1 Improved Medicare for All Quality, Guaranteed National Health Insurance by HEALTHCARE-NOW!
2 Single-Payer Healthcare or Improved Medicare for All! The United States is the only country in the developed world that does not guarantee access to basic health care for residents. Countries that guarantee health care as a human right do so through a single-payer system, which replaces the thousands of for-profit health insurance companies with a public, universal plan. Does that sound impossible to win in the United States? It already exists - for seniors! Medicare is a public, universal plan that provides health coverage to those age 65 and older. Medicare costs less than private health insurance, provides better financial security, and is preferred by patients (Davis, 2010). Single-payer health care is often referred to as Expanded & Improved Medicare for All. Under the single-payer legislation in Congress (H.R. 676): Everyone would receive comprehensive healthcare coverage under single-payer; Care would be based on need, not on ability to pay; Employers would no longer be responsible for health care costs and coverage decisions; Single-payer would reduce costs by 24%, saving $829 billion in the first year by cutting administrative waste and allowing negotiation of prescription drugs; and Single-payer would create savings for 95% of the population. Only the top 5% would pay slightly more. 2 IMPROVED MEDICARE FOR ALL: Quality, Guaranteed National Health Insurance
3 Countries with Single Payer: Lower Costs, Better Access Every international comparison has found that countries with universal, single-payer systems spend half to a third what the U.S. spends, while providing better access to care. $10,000 $8,000 $6,000 $4,000 $2,000 $0 Health Expenditures Per Person, 2012 (OECD) $8,508 $4,522 $4,118 $4,495 $3,405 $3,925 The Commonwealth Fund in 2014 ranked the U.S. last out of 11 developed countries in healthcare performance, while the World Health Organization ranked the U.S. 37th globally, below almost every other developed nation in % 30% 20% 10% 0% Went Without Needed Care Due to Cost, (Commonwealth Fund) 37% United States 13% 18% 15% Canada France Germany United Kingdom 4% 6% Sweden 3
4 Uninsured & Underinsured The crisis of the uninsured is the most visible face of the U.S. health care system s failings. Prior to passage of the Affordable Care Act (ACA) in 2009, 18% of U.S. residents or 48 million people lacked any form of health insurance coverage according to the Census. Lacking insurance increases the chance of death by 40%, and each year more than 45,000 die due to lack of coverage (Wilper, 2009). The primary goal of the ACA is to expand insurance coverage, yet by 2023, 10.9% of the population - 31 million people - will still lack coverage according to the Congressional Budget Office. 25% 20% 15% 10% 5% 0% 16.5% 17.5% 20.0% 10.9% Uninsured % Without ACA Uninsured % With ACA Having insurance does not guarantee access to needed care or protection from financial ruin due to health care costs. Those who are underinsured have insurance, but with deductibles, co-payments, and co-insurance so high that they experience barriers to care and financial burdens almost as extensive as those without any insurance at all. 4 IMPROVED MEDICARE FOR ALL: Quality, Guaranteed National Health Insurance
5 Went without needed care due to costs, by insurance status, 2012 (Commonwealth Fund) 68% 53% 31% Uninsured Underinsured Insured The Commonwealth Fund estimates that 31.7 million residents, The Commonwealth Fund estimates that 31.7 million residents, 11.8% 11.8% of of the the population, population, were were underinsured underinsured in in a - a group group almost as as large large as as the the uninsured. They They also also found that that the the under- underinsured go without go without needed needed care care due to due costs to costs and struggle and struggle to pay to pay off off outstanding medical bills bills in in numbers only only slightly lower lower than than the the uninsured. uninsured. The ranks of the underinsured may grow even more quickly with The ranks of the underinsured may grow even more quickly with passage of health reform. When Massachusetts passed a similar passage of health reform. When Massachusetts passed a similar reform in 2006, the uninsured population declined, but the share reform of residents in 2006, with the high-deductible uninsured population plans (underinsured), declined, but the increased share of residents from 3.4% with prior high-deductible to reform to plans more than (underinsured), 11.3% just increased one year after from 3.4% reform prior (Mass. to reform DHCFP, to more 2010). than 11.3% just one year after reform (Mass. DHCFP, 2010). Even those with the best health coverage often find that their Even health those security with the is illusory. best health More coverage than 3/4ths often of find those that who their declared bankruptcy due to medical issues had health insurance health security is illusory. More than 3/4ths of those who declared at the onset of their illness or injury, often losing coverage when bankruptcy they become due sick to medical or injured issues and had subsequently health insurance lost their at jobs the onset of (Himmelstein, their illness or 2009). injury, often losing coverage when they become sick or injured and subsequently lost their jobs (Himmelstein, 2009). 5
6 For-Profit Healthcare is Unsustainable Healthcare costs are rising so rapidly that the U.S. now spends almost twice as much as the next highest-spending country. Healthcare is projected to consume 20% of all spending by 2022, and to continue rising rapidly for future generations (CMS, 2013). Per Capita Healthcare Spending (OECD) $10,000 $8,389 $8,000 $6,000 $4,000 $2,000 $4,723 $3,172 $ United States Germany Canada France Sweden United Kingdom A single-payer healthcare system allows countries to budget their health care spending and choose how much they wish to spend each year, and allocate funds where they are most needed. It also allows the country to negotiate lower prices for prescription drugs and medical devices by using bulk purchasing power. 6 IMPROVED MEDICARE FOR ALL: Quality, Guaranteed National Health Insurance
7 Unacceptable Healthcare Inequities and Disparities Unacceptable Healthcare Inequities and Disparities Without a right to healthcare, insurance coverage is highly is highly dis- discriminatory in in the the United States. Groups that are discriminated against in the labor market such as as people of of color color and and immigrants immigrants are much are less much likely less to likely receive to receive quality workplace quality workplace health insurance, health insurance, while those while with those greater with health greater needs health such as needs women, such the as disabled, women, the and disabled, anyone with and a anyone chronic with health a chronic condition health suffer condition suffer disproportionately disproportionately from from high high deductibles deductibles and and copayments. co-payments. 35% 30% 25% 20% 15% 10% 5% 0% Uninsured by Race/Ethnicity, 2012 (Census, CPS) 11.1% Non-Hispanic White 15.1% 19.0% 29.1% Asian Black Hispanic The ACA will increase insurance coverage for all groups, there is no The reason ACA to will believe increase that insurance it will reduce coverage these inequities. for all groups, After health there is reform no reason in Massachusetts to believe that cut it the will uninsured reduce these population inequities. half, After large health racial and reform ethnic in Massachusetts inequties there continued cut the uninsured unchanged population (Zhu, 2010). in half, large racial and ethnic inequities there continued unchanged (Zhu, 2010). 7
8 How Single-Payer Saves Billions by Cutting Out Waste Single-payer healthcare would save $829 billion in its first year that's 24.3% of our total health care spending! If reinvested into our healthcare system, what would that $829 billion buy? Total current U.S. healthcare spending: $3.42 TRILLION $829 BILLION SAVINGS by eliminating waste Comprehensive health coverage for every resident of the United States. Elimination of all co-payments, deductibles, and other cost sharing. Fair reimbursement for physicians and hospitals, above Medicaid and Medicare rates. Providing income security and retraining for potentially displaced workers. Replacing for-profit hospitals, providing poor care, with safer and more efficient non-profit hospitals. $198 billion per year in savings left over - enough to eliminate the federal deficit in a few short years! 8 IMPROVED MEDICARE FOR ALL: Quality, Guaranteed National Health Insurance
9 Here s where $829 BILLION IN SAVINGS for the first year come from: $260 BILLION $201 BILLION Single-payer would increase federal tax revenue by $260 billion per year by eliminating current public subsidies and tax credits for private health insurance. Bringing insurance administration costs down to Medicare levels would save $201 billion per year by eliminating insurance company profits, advertising, lobbying costs, and exorbitant executive pay. $221 BILLION Replacing hundreds of payers with one payer simplifies billing for providers. Hospitals, physicians, dentists, nursing homes, and others would reduce administrative costs by 36%, saving $221 billion per year. $32 BILLION Single-payer would eliminate the need for employers to manage health benefits for their workers, saving $32 billion per year. $116 BILLION Paying the same prescription drug prices as Europe by negotiating costs for the whole country, would reduce spending on pharmaceuticals by 38%, saving $116 billion per year. (SOURCE: Friedman, 2013) 9
10 Frequently Asked Questions QUESTION: Won t single-payer lead to long wait times and rationing of care? ANSWER: No. Every healthcare system has to ration its resources, but in the United States we ration based on ability to pay - leaving millions outside of the system - while single-payer systems ration based on medical need. As a profit-driven system, the United States does have problems with wait times for unprofitable forms of care such as primary care, mental health, and even emergency care, while it performs better on income-generating forms of care such as specialty procedures and oncology. Most countries with single-payer do not have wait time problems for any category of care (Commonwealth Fund, 2014), but Canada and England for example have had wait time problems for elective procedures and imaging services due to underfunding of equipment and specialists - particularly when conservative governments have been elected and slashed healthcare budgets. The United States spends two to three times what these countries spend on healthcare per person, and would not experience shortages by switching to a single-payer system. QUESTION: Is single-payer healthcare socialized medicine? ANSWER: No. Under socialized medicine healthcare delivery - hospitals, physicians offices, nursing homes, etc. - are public. Countries with socialized medicine provide excellent and affordable care, but single payer only refers to public (and universal) health insurance, not healthcare delivery. Providers would continue to be a mix of public and private, such as we have today. QUESTION: I have good health benefits through my work, why would I want single-payer reform? ANSWER: Many with excellent workplace health insurance have found that a serious illness or injury may cause them to lose their job, and subsequently their health insurance. Furthermore, employers pay the full cost of health insurance out of reduced wages, and health care costs are devastating municipal, state, and federal budgets, cutting into vital public services like education and infrastructure. Single-payer reform means health 10 IMPROVED MEDICARE FOR ALL: Quality, Guaranteed National Health Insurance
11 security that cannot be taken away by misfortune; savings for households, employers and government; and the ability to control cost growth into the future. QUESTION: Will this put the government between me and my health care provider? ANSWER: No. Currently private corporations - health insurers - stand between you and your care providers, determining which physicians and hospitals you are allowed to see, imposing deductibles and co-payments that often make appropriate treatments impossible, and refusing to pay for care that your providers deem necessary. Under a single-payer system every resident would have full choice of provider, we could eliminate cost barriers to recommended care, and the only oversight for determining what care is appropriate would be provided by medical experts overseeing their peers - not the government. QUESTION: Would single-payer drive up my taxes? ANSWER: Single-payer would replace high, unpredictable premiums with low, stable taxes. Unless you are among the top 5% of income earners, this would reduce your total healthcare costs. Sources Karen Davis et al, Medicare Beneficiaries Less Likely To Experience Cost- And Access-Related Problems Than Adults With Private Coverage, Health Affairs, Vol. 31, No. 8 (August 2012): Karen Davis et al, Mirror, Mirror on the Wall: How the Performance of the U.S. Health Care System Compares Internationally, Commonwealth Fund, June Gerald Friedman, Funding HR 676: The Expanded and Improved Medicare for All Act, July 31, Health Care in Massachusetts: Key Indicators, Massachusetts DHCFP, Health Systems: Improving Performance, World Health Organization, David U. Himmelstein et al, Medical Bankruptcy in the United States, 2007: Results of a National Study, American Journal of Medicine, Vol. 122, Iss. 8 (August 2009): National Health Expenditure Projections , Centers for Medicare & Medicaid Services, Andrew P. Wilper et al, Health Insurance and Mortality in US Adults, American Journal of Public Health, Vol. 99, No. 12 (December 2009): Jane Zhu et al, Massachusetts Health Reform and Disparities in Coverage, Access and Health Status, Journal of General Internal Medicine, Vol. 25, No. 12 (December 2010):
12 Take Action: Get Involved! The most important action you can take is to sign up for Healthcare-NOW! s list, so you can stay connected with the movement and get updates on organizing efforts near you! Here s how to get involved: Visit to:»» Sign up for s and stay connected.»» Make a donation to make health care a right!»» Write an op-ed or letter to the editor.»» Ask your legislators to support single-payer!»» Find a local single-payer group to join. HEALTHCARE-NOW! 1315 SPRUCE ST., PHILADELPHIA, PA Healthcare-NOW! is a grassroots organization that addresses the health insurance crisis in the U.S. by educating and advocating for the passage of single-payer healthcare legislation, such as H.R We support building the movement necessary to implement a publicly-funded, single-payer healthcare system that is universal, equitable, transparent, accountable, comprehensive, and that removes financial and other barriers to the right to health care. Join us!