prospects for universal health insurance – a regional perspective ----- the case for georgia...

Prospects for Universal Health Prospects for Universal Health Insurance – Insurance –

a Regional Perspectivea Regional Perspective----------

The case for The case for Georgia SecureCareGeorgia SecureCare

------------

Henry S. Kahn, MD, FACPHenry S. Kahn, MD, FACPDecember 2006

"Of all the forms of inequality, injustice "Of all the forms of inequality, injustice in health care is the most shocking in health care is the most shocking and most inhuman"and most inhuman"

A great A great southernersoutherner speaking nearly speaking nearly 40 years ago………40 years ago………

How do southerners feel now ?How do southerners feel now ?

Louisiana, September 2005

[photos from Atlanta J-C]

What, me What, me worry ?worry ?

Is universal, consolidated, comprehensive Is universal, consolidated, comprehensive health care financing for the USA --health care financing for the USA --

Irrelevant Irrelevant (-nobody cares)(-nobody cares) ? ?

Too expensive Too expensive (-budget buster)(-budget buster) ? ?

Liberal fantasy Liberal fantasy (-no popular support)(-no popular support)??

All of the above ? ? All of the above ? ?

Ranks of poor and uninsured swellRanks of poor and uninsured swell ((Atlanta Journal-ConstitutionAtlanta Journal-Constitution, , August 30, 2006)August 30, 2006)

An estimated An estimated 1.7 million Georgians were 1.7 million Georgians were uninsureduninsured in 2005, up from 1.5 million the year before, in 2005, up from 1.5 million the year before, according to a according to a Census Bureau Census Bureau survey. survey.

Georgia's two-year average climbed to Georgia's two-year average climbed to 18.1 percent 18.1 percent uninsured uninsured in 2004-2005, from 16.9 percent in 2003- in 2004-2005, from 16.9 percent in 2003-2004, according to the survey. 2004, according to the survey.

That figure leaves Georgia tied for eighth among That figure leaves Georgia tied for eighth among states with the highest uninsured rates. states with the highest uninsured rates.

The estimate of Americans without insurance rose to The estimate of Americans without insurance rose to 46.6 million, or 46.6 million, or 15.9 percent of the population15.9 percent of the population, ,

…………up from 45.3 million, or 15.6 percent.up from 45.3 million, or 15.6 percent.

Percent of Population withPercent of Population withGovernment-Assured InsuranceGovernment-Assured Insurance

Note: Germany does not require coverage for high-income persons, but virtually all buy coverageSource: OECD, 2002 - Data are for 2000 or most recent year available

92%100% 100% 100% 100% 100%

45%

0%

20%

40%

60%

80%

100%

U.S. Germany France Canada Australia Japan U.K.

We’re We’re payingpaying for national health insurance, for national health insurance, but we’re but we’re notnot getting it ! getting it !

We outspend other societies for health care, We outspend other societies for health care, but we don’t provide universal coverage.but we don’t provide universal coverage.

What What structural changesstructural changes could make it could make it better?better?

Georgians for a Common Sense Health Plan: Georgians for a Common Sense Health Plan: GCSHP GCSHP GoalsGoals ------ ------

Universal - covers everyone with full choice of Universal - covers everyone with full choice of providerprovider

Comprehensive - all needed care, no co-pays*Comprehensive - all needed care, no co-pays*

Single, public payer - simplified reimbursementSingle, public payer - simplified reimbursement

Improved health planningImproved health planning

Public accountability for quality and cost, but Public accountability for quality and cost, but minimal bureaucracyminimal bureaucracy

Discourage investor-owned HMOs, hospitals, etc.Discourage investor-owned HMOs, hospitals, etc.

Are our ideals realistic for Georgia?Are our ideals realistic for Georgia?

1)1) Are Georgians concerned?Are Georgians concerned?

2)2) Would financing reform in our State be Would financing reform in our State be affordable and sustainable?affordable and sustainable?

3)3) ‘‘Feasibility?’: How deep and wide is Feasibility?’: How deep and wide is Georgia political support?Georgia political support?

Grant support from Healthcare Georgia Foundation

Concerned about health care or insurance?Concerned about health care or insurance?

ALL Strongest Subgroup Responses

Very concerned 36% <$30,000No health insuranceDemocrat (ID)African-AmericanDemocrat (history)South GANot registered to voteNot marriedRuralEmployed part-time/both

52%48%45%45%44%44%43%42%41%41%

Somewhat concerned 23% --

Not very concerned 15% Republican (history)>$80,000Republican (ID)$50-80,000

23%23%21%20%

Not at all concerned 25% >$80,00060 and overIndependent (ID)MenMen 18-49Men 50+Republican (history)North GA

32%30%30%29%29%29%29%29%

Phone survey of 800 voters, weighted by gender, party identification,education, race, age, region, & union status. Margin of error +/- 3.5%

SecureCareSecureCare: A Georgia health program: A Georgia health program

single plansingle plan operated by the state or a non-profit operated by the state or a non-profit

replacereplace allall existing public and private health existing public and private health insurance; coverage is insurance; coverage is notnot connected to a job connected to a job

choose any primary care doctor you wantchoose any primary care doctor you want

no deductibles; -- a $25 co-payment only for no deductibles; -- a $25 co-payment only for visits to a specialist without a referralvisits to a specialist without a referral

generous, comprehensive coveragegenerous, comprehensive coverage, including , including doctors, hospitals (by doctors, hospitals (by global budgetsglobal budgets), ), emergency care, prescriptions, mental health emergency care, prescriptions, mental health services, dental care, and services, dental care, and long-term carelong-term care..

What would What would SecureCareSecureCare look like? look like?

• everyone receives a health care card assuring payment everyone receives a health care card assuring payment for all needed carefor all needed care

• complete free choice of doctor, hospital, other providerscomplete free choice of doctor, hospital, other providers

• doctors and hospitals remain independent and non-profit, doctors and hospitals remain independent and non-profit, negotiate fees and global budgets with negotiate fees and global budgets with SecureCareSecureCare

• local planning boards allocate major capital expenditures local planning boards allocate major capital expenditures & expensive technology& expensive technology

• progressive taxes (“premiums”) go to progressive taxes (“premiums”) go to SecureCareSecureCare Trust Trust FundFund

• a single public agency processes and pays billsa single public agency processes and pays bills

• accountability and quality control through periodic accountability and quality control through periodic reviews (reviews (macromacro patterns, not micro management) patterns, not micro management)

SecureCareSecureCare: Proposed funding sources: Proposed funding sourcesemployer payroll tax = 9.1% of wages and salaries for all employer payroll tax = 9.1% of wages and salaries for all employees ($14.2 billion)employees ($14.2 billion)

government spending for discontinued health programs government spending for discontinued health programs ($12.8 billion)($12.8 billion)

income tax payment for all Georgians computed to be income tax payment for all Georgians computed to be equal to about 22.2% of each taxpayer’s federal income equal to about 22.2% of each taxpayer’s federal income tax ($6.0 billion)tax ($6.0 billion)

increase in the state sales tax on non-grocery items of increase in the state sales tax on non-grocery items of one % point ($1.25 billion)one % point ($1.25 billion)

increase in tobacco taxes of 50increase in tobacco taxes of 50¢¢ per pack with per pack with proportionate increases in taxes for other tobacco taxes proportionate increases in taxes for other tobacco taxes ($215 million)($215 million)

increase in taxes on alcoholic beverages ($52 million)increase in taxes on alcoholic beverages ($52 million)

-- NO PRIVATE PREMIUMS; NO OUT-OF-POCKET BARRIERS ---- NO PRIVATE PREMIUMS; NO OUT-OF-POCKET BARRIERS --

Georgia health spending, 2003, Georgia health spending, 2003, in millionsin millions

Status quo: Total by all payers:Status quo: Total by all payers: $ $ 37,15037,150

SecureCare: SecureCare: ↑ utilization↑ utilization $ 3,840$ 3,840

SecureCare: ↓ administr costs ($ 3,815)SecureCare: ↓ administr costs ($ 3,815)

SecureCare: bulk purchasing ($ 741)SecureCare: bulk purchasing ($ 741)

Net change in health spending: Net change in health spending: ($ 716)($ 716)

Age of Family Head

- $537

$384

-$916

- $2,299

-$122

- $3,000

- $2,500

- $2,000

- $1,500

- $1,000

- $500

$0

$500

$1,000

Under 24 25 - 34 35 - 44 45 - 54 55 - 64 65 and

Over

Total

$761$592

Change in average family health care spending by Age of Family Head under the Georgia SecureCare program in 2003: after wage effects

The Lewin Group, October 2003

-$986-$1,934

-$1,536 -$1,428-$957 -$704

$903

$2,285

$4,570

$8,820

-$4,000

-$2,000

$0

$2,000

$4,000

$6,000

$8,000

$10,000

Less than$10,000

$10,000-$19,999

$20,000-$29,999

$30,000-$39,999

$40,000-$49,999

$50,000-$74,999

$75,000-$99,999

$100,000-$124,999

$125,000-$149,999

$150,000or More

Change in average health care spending per family under the Georgia SecureCare program by Family Income in 2003: after wage effects

The Lewin Group, October 2003

"You have your choice of a weekly pay check or health insurance"

$21

$1,112

$668

$246

$829

$-115

$122

$2,595

$2,417

$2,152$2,069

$1,966

$2,643

$2,453

$0

$500

$1,000

$1,500

$2,000

$2,500

$3,000

$3,500

Under 10 10 - 24 25 - 99 100 - 499 500 - 999 All

Workers

Currently Offer Coverage Currently Do Not Offer Coverage

1,000 orMore

Change in private employer health care spending per worker by firm size and current insuring status under the Georgia SecureCare program in 2003: before wage effects

Trial 1:Trial 1: Would you support Would you support SecureCareSecureCare??ALL Strongest Subgroup Responses

Strongly support 52% African-American<$30,000No health insuranceDemocrat (ID)Not registered to voteDemocrat (history)Not marriedSouth GAUrbanEmployed part-time/bothRuralWomen 18-49

69%67%66%65%65%63%61%59%58%58%57%57%

Somewhat support 20% $50-80,000 24%

Somewhat oppose 5% --

Strongly oppose 13% >$80,000Republican (history)Republican (ID)Men 50+WhiteMarried

27%25%23%17%17%17%

Don’t know 11% Women 50+60 and overNo partisan vote pattern (history)

16%15%15%

Trial 2:Trial 2: Would you support Would you support SecureCareSecureCare??ALL Strongest Subgroup Responses

Strongly support 33% No health insuranceDemocrat (ID)<$30,000African-AmericanDemocrat (history)Not registered to voteSouth GANot marriedChildrenEmployed part-time/bothRural18-39$30-50,000

52%45%44%43%42%42%42%40%39%39%38%38%38%

Somewhat support 29% $50-80,000UrbanWomen 18-49$30-50,000

37%35%34%33%

Somewhat oppose 9% --

Strongly oppose 17% >$80,000Republican (history)Republican (ID)Men 50+Married

29%28%25%22%22%

Don’t know 13% 60 and overWomen 50+

26%24%

Private insurers’ High OverheadPrivate insurers’ High Overhead

56% of Medical Students & Faculty56% of Medical Students & FacultyFavor Single Payer;Favor Single Payer;

Majority of Med School Deans ConcurMajority of Med School Deans Concur

Source: NEJM 1999; 340:928

22%

56%

3%19%

Managed Care Single PayerNo Preference Fee-for-service

“What is the best health care system for the most people?”

Thanks for your attentionThanks for your attention, and to many , and to many concerned groups concerned groups

------------------Physicians for a National Health ProgramPhysicians for a National Health ProgramPhysicians’ Proposal Writing CommitteePhysicians’ Proposal Writing CommitteeNational Nurses Organizing CommitteeNational Nurses Organizing CommitteeGeorgians for a Common Sense Health Georgians for a Common Sense Health PlanPlanHealth-STATHealth-STATHealth Care NOW (H.R. 676, Health Care NOW (H.R. 676, Rep. John Rep. John ConyersConyers))American Medical Student AssociationAmerican Medical Student Association

Some useful websites:Some useful websites:

www.pnhp.orgwww.pnhp.org

www.commonsensehealthplan.orgwww.commonsensehealthplan.org

www.healthcare-now.orgwww.healthcare-now.org

(http://drsteveb.dailykos.com ?)(http://drsteveb.dailykos.com ?)

December 2006

““Medical” Savings Accounts: No SavingsMedical” Savings Accounts: No Savings

Sickest 10% of Americans use 72% of care. MSA's Sickest 10% of Americans use 72% of care. MSA's cannot lower these catastrophic costscannot lower these catastrophic costs

The 15% of people who get no care would get The 15% of people who get no care would get premium “refunds”, removing their cross-subsidy for premium “refunds”, removing their cross-subsidy for the sick but not lowering use or costthe sick but not lowering use or cost

Discourages preventionDiscourages prevention

Complex to administer - insurers have to keep track Complex to administer - insurers have to keep track of all out-of-pocket paymentsof all out-of-pocket payments

Congressional Budget Office projects that MSAs Congressional Budget Office projects that MSAs would increase Medicare costs by $2 billion.would increase Medicare costs by $2 billion.

What's Wrong withWhat's Wrong withTax Subsidies and Vouchers?Tax Subsidies and Vouchers?

• Taxes go to wasteful private insurers, overhead >13%Taxes go to wasteful private insurers, overhead >13%

• Amounts too low for good coverage, especially for the Amounts too low for good coverage, especially for the sicksick

• High costs for little coverage - much of subsidy replaces High costs for little coverage - much of subsidy replaces employer-paid coverageemployer-paid coverage

• Encourages shift from employer-based to individual Encourages shift from employer-based to individual policies with overhead of 35% or morepolicies with overhead of 35% or more

• Costs continue to rise (e.g. FEHBP)Costs continue to rise (e.g. FEHBP)

• Many are unable to purchase wisely - e.g. frail elders, Many are unable to purchase wisely - e.g. frail elders, severely ill, poor literacyseverely ill, poor literacy

prospects for universal health insurance – a regional perspective ----- the case for georgia...

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