Health Care for Health Care for AllAll

Health Care for Health Care for AllAll

Fiscally conservative Socially responsible

Rob Stone MDDirector, Hoosiers for a Commonsense Health

Plan

Assistant Professor of Emergency Medicine, IUSM

DISCLOSURES

Dr. Rob Stone has no relevant financial relationships with commercial interests.

Slides can be downloaded at: HCHP.info/Presentations

Single-Payer No-Brainer

☝ EMTALA – We already live with healthcare as a human right

☝ We come out ahead financially☝ Best way to get everyone covered

= less primary care done in ED and fewer hassles making referrals

Single-Payer Downside

☟ If you practice in a tony suburb☟ If you fear the power of big

government more than the power of big corporations

Our Non-System of Illness Care

Lack of Insurance Kills1 every 12 minutes120 every day45,000 a year People without insurance: Live sicker and die younger

The safety net is full of holes

American Journal Public Health, Wilper et al, Dec 2009

President G W Bush President G W Bush

““I mean, people I mean, people have have access to health care in access to health care in America.America.

After all, you just go to an After all, you just go to an emergency room.”emergency room.”

Cleveland, Ohio, July 10, 2007Cleveland, Ohio, July 10, 2007

Indiana Governor Mitch Daniels

“We already have universal health care in this state – anyone can go to the emergency room and get care 24/7.”

September 10, 2001September 10, 2001

ED’s Feel the Pinch

☤ AMI and other urgent patients have increased wait times due to overcrowding by patients unable to obtain non-urgent care elsewhere1

☤ Uninsured children over 3X more likely to die from trauma-related injuries than children with commercial insurance2

1”Waits To See An Emergency Department Physician: 1997– 2004” Wilper et al, Health Affairs 27, no. 2 (2008)2"Lack of Insurance Negatively Affects Trauma Mortality in U.S. Children” Rosen et al, Journal of Pediatric Surgery, 10/09

Insurance Premiums • Workers’ Earnings • Inflation

1999-2008

Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 2000-2008. Bureau of Labor Statistics, Consumer Price Index

Bankruptcy 2009

$ 62% caused by illness and medical bills

$ Most were middle class$ 78% were insured when

they became ill

Himmelstein et al, American Journalof Medicine, August 2009

Health Spending Per Capita

Rampel, US Health Spending Breaks From the Pack, NYT 7/8/09

What Are We Paying For?

An incredibly complex system

Thousands of plans Armies of people to:

-deny coverage and payments

- collect payments

- determine eligibility

Where is the bureaucratic nightmare?

U.S. Overhead Spending

International Journal of Health Services 2005; 35(1): 64-90 ***

Medicare’s Efficiency: 3% Overhead

$ 2003, 31% health spending on overhead – could save $286 Billion1

$ 1993, CBO: “The net cost of Single Payer would be negative.”2

$ 1991, GAO: “If US shifted to coverage like Canada, savings would offset the expense of universal coverage”31New England Journal of Medicine 8/21/2003

2Congressional Budget Office, 1993, 3 separate reports3General Accounting Office, 06/91 ref: T-HRD-91-35

Brief History WWII: Wage and

price controls 1947: Truman

pushes for National Health Insurance

AMA and Southern legislators oppose

History (continued)

The birth of the Blues 1965: Medicare and

Medicaid

Greg Henry MD

“Medicare… should have been called the ‘Savior of Internal Medicine Act.’”

Emergency Physician Monthly October ‘09