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Text and graphics by: Solveig Wilder, MSW Based on a class given in Spring 2006 at the CUNY Graduate Center for Worker Education by: Nick Unger – Health Advisor to TWU Local 100 and board member of Universal Healthcare Action Network (UHCAN). Featuring Guest Speakers: Dianne Archer - Medicaid Rights Center Jeff Gold – Working Families Party of New York Mark Hannay – Director of Metro NY Health Care for All Martha Livingstone, Ph.D. – Health and Society Department at SUNY Old Westbury Len Rodberg, MD - Physicians for a National Health Program (PNHP) With information and data from: Richmond, Julius B., MD, and Fein, Rashi, MD (2005): The Health Care Mess – How We Got
WHEN I WAS YOUNG
I was mostly healthy and did not give much thought to healthcare in the United States.
I became very sick.
AND ALL OF A SUDDEN…
I found myself caught up in the U.S. healthcare MAZE!!!
Money Degrees Friends in High Places OR HEALTH INSURANCE!!!
I WAS NOT ALONE
There are 40 million UNINSURED Americans. There are 31 million UNDERINSURED Americans. These statistics do not include the 8 to 14 million undocumented workers and children living in America without healthcare coverage.
INSURED UNINSURED UNDERINSURED
MOST UNINSURED AMERICANS ARE:
Between 19 and 64 Employed
20% 40% UNDER 19 19 - 34 35 -64 40%
0-$25,000 33% $25,000-$49,999 $50,000-$74,999 $75,000 and up
F/T WORKER 17%
5% WHITE HISPANIC BLACK 30% ASIAN
UNEMPLOYED P/T WORKER
THE PROGNOSIS IS ABYSMAL FOR AMERICANS WITHOUT HEALTHCARE
Uninsured Americans have 25 percent higher mortality rates.
18,000 Americans die prematurely each year because they lack health insurance; breast cancer.
Uninsured women are 50 percent more likely to die of
55 percent of uninsured Americans postpone getting help with ailments because they fear the cost.
percent cannot afford to purchase prescribed medications; 32,000 Americans forego life-saving medical treatments for heart disease.
Many children in uninsured households never see a doctor, including:
EXPENDITURES ON HEALTHCARE IN THE US HAVE INCREASED DRAMATICALLY SINCE 1960
1800 1600 1400 1200 1000 800 600 400 200 0 1960 1970 1980 1990 1995 2000 2001 2002 2003 National Health Expenditures (in Billions)
TOTAL HEALTH EXPENDITURES AS A PERCENT OF GROSS DOMESTIC PRODUCT ARE HIGHEST IN THE US
16 14 12 10 8 6 4 2 0
d S. U. rlan e i tz Sw en ed Sw ain Sp gal rtu Po d lan Po y a d rw an No ea l Z s w d Ne rlan e th Ne n pa Ja ly Ita d lan Ire ry a ng Hu e c ee Gr ny a rm Ge e c an Fr d n nla Fi ark nm De a d na Ca m iu lg Be i a r st Au ali a r st Au
10.8 9.1 7.6 9 9.4 8.6 7 7.4 6.9 6 9.4 9.4 8.3 8.5 7.8 8 8.9 9.3 7.5 8.8
Australia Austria Belgium Canada Denmark Finland France Germany Greece Hungary Ireland Italy Japan Netherlands New Zealand Norway Poland Portugal Spain Sweden Switzerland U.S.
BUT HEALTH OUTCOME RANKINGS FOR THE US ARE AMONG THE WORST IN THE WORLD
COUNTRY Sweden Finland Spain Japan Norway Austria France Germany Denmark Switzerland Italy Belgium Australia Netherlands Portugal Ireland Canada Greece New Zealand United States Hungary
INFANT MORTALITY RANKING (2002)
2.8 3.0 3.0 3.4 3.5 4.1 4.1 4.3 4.4 4.5 4.7 4.9 5.0 5.0 5.0 5.1 5.4 5.9 6.2 7.0 7.2 7.5
2 4 4 6 7 8 8 11 12 13 14 16 17 17 17 20 23 25 26 28 29
COUNTRY Japan Sweden Switzerla nd Canada Australia Italy Norway New Zealand Netherlan ds Spain Austria Germany France Greece Belgium Denmark Ireland Finland United States Portugal Poland Hungary
LIFE EXPECTANCY -MEN
78.1 77.6 77.4 77.1 77.0 76.7 76.2 76.0 75.8 75.6 75.6 75.6 75.5 75.4 74.9 74.7 74.7 74.6 74.4 73.5 70.2 68.1
RANKI NG (2001) 2 3 4 5 7 8 10 11 13 14 14 14 18 19 21 22 22 25 26 27 32 35
LIFE EXPECTANCY FOR WOMEN
84.9 82.1 83.0 82.2 82.4 82.8 81.5 80.9 80.7 82.9 81.5 81.3 82.9 80.7 81.1 79.3 79.7 81.5 79.8 80.3 78.3
RANKI NG (2001) 1 9 3 8 7 6 11 17 18 4 11 14 4 18 15 27 26 11 25 21 32
GREAT BRITAIN HAS UNIVERSAL HEALTHCARE AND MUCH BETTER RESULTS
Per Capita Healthcare Spending Infant Mortality Rates
5000 4000 3000 2000 1000 0
8 6 U.K. 1461 4 2
Life Expectancy (Avg. M/F)
72.0 71.5 71.0 70.5 70.0 Overall Performance Rating (1 = best; 40=worst) 69.5 69.0
% of Population Satisfied with Healthcare System
40 30 20 10 0
U.S. 37 U.K. 18 60% 50% 40% 30% 20% 10% 0% U.S. 40%
UK NATIONAL HEALTH INSURANCE VS. US HEALTHCARE SYSTEM
FINANCING: SINGLEDELIVERY: SOCIALIZED ACCESS: OPEN TO PAYER EVERYONE (mostly Government(mostly Government 3 - Tertiary Care: Facilities) serious Run Focus is on the most Tier Financing) ailments that affect approximately 10 percent of the
Progressive Tax: 82% Employer-Employee Contributions: 13% User Charges: 4% population. Patients are assigned to a Sub-Specialist for things like heart disease and spinal injuries. Tier 2 - Secondary Care: Focus is on more serious ailments that affect approximately 10 to 50 percent of the population. Patients are assigned to a Specialist in things like surgery, neurology, OB/GYN, pediatrics, and psychiatry. Tier 1 - Primary Care: Focus is on treating common health problems and implementing preventive measures throughout the UK. Everyone is assigned a General Practitioner (GP), who is responsible for developing treatment plans, providing treatment for common health problems, monitoring health, and making referrals for more serious health problems. No distinction is made between the employed and unemployed, or social insurance and public assistance.
Government (Regressive Tax) Private Insurers
DELIVERY: MULTIPLE PROVIDERS
For-Profit Agencies Hospitals
ACCESS: OPEN TO SOME CITIZENS
Those with MONEY Schools & Universities
Non-Profit Agencies Mental Institutions Nursing Homes Research Programs
Those with INSURANCE
The DESERVING POOR
THE INSTITUTE FOR MEDICINE OFFERS FOUR PROTOTYPES FOR HEALTHCARE REFORM IN THE US
PROTOTYPE 1: MAJOR PUBLIC PROGRAM EXPANSION AND NEW TAX CUTS Employer-based health coverage would remain as is. Employers would not be required to provide any more health coverage than they do now, and tax breaks for employers and untaxed health benefits for employees would continue. Tax credits would be given to individuals who purchase healthcare coverage from private insurers. Medicare would be offered to Americans at age 55 for a modest premium. Medicaid and SCHIP would be combined. PROTOTYPE 2: EMPLOYER MANDATE, PREMIUM SUBSIDY, AND INDIVIDUAL MANDATE All citizens would have healthcare coverage from either the government, their employers, or private insurers. Employers would be required to provide healthcare coverage for all employees and contribute to employee premiums. The federal government would subsidize the healthcare costs of employers of low-wage workers. Medicare would remain as is, while Medicaid and SCHIP would be combined. PROTOTYPE 3: INDIVIDUAL MANDATE AND TAX CREDIT All citizens would be required to secure healthcare coverage through the private market. The federal government would provide all citizens with an advance, refundable tax credit. State governments would regulate healthcare insurance.
PRESIDENT GEORGE W. BUSH SUGGESTED MORE MODEST REFORMS IN HIS STATE OF THE UNION ADDRESS
HEALTH CARE FINANCING WHO WILL PAY? Healthcare will pay for itself with money saved from “health savings accounts,” and by curtailing lawsuits, closing loopholes, privatizing healthcare, and increasing efficiency (i.e., reducing medical errors and increasing the use of electronic records). WHO WILL BENEFIT? American business, because it keeps them “competitive;” the elderly; and “the needy.” WHO WILL SACRIFICE? Virtually no one, because it “eliminates the need for sacrifice.”
HEALTH CARE DELIVERY HEALTHCARE DELIVERED BY: more private agencies and fewer government agencies. UNCLEAR how healthcare will be organized. UNCLEAR what the quality of healthcare will be.
HEALTH CARE ACCESS HEALTHCARE AVAILABLE TO: “All Americans.” UNCLEAR how all Americans will access healthcare. UNCLEAR what the barriers to access will be.
SO FAR, ATTEMPTS TO INTRODUCE UNIVERSAL US HEALTHCARE HAVE FAILED MISERABLY
WE WE WE WE NO NO WANT WANT DON’T WANT BIG NEW CHOICE! FREEDOM! WANT TO TO WAIT!
GOVERNMENT! TAXES! SLOPE TO SO
IT’S A SLIPPERY CIALISM!
BUT I PREDICT AMERICANS ARE GOING TO LOVE IDIOT-PROOF US HEALTHCARE
IDIOT-PROOF US HEALTHCARE IS SO EASY TO UNDERSTAND
HEALTH CARE FINANCING WHO WILL PAY? Federal/State governments with funds from a progressive tax (Single-Payer). WHO WILL BENEFIT? Virtually everyone. WHO WILL MAKE SACRIFICES? Rich people with VERY little time to spare.
HEALTH CARE DELIVERY HEALTHCARE DELIVERED BY: Government-Run Agencies (Single-Provider). HEALTHCARE ORGANIZED: As simply and comprehensively as possible, with a heavy emphasis on general practitioners. QUALITY ASSURED BY: Top-notch computer tracking systems and quality assurance teams staffed with consumer advocates.
HEALTH CARE ACCESS HEALTHCARE AVAILABLE TO: Everyone in the US, including immigrants and tourists. BARRIERS TO ACCESS: All barriers related to financial circumstances, employment, geography, demographics, etc., will be eliminated – along with the paperwork!
AND IDIOT PROOF US HEALTHCARE IS SO EASY FOR CONSUMERS AND PROVIDERS TO MANAGE
DELIVERY: SOCIALIZED (Government-Run Facilities) ACCESS: OPEN TO EVERYONE IN THE UNITED STATES
FINANCING: SINGLEPAYER Government Financing)
Tier 3 - Tertiary Care: Focus is on the most serious ailments that affect approximately 10 percent of the population. Patients are assigned to a Sub-Specialist for things like heart disease and spinal injuries.
Progressive Tax: 90% Employer: 10% Consumer: Not a Red Cent
Tier 2 - Secondary Care: Focus is on more serious ailments that affect approximately 10 to 50 percent of the population. Patients are assigned to a Specialist in things like surgery, neurology, OB/GYN, pediatrics, and psychiatry.
NO DISTINCTIONS ARE MADE BETWEEN:
• Employed/Unemployed • Social Insurance/Public Assistance • Citizens/Aliens
Tier 1 - Primary Care: Focus is on treating common health problems and implementing preventative measures throughout the US. Everyone is assigned a General Practitioner (GP), who is responsible for developing treatment plans, providing treatment for common health problems, monitoring health, and making referrals for more serious health problems.
IDIOT-PROOF US HEALTHCARE COMBINES THE BEST IDEAS FROM LEADING PROPONENTS OF HEALTHCARE REFORM
Dr. Len Rodberg of Physicians for a National Health Program (PNHP) says National US Healthcare MUST: Guarantee automatic enrollment in a national healthcare program that is publicly financed; Be critically supervised to guard against “parasitic companies.” Dianne Archer of the Medicaid Rights Center says National US Healthcare MUST BE: Modeled after the US Medicare program, which works because it is: Affordable; Automatic; Able to negotiate prices; Reliable and efficient; Shares costs and benefits across the American spectrum. Mark Hannay of Metro Healthcare for All and Professor Martha Livingstone of SUNY Old Westbury Both Mark Hannay and Professor Livingstone would like to see things “go further.” But single-payer healthcare reforms would move us a step forward. Instead of healthcare being a “for profit enterprise,” it will come out of our taxes (progressively); It is portable coverage, so we won’t lose our coverage when we move from job to job; It will cover all “necessary” treatment, as well as preventive healthcare measures. Jeff Gold of the Working Families Party (WFP) say National US Healthcare MUST BE: Universal; Portable and long term; Equitably financed; Flexible regarding choice of
ALL AMERICANS WILL BE GIVEN THE OPTION TO WITHDRAW FROM IDIOT-PROOF US HEALTHCARE
Just go to WWW.IPULLOUT.COM. Click on “I Don’t Want Idiot-Proof US Healthcare.” Fill out the form designed to ensure that you are a US citizen of sane mind and body capable of making complex choices about your health and well-being. After a background check of your health records, you will be interviewed by an Idiot-Proof US Healthcare Specialist. You will be asked to sign a consent form stating that you understand refusing Idiot-Proof US Healthcare will leave you without coverage in the event of any and all illnesses. You will receive notice in the mail of your removal from Idiot-Proof US Healthcare. Your employer and family members will be informed of your decision. Each year, you will receive a rebate check of about
AMERICANS CAN ALSO CHOOSE NOT TO PUT UP THE MONEY FOR NON-CITIZENS
Just call 1-800-I-PUT-OUT, and an Idiot-Proof Call Representative will be ready to assist you. At the end of each year, you will receive a rebate check calculated by dividing the total estimated cost of undocumented workers to State and Federal US governments by the total number of US citizens. For example, in 2002, a 10.4 billion dollar net loss would be divided by 300 million,
DESPITE CRIES FROM EVERY CORNER AGAINST SOCIALIZED MEDICINE, WE WILL RALLY SUPPORT FOR IDIOT-PROOF US HEALTHCARE BY…
Dr. Len Rodberg of Physicians for a National Health Program (PNHP) Keeping it simple and making it work with what’s already out there! Mark Hannay of Metro Healthcare for All. Accepting that US healthcare policy is inextricably intertwined with politics; Realizing that a good idea alone is not enough; Beating back bad ideas like the ones presented by President Bush in his State of the Union Address; Building a movement on all levels – local, state and federal – and staying abreast of municipal, state and federal healthcare proposals; Stressing moral, medical, public health, and economic imperatives;
Dianne Archer of the Medicaid Rights Center Letting Americans know that the current US public healthcare system is not bad and is not “broken;” Making sure the issue of National Healthcare remains at the forefront of the political debate, and actively engage the media; Exposing the narrow interests of those who are opposing national healthcare, including private insurers, pharmaceutical companies, and other powerful business groups; Stressing the financial benefits of national healthcare. Jeff Gold of the Working Families Party (WFP) and Professor Martha Livingstone of SUNY Westbury Recognizing that healthcare issues
TOP-TEN REASONS TO SUPPORT IDIOT-PROOF US HEALTHCARE: 10. You and your loved ones will live longer; 9. You and your loved ones will get sick less often; 8. You and your loved ones will live with less pain; 7. You and your loved ones will have fewer financial worries; 6. You and your loved ones will be more likely to receive only appropriate and warranted treatment; 5. You and your loved ones will be less likely to contract communicable diseases; 4. You and your loved ones will be much less likely to be fleeced when seeking cutting-edge treatments and life-saving prescription drugs; 3. You and your loved ones will no longer be
AND THE NUMBER ONE REASON FOR SUPPORTING IDIOT-PROOF US HEALTH CARE IS:
No American should ever have to suffer the way I did when I became sick without healthcare insurance!!! E PLURIBUS UNUM!!!
SO PLEASE, DON’T BE AN IDIOT. SUPPORT UNIVERSAL HEALTHCARE FOR ALL!!!
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