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HealthCarePrescriptions for Californians: There Is a Train Wreck Ahead in fact, its here


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Title: HealthCarePrescriptions for Californians: There Is a Train Wreck Ahead in fact, its here

HealthCare/Prescriptions for Californians
There Is a Train Wreck Ahead in fact, its
  • 11/5/2009
  • Margie Metzler
  • 916-921-5008
  • Website

This program operates under a grant from the
California Wellness Foundation
What is the Healthcare Train Wreck?
  • -- and how can we talk about it so people get

Just the Facts, Maam!
  • High Cost of American Medical Care (vs. the rest
    of the world)
  • We are number 37 in the world for med. Outcomes
    (between Costa Rica/Slovenia) (http//
  • Who gets medical care? (hint rich, good
    insurance, children covered by SCHIP, Medicare
    recipients, Medicaid recipients)

Medical Issues
  • Who doesnt get medical care? (Underinsured and
    uninsured, plus people kicked out by insurers)
  • The Uninsured 47 Million and growing (7 million
    in California)
  • Medicare Part D is still a mess and getting
  • Other Prescription Drug Issues Errors and

Why dont they get health care?
  • Working poor
  • Those who work part-time jobs temp, teachers,
  • Unemployed
  • People who are really sick

Can we agree on a set of universal principles?
  • Every working parent must be able to take their
    kids to the doctor
  • Medical decision must be made by us and our
    doctors, not insurance company bean counters
  • No one should profit from peoples suffering
  • Pricing for care must not be a secret
  • We should not be herded to a panel of
    physicians because its good for insurance
    company executives

A philosophical divide
  • Guaranteed, affordable health care vs. forcing
    people to buy insurance

Per Capita Spending on Health Care 2004 (How
Does GM Compete In A Global Market?)
Source Organization for Economic Co-Operation
and Development (OECD) Health Data 2006 (in U.S.
dollars adjusted for purchasing power parity)
Health care costs, vs. earnings and overall
Source KFF/HRET Survey of Employer-Sponsored
Health Benefits 2005 Note Data on premium
increases reflect the cost of health insurance
premiums for a family of four. Historical
estimates of workers earnings have been updated
to reflect new industry classifications (NAICS).
Remember Part D?
  • Did it really work?
  • Whos happy now?
  • Can the mess be cleaned up?

Medicare Part D
  • Monthly Premium
  • Varies can be deducted from your SS check or
    paid directly to plan
  • Annual Deductible
  • Co-payments
  • No coverage during donut hole
  • Still pay premiums, even though no coverage

Part D Who Wins??
  • Average senior saved 9 per month
  • Jay Gellert, Health Net 11,639,834
  • William McQuire, United Health Group 10,697,442
  • Larry Glasscok, Wellpoint (Blue Cross)
  • Edward Harnway, Cigna, 12,373,300
  • Insurance Company profits increased 234 from
    2000 to 2004

Modern Healthcare April and July Issues 2006
Other Issues
  • No negotiating for best prices like VA and
  • States cant regulate insurance plans
  • Late Enrollment Penalty 1 penalty per month and
    the penalty lasts forever
  • Some retirees lost their creditable coverage for
  • Originally, insurance companies could change
    prices, formularies, co-pays, deductibles at
    will, but not you!

  • Its a legislative problem and will require a
    legislative solution
  • Opening up US prescription drug pricing to world
    competition and free trade (Prescription Drug
    Importation debate)
  • Dont vote for anyone who is not part of the

Medication Errors Types
  • Institute of Safe Medication Practices Major
    Causes of Medication Errors
  • Critical patient information is missing
  • Critical drug information is missing
  • Miscommunication of drug order
  • Drug name, label, packaging problem
  • Drug storage or delivery problem
  • Environmental, staffing, workflow (lighting,
    noise, workload, interruptions, etc.)
  • Lack of staff education
  • Patient education problem (Lack of patient
    consultation, non-compliance)
  • Lack of quality control or independent check
    systems in pharmacy
  • Physician knowledge is lacking

No More Vioxxes!
  • Register all clinical trials and make results
  • Regulation of industry marketing
  • JAMA standards
  • Litigation (PAL)
  • Best Buy Drugs (
  • Drug Effectiveness Review Project (DERP) Oregon
    Health Science University Evidence-Based
    Practice Center. Medication Errors Panel Report
    (CA State Cap.)

Rx Marketing to Doctors
  • Industry spends 12 B/year on drug marketing to
    MDs, or 13,000/doctor
  • There is 1 sales rep for every 5 MDs
  • Gifts, lunches, trips, educational grants,
    entertainment, free samples
  • Even small gifts create obligation and influence
    prescribing decisions
  • Free samples create loyalty to brand and
    unwillingness to use generics (30-80 lower cost)
  • Doctors are paid to promote expensive new drugs
    and off- label uses

The FDA and the Pharmaceutical Industry
  • US drug prices are the highest in the world and
    getting worse. We paid 81 more for brand drugs
    (average) than Switzerland, Britain, Germany,
    Canada, Sweden, France, and Italy.
  • FDA ties to Pharma (Tauzin)

What is to be done?
  • 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

When did other countries get guaranteed,
accessible healthcare systems?
  • Germany 1883
  • Switzerland 1911
  • New Zealand 1938
  • Belgium 1945
  • UK 1946
  • Sweden 1947
  • Greece 1961
  • Japan 1961
  • Canada 1966
  • Denmark 1973
  • Australia 1974
  • Italy 1978
  • Portugal 1979
  • Spain 1986
  • South Africa 1996
  • Thailand 2006

What will it take to win? Everybody in one risk
  • Doctors
  • Hospitals
  • Providers
  • Businesses
  • Voters need to provide politicians a safe haven
    so they can do the right thing

YOU and your family and friends!
Why AB8/SBX 1 1 wouldnt have worked
  • Does not actually require the employer to
    purchase health insurance
  • Provides for HSAs
  • No cost containment

How do we talk about Health care?
  • Iraq War, Economy, Healthcare. Combine them!
  • Voters are concerned will cost more
  • Voters are frightened and resent that insurance
    companies deny coverage
  • Voters support reform proposals in principle
    but are afraid they will lose what they have.
  • The concept of quality affordable health care
    is more appealing than universal coverage
  • Voters strongly support Medicare but believe it
    has problems. (Part D has hurt us)

Core Beliefs
  • Core value pursuit of American Dream, our
    countrys destiny, familys well-being and
  • Voters use moral terms no American should be
    denied health care.
  • Voters see it as a necessity. Market forces are
    not enough.
  • Voters believe everyone should have access to
    quality, affordable health care but dont want
    to pay for undeserving.
  • Voters want an American solution. Skeptical of
    government run, but role as a watchdog.

  • Cynicism about government
  • Concerns about government bureaucracy, red tape,
    high costs
  • Who pays for it?
  • Fear of higher costs, higher taxes
  • Scarcity voters worry about what they will lose
    in quality
  • Illegal immigrants and other undeserving people
  • Perceived impact on small businesses
  • The ability of powerful interests to block action

Dealing with Barriers
  • Incorporate personal responsibility
  • Include options and choices in proposals make
    sure its employee choice, not just employer
  • Use preventive care as a stepping stone
  • Find a uniquely American solution, including
  • Emphasize security and peace of mind Focus on
    support for small business
  • Define a role for government as watchdog and rule
  • Animate anger, not fear

Say what?
  • Not Universal coverage But Quality affordable
    health care
  • Not A system like Social Security Canadian Style
    Health Care But
    American health care
  • Not Medicare for All But a choice of
    public and private plans
  • Not Free But Sliding
  • Not Wellness But Prevention
  • Not Inexpensive But Smart
    investments investing in the
  • Not Competition But Choice

Dealing with Barriers Immigrants
  • When we pass Clean Air Legislation, build roads,
    or open new schools its for everyone in our
  • Immigration is a federal issue
  • Covering undocumented workers actually improves
    Californias rates
  • Public Health Risk
  • Providing preventative care is less expensive
    than treating someone who is very ill
  • Only 6 of the uninsured population are
  • 85 of the uninsured are people who dont get
    health coverage from their employer
  • Only 11 per household per year is spent on
    taxes to cover care to undocumented workers

The masses will move to California because we
have healthcare
  • SB 840 requires residency
  • California was the first state in our nation to
    pass Social Security
  • Will the masses move here from other states?
    (think about it!)

Tactics used to scare us
Doctors will leave
  • Earnings roughly twice as much as elsewhere
    incomes 6. 6 times greater than the average
  • 58 billion in excess income after loans are paid
  • 8 billion as investors in diagnostic labs and
    outpatient surgical clinics
  • Student loans
  • Doctors spend years in school
  • Important jobs
  • Anesthesiologists 425,000
  • Specialists 274,000
  • General Practitioners 173,000

Tactics to Scare Us!
Small businesses?
  • Californias tax payers paid 32 million dollars
    in uncompensated care for Wal-Mart in 2005
  • Shared responsibility Government, Employers and
  • Should a small business have to pay what
    McDonalds or Wal-Mart pays?
  • Senator Kuehl wants small business at the table

Its American for everyone to pay their fair share
Mr. Starbucks
  • Howard Schultz (Mr. Starbucks)
  • Every American should have healthcare
  • No one should have to pay more than 10 of their
  • Business should be insulated from excess health
    inflation to remain competitive

What does single payer save schools?
  • Eureka City Schools 1.5 to 2.6 million
  • Salinas UHSD -4 to 6.5 million
  • Stockton USD- 9.9 to 17 million
  • San Diego USD- 15 to 41 million
  • Elk Grove USD- 2 to 12 million
  • LAUSD- 127 to 279 million
  • Long Beach Combined Employer and Employee Savings
    of 22 million
  • Visalia USD- 8.7 to 12.8 million

Assumptions Use payroll tax rates suggested
by the Lewin Report, 8.17 for employers, 3.78
for employers, for a combined 11.95
What do we need from you?
  • Talk about this with your community
  • Get the stories of those who are struggling
    (human tragedy)
  • Fill out the cost calculation
  • Pass Resolutions
  • Recruit volunteers
  • Participate in Campaigns

Will it work again?
"Harry and Louise," 1993 Never again!
Why have incremental reforms proven so
ineffective in practice?
You Cant Cross a Chasm in Small Steps David
Lloyd George
Something to Ponder…
  • We have a publicly financed military to protect
  • We have publicly financed police and fire to keep
    us safe
  • We have publicly financed education to provide
    education to all children
  • Why dont we have publicly financed health care
    to provide health care to all?

Can We Do It?
Gray Panthers Still Supports Californias SB 840,
Single-Payer Healthcare!
  • Security Choice Comprehensive Benefits hospital,
    medical, surgical, mental health dental and
    vision care prescription drugs and medical
    equipments, diagnostic testing, hospice care and
  • High Quality
  • Efficient Administration
  • Shared Responsibility
  • Fair Reimbursement Cost Controls

Maggie Kuehns vision
  • Maggie supported single-payer in 1970…
  • and Gray Panthers have never wavered since!

Federal Congress people
Representative Find your Congressperson http//ww
  • Senators
  • http//
  • Boxer, Barbara- (D - CA) 112 Hart Senate Office
    Building, Washington 20510
  • (202) 224-3553
  • Web form
  • Feinstein, Dianne- (D - CA) 331 Hart Senate
    Office Building, Washington DC 20510
  • (202) 224-3841
  • Web Form

Where to Go For Help/Info
  • Health Insurance Counseling and Advocacy Program
    (HICAP) Call 1-800-434-0222 to reach your local
    HICAP or go to
  • National Committee to Preserve Social Security
    and Medicare http// (a
    national, nonprofit organization)
  • Social Security 1-800-772-1213 or go to
  • Center for Medicare and Medicaid Services (CMS)
    Call 1-800-MEDICARE or go to
  • Low income subsidy go to
    help or call 1-800-772-1213

Together, we can fix this mess!
  • Guaranteed affordable health insurance coverage
    for every American with a choice of private or
    public plans that cover all necessary medical
    services, paid for by payroll taxes on employers
    and individuals on a sliding scale.

…Only fear can stop us!