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HealthCare/Prescriptions for Californians: There Is a Train Wreck Ahead


HealthCare/Prescriptions for Californians: There Is a Train Wreck Ahead in fact, it s here! * Margie Metzler 916-921-5008 – PowerPoint PPT presentation

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Title: HealthCare/Prescriptions for Californians: There Is a Train Wreck Ahead

HealthCare/Prescriptions for Californians
There Is a Train Wreck Ahead in fact, its
  • 12/4/2013
  • 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
  • Of all the forms of inequality, injustice in
    health care is the most shocking and inhumane.
  • ? Martin Luther King, Jr.

Just the Facts, Maam!
  • Highest Cost of American Medical Care in the
  • 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)

Some people still say we have the best healthcare
in the world.
  • Dick Cheney does. He is in a single-payer
    healthcare plan provided by the Federal
  • Are you?
  • The government is not an alien force. It is us.

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 (the dreaded
    pre-existing condition!)

Without Health Care for All, we will not regain
our dignity as a nation.
History 1700 to 1840
  • Hospitals provide isolation and maintenance,
    cures happen at home.
  • Financed through (1) taxes (public hospitals)
    and (2) charity (private hospitals, often with
    religious sponsorship).
  • hospital is a substitute home for the indigent
    and mentally ill.
  • Anyone can practice "medicine."
  • Sickness is caused by moral turpitude or 
    imbalance with nature.
  • 1798 Congress established the National Marine
    Health Service (now the Public Health Service)
    financed by compulsory deductions of 20 cents a
    month from seamen's wages.

1840-1860 Industrialization and beginning of
Middle Class
  • People moved out of home and need hospitals.
    Maintenance self pay.
  • Cities have pest facilities for mentally ill
    and alms houses for the poor (forerunner of
    public hospitals)
  • No financing poor paid for with taxes or
    charity, or doctors socialized medicine Barter
  • Doctors form AMA in 1847.
  • Anyone can still practice medicine.

1860s - early 1900s
  • Hospital becomes place of Healing
  • Medicine becomes a Science (Crimean and Civil
  • Surgery and Nursing
  • Pasteurs germ theory
  • Laboratories for diagnosis, X-rays and
    anesthetics. Enhance role of hospitals.
  • Public Health Service est. in 1887 became
    National Institutes of Health.
  • In Germany, Bismarck provides safety net to
  • AMA role advances

  • Medicine becomes a profession with state
    licensing, self-regulation peer evaluation.
  • 1914 American Association for Labor Legislation
    (AALL), first national conference on social
    insurance free medical care, paid sick leave
    and small death benefit. Doctors and insurance
    companies kill it.
  • Some unions support, but Samuel Rompers, AFL,
    denounced as a menace to the rights, welfare,
    and liberty of American workers.
  • Insurance companies offer health insurance to
    kill future efforts.

  • Doctors incomes (and prestige) skyrocket
  • General Motors contract to insure 180,000

  • Depression need for unemployment insurance and
    old age benefits
  • Social Security Act passed. Many fought for
    health insurance but failed.
  • Hospitals create the first structured pooled
    financing mechanism Blue Cross. Blue Shield for
    surgery follows. Blue Cross offers private
    coverage for hospital care insurance companies
  • 1933 Federal Emergency Relief Administration
    limited medical, dental and nursing for indigent.
  • 1935 Works Project Administration to construct
    and improve hospitals

1930s Continued
  • Employers begin to provide health benefits
  • Group practices set up (early HMOs). Medical
    profession want to prohibit.
  • Commercial insurers compete with The Blues,
    which are non-profit.
  • 1939 Survivors benefits added to Social

  • 1942 WWII, wage and price controls are imposed
    on employers offer health benefits to compete.
  • 1945 Truman proposes universal healthcare
    system. Denounced by AMA, doctors, US Chamber of
    Commerce. Plan called a communist plot by a House
    subcommittee Southern politicians feared
    healthcare would lead to federal action against

  • 1954 IRS exempts employer-purchased health
  • 1956 CHAMPUS (govt financing of health services
    to military dependents in civilian facilities
  • National health care expenditures are 4.5 of GNP
  • Huge growth in medications beg. of organ
  • Employer coverage goes from 1 to 32 million

1960s Pressures for govt Ins. System fought
by org. medicine and insurers
  • Price of hosp. care doubles
  • People (esp. aged) cant afford healthcare or
    insurance (over 700 for-profits cherry pick young
    and healthy people and costs go up.)
  • 1960 Fed. Employees health benefits
  • In Europe, organized labor worked with
    politicians for HC for everyone. Not here!
  • Kennedy campaigns on HC issues

1965-70 Johnson Years
  • 3 separate bills Wilbur Mills combines into one
  • 1965 Medicare and Medicaid authorized. Signed in
    Independence MO with Truman present.
  • Civil Rights legislation
  • Doctors and hospitals overcharge and costs of
    Medicare and Medicaid spiral

1970s Limits
  • 1971 Sen. Edward Kennedy becomes chair of Senate
    Health Services Subcommittee and promotes
    National health insurance. Issues a report, The
    Health Care Crisis in America.
  • Pres. Nixon senses competition in 1972 election
    and releases his own health-care plan., the
    National Health Insurance Partnership Act, aimed
    to preserve the private insurance market while
    requiring employers to either cover workers or
    make payments into a government insurance fund.
    (Sound familiar?) Supported by many major US
  • Watergate happens both plans die.

1970s continued
  • Kennedy tries compromise national health
    insurance bill and pleases no one.
  • New president Gerald Ford urges lawmakers to
    approve a national health insurance bill. Goes
  • 1973-75 90 sep. bills introduced in 93rd Congress

Late 1970s and 80s
  • Carter wanted national program but focuses on
    reining n in costs In the previous 10 years, the
    consumer price index went up 79, while hospital
    costs went up 237 . Carter proposed caps on
    hospital charges, but hospitals and business
    lobbied fiercely against it.
  • Reagan elected on promise to limit government no
    one tries again until Clinton.
  • Managed care resurrected.

Clinton Will it work again?
"Harry and Louise," 1993 Never again!
So weve had all this time
  • And what have we got?
  • Millions uninsured
  • Millions underinsured
  • Millions dumped when they get sick
  • Millions getting MRSA and other conditions form
  • Millions refused because they have pre-existing
  • Millions hounded into bankruptcy by hospital debt
  • Millions forced to pay hospitals tens of
    thousands of dollars before they can even be seen

And hows that working for us?
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?
  • Health care for profit or for people?
  • Is our goal care or 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)
Percentage of GDP Spent on Health Care
Remember Part D?
  • Hows privatizing working for you?
  • Did it really work?
  • Whos happy now?
  • Can the mess be cleaned up?

Medicare Part D
  • Monthly Premium Varies
  • Annual Deductibles vary
  • Co-payments vary and change yearly
  • No coverage during donut hole
  • Still pay premiums, even though no coverage
  • Cant easily compare plans

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
Medication Errors Types
  • Institute of Safe Medication Practices Major
    Causes of Medication Errors
  • Critical patient and drug information is missing
  • Drug name, label, packaging problem
  • Lack of staff education
  • Patient education problem (Lack of patient
    consultation, non-compliance)

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
  • Did 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 preventive 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

Myths, Misinformation, and the Pursuit of Profit
  • America has the best health care system in the
    world. There is an ever-widening disparity
    between rich and poor, and esp. in HC. WE are 1
    in spending and technology. 37th overall, 54th in
    fairness (tied with Fiji).
  • Everybody has access to care through the
    emergency room. (Most expensive and inconvenient
    way possible.) Many dont go till its too late.
  • The free market is always the solution. Weve
    given it half a century. It isn't getting better.
    (Hows that working for you?)
  • Private is always better than public. Fraud
    Tenet paid 300 million in fines, HCA/Columbia
    paid 740 M. Blue Cross of Illinois paid 140.
    Government does lots of things best
  • Socialized military
  • Socialized schools
  • Socialized Airport security
  • Socialized Defense
  • Socialized Road construction
  • Socialized Police
  • Socialized Firefighters

More myths
  • Overhead private ins. companies pay as much as
    30 in overhead costs, such as advertising and
    administration. Medicare pays 2-3.
  • Medicare is going broke. Changes will always have
    to be made, as in any business. This is totally
    fraudulent. Every developed industrialized
    country assures coverage for everyone, and they
    spend much less than we do. The AMA and other
    organizations intentionally spread this
  • Americans will not accept health care rationing
    like they have in other countries. Rationing is a
    loaded, deceptive word that triggers gut
    reactions. We already have waiting times here.
    And in this country we ration on money, not need
    for care. Is this fair or rational?
  • Canadas health care system is terrible and
    failing. Not true. I usually ask them to name
    someone who is a normal Canadian who would prefer
    our system. Most other nations regard our
    healthcare system as barbaric. (My brother lives
    in Germany and became a citizen years ago
    precisely for health care.)

More myths 2
  • Drug prices are higher in the US because our
    pharmaceutical industry spend billions of dollars
    on research and development. Our drug companies
    have the highest profit margin, 19, of all US
    corporations, with average 5. They spend three
    times as much on marketing and admin. costs as on
    RD. (HHS report lied about this). They have
    manipulated patent law to keep cheaper generic
    products off the market given kickbacks to
    doctors who overcharge Medicare for drugs, price
    fixing, paying off various professionals
    including physicians, bribed legislators
    (Medicare Part D), and created phony grassroots
    groups like Citizens for a Better Medicare.
    (See Marcia Angell, editor of The New England
    Journal of Medicine.

More myths 3
  • We can get to Universal Coverage Through
    Incremental Changes. And how is that working for
  • We do have successful single payer models
    Medicare, Medicaid, Indian Health System, VA,
    SCHIP. They all work better than the private

You Cant Cross a Chasm in Small Steps David
Lloyd George
Why have incremental reforms proven so
ineffective in practice?
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
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

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

More features of SB 840
  • True universality no more cherry-picking.
  • Tax-based financing, like Medicare, in accordance
    with income, instead of premiums, deductibles,
    and co-pays. You already paid through taxes!
  • Full choice of providers.
  • Elimination of the odd link between employers and
    health insurance coverage.
  • Coverage for all necessary services inpatient
    and outpatient, ER, long-term care, mental
    health, dental, substance abuse care,
    prescriptions, eye care.

Even more features of SB 840
  • Preventive care
  • Practice of medicine based on scientific
  • Public accountability
  • Simplified administration
  • Reasonable and timely reimbursement for providers
  • Treatment of health as a public good instead of
    as a market commodity.

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

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!
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