a fireside chat about healthcare

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A Fireside Chat About Healthcare. Rose Roach Chair, Health Care Committee, CDP Progressive Caucus Field Director, CSEA PDA, Health Care Issues Organizing Team. Can we agree on a common set of values and economic principals?. Everyone should be treated by a doctor if they are ill. - PowerPoint PPT Presentation


  • A Fireside Chat About HealthcareRose Roach Chair, Health Care Committee, CDP Progressive Caucus Field Director, CSEAPDA, Health Care Issues Organizing Team

  • Can we agree on a common set of values and economic principals?Everyone should be treated by a doctor if they are ill.Medical care should be returned to the hands of medical professionals, not insurance company accountants.No one should profit from another persons suffering.Pricing for hospitals and doctors should not be a secret. We need public disclosure.

    Everyone deserves health care when they need it.

  • Do We Have a Health Care Crisis?Yes!

    Why Do We Have a Health Care Crisis?

    The United States has the most privatized health care system in the advanced world; it also has, by far, the most expensive care, without gaining any clear advantage in quality for all that spending. Health is one area in which the public sector consistently does a better job than the private sector at controlling costs. Nobel Prize Economist Paul Krugman Health Care Statistics That Establish the Need for Reform

  • Healthcare Impacts Everything123 dead every day 2,739 bankrupt Incalculable toll of sufferingOur most vulnerable communities (no health planning)Bankrupting our state and nation

  • No cost control is eating up our public education budget

  • Insurance Premiums Workers Earnings Inflation 1999-2008

    Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 2000-2008. Bureau of Labor Statistics, Consumer Price Index

  • Who Are The Uninsured?Only 6% of the uninsured are immigrants

    The uninsured are families that work hard, play by the rules, pay their taxes, and yet dont get basic health coverage

    80% of the uninsured are in working families

    Over 85% of the uninsured are either not offered or not eligible for health insurance from their employer

  • The Epidemic of UnderinsuranceSource: Too Great a Burden, Families USA, December 2007 Number of people spending more than 10% of income on health care (Millions)













  • What Do We Get For Our Money? The most expensive health care in the world The best health care in the world?

  • The Issue Of Quality

    98,000 preventable deaths due to medical errors

    One million adverse events associated with hospitalizations

    Up to 195,000 accidental deaths in hospitals

    Institute of Medicare: To Error is Human, 2001At the top: France is #1

    US ranks 37th, between Costa Rica and SloveniaWorld Health Organization Global Health Rankings

    Maternal Mortality Deaths/100,000 Births

    US = 15.1; next closest industrialized nation France = 7

  • Cost Increases: The Usual SuspectsAging populationNew technologyThose darn trial lawyers!New wonder drugsIrresponsible consumers who use too much because they dont pay enoughNOT!!!

  • Elderly as Percent of Total Population

  • MRI Units per Million PeopleOECD, 2004 (2002 Data, U.S., Canada, and Germany are 2001)












  • Tobacco SmokersOECD, 2004 (2002 Data, U.K is 2001)








    % population smoking daily




  • Why spend so much AND get so little? Our profit-driven insurance system AND as long as millions are left out, everyone will suffer

    Our Multi-Payer Health Care System is Fragmented and Inefficient:

    Wasteful administrative costs ($.25 - $.40 per $1.00)

    Exorbitant increases in insurance company profits (Between 2000 and 2009, insurance company profits increased by more than 400%. Modern Health Care 2004 )

    Extraordinary compensation for industry CEOsRoy Williams CEO Aetna - $24,300,122; H. Edward Hanway Cigna $12,236740; Angela Bray Wellpoint - $9,844,212; Dale Wolf Coventry Healthcare - 9,047,469; Michael Niedorff Centene - 8,744, 483; James Carlson Amerigroup - $ 5,292,546; Michael McAllister Humana $4,764,309; Jay Gellert Health Net - $4,425,355; Steven Helmsley United Health Group - $3,241,042; Billy Tauzin CEO PhRMA - $2,000,000; Karen Ignani Amer. Health Insurance Plans - $ 1,580,000

    Unexplained cost variations in hospital charges

  • Uwe E. Reinhardt, The Pricing Of U.S. Hospital Services: Chaos Behind A Veil Of Secrecy, Health Affairs, Vol 25, Issue 1, 57-69

    The Pricing of U.S. Hospitals:Chaos Behind a Veil of SecrecyThere is no method to this madness. As we went through the years, we had these cockamamie formulas. We multiplied our cost to set our charges.- William McGowan, CFO of the UC, Davis, Health System, Wall Street Journal, 27 December, 2004

  • Hospital Inpatient Days per CapitaRationing?

  • Physician Visits per Capita

  • Root Causes of the Health Care Crisis

  • I dont believe theres any problem in this country, no matter how tough it is, that Americans, when they roll up their sleeves, cant completely ignore.George Carlin

  • HEALTH REFORM: PPACAPresident Obama did not want to start from scratch

    He had two fundamental choices: 1) to build on the public sector (Medicare) or2) to build on the private sector

    He chose to try to reach universal coverage by expanding private insurance

  • The Best Democracy Money Can Buy?Health industry spending - $280 million on lobbying first half of 2009113 health lobbyists per member of Congress2 1The Center for Responsive Politics 2American League of LobbyistsSenate framework written by Liz FowlerFormer VP of Public Policy for WellPoint/Anthem

  • HEALTH INSURANCE REFORM - PPACAMoves forwardStanding still

    Mandates coverage of check-ups and other preventive servicesReduces or eliminates co-pays and deductibles, but only on preventive services Children can remain on parents policy until age 26 not based on IRS definition of dependentChronic Disease ManagementPayment Reforms (e.g., medical homes)Primary care/quality pilots

    Expanded coverage, but not universalNo bulk purchasing of RxCost control by market meansNo definition of standard benefits packageChoice thru State-based exchanges, but no public optionFunding: Excise tax on Cadillac plans, Medicare cutbacks and revenue from reduced fraud and abuse

  • Health Reform Bill:Proven Cost Control Provisions

  • Global budgeting of hospitalsCapital investment planning Emphasis on primary care; coordination of care; alternative ways of paying for careBulk purchasing of pharmaceuticalsAutomatic enrollment Federal guaranteeAll residents of the United States covered


    Expands Choice for Everyone with no limit to a network of providers meaning free choice of doctor and hospital

    Delinks health insurance from employment

    Eliminates Co-Pays and DeductiblesPublic funding- Payroll tax - Corporate taxes- Income taxes

    No premiums: regressive

    No increase in overall health care spending, because of administrative savings

    Reducing defensive medicine

  • WHATS INCLUDED IN A SUSTAINABLE, SECURE AND JUST DOCTOR/PATIENT HEALTH CARE SYSTEMComprehensive coverage- Preventive services- Hospital care- Physician services- Dental services- Mental health services- Medication expenses- Reproductive health services-Home Care/nursing home careAll medically necessary servicesAny exclusions? How decided? Based on a clinical decision, not a financial one.

  • Vermont Option 11A--Government-run Single Payer system withcomprehensive benefit package1BGovernment-run Single Payer system withessential benefit package Option 2Public Option Option 3 (Public-Private Single Payer) Essential benefit package, Independent board, thirdparty manages provider relations and claim adjudication/processingRecommended Option 3, Public Private Single PayerMost likely to be acceptable to major stakeholders, will produce most savings, should rely on market when possible, minimize political interference, gain transparency and accountability

  • Vermonts Proposed Essential Benefit PackagePrinciples:Cover every resident with at least 87% of medical and 77% of drug expenses (as the average private health insurance now covers)Expand coverage for dental and vision care.Exclude nursing home and homecare.Emphasize prevention and primary careFinancial risk protection against health expenditure that causes impoverishment by capping out-of-pocket cost.Availability of supplemental coverage in addition to the essential benefit package with private insurance.Services covered: Prevention, medical, mental health, other professionals, drugs, some dental and vision.Cost sharing by patients: Modest copayments for outpatient services (no copayment for preventive services), and deductible and coinsurance for inpatient hospital services.

  • Frequently Noted Concerns

  • I have a good health plan nowwhy should I support this?Hows your current health plan working for you?What has been the impact of rate increases on real income?How has it impacted salary, programs, etc?

    Health care rates have gone up 87% over the last five