Human services in Obama s first Year or More of the Same is not Health Care Reform .

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Health Care in Obama’s 1st Year or More of the Same is not Health Care Reform. Leonard Rodberg, PhD Urban Studies Dept., Queens College/CUNY and NY Metro Chapter, Physicians for a National Health Program Teach-in New York City July 25, 2009
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Medicinal services in Obama\'s first Year or More of the Same is not Health Care Reform Leonard Rodberg, PhD Urban Studies Dept., Queens College/CUNY and NY Metro Chapter, Physicians for a National Health Program Teach-in New York City July 25, 2009

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Why Health Care Is On the Agenda: Escalating Cost Average Annual Premiums for Single and Family Coverage, 1999-2008 Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 1999-2008.

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International Comparison: Universal Coverage at Less Cost - They Must Be Doing Something Right! Normal spending on wellbeing per capita ($US PPP*) * PPP = Purchasing Power Parity. Information: OECD Health Data 2008, June 2008 variant. None depend on private revenue driven protection, all have a solid part for government.

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High Cost of Health Insurance Premiums: Even the Middle Class Can No Longer Afford It National Average for Employer-if Insurance: Single Coverage $ 4,704 for each year Family Coverage $12,680 every year Median family unit pay = $50,233 Source: Kaiser Family Foundation/HRET Survey of Employee Benefits, 2008; U.S. Registration Bureau, 2008

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The Epidemic of Underinsurance Number of individuals spending more than 10% of salary on medicinal services (Millions) Source: Too Great a Burden , Families USA, December 2007

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Medical expenses make genuine money related issues for a huge number of us Source: Health Tracking Poll, Kaiser Family Foundation, April 2008

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Health Care Costs Are Concentrated Among a Few People in Any One Year Percent of Health Care Costs This Year\'s Underinsured Source: Medical Expenditure Panel Survey, US Agency for Healthcare Research and Quality, 1999 While millions are underinsured, millions more don\'t believe there\'s an issue!

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The President\'s Principles for Health Care Reform Protect Families\' Financial Health… diminish developing premiums and different expenses… shield from insolvency because of disastrous sickness. Make Health Coverage Affordable... diminish high managerial costs, squander, wasteful aspects. Go for Universality… put the United States on an unmistakable way to cover all Americans. Give Portability of Coverage… not bolted into their employment just to secure wellbeing scope. Ensure Choice… give a decision of wellbeing arrangements and doctors… have the choice of keeping their manager based wellbeing arrangement. - "A New Era of Responsibility," President\'s Budget, Feb. 26, 2009

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The Progress of US Health Care Reform Employer command Individual mandate* * "each qualified individual must select in an appropriate wellbeing arrangement for the individual and must pay any premium required regarding such enlistment." (S.1775) Public option** ** "you can enlist in the new open arrangement"

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The Mandate Model Everyone required to have protection Employers must offer protection or contribute Continued dependence on private protection, with the choice of an open arrangement "Keep what you have" ��  D oesn\'t address underinsurance. No direction of insurance agency premiums, deductibles, co-pays, or installment and foreswearing hones Increases the framework cost by several billions of dollars No cost reserve funds or practical approach to control costs, the length of there are numerous different arrangements and payers.

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The Obama/Congressional Plan Employment-based protection unaltered, so - - Employers can at present change scope - - Insurers can in any case change systems - - Employees still bolted into occupations Employees must acknowledge business arrange on the off chance that they can bear the cost of it (premium < 11% or 12.5% of pay) Starting in 2013, the uninsured can get to a protection "trade" with appropriations up to 400% of the Federal neediness level Public arrangement choice accessible in the trade "Hardship waiver" for the individuals who can\'t manage the cost of it

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The Massachusetts Plan: Insurance Still Costly and Unaffordable * Also doctor & healing center co-pays Source: (Boston Area, Jan 2009)

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Why a Public Option? Give steadiness, wide pooling of dangers, straightforwardness, reasonableness, expansive supplier get to, wellspring of information Competitive benchmark to constrain private arrangements to decrease prices,improve scope ("keep them fair") Lead in limiting expenses and enhancing quality Without it, there\'s no change, since there is no other change in the framework Source: Jacob Hacker, Healthy Competition , Berkeley Law and Institute for America\'s Future, April 2009, Howard Dean, Barack Obama

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Why Not a Public Option? From supporters of private protection – "Out of line rivalry" from government Would undermine private protection, utilize intrinsic forces of government to farthest point rivalry, come up short on specialists and doctor\'s facilities Will in the end prompt "government-run" framework From single payer supporters – Private safety net providers will specifically market to the solid ("antagonistic determination") Retains private protection Doesn\'t get every one of the reserve funds conceivable with single payer

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What Happened to the Public Plan? The Original "strong" Plan Open enlistment Medicare-like, upheld by the Federal Government 119 million individuals (Lewin) The Congressional Plan Restricted enlistment (just the uninsured) Self-supporting, take after same standards as private safety net providers Perhaps 10 million individuals (CBO) The 800-pound gorilla has transformed into a mouse!

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What Will Control Costs under the Congressional Plan? Accentuation on anticipation Computerization Chronic ailment administration Payment changes (e.g., medicinal home, "packaging") Comparative adequacy explore The Congressional Budget Office says these will (1) not cut costs fundamentally and (2) not restrain the proceeding with ascend in cost.

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Covering the Uninsured and the Underinsured? $1 Trillion/seven years = $130 billion/yr Number of Uninsured Covered: 37 million Number of Uninsured Remaining: 17 million [ Source: Congressional Budget Office, Letter to Rep. Charles Rangel, July 17, 2009] Number of Underinsured: 50 million+ Even a Trillion dollars is insufficient! Add up to cost of making social insurance reasonable: $200-300 billion/year Single Payer can give it!

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Senate Finance Committee Considers How to Pay for HCR Senate Finance Committee Considers How to Pay for Health Care Reform What\'s on the table? New Taxes! Surtax on the well off Employer-based medical coverage Hospitals Sodas Alcohol Tobacco The Invisible Pot of Gold! What\'s off the table? $400 Billion in investment funds from Single Payer Elimination of private revenue driven protection Savings in doctor\'s facility and MD charging costs $400B

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Will the Mandate Plan Pass? Will business acknowledge the order to give scope? Will private insurance agencies acknowledge ensured issue and group rating? Will traditionalists acknowledge the new assessments expected to finance the appropriations for the individual order? Will the overall population bolster an arrangement with an order to buy protection?

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The Bottom Line on the Congressional Plan If it passes in some shape, it would: Make the world\'s most costly framework much costlier. Not accomplish all inclusive scope Not enhance scope for the normal individual. Not make moderate protection accessible. Not contain the proceeding with development in cost. Not accomplish President Obama\'s objectives. It doesn\'t generally change the framework. It just won\'t work!

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Conyers: Expanded and Improved Medicare though "single payer national wellbeing couldn\'t care less" HR 676 Automatic enlistment Comprehensive advantages Free decision of specialist and doctor\'s facility Doctors and doctor\'s facilities stay autonomous Public organization forms and pays charges Financed through dynamic expenses Costs contained through capital arranging, planning, essential care accentuation

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New – Sanders (& McDermott): American Health Security Act S 703 (HR 1200) Automatic enlistment Comprehensive advantages Operated by States utilizing Federal guidelines Free decision of specialist and clinic Doctors and doctor\'s facilities stay free Public office forms and pays charges Financed through finance charges

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How We Pay for Health Care Today Federal Government (existing Medicare, Medicaid, other) 34% Private Insurance 34% Out of pocket 12% State and Local Government (existing Medicaid, other) 13% Other private assets (philanthropy, and so on.) 7% Source: Health Affairs , Feb. 2008; information for 2006

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How Single Payer Could Be Paid For: One Example from a Recent Study of a California Plan

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Billing and Insurance: Nearly 30% of All Health Care Spending 28%

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Covering Everyone with No Additional Spending $ B 134 107 241 Additional costs Covering the uninsured and inadequately protected +6.4% Elimination of cost-sharing and co-pays +5.1% Savings Reduced clinic regulatory expenses - 1.9% Reduced doctor office costs - 3.6% Reduced protection managerial expenses - 5.3% Bulk acquiring of medications & hardware - 2.8% Primary care accentuation & lessen misrepresentation - 2.2% Total Costs +11.5% - 21 - 76 - 111 - 59 - 46 - 313 Total Savings - 15.8% Net Savings - 4.3% - 73 Source: Health Care for All Californians Plan, Lewin Group, January 2005

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Single payer offers genuine apparatuses to contain costs Budgeting, particularly for doctor\'s facilities Capital speculation arranging Emphasis on essential care, coordination of care, and option methods for paying for administrations Bulk obtaining

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Conclusions A framework in light of private protection will never prompt widespread scope, nor would it be able to control costs Only single payer can give extensive administrations while costing close to we now spend. Just single payer can control costs going into what\'s to come. On the off chance that an order

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