achieving universal health care for kids (& adults): the minnesota health plan ann settgast, md...
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Achieving Universal Health Care for Kids (& Adults): The Minnesota
Health Plan
Ann Settgast, MD
University of Minnesota
Pediatric Grand Rounds
August 31, 2011
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Disclosures
• No financial relationships
• No discussion of off label or investigational use
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The U.S. health care system becomes a more embarrassing disaster each year… — Donald Kennedy, former President,
Stanford University; former EditorScience, August 15, 2003
America has the best health care system in the world, pure and simple.
— President George W. Bush, addressing the American Hospital Association, May 1, 2006
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The U.S. health care system becomes a more embarrassing disaster each year… — Donald Kennedy, former President,
Stanford University; former EditorScience, August 15, 2003
America has the best health care in the world, pure and simple.
— President George W. Bush, addressing the American Hospital Association, May 1, 2006
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- National research & education organization of ~ 18,000 physicians and medical students advocating universal, comprehensive, single-payer health insurance
- Single-payer care provides a more cost efficient and equitable way to administer health care
- “…access to high-quality health care is a right of all people and should be provided equitably as a public service rather than bought and sold as a commodity…”
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Objectives
• Distinguish single-payer healthcare reform from other reform proposals
• Define the problems of uninsurance and underinsurance as they relate to US children
• Introduce the Minnesota single-payer movement
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Definitions• Universal health care
– Access for all – Doesn’t specify how
• Socialized medicine– Publicly financed– Publicly owned
• Single-payer system– Publicly financed– Privately owned
(delivered)
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What is Single-Payer?
• Hospitals & clinics now bill > 1000 payers (insurers)
• In a single-payer system, there would be no private health insurance
• Recovery of $400 billion annually due to drastically reduced administrative costs
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Why Single-Payer?
Quality
Access
Cost
US has
major problems in all 3 areas
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480,000 Uninsured
Source: http://www.census.gov/hhes/www/hlthins/hlthins.html
68% of the uninsured nonelderly have a FULL-TIME worker in the household.
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Does being uninsured matter?
45,000 adult deaths per year
Source: Wilper et al. American Journal of Public Health, 2009
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Likelihood of Hospitalization After an Injury by Coverage Type
n=1847 injuries in children <18 yrs
Hospitalization
Insurance
Type
Adjusted OR 95%
Private 2.21 0.73-6.63
Medicaid Ref
Uninsured 4.07 1.13-14.66
S Hostetler et al., Health Care Access After Injury by Insurance Type in a Pediatric Population, Pediatric Emergency Care Vol. 21 (7) July 2005 National Health Interview Survey 2000,01,02
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* Adjusted for gender, race, age, region, hospital type, comorbid disease
J Public Health (2010) 32 (2): 236-244 (Data from 23 535 491 pediatric inpatient hospitalizations over 18 years from 37 US states were analyzed).
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“The Hidden Uninsured”Among Children Insured in Jan 2006, Percent
Uninsured in Each Month, Jan 2006 to Dec 2007
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Underinsurance
Himmelstein et al, American Journal of Medicine, June 4, 2009
• 62% of personal bankruptcies due to medical expenses (2007)–50% in 2001
• 78% of people with medical bankruptcies had health insurance when they got sick
“Medical impoverishment, although common in poor nations, is almost unheard of in wealthy countries other than the US.”
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“Underinsurance Among Children in the United States”, NEJM, 2010, 363;9
• 14.1 million US children with continuous coverage are underinsured
• Underinsurance defined:– “Insurance does not provide adequate
benefits, provider choices, or coverage of costs.”
Data: 2007 National Survey of Children’s Health – sample size 91,642 children
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“Underinsurance Among Children in the United States”, NEJM, 2010, 363;9
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Why Single-Payer?
Quality
Access
Cost
US has
major problems in all 3 areas
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Why Single-Payer?
Quality
Access
Cost
US has
major problems in all 3 areas
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US ranked 37th by the WHO World Health Report
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Why do we pay more and get less?
• 31 cents of each healthcare $ is spent on administration
• Administrative spending comes from two sides:– Providers– Payers
(Steffie Woolhandler et al., “Costs of Health Care Administration in the United States and Canada,” New England Journal of Medicine 2003;349:768-75)
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Interactions between physician practices & insurers are costly
Morra et al, Health Affairs, August 2011, 30:8, 1443-1450
$0$10,000$20,000$30,000$40,000$50,000$60,000$70,000$80,000$90,000
Spending per physician peryear interacting with
payer(s)
Ontariophysicianpractices
US physicianpractices
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Why do we pay more and get less?
• 31 cents of each healthcare $ is spent on administration
• Administrative spending comes from two sides:– Providers– Payers
(Steffie Woolhandler et al., “Costs of Health Care Administration in the United States and Canada,” New England Journal of Medicine 2003;349:768-75).
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Insurance (Payer) Overhead
16.3%
19.9%
26.5%
3.1%
0%
10%
20%
30%
Medicare Non-Profit Blues CommercialCarriers
Investor-OwnedBlues
International Journal of Health Services 2005; 35(1): 64-90
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Why are their administrative costs higher than Medicare’s?
• Advertising/marketing• Enrolling/disenrolling• Underwriting• Denial of claims• Deciding what to cover (exclusions, pre-existing
conditions)• Negotiating multiple contracts with providers • Lobbying ($1.2 billion in 2009)• Salaries (CEO pay at top 10 insurers in 2009 =
$228 million)• Profit (Top 5 insurers reported $11.7 billion in 2010)
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April 13, 2011
UnitedHealth Group Inc. CEO Stephen
Hemsley took home $48.8 million in total
compensation in 2010.
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Admin costs of private payers versus Medicare:
• Do these “services” make our patients healthier?
• Should we be spending these healthcare dollars on healthcare??
• Do these “services” help you as a doctor to diagnose, treat, or prevent illness?
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Is it feasible???• We already have…
– Excellent hospitals and well-trained professionals – A nation of vast wealth with sufficient spending – Acceptance of pooled resources to publicly fund the
military, the NIH, the CDC, highways and roads, police and fire services, schools, libraries, water sanitation, etc.
• And…– Every other industrialized nation is doing it!
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What do doctors think of single-payer?
• 5000 surveys, 2008: 51% response rate
• “In principle, do you support or oppose government legislation to establish national health insurance?”
• 59% supported (49% in 2002)
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Support for government legislation to establish National Health Insurance in 2007 and 2002, by specialty
Annals of Internal Medicine, 1 April 2008, Volume 148 Issue 7, Pages 566-567
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But didn’t we just pass historic national reform?
• Individual Mandate– Mandated health insurance for some (23 million
will remain uninsured in 2019)– Policies required to cover at least 60% of
expected health costs (problem of underinsurance remains alive and well)
– Raises costs
“While the legislation will enhance access to insurance, the trade-off will be an accelerated crisis of costs and perpetuation of the current dysfunction…” – Jeffrey Flier, dean of Harvard Medical School
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SF 8/HF 51
Chief author - Senator John Marty
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Minnesota Health Plan• Who: All Minnesota residents• What: All medically necessary services
– Inpatient/outpatient services– Rehab care/NH care/HHC/Hospice– Immunizations/preventive care– Prescription drugs/Medical equipment– Mental health care– Dental and vision care
• How: Funded through premiums based on ability to pay + a business health tax
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Unique features of a Single-Payer System
• Guaranteed care for all
• Decreased costs
• Healthcare de-linked from employment
• Free choice of provider
• Publicly accountable & responsive
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Thank you for your attention!• Educate yourself and
others (www.pnhp.org)• Join PNHP-MN and/or
sign our physician resolution
• Invite a PNHP speaker to your organization or group’s event
• Support the single payer resolution at the 2012 AAP annual leadership meeting
“Of all the forms of inequality, injustice in healthcare is the most shocking and inhumane.”
- Dr. Martin Luther King, Jr.