1. Healthcare Reform: Is It Necessary? Subroto Kundu, M.D. Consultant Neurologist SF Bay Area

2. Public Opinion is often a mish-mash of misconceptions and myths.. (…and then there is Fox News)

6. What is Wrong with our System ? We spend far more money than any other country on health care... … but get far fewer benefits, far worse health outcomes, and far less patient satisfaction.

9. Approaching these myths with appropriate scientific validation is not hard to do….

11. 45 Million Uninsured

13. Maternal Mortality 1999

14. Infant Mortality, 1999 Deaths In First Year Of Life/1000 Live Births Source: OECD, 2002 5.7 5.3 5.1 4.5 4.3 3.4 7.1 0 1 2 3 4 5 6 7 8 U.S. AUSTRALIA CANADA ITALY GERMANY FRANCE SWEDEN

15. Life Expectancy For Women, 1999 Source: OECD, 2002 - Data on Italy are for 1998 82 80.7 82.5 79.8 81.6 81.7 79.4 77 78 79 80 81 82 83 U.S . U.K. GERMANY I TALY CANADA SWEDEN FRANCE YEARS

16. Life Expectancy For Men, 1999 Source: OECD, 2002 - Data for Italy are for 1998 74.7 75 75 75.3 76.3 76.7 73.9 70 71 72 73 74 75 76 77 78 U.S. GERMANY FRANCE UK ITALY CANADA SWEDEN YEARS

17. Hospital Inpatient Days Per Capita, 2000 Source: OECD, 2002 1.1 1.2 2.4 2.6 2.7 4 0.8 0 1 2 3 4 U.S. Canada U.K. France Australia Germany Japan Days/person

18. Consider Associated Statistics…..

19. Poverty Rates, 1997 U.S. and Other Industrialized Nations Source: Luxembourg Income Study Working Papers Note: U.S. figure for 1997, other nations most recent available year 6% 8% 9% 11% 11% 11% 17% 0% 5% 10% 15% 20% Netherlands France Sweden Canada UK Germany US % of Population Below Poverty Level

20. Americans Lead the World in Hours Worked Source: International Labor Organization, 1999 1399 1560 1656 1731 1889 1883 1966 0 250 500 750 1000 1250 1500 1750 2000 Norway Germany France U.K. Japan U.S. (1980) U.S. (1997) Hours/worker-year - 1997

21. Incarceration Rates, 2000

24. Myth #2: We Don’t Have the Money to Cover Everyone

28. HEALTH COSTS AS % OF GNP: U.S. & CANADA, 1960-2001 CANADA'S NHP ENACTED NHP FULLY IMPLEMENTED Source: Statistics Canada, Canadian Inst. for Health Info., & NCHS/Commerce Dept 5 6 7 8 9 10 11 12 13 14 15 1960 1965 1970 1975 1980 1985 1990 1995 2000 % of GNP CANADA U.S.

29. Myth # 3: Government Is Less Efficient Than the Private Sector

30. Overhead & Profit As Percent of Premium

31. Private insurers’ High Overhead

32. Medicare Coverage is Better than Private

33. Healthcare Cradle to Grave… Productive years 90% of healthcare expenditure done in last 10% of life Medicare: government spending Healthiest portion of life least healthcare spending HMO/PPO Spending Only earning period of life Highest contribution to healthcare 25 65

34. services Patients Medical Providers Pvt Health Insurance payment payment Auto Insurance Workmens Compensation Home Owners Insurance Misc Health Insurance payment payment payment payment MediCare MediCaid

35. So, what would you say to a plan that reduced the multiple payments with a single coverage…

36. services Patients Medical Providers payment payment Single Insurance Payer Specially one with 3.1% overhead And no profit

37. 56% of Medical Students & Faculty Favor Single Payer, Med School Deans Source: NEJM 1999; 340:928 “ What is the best health care system for the most people?”

38. Harris Poll: “Government Should Provide Quality Medical Coverage to All Adults . . .” Source: USA Today/Harris Poll - 11/23/98 77% 53% 52% 47% 0% 20% 40% 60% 80% General Public Employers State Legislators Congressional Aides Percent agreeing

40. Myth #4: Single Payer Means Single Delivery System

42. Myth #5: We Will Have Rationing “Like They Have in Canada”

43. We do have “rationing” already. We only recognize them differently, such as by limited access to healthcare, denials by insurance companies, high cost

45. U.S. Public Spending Per Capita for Health is Greater than Total Spending in Other Nations Note: Public includes benefit costs for govt. employees & tax subsidy for private insurance Source: NEJM 1999; 340:109; Health Aff 2000; 19(3):150 $1,670 $1,750 $1,850 $2,230 $2,430 $2,620 $1,760 $2,600 $0 $1,000 $2,000 $3,000 $4,000 $5,000 U.K. Sweden Japan France Canada Germany U.S. $ Per Capita Total Spending U.S. Public U.S. Private

46. Out-of-Pocket Payments, 2000

47. Myth # 6: It is Bad for Business

48. Employers’ Health Benefit Costs US vs. Canada

49. Healthcare cost to US businesses…

50. Myth # 7: Our population is older than the rest of the world

51. Elderly as Percent of Total Population, 2000 Source: Health Affairs 2000; 19(3):192 12.1% 12.8% 15.9% 16.0% 16.4% 17.1% 12.5% 0% 5% 10% 15% 20% U.S. Australia Canada France U.K. Germany Japan Percent of Population Older Than 65

52. Infant Deaths by Income, Canada 1996 Even the Poor Do Better than U.S. Average

53. MYTH # 8: Doctors will leave “ DOCTORS ARE LEAVING CANADA IN DROVES FOR THE PROMISED LAND OF THE USA”

54. Few Canadian Physicians Emigrate

55. Applicants per Medical School Place Source: JAMA; 282:892; Canadian Medical Education Statistics, 1999:150

56. Myth # 9: We Don’t Want All That Government Intrusion Instead, We Now Have Private Sector Intrusion

57. The Administrative Nightmare $384 Billion Spent on Administrative Costs Last Year. Saving Half of This Would Easily Cover the Uninsured

58. Physicians' Billing & Office Expenses United States & Canada, 2000 Source:Woolhandler/Himmelstein NEJM 1991;324:1253 (updated) $430 $102 $0 $100 $200 $300 $400 $500 U.S. CANADA $ PER CAPITA

59. Hospital Billing & Administration United States & Canada, 2000 Source: Woolhandler/Himmelstein NEJM 1991; 324:1253 & 1993; 329:400 (updated) $372 $68 $0 $100 $200 $300 $400 $500 U.S. CANADA $ PER CAPITA

60. Growth of Physicians, RNs & Administrators 1970-1998 Bureau of Labor Statistics, NCHS Percentage Growth

61. Do you want your health care dollars spent Here or Here?

63. The Single Payer System

67. Who Benefits from the Single Payer System? You do!! And do all providers who are not paid for their services, but look towards their “HMO” kickbacks

68. Who Loses from the Single Payer System? The Insurance Company and its brokers!! Money Managers

70. THANK YOU !