A Fireside A Fireside Chat About Chat About HealthcareHealthcare

Rose Roach Rose Roach Chair, Health Care Committee, CDP Progressive Caucus Chair, Health Care Committee, CDP Progressive Caucus

Field Director, CSEAField Director, CSEAPDA, Health Care Issues Organizing TeamPDA, Health Care Issues Organizing Team

Can we agree on a common set of values Can we agree on a common set of values and economic principals?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 person’s 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?Do We Have a Health Care Crisis?Yes!Yes!

Why Do We Have a Health Care Why Do We Have a Health Care Crisis?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 Healthcare Impacts EverythingEverything

123 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 No cost control is eating up our public education budgetour public education budget

Insurance Premiums • Workers’ Earnings • Insurance Premiums • Workers’ Earnings • Inflation Inflation 1999-20081999-2008

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

119%

34%

29%

0%

20%

40%

60%

80%

100%

120%

140%

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

Health Insurance Premiums

Workers' Earnings

Overall Inflation

Who Are The Uninsured?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 don’t 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 UnderinsuranceThe Epidemic of Underinsurance

0

10

20

30

40

50

60

70

2000 2007

Insured Uninsured

Source: 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?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 QualityThe 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, 2001

At the top: France is #1

US ranks 37th, between Costa Rica and Slovenia

World Health Organization Global Health Rankings

Maternal Mortality – Deaths/100,000 Births

•US = 15.1; next closest industrialized nation France = 7

Cost Increases: Cost Increases: The Usual SuspectsThe Usual Suspects

Aging population New technology Those darn trial

lawyers! New wonder drugs Irresponsible

consumers who use too much because they don’t pay enough

NOT!!!

Elderly as Percent of Total PopulationElderly as Percent of Total Population

MRI Units per Million MRI Units per Million PeoplePeople

OECD, 2004 (2002 Data, U.S., Canada, and Germany are 2001)

Tobacco SmokersTobacco Smokers

OECD, 2004 (2002 Data, U.K is 2001)

Why spend so much Why spend so much ANDAND get so little? get so little? Our profit-driven insurance system AND as long

as millions are left out, everyone will sufferOur “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 CEO’s•Roy 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:The Pricing of U.S. Hospitals:Chaos Behind a Veil of Secrecy”Chaos Behind a Veil of Secrecy”

“There is no method to this madness. As we went “There is no method to this madness. As we went through the years, we had these cockamamie through the years, we had these cockamamie

formulas. formulas. We multiplied our cost to set our charges.”We multiplied our cost to set our charges.”

- - William McGowan, CFO of the UC, Davis, Health System, William McGowan, CFO of the UC, Davis, Health System, Wall Street Journal, Wall Street Journal, 27 December, 200427 December, 2004

Hospital Inpatient Days per Capita

Rationing?

Physician Visits per Capita

Root Causes of the Health Care Crisis

I. Dysfunctional health insurancePrivate insurance– Job-based– For-profit– Multiple plans, pools– Fee for service (FFS)– FFS rewards procedures

Public insurance– Limited eligibility– Tied to state budgets

II. No real health care systembased on population needs.

Most adults 21-65 excludedEligibility/means testingCapricious, low fundingLow reimbursementFew providers accept itCost shifting

Covers only workersEmployer’s discretionExcludes or penalizes sickestComplex administrationCostlyUninusuranceOpen ended expensesAnswers to investors

No way to rationally allocate resources, plan or budget

“I don’t believe there’s any problem in this country, no matter how tough it is, that Americans, when they roll up their sleeves, can’t completely ignore.”

George Carlin

HEALTH REFORM:HEALTH REFORM: PPACAPPACA

President 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 The Best Democracy Money Can Buy?Can Buy?

$ Health industry spending - $280 million on lobbying first half of 20091

$ 13 health lobbyists per member of Congress2

1The Center for Responsive Politics 2American League of Lobbyists

Senate framework written by Liz Fowler

Pharma spent $100,000,000

supporting reform

Former VP of Public Policy for WellPoint/Anthem

HEALTH INSURANCE REFORM - HEALTH INSURANCE REFORM - PPACAPPACA

Moves forward… Standing still…

Mandates coverage of check-ups and other preventive services

Reduces or eliminates co-pays and deductibles, but only on preventive services

Children can remain on parent’s policy until age 26 – not based on IRS definition of dependent

Chronic Disease Management

Payment Reforms (e.g., medical homes)

Primary care/quality pilots

Expanded coverage, but not universal

No bulk purchasing of Rx Cost control by market

means No definition of standard

benefits package Choice thru State-based

exchanges, but no public option

Funding: Excise tax on “Cadillac” plans, Medicare cutbacks and revenue from reduced fraud and abuse

Health Reform Bill:Health Reform Bill:Proven Cost Control ProvisionsProven Cost Control Provisions

Global budgeting of hospitals

Capital investment planning

Emphasis on primary care; coordination of care; alternative ways of paying for care

Bulk purchasing of pharmaceuticals

Automatic enrollment Federal guarantee All residents of the

United States covered

CREATE A SUSTAINABLE, SECURE AND JUST CREATE A SUSTAINABLE, SECURE AND JUST “DOCTOR/PATIENT” HEALTH CARE SYSTEM“DOCTOR/PATIENT” HEALTH CARE SYSTEM WHICH WHICH

OFFERS OFFERS REALREAL TOOLS TO CONTAIN COSTS TOOLS TO CONTAIN COSTS

What Should We Have Done?

“Everybody in, nobody out”

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

WHAT’S INCLUDED IN A SUSTAINABLE, WHAT’S INCLUDED IN A SUSTAINABLE, SECURE AND JUST DOCTOR/PATIENT HEALTH SECURE AND JUST DOCTOR/PATIENT HEALTH CARE SYSTEMCARE SYSTEM

Comprehensive coverage- Preventive services- Hospital care- Physician services- Dental services- Mental health services- Medication expenses- Reproductive health services-Home Care/nursing home care“All medically necessary services”Any exclusions? How decided? Based on a clinical decision, not a financial one.

VermontVermont• Option 1 1A--Government-run Single Payer system with

comprehensive benefit package 1B—Government-run Single Payer system with

essential benefit package

• Option 2—Public Option

• Option 3 (Public-Private Single Payer) –

Essential benefit package, Independent board, third

party manages provider relations and claim adjudication/processing

Recommended Option 3, “Public Private Single Payer”

“Most likely to be acceptable to major stakeholders, will produce most savings, should rely on market when possible, minimize political interference, gain transparency and accountability”

Vermont’s Proposed Essential Benefit Vermont’s Proposed Essential Benefit PackagePackage

Principles: 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 care Financial 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 Frequently Noted ConcernsNoted Concerns

I have a good health plan I have a good health plan nownowwhy should I support why should I support this?this?How’s 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 yearsIf nothing is done, experts say that by 2014 health care rates for a family of 4 will cost $23,000 at an 8% inflation factor or $27,000 at a 10% inflation factorWho will be able to afford those premiums?

If nothing is done, will only the rich be able to afford health care?

ImmigrantsImmigrants

Immigration is a federal issue – we’re talking about health care

Undocumented workers come here to work, not to get health care

Undocumented workers fear deportation so they do not readily access health care unless it’s an emergency

Providing preventative care is less expensive than treating someone who is very ill

Only 6% of the uninsured population are immigrants. Immigrants are not the problem

Only $11 per household per year is spent on taxes to cover care to undocumented workers*California Immigrants Right Center

It’s about a public health risk and ultimatelyyou will decide through an initiative or

legislative representative

What about small business?What about small business?

California’s tax payers paid $32 million dollars in uncompensated care for Wal-Mart in 2005 – small businesses pay for Wal-Mart employees health care through taxes as those employees access public programs (i.e. Healthy Families). Is that fair?

Shared responsibility – Government, Employers and Individuals

Potential for reducing Worker’s Comp. costs by 50% or more as the bill calls on the commissioner to investigate the feasibility of incorporating the medical portion of workers compensation into the system.

THEY MUST BE PART OF THE SOLUTION AND ENGAGE IN THE DEBATE!

S703 and HR 1200S703 and HR 1200 The American Health Security Act of

2011 (the Act) provides every American with affordable and comprehensive health care services through the establishment of a national American Health Security Program (the Program) that requires each participating state to set up and administer a state single payer health program. The Program provides universal health care coverage for the comprehensive services required under the Act and incorporates Medicare, Medicaid, the Children's Health Insurance Program, the Federal Employees Health Benefits Program and TRICARE (the Department of Defense health care program), but maintains health care programs under the Veterans Affairs Administration. Private health insurance sold by for-profit companies could only exist to provide supplemental coverage.

The cornerstones of the Program will be:

◦ fixed, annual, and global budgets

◦ public accountability, measures of quality based on outcomes data designed by providers and patients

◦ a national data-collection system with uniform reporting by all providers,

◦ a progressive financing system.

• It will provide universal coverage, benefits emphasizing primary and preventive care, and free choice of providers.

• Inpatient services, long term care, a broad range of services for mental illness and substance abuse, and care coordination services will also be covered.

Do we bankrupt the insurance industry or do we bankrupt the

country?

““You Can’t Cross a Chasm in Small Steps”You Can’t Cross a Chasm in Small Steps” David Lloyd George, British Chancellor and Reformer , Prime Minister from 1916 to 1922.David Lloyd George, British Chancellor and Reformer , Prime Minister from 1916 to 1922.

What you can doWhat you can do Check out these websites:

◦ www.healthcare-now.org◦ www.pnhp.org◦ www.medicareforall.org◦ www.singlepayernow.net

Have your PDA chapter pass a resolution in support of SB 810 and a single payer initiative

Organize:

◦ A community town hall forum on health care

◦ A protest at a local insurance company building

Sign up as a member of Single Payer Now to get regular updates of actions

Schedule an informational meeting on single payer with any other groups/organizations you belong to

Volunteer to become a “health care activist”; get trained and help educate the public on single payer

Lobby your state legislator to support SB 810/initiative

Lobby your federal representative(s) to support:

◦ Senator Boxer and Feinstein – S703

◦ Congressional Representatives – HR 1200

Share your story about health care

Talk to everybody you know – tell them the need to fear the status quo, not change!