1. Healthcare for All – Washington
Washington Health Security Trust:
How to get to state-based
universal health care
[Show this slide while audience gets seated.]
[Introduce yourself briefly.]
We want to show in this 20-minute presentation that it is very possible to get to universal coverage for all residents in the state of Washington. Beginning in 2017, individual states are allowed to implement their own health coverage plans under the Affordable Care Act.

2. “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.”
in a 1966 speech to the Medical Committee for Human Rights
Many of us believe that health care is a human right and that it should be treated as a public good.

3. Does this make sense to you?
Public goods are services made available to all and paid for with public funds. These include fire, police, libraries, schools, freeways, and transit.

4. Paying much more while getting much less
U.S.
Health care spending per person
Premature death, ages 0-69
We in the United States spend more per person on health care than any other industrialized country, but our rates of preventable early death from illness and injury are higher than in most countries.
We pay nearly double what other countries pay for health care, but we don’t receive twice as much benefit. The next 3 slides will illustrate some of the major drivers of this cost/benefit disconnect.
[Potential years of life lost, all causes, per 100,000; OECD Health at a Glance 2013]
[OECD=Organisation for Economic Cooperation and Development]
U.S.
US Dollars
Potential years of life lost per 100K

5. The high cost of care in the U.S.
Costs for Selected Procedures, U.S. vs. France (2012 data from International Federation of Health Plans)
One of the biggest factors contributing to our higher costs is a lack of pricing transparency. Here’s how some of our health-care costs compare with the same items in France, which has one of the most effective health care systems in the world. Have you ever tried comparison shopping for an appendectomy?
Public Citizen, “Severing the Tie That Binds: Why a Publicly Funded, Universal Health Care System Would Be a Boon to U.S. Businesses” 5

6. The cost of deferred care
A 12-year-old boy had an abscessed tooth. His mother was unable to pay $80 to have it pulled. He developed a severe brain infection. After two surgeries and weeks of care costing $250,000, he died.
Cost of pulling an abscessed tooth
Cost of treating a brain infection
$80
$250,000
A second major reason for our higher costs is that when health care is treated as a commodity, people who can’t afford it will delay getting care. The difference between preventive care and catastrophic care comes out of your pockets in the form of taxes and insurance premiums.
“Toothache Leads to Boy's Death.” ABC News, March 5,

7. Private insurers’ high overhead
A third factor is high administrative overhead. This chart compares the cost of private insurance with publicly funded health coverage. Even HMOs, which provide the most cost-effective health-care delivery in the private sector, have much higher administrative costs than Medicare.
[Other calculations put Medicare overhead at closer to 3 or 4 percent.]

8. How the U.S. does it
Complex, bureaucratic intermediaries stand between you and your doctor.
Your family
Private insurers
On the left: Insurance companies now stand between you and your doctor – interfering with treatment and denying claims.
On the right: How many of you have ever seen what’s behind the door of the hospital billing department? All those employees are required to sift thru the hundreds of insurance plans offered just in Washington State to find out what hospitals can get in reimbursements. Insurance companies have an equal number trying to deny as many claims as possible.
Don’t let the insurance company come between you and your provider.
Your doctor 8

9. How other countries do it
Other countries regard health insurance as a public good.
They cover all residents.
They have fees supervised by the government.
They have no deductibles, though perhaps co-pays.
They have one universal benefit plan.
Supplemental insurance is allowed.
Returning to the idea of the public good, most industrialized countries have developed systems that:
[1] cover everyone,
[2 & 3] control costs,
[4] cover all medically necessary conditions, and
[5] allow for supplemental coverage.
Because it’s a public good, people don’t have to worry about their health care.

10. Useful features of the Affordable Care Act
Young adults eligible for parents’ insurance
No lifetime limits on coverage
Medicare “donut” hole eliminated over 10 years
Preventive care included at no charge
Price discrimination now limited only to age and tobacco usage
States allowed to innovate with better plans
Now, in the U.S., we have the Affordable Care Act, which offers some benefits::
[1] expanded coverage for young adults,
[2 & 3] no gaps or limits in coverage,
[4] free preventive care, and
[5] more equitable pricing.
[6] Most importantly, it allows states to develop their own plans that meet or exceed ACA’s coverage requirements and deal with its drawbacks.

11. Problems with the Affordable Care Act
25 million or more uninsured after 2017
Provider continuity not guaranteed
Age discrimination in pricing
Half of the States have chosen not to expand Medicaid
Erratic oversight due to regulation at the state level
Four levels of cost sharing based on premium (platinum, gold, silver, bronze)
The ACA
[1] will leave many people uninsured,
[2] offers no guarantee of continuity,
[3] charges older people up to 3 times as much as younger.
[4 & 5] Also, many states have opted out of offering even the partial benefits of the ACA.
[6] Finally, it offers inadequate benefits to those who can’t afford an expensive plan. The promise of choice is really an illusion of coverage.

12. We can do better! Universal coverage: Everybody in, nobody out
A single agency for health care financing
Publicly financed, but privately delivered
An improved ability to control costs
Continuity of care, regardless of employment status
Universal coverage means that
[1] everyone is covered.
[2] A single, [3] publicly financed agency will pay for all medically necessary treatments
[4] while implementing cost controls and
[5] ensuring continuous care.

13. Washington Health Security Trust
All Washington residents covered
Simple, easy to understand
Comprehensive health coverage (medical, vision, and mental health) with no deductibles or co-pays
Choice of any licensed provider
Lower cost - much lower administrative costs and negotiated prices
Purchase of supplementary benefits allowed
The Washington Health Security Trust will
[1] cover all Washington residents,
[2] be simple to understand,
[3] offer comprehensive coverage,
[4] eliminate provider networks,
[5] negotiate for lower prices, and
[6] allow residents to buy supplemental coverage if desired.
The WHST will end uninsurance in our state.
[Note: People who have federally protected coverage will be exempt from the WHST, at least in the beginning.]

14. How the WHST is to be financed
Joint Select Committee on Health Care Oversight will:
commission an actuarial study
devise a financing system to raise sufficient funds
Funding sources may include:
an employer assessment on ALL employers
an individual premium for all adult residents
new sources of revenue such as taxes on investment transactions
The WHST is a unified financing system.
[1] A legislative committee, the one that currently oversees the ACA exchange, will work out the details of how the WHST will be funded.
[2] Sources of funding are likely to include employer assessments, individual premiums, and new sources of revenue such as taxes on investment transactions.

15. Washington Health Security Trust: “What’s in it for me?”
Whether you’re insured, uninsured, retired, in school, or unemployed, the WHST will provide:
Lower-cost, high-quality care with choice of any licensed provider
Continuity of health coverage regardless of student or employment status
Possible Medigap coverage, supplementing Medicare
Relax! You’re covered.
The WHST offers Kids, Families, and Seniors HEALTH SECURITY that they can TRUST, regardless of age, family size, or employment.
[1] The WHST is affordable and sustainable.
[2] The WHST assures continuity.
[3] Seniors may be able to use the WHST for supplemental coverage. [Eventually it’s hoped that Medicare payments and benefits will be folded into the WHST.]
[4] Increased security about health and less fear of bankruptcy due to high medical costs.

16. Moving ahead – state by state
The Washington Health Security Trust (WHST) bill had a House hearing in 2013, when more than 100 people showed up in support of the bill, and also in We hope to have a hearing in the 2018 session.
In addition to Washington, activists in California, Oregon, New York, and many other states are working to implement universal coverage plans. They regularly share information and strategy as part of the group One Payer States.
The best alternative is for Congress to legislate one unified plan that covers everyone: an Improved Medicare for All.
But while we wait for Congress, Washington is one of 20 states working toward universal coverage.
You can follow the progress of bills in each state on our website, by checking our ‘Resources’ page.

17. What you can do…. (1) Talk to your state legislators in Olympia
Ask them to publicly support the Washington Health Security Trust, HB 1026 / SB 5701.
Use the comment link on the official bill website.
Tell them your personal story…in 60 seconds!
Talk to everyone you know about the WHST
Book a speaker for your group from Health Care For All-Washington
[1] Talk to all three of your state legislators. If the legislators say this isn’t the time because of budget deficits, tell them that one of the main reasons for the deficit is skyrocketing health care costs.
[2] Spread the word!
[3] Invite one of us to talk to your group.
[ ear=2015]

18. What you can do…. (2)
Join Health Care for All—Washington and be a part of our statewide network of supporters
Meet with us …
To practice “10 Best Talking Points”
To plan meetings with legislators
To rehearse our personal stories
[1] We are building a grass-roots network in all 49 legislative districts to advocate for the WHST.
[2] We’re also pursuing an educational campaign. We will need 1.5 million voters to defend the WHST if it is passed and then challenged at the ballot box.

19. Washington Health Security Trust
Don’t wait for Congress to act. Universal coverage is possible, state by state!
On our website you’ll find informational resources for each of the issues that we have talked about today – and more.
Are there any questions?
Rev. 9/17