Health Care
for
All Colorado
Irene Aguilar, M.D.
Vice President,
Health Care for All Colorado
Primary Care Physician
Westside Health Center
Denver Health and Hospitals
Health Care Spending in the U.S.
 2006 - $2.1 trillion (16% GDP)
69% for health care
31% for other costs
Administrative overhead
Profits
 2007 - $2.4 trillion (21% GDP)
Colorado
spending 2007
estimated at:
$30.1 billion
2007: 45.7 Million Uninsured
Government
Insurance
2007 Colorado:
801,000 uninsured
16.4% of population
2006: 80.3 M
2007: 83.0 M
 2.3 Million
In Colorado,
70% of the
uninsured are in
the workforce or
are dependents
of a worker.
What is the cost of health insurance?
 Over $10,000 for employer sponsored family
policy*
 Individual policy (if it can be purchased) more
than $10,000 in after tax dollars
Median income was $52,275 in 2006**
Can the average worker afford health insurance?
*The Lewin Group: Health Spending in Colorado June 2007
**Denver Business Journal August 2007
Average Total Employee Contribution per Enrolled
Employee for Single Coverage at Private-Sector
Establishments Offering Health Insurance in Colorado
Because of rising costs,
the numbers of companies
offering health benefits
continues to decline
1995 – 67%
2000 – 51%
2007 – 41%
National Small Business Association Survey - 2007
37.5% of
Colorado’s
uninsured work
for firms that do
not offer
insurance;
21% are
ineligible for
their employer’s
coverage
37% of companies have taken
cost cutting action
 Instituting wellness programs
 Changing insurance company
 Decreasing covered benefits
 Increasing deductibles and co-pays
 Increasing employee contribution
Access Problems for
Middle Class Families
(Income $25,000-$49,999)
Postponed Needed Care
Problem Paying Bills
Didn't Get Needed Drug
Collection Agency Call
25%
20%
22%
23%
15%
10%
5%
0%
NPR/Kaiser Survey, June2002
13%
12%
Who Pays for Health Care?
Private health insurers
Insure 59% of those with insurance
Pay 19% of total health care costs
Who Pays for Health Care?
Government (taxpayers) – 66%
Federal/State/Local
Medicare - $440 billion (2006)
Medicaid - $330 billion (2006)
SCHIP
Government Employee Insurance Premiums
U.S. Public Health Services (IHS)
U.S. Military
VA System (235,000 employees)
Prisoners (2 million incarcerated)
Public hospitals and clinics
Tax subsidies
Health Care Expenditure per Capita
by Source of Funding in 2005
Adjusted for Differences in Cost of Living
$7,000
$6,000
Out-of-Pocket Spending
$842
Private Spending
$5,000
$4,000
Public Spending
$2,676
$233
$448
$3,000
$431
$328
$482
$250
$507
$832
$390
$2,000
$2,884
$1,000
$2,693
$2,527
$0
$2,337
France
States
a2004
b2002
Source: OECD Health Data 2007
Germany
$392
$121
$2,110
$2,110
$2,064
b
United
$0
$352
$627
Canada Netherlands Australia
$1,829
a
United
New
Kingdom
Zealand
Utilization of Health Care Services
Average Length of Stay in
Hospital in 2005
Average Number of Physician
Visits per Capita in 2005
10
10
8.6
8
8
7.3
6.8
6.1
6.1
6
5.6
5.6
5.4
7.0
6.6
6.1
6.0
5.4
6
5.1
3.8
4
4
2
2
0
0
GER
a
CAN NETH AUS
a
UK
NZ
c
US
a2004
b2003
3.2
cSource:
NZ Ministry of Health, 2004
Source: OECD Health Data 2007 (October 2007)
FR
GER
a
FR
a
AUS
CAN
a
NETH
UK
US
a
NZ
b
In comparison to other
countries, why do we:
 Have 97 million uninsured or
underinsured?
 Spend far more per capita?
 Have poorer outcomes?
 In other words…
 Where is the money?
Growth of Registered Nurses
and Administrators, 1970-2002
Growth since 1970
Administrators
RNs
2500%
2000%
1500%
1000%
500%
0%
1970
1975
1980
Bureau of Labor Statistics & Himmelstein/Woolhandler/Lewontin Analysis of CPS data
1985
1990
1995
2002
What role do medical liability
costs play?
 3% of total costs ($66 billion)
 Majority of patients who are harmed are
not compensated
 Some not harmed are compensated
 Tort reform is not the comprehensive
solution to health care costs
MEDICAL MALPRACTICE INSURANCE
2000-2004
134.5%
160%
140%
120%
100%
80%
60%
40%
20%
9.6%
0%
Payout Increase
Gross Losses Paid
Premiums Increase
Gross Premiums Written
Falling Claims and Rising Premiums in the Medical Malpractice Insurance Industry, July 2005
Drug Companies’ Cost Structure
U.S. Drug Spending, 1990-2003
»200
$182
$161
»160
»(Billions of Dollars)
»Prescription Drug Spending
»180
$142
»140
$122
»120
$104
»100
»80
»60
»40
$40
$55
$46 $48 $51
$61 $67
$75
$85
»20
»0
1990
1992
Source: HCFA, Office of the Actuary
1994
1996
1998
2000
2002
The Health Care
Americans Want
 Free choice of doctor
 Guaranteed access
 High quality
 Affordability
 Trust and Respect
The Health Care
Americans Get
 1/3 are uninsured or underinsured
 Insurance companies deny care to millions more
with expensive illnesses
 Death rates higher than other wealthy nations
 Costs exceed France, Germany and Sweden and
rising faster
 Executives and investors making billions
 Destruction of the doctor/patient relationship
Medicare, Medicaid and Choice
or
Insurance does not = Access
 Only 37% of Colorado Providers
accept Medicaid (adult and
children)
 In 2002 only 37% of primary care
physicians were accepting new
Medicare patients
How do we achieve the ideal?
Dramatically reduce
overhead costs. How?
 Eliminate “for profit” entities in
delivery of healthcare
 Reduce costs of pharmaceuticals
 Allow negotiation of bulk price
 Create a single risk pool of all
residents - makes health care
available and affordable to all
Lewin Group Analysis of
Colorado Proposals*
COLORADO HEALTH SERVICES
SINGLE PAYER PROGRAM
Everyone insured with comprehensive
benefits – No one without coverage
$1.4 billion savings annually
*Colorado Blue Ribbon Commission on Health Care Reform 1/31/2008
Single Payer Health Care
 Universal – covers everyone
 Comprehensive – all needed care, including
dental, mental health, substance abuse
 No or low co-pays
 Simplified reimbursement
 No for profit insurers, hospitals, etc
 Improved health planning
 Public accountability for quality and cost, with
minimal bureaucracy
Single Payer Health Care:
How do we know it can be done?
 Every other industrialized nation has a
healthcare system that assures medical
care for all
 All spend less than we do; many spend
less than half
 Most have lower death rates, more
accountability and higher satisfaction
Single Payer Health Care
Opponents
 Insurance companies - lose business
and lose profit
 Pharmaceutical companies - lose profit
 Many providers - fear change
 Some small businesses - forced to pay
a share
 The insured – fear less coverage and
more costs
Single Payer Health Care
Supporters
 The uninsured - all would be covered
 The elderly & middle class - ends
underinsurance and risk of bankruptcy
 Medicaid & Medicare recipients - assures
equal choice in care
 Big business - contains costs
 Health Care Providers - helps patients,
curtails bureaucracy
 Employees – bargain for salary increases
instead of health benefits
Single-payer or
National Health Insurance.
U.S. Physicians
No Opinion
9%
Oppose
32%
Support
59%
Support for National Health Insurance among U.S. Physicians: 5 Years Later
Carroll and Ackerman Ann Intern Med.2008; 148: 566-567
Elected leadership should work
for taxpayers, not for special
interests.
Our healthcare dollars should be
spent to guarantee access to
comprehensive high quality
health care.
We need to advocate for REAL
healthcare reform.
What can you do?
 Write your federal legislators and ask them to
endorse HR 676 – Improved Medicare for All
 Talk to your state legislators and ask them to
support Single Payer Health Care in Colorado
 Educate yourself about the REAL ISSUES in
health care reform
 Join us :
www.healthcareforallcolorado.org
“True compassion is more than
flinging a coin to a beggar;
it comes to see that an edifice
which produces beggars
needs restructuring.
Martin Luther King, Jr.
Stephen Colbert on the
Bush Health Plan
“It’s so simple. Most people who
can’t afford health insurance are also
too poor to owe taxes. But if you give
them a deduction from the taxes they
don’t owe, they can use the money
they’re not getting back to buy the
health care they can’t afford.”