Download Speak Up: Talking About Single Payer on the Wards

Speak Up: Talking About
Single Payer on the Wards
Desireé Conrad, Anna Zelivianskaia
University of Illinois-Chicago College of Medicine
Class of 2016
What is single payer?
• SINGLE-PAYER: A way of financing healthcare for the entire population
in a geographic/political entity. And financing is different from delivering
healthcare. A publicly financed system can be delivered two different ways:
• Private care delivery: Traditional Medicare, FFS Medicaid, Canada
• Public care delivery: VA, Military health system, Indian Health Service,
Great Britain
Either option eliminates private health insurance except for supplemental
benefits not covered in single-payer program.
Opportunities and Barriers to Promoting Single
Payer
• Opportunities: physicians commenting on problems with U.S. healthcare,
seeing un- or underinsured patients in clinic, talking about the costs of
various medical tests
• Barriers: I’m a lowly medical student and there’s a hospital hierarchy, I don’t
know where to start, I don’t want to seem like I’m advertising an
organization when I should be focused on patient care
Learn the Facts
• The U.S. spends approximately 2x as much per capita on healthcare spending
compared to other developed nations (exact comparison figures vary by country)
• Health care costs make up 17.7% of the U.S. GDP while the average developed
nation spends 9.3%
• Yet we have the lowest life expectancy at 78.7 years compared to UK, Canada,
France, Italy, Germany, and Sweden
• We rank 26th out of 36 member countries in life expectancy
Note: Data are for 2011 or most recent year available
Source: OECD report, 2013
Case Study: Chicago
Geography of Disparity
High breast cancer mortality,
African American communities
High breast cancer mortality,
Non-African American communities
Hospitals with American College of
Surgeons Approved Cancer Programs
Age-Adjusted Female Breast Cancer Mortality for Chicago, Per
100,000 Population. 2000-2005
Prepared by The Sinai Urban Health Institute
Thanks to Ed Weisbart, MD and David Ansell, MD
• Bottom line: MAJOR HEALTH
DISPARITIES STILL EXIST SO WHAT
ARE WE PAYING SO MUCH FOR…?
Growth of Physicians vs Administrators
Growth Since 1970
3000%
2500%
2000%
1500%
1000%
500%
0
1970
1980
Physicians
1990
2000
Administrators
Data updated through 2013
Source: Bureau of Labor Statistics; NCHS; Himmelstein/Woolhandler analysis of CPS
2010
Single-Payer Savings
• Administration (~16%): focused on assuring care and payment, not
avoiding “risk”
Insurance Administration
Managed Care Administration
No:
• Exorbitant exec salaries, marketing,
lobbying, profit
• Underwriting, insurance reserves,
broker fees, exchange fees
• Eligibility determination, narrow
networks
• Care managed by doctors &
hospitals, not health plans
• No complex financial incentives and
risk adjustment
• Simplified data for QI
• No distortion of data due to “payfor-documentation”
• Much less fraud and abuse
• For entire health care system: ~ 30-40% savings
*Slide taken from presentation “The Business Case for Single Payer by Steve Kemble, M.D., March 11, 2014
Available at www.pnhp.org
It’s Good for Business!
• Reduces direct costs:
• no health insurance administrative costs or retiree benefits for businesses
• bulk purchasing
• negotiated prices
• Reduces risk:
• Access to healthcare for all mitigates the outliers who require more costly care
• Better access to outpatient care
• More incentives for preventative medicine
*Slide adapted from presentation “The Business Case for Single Payer by Steve Kemble, M.D., March 11, 2014
Available at www.pnhp.org
Common Arguments Against Single Payer
Cost
Care
• It will not save money.
• It will decrease physician salary.
• Why should I pay for someone
• Quality of care will suffer.
• It will ration care.
• It will take medical decisions away
• It stifles the free market and is
• It will hamper medical research and
else’s care?
against capitalism.
from physicians and patients.
technological innovation.
Counter Arguments for Cost
• It will not save money.
•
Decreased administrative cost, bulk purchasing, negotiated pricing. IOM estimates $500B lost annually due to diminished productivity
of an uninsured population.
• It will decrease physician salary.
•
When compared to other industrialized nations, average US physician earning is more. However, this is not a fair comparison when less
than ½ the physicians are specialists in other nations. In US, pay for primary care pay lags significantly behind specialty care.
Furthermore, physicians under single payer systems do not have as high of cost for malpractice nor as high of education debt burden.
The average physician salary in Canada is $307, 482.
• Why should I pay for someone else’s care?
•
You already pay for the uninsured. Unfortunately, it is at a much higher cost when the uninsured are seeking urgent care. Urgent care
costs are significantly higher than routine primary care visits.
• It stifles the free market and is against capitalism.
•
In more than 90% of measured areas in the US, competition is restricted to less than three private insurers. An unrestricted free market
would price many people out of insurance.
Counter Arguments for Care
• Quality of care will suffer.
•
Quality of care will improve due standardization of quality improvement initiatives and EBM. The uninsured delay care for
chronic conditions leading to poorer outcomes and more preventable deaths.
• It will ration care.
•
Single payer system would lead to more equitable and efficient distribution of scarce health care resources and services.
• It will take medical decisions away from physicians and patients.
•
Under a singly payer system, health care services are privately delivered by physicians but publicly financed by the
government. This means clinical decisions are still made by the provider and the patient. It will also increase patient
autonomy by eliminating networks and allowing patients to choose their physicians.
• It will hamper medical research and technological innovation.
•
Most medical research is currently funded by NIH (a government agency). Furthermore, the inappropriate use of technology
will be reduced leading to more practice of evidenced-based medicine.