Single Payer 101 Training Universal Health Care for Massachusetts

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1 Single Payer 101 Training Universal Health Care for Massachusetts

2 What s Wrong With Our Health Care System? (the easy part)

3 U.S. Has Lowest Life Expectancy in the Industrialized World OECD, 2011

4 U.S. Has Among Highest Infant Mortality Rates Health, United States, 2007

5 U.S. Has Among Highest Maternal Mortality Rates OECD, 2011

6 Rising Uninsured Population 18.0% 17.0% 16.3% 16.0% 15.2% 15.0% 14.6% 14.0% 13.6% 14.3% 14.7% 13.0% 12.0% 13.1% United States

7 Human Toll of Uninsurance 1987 = Uninsured 25% more likely to die than the insured 2005 = Uninsured 40% more likely to die than the insured United States = 45,000 deaths due to lack of insurance in 2005

8 Insurance Coverage Better in Massachusetts, but Unsustainable 18.0% 16.0% 14.0% 13.6% 13.9% 15.2% 16.3% 12.0% 10.0% 8.0% 7.8% 9.5% 9.6% Health Reform 6.0% 5.6% 4.0% 2.0% 0.0% 4.9% United States Massachusetts

9 Rapid Growth of Underinsured Households 100% 90% 80% 26% 28% 28% 70% 60% 50% 40% 30% 9% 65% 14% 16% 58% 56% Uninsured during year Underinsured all year Insured all year 20% 10% 0%

10 Insurance Not Protection Against Health Care Costs (2010) 70% 60% 50% 46% 63% 52% 58% 40% 30% 20% 10% 28% 27% Insured Underinsured Uninsured 0% Went Without Care Because of Costs in Past Year Had Problems Paying Medical Bills or Medical Debt

11 Most Medically Bankrupt Had Insurance at Onset of Illness 10% 5% 2% 22% 60% Private Insurance Uninsured VA/Military Medicare Medicaid

12 No Change in Mass. Medical Debt and Medical Bankruptcies 70% 60% 50% 40% 59.3% 52.9% 30% 20% 19.1% 19.1% 19.5% 20.3% 10% 0% Problems paying medical bills Paying medical bills over time Bankruptcies related to illness/medical bills* 2006/

13 Rising Share of Mass. Residents with High Deductibles ($1,000+) 12.0% 11.3% 10.0% 8.0% 6.0% 6.1% 4.0% 3.4% 2.0% 0.0%

14 Large Inequities Remain in Mass. Insurance Coverage 35.0% 30.0% 30.7% 25.0% 20.0% 15.0% 10.0% 5.0% 18.5% 8.6% 15.4% 15.0% 9.8% 9.6% 3.3% 3.3% 0.0% White Black or African American Hispanic

15 Little Change in Mass. Inequities in Cost Barriers to Care 20.0% 18.0% 16.0% 14.0% 12.0% 10.0% 8.0% 6.0% 4.0% 2.0% 0.0% 18.2% 16.3% 16.3% 14.5% 11.7% 11.4% 7.5% 5.3% 5.9% White Black or African American Hispanic

16 U.S. Spends Almost Double Next Highest Spending Country

17 U.S. Health Care System the Sixth Largest Economy in the World Country 2010 GDP United States $14,447,100 China $5,739,358 Japan $5,458,873 Germany $3,280,334 France $2,559,850 U.S. Health Care System $2,542,690 United Kingdom $2,253,552

18 Health Care Spending Will Consume the Entire Economy by % 100% Health Care Spending as % of Gross Domestic Product 95% 80% 73% 61% 60% 40% 27% 33% 39% 49% 20% 0%

19 Health Care Costs Responsible for the Federal Deficit

20 State Health Spending is Edging Out All Other Public Programs 140% 130% 120% 110% 100% 90% 80% 70% 60% 50% 40% Massachusetts real state spending by activity, % 99% 70% 48% Real Health Real Education Real Local Aid Real other

21 City of Boston Salaries Falling, Health Care & Pension Costs Rising 125.0% 120.0% 115.0% 110.0% 105.0% 100.0% 95.0% 90.0% 85.0% 106.3% 105.3% 97.9% 120.3% 113.5% 93.6% 80.0% Salaries Health Insurance Pensions

22 City of Boston Salaries Falling, Health Care & Pension Costs Rising 125.0% 120.0% 115.0% 110.0% 105.0% 100.0% 95.0% 90.0% 106.3% 105.3% 97.9% 120.3% 113.5% 93.6% 85.0% 80.0% 1,105 (6.5%) jobs cut from January 2009 to Salaries Health Insurance Pensions

23

24 100% of Minimum Wage Salary to Pay for a Family Health Plan

25 Growing % of Mass. Families with Unaffordable Health Care Costs 25% 20% 20.2% 15% 14.2% 10% 5% 3.6% 5.2% 0% Spent 10%+ of income on health care Spent 25%+ of income on health care

26 Over Half of Home Foreclosures Due to Medical Causes Respondents Self-reported medical cause of foreclosure 50% Un-reimbursed med bills > $ % Lost 2+ wks, work illness /injury 30% Currently unable to work, medical 8% Used home equity to pay medical bills 13% Any of the Above 69%

27 Why Are U.S. Health Care Costs So High? (the hard part)

28 Common Explanations for High Health Care Costs Inadequate Prevention Behavioral factors High obesity rate High smoking rate High levels of drinking Racial and Ethnic Makeup of the U.S. Aging population End of life care Chronic Illnesses High cancer rates High diabetes rates High heart disease rates Overuse of technology (e.g. MRIs, CT scans, etc) Use more prescription drugs Fee-for-service: overuse of tests and procedures Lower cost transparency More third party insurance payers More physician visits More ER and hospitals visits More Medical Malpractice lawsuits Worse electronic health records Higher Cost of drugs Higher cost of medical devices Too much hospital bargaining power More profits More administration/paperwork Higher physician/nurse pay

29 Common Explanations for High Health Care Costs Inadequate Prevention Behavioral factors High obesity rate High smoking rate High levels of drinking Racial and Ethnic Makeup of the U.S. Aging population End of life care Chronic Illnesses High cancer rates High diabetes rates High heart disease rates Overuse of technology (e.g. MRIs, CT scans, etc) Use more prescription drugs Fee-for-service: overuse of tests and procedures Lower cost transparency More third party insurance payers More physician visits More ER and hospitals visits More Medical Malpractice lawsuits Worse electronic health records Higher Cost of drugs Higher cost of medical devices Too much hospital bargaining power More profits More administration/paperwork Higher physician/nurse pay

30 Common Explanations for High Health Care Costs Inadequate Prevention Behavioral factors High obesity rate High smoking rate High levels of drinking Racial and Ethnic Makeup of the U.S. Aging population End of life care Chronic Illnesses High cancer rates High diabetes rates High heart disease rates Overuse of technology (e.g. MRIs, CT scans, etc) Use more prescription drugs Fee-for-service: overuse of tests and procedures Lower cost transparency More third party insurance payers More physician visits More ER and hospitals visits More Medical Malpractice lawsuits Worse electronic health records Higher Cost of drugs Higher cost of medical devices Too much hospital bargaining power More profits More administration/paperwork Higher physician/nurse pay

31 Common Explanations for High Health Care Costs Inadequate Prevention Behavioral factors High obesity rate High smoking rate High levels of drinking Racial and Ethnic Makeup of the U.S. Aging population End of life care Chronic Illnesses High cancer rates High diabetes rates High heart disease rates Overuse of technology (e.g. MRIs, CT scans, etc) Use more prescription drugs Fee-for-service: overuse of tests and procedures Lower cost transparency More third party insurance payers More physician visits More ER and hospitals visits More Medical Malpractice lawsuits Worse electronic health records Higher cost of drugs Higher cost of medical devices Too much hospital bargaining power More profits More administration/paperwork Higher physician/nurse pay

32 Disease Prevalence: U.S. vs. Peer Countries Other Back problems Osteoarthritis/joint disorders 91% 86% 97% Diabetes melitus 122% Hypertension COPD, asthma 67% 77% Mental disorders Cancer Trauma-related disorders Heart conditions 98% 105% 106% 95% 0% 20% 40% 60% 80% 100% 120% 140%

33 Disease Prevalence: U.S. vs. Peer Countries Other 97% Back problems 91% Osteoarthritis/joint disorders Diabetes melitus Hypertension COPD, asthma Mental disorders 86% 77% 67% 98% 122% Disease prevalence = $57 to $70 billion savings Cancer Trauma-related disorders Heart conditions 95% 105% 106% 0% 20% 40% 60% 80% 100% 120% 140%

34

35 14 Physician Visits Per Capita,

36 Hospital Stays per 1,000 population,

37 Average Length of Hospital Stay in Days,

38 What s Driving U.S. Prices? (the easy part that s hard to win)

39 Nations With Universal Health Care Coverage

40 How Single Payer Health Care Is Paid For You Fixed Payroll Tax Government Fund Negotiated Budget Health Care Providers

41 How U.S. Health Care Is Paid For Taxes Premiums Medicaid Medicare Blue Cross Tufts Medical Insurance Separate contracts You Out-of-Pocket Costs Health Care Providers

42 OECD Data, 2010 Insurance Administration Costs

43 Hospital Administration Costs OECD, 2010

44 Aortic Aneurysm Repair Costs Brox. et. al. Arch Internal Medicine, 2003

45 U.S. Pays Higher Prices for the Same Drugs mt.gov.com, 2010

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