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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.

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Presentation on theme: "A Fireside Chat About Healthcare Rose Roach Chair, Health Care Committee, CDP Progressive Caucus Field Director, CSEA PDA, Health Care Issues Organizing."— Presentation transcript:

1 A Fireside Chat About Healthcare Rose Roach Chair, Health Care Committee, CDP Progressive Caucus Field Director, CSEA PDA, Health Care Issues Organizing Team

2 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 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.

3 Do We Have a Health Care Crisis? Yes! Why Do We Have a Health Care Crisis? 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

4 Healthcare Impacts Everything 123 dead every day 2,739 bankrupt Incalculable toll of suffering Our most vulnerable communities (no health planning) Bankrupting our state and nation

5 No cost control is eating up our public education budget

6 Insurance Premiums Workers’ Earnings Inflation 1999-2008 Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 2000-2008. Bureau of Labor Statistics, Consumer Price Index

7 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

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

9 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?

10 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, 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

11 Cost Increases: The 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!!!

12 Elderly as Percent of Total Population

13 MRI Units per Million People OECD, 2004 (2002 Data, U.S., Canada, and Germany are 2001)

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

15 Why spend so much AND get so little? 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 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


17 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 Secrecy” “There 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

18 Hospital Inpatient Days per Capita Rationing?

19 Physician Visits per Capita

20 Root Causes of the Health Care Crisis I. Dysfunctional health insurance Private 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 system based on population needs. Most adults 21-65 excluded Eligibility/means testing Capricious, low funding Low reimbursement Few providers accept it Cost shifting Covers only workers Employer’s discretion Excludes or penalizes sickest Complex administration Costly Uninusurance Open ended expenses Answers to investors No way to rationally allocate resources, plan or budget

21 “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

22 HEALTH REFORM: PPACA President Obama did not want to “start from scratch” He had two fundamental choices: 1) to build on the public sector (Medicare) or 2) to build on the private sector He chose to try to reach universal coverage by expanding private insurance

23 The Best Democracy Money Can Buy? The Best Democracy Money Can Buy? $ Health industry spending - $280 million on lobbying first half of 2009 1 $ 13 health lobbyists per member of Congress 2 1 The Center for Responsive Politics 2 American League of Lobbyists Senate framework written by Liz Fowler Pharma spent $100,000,000 supporting reform Former VP of Public Policy for WellPoint/Anthem

24 HEALTH INSURANCE REFORM - PPACA 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

25 Health Reform Bill: Proven Cost Control Provisions

26 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 “DOCTOR/PATIENT” HEALTH CARE SYSTEM WHICH OFFERS REAL 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 Deductibles Public funding - Payroll tax - Corporate taxes - Income taxes No premiums: regressive No increase in overall health care spending, because of administrative savings Reducing defensive medicine

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

28 Vermont 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”

29 Vermont’s Proposed Essential Benefit Package 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.

30 Frequently Noted Concerns

31 I have a good health plan now why should I support 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 years If 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 factor Who will be able to afford those premiums? If nothing is done, will only the rich be able to afford health care?

32 Immigrants 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 ultimately you will decide through an initiative or legislative representative

33 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!

34 S703 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.

35 Do we bankrupt the insurance industry or do we bankrupt the country?

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

37 What you can do Check out these websites: ◦ ◦ ◦ ◦ 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!


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