Healthcare in crisis Single Payer Medicare for All

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Healthcare in crisis: Single Payer Medicare for All Michael Kaplan, MD, Family Medicine, Lee

Healthcare in crisis: Single Payer Medicare for All Michael Kaplan, MD, Family Medicine, Lee CHP Physicians for a National Health Program PNHP. ORG

What’s So Great About Medicare? 1. You’re in control 2. Far less waste 3.

What’s So Great About Medicare? 1. You’re in control 2. Far less waste 3. Far better health

Medicare Means See the Physicians You Prefer Accepts new Medicare patients 72% 21% 7%

Medicare Means See the Physicians You Prefer Accepts new Medicare patients 72% 21% 7% Non-pediatric primary care physicians across the USA https: //www. kff. org/medicare/issue-brief/primary-care-physicians-accepting-medicare-a-snapshot/ Accessed July 18, 2019 Accepts established Medicare patients Does not accept Medicare patients

Medicare Means Stop Wasting Our Money 20% Insurance Overhead Q 1 2016 19, 9%

Medicare Means Stop Wasting Our Money 20% Insurance Overhead Q 1 2016 19, 9% 18, 8% 18, 7% 15, 9% 10% 5% 0% 2, 2% Aetna Wellpoint/ Anthem United Healthcare Source: Day, Himmelstein, Broder, Woolhandler – Int. J Health Serv 2014 Updated data from firms’ SEC filings (Q 12016) Overhead = (Premium revenue – Medical Expenses) / Premium Revenues 2016 Medicare Trust Fund Report at https: //www. cms. gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Reports. Trust. Funds/Downloads/TR 2017. pdf Humana Medicare A+B

Medicare Means Stop Wasting Our Money on Bureaucracy 1 600 Duke University Hospital System

Medicare Means Stop Wasting Our Money on Bureaucracy 1 600 Duke University Hospital System 957 12 Hospital Beds Billing Clerks (3 Hospitals) Toronto General Billing Clerks https: //newsatjama. com/2017/04/25/jama-forum-where-does-the-health-insurance-premium-dollar-go/ Accessed Sept 2 2019 Toronto General data from private discussions

Growth of Physicians and Administrators Growth since 1970 3000% 2000% 1000% 0% 1970 1975

Growth of Physicians and Administrators Growth since 1970 3000% 2000% 1000% 0% 1970 1975 1980 1985 1990 Managers Bureau of Labor Statistics; NCHS; Himmelstein/Woolhandler analysis of CPS Managers shown as moving average of current year and two previous years 1995 2000 2005 Physicians 2010 2015

Medicare Means Healthier Americans 1 3 USA Rank 5 7 Age 65 9 11

Medicare Means Healthier Americans 1 3 USA Rank 5 7 Age 65 9 11 Women 13 Men Institute of Medicine. Shorter Lives, Poorer Health. Fig 1 -9: Ranking of US mortality rates by age group among 17 peer countries, 2006 -2008. 2013 Peer nations are Australia, Austria, Canada, Denmark, Finland, France, Germany, Italy, Japan, Norway, Portugal, Spain, Sweden, Switzerland, Netherlands, United Kingdom Age 95 -99 90 -94 85 -89 80 -84 75 -79 70 -74 65 -69 60 -64 55 -59 50 -54 45 -49 40 -44 35 -39 30 -34 25 -29 20 -24 15 -19 10 -14 5 -9 1 -4 17 0 -1 15

Which Privatized Medicare way forward? Medicare for Some Medicare for All Today

Which Privatized Medicare way forward? Medicare for Some Medicare for All Today

Single Payer Medicare for All Improve Medicare • Eliminate financial barriers • No deductibles,

Single Payer Medicare for All Improve Medicare • Eliminate financial barriers • No deductibles, copays, coinsurance, etc. • Comprehensive benefits • Add coverage for dental, hearing, glasses, etc. Expand Medicare • Include every American, including Congress • Eliminates wasteful overhead • Negotiated drug prices • Creates the largest “risk pool”

Two Similar Single Payer Bills HR 1384 S 1129 117 Cosponsors 14 Cosponsors Pramila

Two Similar Single Payer Bills HR 1384 S 1129 117 Cosponsors 14 Cosponsors Pramila Jayapal, D-WA Bernie Sanders, I-VT

Two Similar Single Payer Bills Comprehensive coverage • Inpatient, outpatient, ER, lab, etc All

Two Similar Single Payer Bills Comprehensive coverage • Inpatient, outpatient, ER, lab, etc All USA residents covered • Pharmacy You choose your doctors • Oral health • Audiology Prescription drug price negotiations • Vision No premiums, copays, deductibles, or surprises • Full reproductive care Publicly funded (like fire departments, roads, defense) • Much more

Single Payer Medicare for All Makes Economic Sense 29 studies: The savings would fund

Single Payer Medicare for All Makes Economic Sense 29 studies: The savings would fund full coverage. 247 economists: “The time is now for Medicare for All. ” http: //www. pnhp. org/facts/single-payer-system-cost Accessed 2/25/2017 https: //www. nesri. org/news/2019/05/247 -economists-sign-letter-backing-medicare-for-all Accessed 8/13/2019

Single Payer Medicare for All Makes Economic Sense 2. 8% Fraud and waste Uniform

Single Payer Medicare for All Makes Economic Sense 2. 8% Fraud and waste Uniform rates on delivery side 5. 9% Pharmaceutical pricing 1% Increased Utilization 12% 9% 19% Total system administration New Expenses New Savings Note: Percentages are the impact on total healthcare expense. For example, a 40% reduction in the price of pharmaceuticals impacts 14. 7% of total healthcare spend; 0. 4 x. 147 = 059. Source: Pollin, R. , et al. Economic Analysis of Medicare for All. PERI (Political Economic Research Institute), U Mass Amherst

Single Payer Medicare for All Makes Economic Sense 2017 US healthcare consumption $3. 24

Single Payer Medicare for All Makes Economic Sense 2017 US healthcare consumption $3. 24 T “Savings” Increase utilization by 12%: T are$3. 63 not Savings of 19%: 19% 12% “Funding” $2. 93 T overall costs New Expenses New Savings Note: Percentages are the impact on total healthcare expense. For example, a 40% reduction in the price of pharmaceuticals impacts 14. 7% of total healthcare spend; 0. 4 x. 147 = 059. Source: Pollin, R. , et al. Economic Analysis of Medicare for All. PERI (Political Economic Research Institute), U Mass Amherst

Medicare for All Today Privatized Medicare for Some

Medicare for All Today Privatized Medicare for Some

Traditional Medicare (Parts A and B)

Traditional Medicare (Parts A and B)

Medicare Part C (“Advantage”) Needless complexity Multiple forms Multiple bills Multiple contracts Legislated overpayment

Medicare Part C (“Advantage”) Needless complexity Multiple forms Multiple bills Multiple contracts Legislated overpayment Upcoding games

Medicare Advantage Eliminates Choice FL Medicare Advantage Plans including BJC in network? Missouri Medicare

Medicare Advantage Eliminates Choice FL Medicare Advantage Plans including BJC in network? Missouri Medicare Advantage Plans including Mayo Clinic in network? NYC Medicare Advantage Plans including Sloan. Kettering Cancer Institute in network? 0 0 1

Medicare “Advantage” Loss of choice and control Wastes our tax dollars • Only use

Medicare “Advantage” Loss of choice and control Wastes our tax dollars • Only use doctors and hospitals they choose for you • High overhead • Go out-of-network, pay full retail price • Cherry picking, lemon dropping • Legislated overpayment Disappears when you need it • Sickest seniors often want to go back to Traditional Medicare • Might be too late to buy a supplemental

Medicare for All Today Privatized Medicare for Some

Medicare for All Today Privatized Medicare for Some

The “Public Option” sounds great. • Let Americans under age 65 buy into Medicare

The “Public Option” sounds great. • Let Americans under age 65 buy into Medicare • Some plans let employers offer Medicare instead Don’t be fooled. Not really so great. • Misses the savings of single payer • Relies upon premiums (hidden regressive taxes) • Minimal impact on uninsured • Free market appeal • High risk pool, high cost • Easier political lift than Medicare for All • No impact on under-insured • Delays the real change we need

In the Massachusetts State House AN ACT ESTABLISHING MEDICARE FOR ALL IN MASSACHUSETTS (HOUSE

In the Massachusetts State House AN ACT ESTABLISHING MEDICARE FOR ALL IN MASSACHUSETTS (HOUSE BILL H. 1194 AND SENATE BILL S. 683) will guarantee equitable health care access for every resident of the Commonwealth through a single payer health care financing system. All residents will be guaranteed access, without regard to financial or employment status, ethnicity, race, religion, gender identity, sexual orientation, previous health problems, or geographic location. The Act will provide access to health care services that is continuous, without the current need for repeated re-enrollments or changes when employers choose new plans and residents change jobs. Coverage shall be comprehensive and affordable, with no co-insurance, co-payments or deductibles.

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