Australia United

K ingdom

New

Zealand

Out-of-Pocket Spending

Private Spending

Public Spending

ab

a2004b2002

Source: OECD Health Data 2007

Average Length of Stay in Hospital in 2005

5.45.65.66.16.1

6.87.3

8.6

0

2

4

6

8

10

GER CAN NETH AUS UK NZ US FR

a2004b2003cSource: NZ Ministry of Health, 2004

aa c

Source: OECD Health Data 2007 (October 2007)

7.06.6

6.1 6.05.4 5.1

3.83.2

0

2

4

6

8

10

GER FR AUS CAN NETH UK US NZ

Average Number of Physician Visits per Capita in 2005

Utilization of Health Care Services

ba a aa

In comparison to other countries, why do we: Have 97 million uninsured or

underinsured? Spend far more per capita? Have poorer outcomes? In other words… Where is the money?

Growth of Registered Nurses and Administrators, 1970-2002

Bureau of Labor Statistics & Himmelstein/Woolhandler/Lewontin Analysis of CPS data

0%

500%

1000%

1500%

2000%

2500%

1970 1975 1980 1985 1990 1995 2002

Gro

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97

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Administrators RNs

What role do medical liability

costs play?

3% of total costs ($66 billion) Majority of patients who are harmed

are not compensated Some not harmed are compensated Tort reform is not the comprehensive

solution to health care costs

MEDICAL MALPRACTICE INSURANCE2000-2004

9.6%

134.5%

0%

20%

40%

60%

80%

100%

120%

140%

160%

Payout Increase Premiums Increase

Gross Losses Paid Gross Premiums Written

Falling Claims and Rising Premiums in the Medical Malpractice Insurance Industry, July 2005

Drug Companies’ Cost Structure

U.S. Drug Spending, 1990-2003

Source: HCFA, Office of the Actuary

$40$46 $48 $51 $55

$61 $67$75

$104

$122

$142

$161

$182

$85

» 0

» 20

» 40

» 60

» 80

» 100

» 120

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» 160

» 180

» 200

1990 1992 1994 1996 1998 2000 2002

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The Health Care Americans Want

Free choice of doctorGuaranteed accessHigh qualityAffordabilityTrust and Respect

The Health Care Americans Get

1/3 are uninsured or underinsured Insurance companies deny care to millions more

with expensive illnesses Death rates higher than other wealthy nations Costs exceed France, Germany and Sweden and

rising faster Executives and investors making billions Destruction of the doctor/patient relationship

Medicare, Medicaid and Choice or

Insurance does not = Access

Only 37% of Colorado Providers accept Medicaid (adult and children)

In 2002 only 37% of primary care physicians were accepting new Medicare patients

How do we achieve the ideal?Dramatically reduce

overhead costs. How?

Eliminate “for profit” entities in delivery of healthcare

Reduce costs of pharmaceuticals Allow negotiation of bulk price

Create a single risk pool of all residents - makes health care available and affordable to all

Lewin Group Analysis of Colorado Proposals*

COLORADO HEALTH SERVICES SINGLE PAYER PROGRAM

Everyone insured with comprehensive benefits – No one without coverage

$1.4 billion savings annually

*Colorado Blue Ribbon Commission on Health Care Reform 1/31/2008

Single Payer Health Care Universal – covers everyone Comprehensive – all needed care, including

dental, mental health, substance abuse No or low co-pays Simplified reimbursement No for profit insurers, hospitals, etc Improved health planning Public accountability for quality and cost, with

minimal bureaucracy

Single Payer Health Care:How do we know it can be done?

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

All spend less than we do; many spend less than half

Most have lower death rates, more accountability and higher satisfaction

Single Payer Health Care Opponents

Insurance companies - lose business and lose profit

Pharmaceutical companies - lose profit Many providers - fear change Some small businesses - forced to pay

a share The insured – fear less coverage and

more costs

Single Payer Health Care Supporters

The uninsured - all would be covered The elderly & middle class - ends

underinsurance and risk of bankruptcy Medicaid & Medicare recipients - assures

equal choice in care Big business - contains costs Health Care Providers - helps patients,

curtails bureaucracy Employees – bargain for salary increases

instead of health benefits

Single-payer orNational Health Insurance.

U.S. Physicians

Support59%

Oppose32%

No Opinion9%

Support for National Health Insurance among U.S. Physicians: 5 Years LaterCarroll and Ackerman Ann Intern Med.2008; 148: 566-567

Elected leadership should work for taxpayers, not for special interests.

Our healthcare dollars should be spent to guarantee access to comprehensive high quality health care.

We need to advocate for REAL healthcare reform.

What can you do?

Write your federal legislators and ask them to endorse HR 676 – Improved Medicare for All

Talk to your state legislators and ask them to support Single Payer Health Care in Colorado

Educate yourself about the REAL ISSUES in health care reform

Join us : www.healthcareforallcolorado.org

“True compassion is more than flinging a coin to a beggar;

it comes to see that an edifice

which produces beggars

needs restructuring.

Martin Luther King, Jr.

Stephen Colbert on the Bush Health Plan

“It’s so simple. Most people who can’t afford health insurance are also too poor to owe taxes. But if you give them a deduction from the taxes they don’t owe, they can use the money they’re not getting back to buy the health care they can’t afford.”