Where do you stand on Health Care Reform?

1. THE WORLD AS IT IS VERSUS THE WORLD AS IT SHOULD BE Isn’t that what this whole Health Care Reform initiative is about? SINGLE PAYER WOULD CALL UPON ALL SECTORS OF OUR SOCIETY TO CO-FINANCE A UNIVERAL HEALTH CARE FUND FOR ALL AMERICANS In today’s complex world, no problem has an easy solution. Complexity requires that any reform effort take into account the obvious. That is the purpose of this document, to walk you though our existing system’s obvious defects and promote active debate on how to move forward

3. 1. PRIVATE HEALTH INSURANCE (PHI) REPLACE WHAT DOES NOT WORK

4. 1. PRIVATE HEALTH INSURANCE (PHI) REPLACE WHAT DOES NOT WORK IT’S A BUSINESS THAT OPERATES ON A NEGATIVE PREMISE.

5. 1. PRIVATE HEALTH INSURANCE (PHI) REPLACE WHAT DOES NOT WORK IT’S A BUSINESS THAT OPERATES ON A NEGATIVE PREMISE. We pay . . .

6. 1. PRIVATE HEALTH INSURANCE (PHI) REPLACE WHAT DOES NOT WORK IT’S A BUSINESS THAT OPERATES ON A NEGATIVE PREMISE. We pay . . . For something they don’t want to do .

7. 1. PRIVATE HEALTH INSURANCE (PHI) REPLACE WHAT DOES NOT WORK IT’S A BUSINESS THAT OPERATES ON A NEGATIVE PREMISE. We pay . . . For something they don’t want to do . That … in and of itself … makes no sense.

8. 1. PRIVATE HEALTH INSURANCE (PHI) REPLACE WHAT DOES NOT WORK IT PROSPERS FROM 2 OPERATIONAL DYSFUNCTIONALITIES: #1 DIVIDE & CONQUER; #2 FEAR

9. 1. PRIVATE HEALTH INSURANCE (PHI) REPLACE WHAT DOES NOT WORK IT PROSPERS FROM 2 OPERATIONAL DYSFUNCTIONALITIES: #1 DIVIDE & CONQUER; #2 FEAR Our Population is divided . . . 1. Between insurers;

10. 1. PRIVATE HEALTH INSURANCE (PHI) REPLACE WHAT DOES NOT WORK IT PROSPERS FROM 2 OPERATIONAL DYSFUNCTIONALITIES: #1 DIVIDE & CONQUER; #2 FEAR Our Population is divided . . . 1. Between insurers; 2. Between policy holders within an insurer;

11. 1. PRIVATE HEALTH INSURANCE (PHI) REPLACE WHAT DOES NOT WORK IT PROSPERS FROM 2 OPERATIONAL DYSFUNCTIONALITIES: #1 DIVIDE & CONQUER; #2 FEAR Our Population is divided . . . 1. Between insurers; 2. Between policy holders within an insurer; 3. In our very lives as we move around and are dropped and added to different insurance policies.

12. 1. PRIVATE HEALTH INSURANCE (PHI) REPLACE WHAT DOES NOT WORK IT PROSPERS FROM 2 OPERATIONAL DYSFUNCTIONALITIES: #1 DIVIDE & CONQUER; #2 FEAR Our Population is divided . . . 1. Between insurers; 2. Between policy holders within an insurer; 3. In our very lives as we move around and are dropped and added to different insurance policies. 1. We fear the financial consequences of illness;

13. 1. PRIVATE HEALTH INSURANCE (PHI) REPLACE WHAT DOES NOT WORK IT PROSPERS FROM 2 OPERATIONAL DYSFUNCTIONALITIES: #1 DIVIDE & CONQUER; #2 FEAR Our Population is divided . . . 1. Between insurers; 2. Between policy holders within an insurer; 3. In our very lives as we move around and are dropped and added to different insurance policies. 1. We fear the financial consequences of illness; 2. So we pay for private health insurance;

14. 1. PRIVATE HEALTH INSURANCE (PHI) REPLACE WHAT DOES NOT WORK IT PROSPERS FROM 2 OPERATIONAL DYSFUNCTIONALITIES: #1 DIVIDE & CONQUER; #2 FEAR Our Population is divided . . . 1. Between insurers; 2. Between policy holders within an insurer; 3. In our very lives as we move around and are dropped and added to different insurance policies. 1. We fear the financial consequences of illness; 2. So we pay for private health insurance; 3. Someone in our policy group gets sick;

15. 1. PRIVATE HEALTH INSURANCE (PHI) REPLACE WHAT DOES NOT WORK IT PROSPERS FROM 2 OPERATIONAL DYSFUNCTIONALITIES: #1 DIVIDE & CONQUER; #2 FEAR Our Population is divided . . . 1. Between insurers; 2. Between policy holders within an insurer; 3. In our very lives as we move around and are dropped and added to different insurance policies. 1. We fear the financial consequences of illness; 2. So we pay for private health insurance; 3. Someone in our policy group gets sick; 4. Coverage costs more and we pay because …(go to #1 above)

16. 1. PRIVATE HEALTH INSURANCE (PHI) REPLACE WHAT DOES NOT WORK PHI’s two self-reinforcing premises: 1. To act responsibly, Americans must insure their health; 2. Making it mandatory is like your auto or home owner’s insurance obligation.

17. 1. PRIVATE HEALTH INSURANCE (PHI) REPLACE WHAT DOES NOT WORK Premise 1. “Responsibility” or “Right”

18. 1. PRIVATE HEALTH INSURANCE (PHI) REPLACE WHAT DOES NOT WORK Premise 1. “Responsibility” or “Right”

19. 1. PRIVATE HEALTH INSURANCE (PHI) REPLACE WHAT DOES NOT WORK Premise 1. “Responsibility” or “Right” Premise 1. “A commodity that is your responsiblity to pay” or “ A basic right” -- The conclusion to this question will be taken up in Section 3, after taking into account how production, consumption and environmental factors affect our health –

20. 1. PRIVATE HEALTH INSURANCE (PHI) REPLACE WHAT DOES NOT WORK Premise 2. Making it mandatory is like your auto or home owner’s insurance obligation.

21. 1. PRIVATE HEALTH INSURANCE (PHI) REPLACE WHAT DOES NOT WORK Premise 2 – Mandatory Health Insurance : A question of AFFORDABILITY.

22. 1. PRIVATE HEALTH INSURANCE (PHI) REPLACE WHAT DOES NOT WORK Premise 2 – Mandatory Health Insurance : A question of AFFORDABILITY.

23. 1. PRIVATE HEALTH INSURANCE (PHI) REPLACE WHAT DOES NOT WORK Premise 2 – Mandatory Health Insurance : A question of AFFORDABILITY.

24. 1. PRIVATE HEALTH INSURANCE (PHI) REPLACE WHAT DOES NOT WORK Premise 2 – Mandatory Health Insurance : A question of AFFORDABILITY.

25. 1. PRIVATE HEALTH INSURANCE (PHI) REPLACE WHAT DOES NOT WORK Premise 2 – Mandatory Health Insurance : A question of AFFORDABILITY.

26. 1. PRIVATE HEALTH INSURANCE (PHI) REPLACE WHAT DOES NOT WORK Premise 2 – Mandatory Health Insurance : A question of REPLACEABILITY. Property is not like People

27. 1. PRIVATE HEALTH INSURANCE (PHI) REPLACE WHAT DOES NOT WORK Premise 2 – Mandatory Health Insurance : A question of REPLACEABILITY. Property is not like People One body per lifetime, whatever it’s health

28. 1. PRIVATE HEALTH INSURANCE (PHI) REPLACE WHAT DOES NOT WORK Premise 2 – Mandatory Health Insurance : A question of REPLACEABILITY.

29. 1. PRIVATE HEALTH INSURANCE (PHI) REPLACE WHAT DOES NOT WORK Premise 2 – Mandatory Health Insurance : A question of REPLACEABILITY.

30. 1. PRIVATE HEALTH INSURANCE (PHI) REPLACE WHAT DOES NOT WORK Car and Home Owner’s Insurance protects us against EVENTUALITIES Premise 2 – Mandatory Health Insurance : A question of PROBABILITY.

31. 1. PRIVATE HEALTH INSURANCE (PHI) REPLACE WHAT DOES NOT WORK Car and Home Owner’s Insurance protects us against EVENTUALITIES People’s health needs to be insured against the INEVITABLE . We’re bound to get sick. Premise 2 – Mandatory Health Insurance : A question of PROBABILITY.

32. 1. PRIVATE HEALTH INSURANCE (PHI) REPLACE WHAT DOES NOT WORK Premise 2 – Mandatory Health Insurance : A question of PROBABILITY.

33. 1. PRIVATE HEALTH INSURANCE (PHI) REPLACE WHAT DOES NOT WORK Premise 2 – Mandatory Health Insurance : A question of PROBABILITY.

35. 2. THE RELATIONSHIP BETWEEN HEALTH AND HOW WE LIVE Our planet, and our health, are affected by our choices and use of the earth’s resources.

36. 2. THE RELATIONSHIP BETWEEN HEALTH AND HOW WE LIVE Our planet, and our health, are affected by our choices and use of the earth’s resources. .. the AIR we BREATH ( pollution and CO2 ) The enormous volume of CO2 emissions released into the atmosphere is upsetting its chemical balance. This imbalance has not only triggered global warming but potentially compromises the very air we breath. Add to this all the other pollutants that affect air quality and our health, and its obvious we have a serious problem.

37. 2. THE RELATIONSHIP BETWEEN HEALTH AND HOW WE LIVE .. the AIR we BREATH ( pollution and CO2 ) .. the WATER we DRINK ( dumping/sewage ) Our planet, and our health, are affected by our choices and use of the earth’s resources. In a single year, polluters dumped more than 232 million pounds of toxic chemicals into our nation’s rivers and streams. Nationwide, polluters contaminated the drinking water of 23 million Americans. In the last 5 years, industry has violated water pollution laws half a million times. 1 in 10 Americans have been exposed to drinking water that contains dangerous chemicals or fails to meet federal health benchmarks in other ways.

38. 2. THE RELATIONSHIP BETWEEN HEALTH AND HOW WE LIVE .. the AIR we BREATH ( pollution and CO2 ) .. the WATER we DRINK ( dumping/sewage ) .. the LAND we EXHAUST ( overuse/misuse ) Our planet, and our health, are affected by our choices and use of the earth’s resources. Environmental Groups are stepping up their opposition to the coal industries practice of removing the tops of moun-tains with explosives. 500 individual peaks have been removed – the equivalent of 1.2 million acres of land the size of the state of Delaware. In two-thirds of the mountain top removal operations, valley fill is the sister practice of dumping the remaining waste in valleys. In 99% of the valleys some type of water source will be affected. It was true then (1958 Silent Spring) and it holds true now. We are poisoning the earth with chemicals.

39. 2. THE RELATIONSHIP BETWEEN HEALTH AND HOW WE LIVE .. the AIR we BREATH ( pollution and CO2 ) .. the WATER we DRINK ( dumping/sewage ) .. the LAND we EXHAUST ( overuse/misuse ) .. the FOODS we EAT ( processed/empty ) Our planet, and our health, are affected by our choices and use of the earth’s resources. ‘ You are what you eat’ and in food you find completely synthetic ingredients, quasi-edible substances that ultimately do not come from a corn or soybean field but from a petroleum refinery or chemical plant. These chemicals are what make modern processed foods possible. Chemicals, sweeteners, hormones … our bodies are exposed to it all, with grave implications for our national health. From premature menstruation in girls, to breast formation in boys. From obesity to alarming levels of diabetes. The dietary health of America is in trouble.

40. 2. THE RELATIONSHIP BETWEEN HEALTH AND HOW WE LIVE Our planet, and our health, are affected by our choices and use of the earth’s resources. Since 2003, we see a jump in the number of returning Veterans seeking VA health care. How many deserving soldiers have returned home to be denied care? Might there be a relationship between the Iraq War and the rising costs of health care?

49. 3. NO TO PUBLIC OPTION WITH PHI YES TO SINGLE PAYER First we must address “why our Nation is broke”. During President Bush’s term, the National Debt went from President Clinton’s low of 57.7% of GDP to the Bush Era high of 78.1% of GDP in his last year of office (+20 pts).

50. 3. NO TO PUBLIC OPTION WITH PHI YES TO SINGLE PAYER

51. 3. NO TO PUBLIC OPTION WITH PHI YES TO SINGLE PAYER

52. 3. NO TO PUBLIC OPTION WITH PHI YES TO SINGLE PAYER Don’t perpetuate PHI by obligating Americans to pay Health Care Insurance. Consolidate our Health Care Purchasing Power through Taxes (front-end & back-end). The Baucus Health Care Reform Price tag is set to $856 billion over a 10 year period, and foresees middle class families paying 13% of their earnings in Health Insurance Premiums (not including cost-sharing concepts like co-payments, deductibles) The Baucus Plan leaves a back-door penalty that an employer or family must pay if they do not enroll. What happens when most opt out and pay the penalty? Will they still have access to health care? Will the Public Option be viable? Aren’t we asking those with the least likely ability to pay (i.e., those outside the employer covered health care network) to be one of the legs in the Financing Stool of the Public Option? Do we even know how many legs the stool has?

56. 3. NO TO PUBLIC OPTION WITH PHI YES TO SINGLE PAYER Consolidate our Health Care Purchasing Power through Taxes (front-end/back-end). Reference Point: Health Care Costs represent 18% of GDP or $2.5 trillion. Business will match employee contributions to health care. At 2%, this is lower than the 14% average currently paid on median incomes.

57. 3. NO TO PUBLIC OPTION WITH PHI YES TO SINGLE PAYER Consolidate our Health Care Purchasing Power through Taxes (front-end/back-end). Reference Point: Health Care Costs represent 18% of GDP or $2.5 trillion. With a 2% Tax on Income and the application of a 2% Tax on Consumer Goods, the cost to Median Income Households will not exceed 4% of earnings when spending is within means.

58. 3. NO TO PUBLIC OPTION WITH PHI YES TO SINGLE PAYER Consolidate our Health Care Purchasing Power through Taxes (front-end/back-end). Reference Point: Health Care Costs represent 18% of GDP or $2.5 trillion. Earnings in excess of median incomes will result in higher nominal contributions. It could be possible to justify a tiered Health Care Tax on income when this adjustment can be offset with sufficient contributions from other taxed sectors.

59. 3. NO TO PUBLIC OPTION WITH PHI YES TO SINGLE PAYER Consolidate our Health Care Purchasing Power through Taxes (front-end/back-end). Reference Point: Health Care Costs represent 18% of GDP or $2.5 trillion. The taxing of other sectors, that contributed to our systemic crisis, is vital to capturing sufficient funds for Health Care (oil/industry/banking).

60. 3. NO TO PUBLIC OPTION WITH PHI YES TO SINGLE PAYER Consolidate our Health Care Purchasing Power through Taxes (front-end/back-end). Reference Point: Health Care Costs represent 18% of GDP or $2.5 trillion. Ideally , the Health Care Tax applied to income and consumer goods can be managed by State Government. These contributions will represent the States capacity to pay Health Care Providers for services rendered.

61. 3. NO TO PUBLIC OPTION WITH PHI YES TO SINGLE PAYER Consolidate our Health Care Purchasing Power through Taxes (front-end/back-end). Reference Point: Health Care Costs represent 18% of GDP or $2.5 trillion. The taxing of other sectors may be a shared strategy between the State and the Federal Government. A formula must be defined for allocating Federally Collected Health Care Taxes to the States.

62. 3. NO TO PUBLIC OPTION WITH PHI YES TO SINGLE PAYER Consolidate our Health Care Purchasing Power through Taxes (front-end/back-end). Reference Point: Health Care Costs represent 18% of GDP or $2.5 trillion. With a 2% Tax on Income and the application of a 2% Tax on Consumer Goods, the cost to Median Income Households will not exceed 4% of earnings when spending is within means. Earnings in excess of median incomes will result in higher nominal contributions. It could be possible to justify a tiered Health Care Tax on income when this adjustment can be offset with sufficient contributions from other taxed sectors. Ideally , the Health Care Tax applied to income and consumer goods can be managed by State Government. These contributions will represent the States capacity to pay Health Care Providers for services rendered. The taxing of other sectors may be a shared strategy between the State and the Federal Government. A formula must be defined for allocating Federally Collected Health Care Taxes to the States. Transparency will require that any charging of the Single Payer Tax be an isolated item on the transaction document, be it Pay Stub, Sales Receipt or any other instrument where the tax is effectively assessed for collection . Business will match employees contribution to health care. At 2%, this is lower than the 14% average currently paid on median incomes. The taxing of other sectors, that contributed to our systemic crisis, is vital to capturing sufficient funds for Health Care (oil/industry/banking).

63. 3. NO TO PUBLIC OPTION WITH PHI YES TO SINGLE PAYER Consolidate our Health Care Purchasing Power through Taxes (front-end/back-end). Reference Point: Health Care Costs represent 18% of GDP or $2.5 trillion. The percentages and mix of sectors to be taxed for Health Care is suggestive only. It is to support the case that there are more ways than one to approach Health Care Financing. The most prudent and just approach is to spread the burden . The more legs to the stool for Health Care Financing, the greater the safety in the event that one leg or more drop-off or dip in our current crisis.

65. 4. SINGLE PAYER: HOW IT COULD WORK 1. Single Payer Contributions are Pooled by State; 2. Any Citizen can join the Single Payer Risk Pool and is Issued a Health Card; 3. See Your Doctor/Receive Required Preventative Care and Treatment; 4. Health Care Providers Bill the State Directly, and are paid from Pooled Contributions

66. 4. SINGLE PAYER: HOW IT COULD WORK 1. Single Payer Contributions are Pooled by State; 2. Any Citizen can join the Single Payer Risk Pool and is Issued a Health Card; 3. See Your Doctor/Receive Required Preventative Care and Treatment; 4. Health Care Providers Bill the State Directly, and are paid from Pooled Contributions

67. 4. SINGLE PAYER: HOW IT COULD WORK 1. Single Payer Contributions are Pooled by State; 2. Any Citizen can join the Single Payer Risk Pool and is Issued a Health Card; 3. See Your Doctor/Receive Required Preventative Care and Treatment; 4. Health Care Providers Bill the State Directly, and are paid from Pooled Contributions

68. 4. SINGLE PAYER: HOW IT COULD WORK 1. Single Payer Contributions are Pooled by State; 2. Any Citizen can join the Single Payer Risk Pool and is Issued a Health Card; 3. See Your Doctor/Receive Required Preventative Care and Treatment; 4. Health Care Providers Bill the State Directly, and are paid from Pooled Contributions

69. 4. SINGLE PAYER: HOW IT COULD WORK 1. Single Payer Contributions are Pooled by State; 2. Any Citizen can join the Single Payer Risk Pool and is Issued a Health Card; 3. See Your Doctor/Receive Required Preventative Care and Treatment; 4. Health Care Providers Bill the State Directly, and are paid from Pooled Contributions

70. 4. SINGLE PAYER: HOW IT COULD WORK 1. Single Payer Contributions are Pooled by State; 2. Any Citizen can join the Single Payer Risk Pool and is Issued a Health Card; 3. See Your Doctor/Receive Required Preventative Care and Treatment; 4. Health Care Providers Bill the State Directly , and are paid from Pooled Contributions

71. 4. SINGLE PAYER: HOW IT COULD WORK 1. Single Payer Contributions are Pooled by State; 2. Any Citizen can join the Single Payer Risk Pool and is Issued a Health Card; 3. See Your Doctor/Receive Required Preventative Care and Treatment; 4. Health Care Providers Bill the State Directly, and are paid from Pooled Contributions

79. CONVICTION, ACTION & RESOLVE CAN LEAD TO A SINGLE PAYER VICTORY WE HAVE TO BELIEVE THAT WE CAN INFLUENCE CHANGE AND BRING THE WORLD CLOSER TO WHAT IT SHOULD BE