Brought to you by:

The Illinois Single-Payer Coalition (ISPC)

With contributions from:

John Perryman, Charles Cappell,

Physicians for a National Health Program (PNHP)

Our current healthcare system and a single payer solution

Single Payer 101:

This presentation is meant for educational purposes.

ISPC is a 501(c)3 organization and, as such, does not endorse or oppose any candidates for public office.

So, what about our current

healthcare system?

Costs

Healthcare Expenditure as % of GDP

Healthcare Expenditures

Per Person in 2020

Why are costs so high?

No mechanism to control costs

Administrative waste & complexity

1

2

Price of an MRI in the San Francisco area

Uncontrolled Costs during Pandemic

Total Cost of Hospital and Physician: Appendectomy

Hospital Cost Per Day

Drug Prices: Canada vs. USA

Arbitrary Drug Price Increases

Calcium EDTA (for lead poisoning): $950 in 2013; $27,000 in 2016 (after corporate acquisition)

Epi-pen (for severe allergic reaction): $100 in 2007; more than $600 in 2015 (after corporate acquisition by Mylan)

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Glumetza (type 2 diabetes): increased 381% in 2015

Gleevec (leukemia): $27,000 in 2001;

$120,000 in 2017 (after acquisition by Novartis)

In 2022, prices for Tecartus and Yescarta

(lymphoma treatments) both increased $25,000

​

Why does this happen?

Because nothing stops it!

Administrative Waste & Complexity

Administrative Waste & Complexity

• Employer-based private insurance
• Medicare, Medicare Advantage, Medicare supplement
• Medicaid, Managed Care Organizations
• ACA health exchanges
• Children’s Health Insurance Program
• Student health plans
• Veterans Health Administration
• RICARE
• Indian Health Service

Current Insurance Providers:

Overhead costs by insurance type

Profits, Profits, Profits

wendellpotter.substack.com/p/big-insurance-2022-revenues-reached

So, what about our current

healthcare system?

Access

The Uninsured

https://www.cdc.gov/nchs/fastats/health-insurance.htm

The Insurance “Hierarchy”

https://www.nber.org/digest/sep20/variation-public-and-private-insurers-hospital-reimbursements

Different insurers reimburse at different levels

Meanwhile, community and public hospitals have far more uninsured and Medicaid patients.

Hospital try to optimize their 'payer mix' by looking for ways to attract wealthier, private insurance patients.

• Medicaid pays the lowest
• Medicare pays more
• Private insurance pays the most

Hospital Hierarchy

Community and Rural Hospitals are Closing

*This is not a complete list of hospital closures in IL

Mercy Hospital, Chicago, 2021

St Mary’s Hospital, Streator, 2015

St Elizabeth’s, Belleville, 2015

Kenneth Hall, East St Louis, 2011

Jackson Park Hospital,

Chicago, 2019

MetroSouth, Blue Island, 2019

Franciscan, Chicago Heights, 2018

Silver Cross, Joliet, 2012

Closed its labor & delivery unit

40% of patients on Medicaid

Moved 5 miles west to wealthier Olympia Fields

Moved 3 miles N to wealthier city New Lenox

Moved 7 miles NE to wealthier city O’Fallon

Served the uninsured

(4x more than the national average)

In 2020:

The U.S. still had ~ 31.6 million people without insurance

The number of children without coverage is up to 3.7 million

23% of working-age Americans were "underinsured" and 46% of respondents to a Commonwealth Fund survey said they skipped or delayed care because of the cost

• 67% of those filing bankruptcies attributed healthcare costs as a major factor

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• 70-80% of those had private insurance when they became ill

​

• 57% of people who lost their homes to foreclosure identified medical debt as a major cause

More bad news…

Average Contributions to Premiums

Deductibles Are Rising Even More Than Premiums

Deferring Care Due to Cost

• Had a medical problem but did not visit doctor or clinic
• Did not fill a prescription
• Skipped recommended test, treatment, or follow-up
• Did not get specialist care

Percent of adult ages 19-64 who reported any of the following cost-related access problems:

The Ultimate Sacrifice:

Excess Deaths Due to Lack of Insurance

Excess deaths in 2022 totaled 34,527

Here in Illinois...

Illinois Medicaid started a managed care system

• Now, nearly all Medicaid enrollees are required to enroll in a managed care organization (MCO) (i.e. a private insurance company)
• These MCOs make a profit by denying care and having extremely limited provider networks

2011

2021

30.8% of our total state expenditures went to Medicaid

In summary: Taxpayer money is funding

private profits while patients get subpar care

So, what about our current

healthcare system?

Outcomes

INFANT MORTALITY

PREVENTABLE MORTALITY

LIFE EXPECTANCY

32nd

26th

31st

U.S. Rankings:

Maternal Mortality Rates

Far higher here than in comparable countries… and rising

The Ultimate Sacrifice:

Excess Deaths Due to Lack of Insurance

Excess deaths in 2022 totaled 34,527

Racial Inequity

Four more stops on the blue line and life expectancy plummets

-David Ansell

Months of Adult Black Lives Lost as Compared to Whites

Medical prevention and treatment would help 86% of the difference in life expectancy

African Americans ages 18-49 are 2x as likely to die from heart disease than Whites.

African Americans ages 35-64 years are 50% more likely to have high blood pressure than Whites.

The life expectancy of Black Americans is 4 years lower than White Americans

Black Men spend MORE on Health care than other groups

Non-Hispanic Black individuals experienced more than 2-fold

higher cumulative lifetime healthcare expenses compared with individuals of other racial and ethnic groups

​

American Journal of Preventive Cardiology,Volume 14, 2023

COSTS

ACCESS

OUTCOMES

How do we measure up?

Healthcare System Performance VS. Spending

"Improved Medicare for All"

The Solution:

Single Payer

How It Works

• Covers everyone, from birth to death
• Comprehensive coverage, including payments to medical, preventive, dental, vision, hearing, long-term care, prescriptions, mental health, and reproductive care
• No cost-sharing (i.e. no co-payments, no premiums, no deductibles)
• Paid for by one national payer, but care still provided by private institutions

What is Single Payer?

Why do we say IMPROVED Medicare for All?

Because we need current Medicare to be IMPROVED

1

2

3

Expanded coverage to include vision, dental, pharmaceuticals, and long-term care

Remove expensive cost-sharing (premiums,

co-payments, deductibles)

No need for supplemental private insurance

Benefits of Single Payer (SP)

Lower healthcare costs!

More effective in negotiations

Government accountability

More equitable care

Healthcare not tied to employment

Better equipped to improve public health outcomes

Improve provider financial stability

No medical bankruptcies

Transparency

Lifts the burden from employers & local municipalities

Freedom to get care

✓

✓

✓

✓

✓

✓

✓

✓

✓

✓

Universal Healthcare Means

Racial Disparities Nearly Disappear

Health Costs: USA vs Canada

Current Single Payer Legislation

How are we going to pay for this???

Costs and Savings of SP (in billions)

Costs and Savings of SP

Will government spending on healthcare increase? Yes.

How will the government pay for these additional costs?

Friedman proposed a tax plan that could fully fund SP.

​

It includes:

• Existing sources of federal revenues for health care
• Employer payroll tax, tax on unearned income, tax on stock trades
• Income tax, only applying to households making more than $225,00

​

Single payer will increase income for the bottom 95%

Why are we even ASKING OURSELVES

THIS QUESTION??

Nearly ALL legislation passes without mandating funding:

• Infrastructure
• Emergency relief
• Tax cuts
• War
• Bank bail-outs (estimates vary from trillions to tens of trillions of dollars)

Taxes were not raised before (or after) any of these were passed

​

...because they didn’t need to be.

Based on this theory, when the U.S. gov debt soared in 2008, many economists said high inflation was inevitable.

• But in fact, inflation has been very low over the past 10 years despite massive spending on the Wall Street bailout, increases in military spending, and tax cuts.
• Also, Japan has been trying to raise its inflation rate since the late-1990s and hasn’t been able to despite hefty gov spending.

What about Inflation?

The same economic ideas that failed to predict the Great Recession have also failed to understand or predict inflation.

Traditional economic theory says money creation or government debt causes inflation.

In Summary...

We spend an exorbitant amount on healthcare right now. This is because our system is flawed and inefficient.

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Moving to SP will undoubtedly cut long-term spending.

• The biggest savings will come in our ability to gain control over long-term healthcare inflation (remember the trend of Canada’s healthcare costs compared to the U.S.’s).

​

Any additional costs incurred by the gov to implement single payer can be paid for with or WITHOUT raising taxes.

In Summary...

If Congress wants to fully fund SP, they can.

• They can fund it in a way that doesn’t tax the bottom 95% of people.
• For the top 5%, they will have the security of knowing they can’t go bankrupt from getting sick (only the ultra, ultra-wealthy are immune from this).

…..AND give its people healthcare!

Moving to single payer will make the economy more efficient

Thank You!

-The Illinois Single Payer Coalition

ilsinglepayer.org

info@ilsinglepayer.org

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