Healthcare Security and

Justice

Joey FoyShearer FellowPNHP-CAUniversity of LondonUCSF School of Nursing

Overview•Current State of US Health System•Community Health Insurance/ “Public-option for All”•Affordable Care Act of 2010•Community Health Insurance in CA•Senate Bill 810•CaHPSA & The Movement in CA

How to organize a health system•Beveridge Model

•Bismarck Model

•National Health Insurance

•Out-of-Pocket

The US has the BEST healthcare in the world!•51+ million without ANY health insurance

•25+ million without adequate health insurance

•62% of bankruptcies are medically related

•45,000+ preventable deaths each year

Himmelstein & Woolhandler, 2007

Life Expectancy at Birth

Infant Mortality

Maternal Mortality

WHO World Health Report, 2000

What is so different about the

US System?•Only developed country without guaranteed universal coverage•Only developed country based on a for-profit insurance model to provide basic health coverage•Only developed country where people can go bankrupt from medical bills

"We will not sacrifice profitability for membership."•Angela Braly, CEO Wellpoint

•$2.5 billion 2009 profit

•$13 million 2009 executive compensation

•Industry norm, not the exception

Forbes.com

How a “Public-Option for All” Works•Everyone is covered automatically•Single plan with comprehensive benefits•Freedom to choose provider/hospital•Coverage is attached to YOU•A social public good, not a commodity▫Public schools▫Police and fire departments▫Highways

How Guaranteed Health Insurance Saves Money•Streamlined administration and billing process through a single-payer•Bulk purchasing of pharmaceuticals•No marketing costs•Increased emphasis on primary and preventive care•Non-profit system

Streamlined administration and billing

Bulk purchasing of pharmaceuticalsDrug Prices for 30 Most Commonly Prescribed Drugs, 2006–07

US is set at 1.0

Source: OECD Health Care Quality Indicators, 2009

Single Guaranteed Plan – No Marketing

Increased emphasis on primary and preventive care

Diabetes Lower Extremity Amputation Rates per 100,000 Population Age 15 and Older, 2007*

Source: OECD Health Care Quality Indicators, 2009

Non-profit System

Didn’t we just have health reform?

Affordable Care Act of 2010•Individual Mandate to obtain insurance

•Expansion of Medicaid (low income)•Establish state insurance exchanges (middle income subsidies)▫Guaranteed issue, Community rating▫Participating insurers must offer 4 levels

• Large businesses (50+ employees) must offer insurance or pay a fine

Kaiser Family Foundation: 2010

Affordable Care Act of 2010•Does not cover everyone•Does not simplify billing and administration

•Does not develop adequate cost controls

•Experience of Massachusetts has been “unaffordable underinsurance” for many

•Constitutionality is currently being challenged in Supreme Court

Kaiser Family Foundation: 2010

Source: Woolhandler, et al, New England Journal of Medicine, August 2003 & Int. Jrnl. Of Hlth. Services, 2004

3.1%

26.5%

19.9%

16.3%

Public vs Private Spending

Source: Woolhandler et al, NEJM, 8/2003 & Intl. Jrnl. of Hlth. Services, 2004

Admin.Costs

Physician Salaries

Ref: US General Accounting Office/National Bureau of Economic Research, 2009

Specialty US Average Malpractice

Canada Average Malpractice

OB/GYN $64,000 $35,000

Community Health Insurance in California•Single-payer legislation has passed twice in CA•7.2 million additional Californians covered•$8 billion in first year savings

Source: Lewin Group, January 2005

Senate Bill 810: The California Universal Healthcare Act•Legislation creates the California Health Care Agency

•All existing state funding streams are collected

•Income tax replaces insurance premiums

•Did not pass a senate floor vote in January

•Will be reintroduced in early 2013

Services Covered Under SB 810• Inpatient/outpatient health

facility services• Inpatient and outpatient

services by licensed professionals

• Diagnostic imaging, laboratory services

• Rehabilitative care• Emergency transportation and

necessary transportation for health care services

• Language interpretation• Child and adult immunizations

and preventive care• Health education• Hospice care• Home health care• Home and Community based care• Adult day care

• Prescription drugs• Mental Health Care • Dental care• Orthodontia• Podiatric care • Chiropractic care • Acupuncture• Blood and blood products• Emergency care services• Vision Care including eyeglasses• Hearing including hearing aids• Case management• Substance abuse treatment• Durable medical equipment

including hearing aids• Care in skilled nursing

facilities• Dialysis.

California Health Professional Student Alliance•Started in 2008•Chapters:▫ UCLA▫ USC▫ CSU Long Beach▫ Samuel Merritt University

•20 Statewide leadership positions•Campaign for a Healthy California•Student-run autonomous organization affiliated with PNHP-CA

Take Action!

•Get educated!▫www.cahpsa.org▫www.pnhpcalifornia.org▫www.pnhp.org

•Spread the word!•Get involved at your school!•Help build the growing movement for healthcare justice in California!

Lobby Day

•Annual Event•January 8-9, 2012•Sunday, January 8▫Student Leadership Workshop

•Monday, January 9▫March, rally and legislative visits

Thank YOU!

•Contact me▫joey@pnhpcalifornia.org▫Facebook – Joseph Foy, Shearer Fellow

•Additional Resources▫singlepayernow.net▫healthcare-now.org▫youtube.com/user/CaPAFellow

•Questions?