Pennsylvania Looks at Pennsylvania Looks at Universal Health CareUniversal Health Care

Scott L. Tyson M.D.

Pediatrics South

Pennsylvania House of Representatives

February 27, 2007

Universal Health Care means 100%Universal Health Care means 100%

Incremental steps - who do we leave out and why?

Giant step - leave no one out, but do we have the political will?

Different approaches to Universal Health Different approaches to Universal Health CareCare

Employer based - pay or play? Individual mandates - those who can afford

private insurance must buy insurance Public financing (single payer)

How Should We Decide?How Should We Decide?

Quality, Affordable Health Care for All Pennsylvanians

Getting Value for our Money Framework for Lasting fix Predictable Costs Easy to Understand

Private Insurers?Private Insurers?

Include them?– Major middleman in health care financing

– Multiple payers, increased bureaucracy

– 15-25% administrative overhead

Exclude them?– Major administrative savings

– Bulk purchasing

– Stronger cost control

– Universal coverage

What Do Americans Want?What Do Americans Want?

Do you think it's the government's responsibility to make sure that everyone in the United States has adequate health-care?

Total Men Women

Yes 64% 60% 68%

No 34% 38% 26%

Don’t Know

4% 2% 6%

Quinnipiac University Poll, Feb. 22, 2007

Are you willing to pay more in federal taxes to provide health care to all Americans?

Total Men Women

Yes 53% 49% 57%

No 42% 47% 38%

Don’t Know

4% 3% 5%

Quinnipiac University Poll, Feb. 22, 2007

Does Business Want Universal Health Care?Does Business Want Universal Health Care?

Does Business Want Universal Health Care?Does Business Want Universal Health Care?

YES!!

Retiree Health Benefits!Retiree Health Benefits!

GM retiree cost is $60 Billion!GM retiree cost is $60 Billion!

Source: Wall St. Journal, March 11, 2004

GM Lays Off 30,000GM Lays Off 30,000

Source: NY Times, Nov. 21, 2005

Ford Cuts 25,000 JobsFord Cuts 25,000 Jobs

Source: USA Today, Jan 2006

Chrysler is in trouble due to health careChrysler is in trouble due to health care

Chrysler faces $21.1 billion in future retiree health care liabilities . . . and the majority of the obligation is not funded. The massive liability is one of the key hurdles DaimlerChrysler is seen facing as it tries to sell its US unit.Wall St. Journal, Feb 26, 2007

Financial Accounting Standards Board Financial Accounting Standards Board Rule #158Rule #158

Employers Accounting for Defined Benefit Pension and Other Postretirement Plans

Requiring an employer to recognize the … status of a defined benefit postretirement plan as an asset or liability in its statement of financial position . . .

Starts Dec. 15, 2006

Standard and Poor 500 have $321 Billion Standard and Poor 500 have $321 Billion Health Care Liability!Health Care Liability!

Source: Wall St. Journal, June 6, 2006

$1 Trillion Public Retiree Obligation$1 Trillion Public Retiree Obligation

Source: USA Today, May 18, 2006, Reuters June 13, 2006

Gov’t Sticker Shock-$600 Billion to $1.3 Gov’t Sticker Shock-$600 Billion to $1.3 TrillionTrillion

Source: WSJ, Nov. 9, 2006Wall St. Journal, Nov. 9, 2006

Only 100% Universal Health CareOnly 100% Universal Health Care

Discounts future health care costs Dramatically eliminates retiree health

liability on balance sheet

Looking at MalpracticeLooking at Malpractice

Allegheny County vs. Quebec Allegheny County vs. Quebec malpractice premiums, 2004malpractice premiums, 2004

Source: PA Medical Society, Canadian Medical Protective Assoc, US Dollars, 2004

$904 $1,183

$4,931

$10,132

$22,317

$43,185

$-

$5,000

$10,000

$15,000

$20,000

$25,000

$30,000

$35,000

$40,000

$45,000

$50,000

Family Practice Cardiology General Surgery

Allegheny County vs. Quebec by high Allegheny County vs. Quebec by high malpractice specialties, 2004malpractice specialties, 2004

Source: PA Medical Society, Canadian Medical Protective Assoc, US Dollars, 2004

$13,539

$7,932$11,780

$56,283

$44,508

$66,313

$-

$10,000

$20,000

$30,000

$40,000

$50,000

$60,000

$70,000

Obstetrics Orthopedic Surgery Neurosurgery

Possible Reasons for Less Malpractice Possible Reasons for Less Malpractice Fees in CanadaFees in Canada

Access to preventative services for all Under universal coverage, all future health

care costs covered by health care system

Harrisburg, We Have A Problem . . .Harrisburg, We Have A Problem . . .

Year Closed Hospital Beds Outcome

1994 Sacred Heart Hospital & Rehab. Ctr 234 Closed

1995 Community Hospital of Chester 179 Converted to Outpt Clinics

1995 Thomas Jefferson UH Ford Road 38 Converted to Outpt Clinics

1997 Allegheny Univ Hospitals, Mt Sinai 141 Closed

1997 Institute of Pennsylvania 91 Sold to become Kirkbride Center

1999 Germantown Hospital 88 Converted to Outpt Clinics

1999 Neumann Medical Center 133 Converted to Outpt Clinics

2000 John F. Kennedy Memorial Hospital 103 Converted to Outpt Clinics

2000 City Avenue Hospital 44 Closed

2002 Mercy Community Hospital 113 Converted to Outpt Clinics

2003 Parkview Hospital 149 Closed

2003 Elkins Park Hospital 114 Purchased by Einstein

Number of Beds removed from Inpatient Use(excl.s Elkins Park, some or all of whose bed capacity

will be used by Einstein/MossRehab)

1,222 25.3%

Bed Capacity Reduction At Hospitals Remaining open 3,615 74.7%

12 Phila. hospitals have closed from 12 Phila. hospitals have closed from 1994-20031994-2003

Source: Delaware Valley Healthcare Council

One More Hospital ClosedOne More Hospital Closed

Phila Inquirer, Feb. 17, 2007

Despite a Full Hospital . . . .Despite a Full Hospital . . . .

We Have A Health Crisis in PennsylvaniaWe Have A Health Crisis in Pennsylvania

900,000 - 1.3 million uninsured More Hospital Closures Inadequate SCHIP funding Impending retiree health benefit crisis Inadequate funding of public health

workforce

SB 300 vs. Governor’s PlanSB 300 vs. Governor’s Plan

SB 300 Governor’s Plan

Universal coverage

Yes No

Cost control Yes Minimal

Administrative complexity

Simple Complex

Benefits Comprehensive Restricted by Insurers

Independent analysis for California Independent analysis for California shows single payer saves billionsshows single payer saves billions

$8 billion

Lewin Group, Jan. 19, 2005

Independent analysis for Conn. shows single payer Independent analysis for Conn. shows single payer saves $500 million, adds 6-11,000 more jobssaves $500 million, adds 6-11,000 more jobs

Universal Health Care Foundation of Conn., Jan. 30, 2007

Independent analysis of single payer for Independent analysis of single payer for America would save a trillion dollars!America would save a trillion dollars!

National Coalition on Health Care, Aug 1, 2005

Single Payer Health InsuranceSingle Payer Health Insurance

Universal Health Care Saves the most money Fixes Distortions in Health Care Financing Solves the Malpractice Crisis Quality is Directly Proportional to Funding

Government is the “swing” voteGovernment is the “swing” vote

Government

Business People

Questions? Questions?