May 16 Town Hall Summaries

Winning Health Care for All

May 16, 2009, Town Hall, Seattle, Washington

Here are the program and a summary of presentations made at the Town Hall event.

PROGRAM

Introduction
Rev. Bev Spears Legislative Director, Washington CAN

Health Care for All: If Not Now, When?
The Honorable Jim McDermott
U.S. Representative, 7^th District

A Health Care Conversation

Rev. Bev Spears

The Honorable Jim McDermott

Q&A Session (audience is welcome to submit written questions)

Rachel Berkson

Chair, State Council SEIU

Panel Discussion, Rev. Bev Spears, Moderator

The Honorable Jim McDermott

David McLanahan, M.D.

Physicians for a National Health Program

Teresita Batayola

CEO, International Community Health Services

And here is a photo montage.

http://www.youtube.com/watch?v=OOOdDFEMXlA

A. The Honorable Jim McDermmot, US House of Representatives

There are 50 million people without health coverage. In addition to these, 25 million more are underinsured—they have insurance but it is so inadequate that they would almost be better off without it.

We say that we have the best health care in the world, but the U.S. is 37^th in the world in health outcomes such as infant mortality, longevity, etc. In 2005 we spent $6600 per person for health care. For half that, Canada covers everyone, and Canada is not alone.

The percentage of health care offered by employers has fallen 9%. Between 2000 and 2005, the number of Americans with health insurance has fallen by 1%, but employment with health insurers has gone up 32%.

Recently health insurers claimed that they would agree to save $2 trillion, but are now trying to backpedal from this representation. We can’t count on the insurers; they know they have to come to the table because something is going to happen.

The last time health care reform was tried was in 1993. The insurance industry ran the Harry & Louise ads, making the public afraid. But today even the insurers are calling for reform. Rep. McDermott is guardedly optimistic.

The best health care system in the world is in France. The French spend 50% of what the US does. There is 1 physician for every 430 persons in France; in comparison, in the U.S., there is 1 physician for every 1230 persons.

As people live longer, there are a lot more chronic illnesses. The right people to manage chronic illnesses are primary care physicians. We can’t increase the number of primary care physicians until we alleviate the problem of the crushing cost of going to medical school. Doctors drive debt in the system. They’re the ones who make the decisions. Because of the debt they incur in medical school, they gravitate toward specialty practices to pay off the debt. Medicine has become a profession where people think of dollars all the time.

Representative McDermott has submitted a bill that would make medical school tuition free. Forty-five thousand enter medical school annually. They would get free tuition in return for 4 years of public service in the medical field. Assuming President Obama is reelected, during the remaining 7 years of his administration, there would be 315,000 new primary care physicians. That would change the profession drastically.

Advocates of the single payer system would like to get reform in just one step. Obama, however, saw what happened to Hillary Clinton when she tried that. Obama has thus adopted the two-step approach: the President has told us that if you have insurance and you like it, you can keep it, and we’ll do something for everyone else.

The something else is the public option. What are we going to get with the public option?

Five hundred thousand families each month are losing health insurance because of unemployment caused by the bad economy. So when we talk about the public option, we’re not talking about “them”, we’re talking about “us.”

What’s going to go into the public option? Insurance companies want to put everyone in the public option who is sick or who would cause problems. They want to make the public option a dumping ground.

Reimbursement levels are an issue. Currently, we don’t pay doctors to talk with the patients. Doctors are instead paid for tests and procedures. We have to rethink how doctors are paid to change this system.

The father of modern medicine said, “Listen to the patient—he will tell you what’s wrong”, but that is not what is happening.

To get reform, we need to keep the pressure on. Pay attention to what’s going on. Let your representatives know what you think. Before this, business, the medical profession, and even some unions weren’t interested in changing the health care system. Now they are. But to get it done, we need to keep the pressure on.

You do your part, and I’ll do mine.

B. Dialogue Between Rep. McDermott and Rev. Bev Spears, Moderator

Q. You’ve met with President Obama?

A. The Progressive Caucus met with him. Two or three made presentations to the President about the need for a strong public option, one designed for everyone. The President said he wants a public option. He has a lot of political capital and will need to spend some of it to get things changed. The insurance and pharmaceutical companies do not want change.

Q. The House version has a public option, the Senate seems more tenuous.

A. It’s not going to be easy. It will be a tough job bringing people together. Leadership says there will be a bill by 6/1, and that it will be on the floor by July. But congressional committees get caught up with infighting. We need to keep people focused. We know something has to happen. The factors are present that will make people drive to a compromise.

Q. The public option as a bridge. Is that because single payer isn’t going to happen?

A. Once the president told people with health insurance that they didn’t have to change, that cemented the insurance industry into whatever happens.

The single payer system is not complicated. Single source—everyone gets coverage. But once the insurers are in it, costs go up. There are many insurers, which means many different forms and procedures—it’s a reason why we pay more. If there is a good public option, that will wither away.

When FDR came to power, unemployment was at 25%. But it still took him 2 years to enact unemployment compensation. So the current timetable may be too ambitious, but we need to keep pushing and eventually we’ll get there.

Q. The budget crisis in the State. You got the Basic Health Plan enacted and now 40,000 have to be cut from that program.

A. Washington State has tried as hard as anyone. I did, Phil Talmadge did, Mike Lowery did. The health care system in Canada began in British Columbia and Saskatchewan. Once it was established there, it spread until the entire country had it 20 years later. But in our country, one problem with starting on a state-by-state basis is ERISA. That federal law says that multistate companies can’t be forced to do anything by individual states. We could do a public option at the state level if we were willing to do something about ERISA, but that would be very difficult.

Q. It seems that minorities have more health care barriers.

A. It’s the right of all Americans to be covered and that has to be there from the start. Some countries have the right to health care in their Constitutions. We need to spend more dollars on preventative care, which would cut down later on more costly problems. We could use alternatives to MD’s, such as nurse practitioners, physician assistants, etc. We need more primary care level practitioners of various types to deal with the volume.

Q. What about immigrants, including people without papers?

How can you run a hospital and refuse somebody?? In Germany, you’d be in. And children, how can you refuse children? It would be un-American.

If you have something you want to change, put your foot in the door, then your knee, then your leg, and pretty soon you’re in the door.

We won’t get everything we want, but life isn’t that way. You only get out of the political process what you push your representatives to do.

I recommend a book entitled, “Do Not Resuscitate” by John Geyman.

C. Question/Answer Session (audience questions)

Q. What about alternative health providers?

A. We need to change the way we pay people to emphasize the preventive aspects. Fifteen minutes and a few pills could prevent $15-$20,000 episodes. The emphasis has to be on primary care.

Q. How committed is the President to universal care and how come he is not pushing single payer?

A. He wants to be sure we get this thing going and not get undermined. He had to tell people, if you like what you have, you can keep it. The President decided not to take on everything all at once, but in pieces. It’s like you can’t eat the whole elephant all at once. You have to go bite by bite.

Q. Medicare and Medicaid are limited. Will the public option also be? And what about dental?

A. To have a real public option, you have to have generous benefits the private options have—about 20% more than Medicare. That’s why Medicare recipients have to buy Medigap policies.

Even if you have insurance that pays 80%, what if you have a $500,000 bill, which is hardly unusual. You’d still be stuck with a $100,000 bill you’d have to pay out of your own pocket.

The public option has to cap out of pocket expenses. And if there’s no dental care, that can lead to medical problems. The public option needs to provide at least a basic dental plan. What Congress has, by the way, is not as good as some of the private plans.

Q. What are the differences between your bill and the Congress’s bill?

A. The Congressional bill puts everyone into Medicare. My bill requires each State to have the same benefit package, but gives each state the funds to create their own delivery plans. For example, Washington State has Group Health, but not everyone does, so each state has to figure out how to deliver the services.

Q. What about funding?

A. Financing is always the question. In 1993 we spent $950 billion on health care. A suggestion was made for a 10% payroll tax. Most businesses were spending 12-13% for their health care plans. Only Chrysler was interested in the 10%. Now businesses are paying 16% and realize that that will continue to increase.

We need some sort of tax according to ability to pay, for example, like the Social Security tax. The system is going to cost money. It will not be for free. Right now, the employer pays and gets a tax writeoff. The employee gets benefits and also gets a tax benefit.

It’s better to have the pubic decide how to finance the plan, rather than have the insurers, who will run up the premiums.

D. Rachel Berkson, SEIU

There will be a May 30 march, which will be part of a national network of demonstrations in April and May, culminating in Washington, D.C. on June 25. Go to http://www.may30march.org/. We must achieve health care reform in 2009. There are 150 organizations sponsoring the march. Five thousand are expected at the minimum, but we need more to make sure the politicians hear us. Each person should bring 10 persons. It begins at Pratt Park and goes to Westlake Center. There will be big name speakers.

E. Panel Discussion

Teresita Batayola, CEO, International Community Health Services

We’re in a fight for survival. It has been a crisis for many decades. Community health services have existed for 30 years and funding has been extremely limited at times, but especially now. Reform has to take place now because they’re in survival mode for the next 2-3 years.

Forty thousand will lose coverage under the Basic Health Plan. These are the working poor. Under the Basic Health Plan, they pay premiums and copays; it isn’t a give away. And Basic Health, like Medicare and Medicaid, isn’t perfect. These coverages are all limited.

Expect 900,000 to be uninsured by the end of this year.

Access for all is the first and foremost principle. Also we are interested in comprehensive and preventative care. Access for all to the ER is not enough. Any solution should include community-based care that includes a healthy environment, etc.

Quality of care is also important. And we need cultural and linguistic competence.

Recently the State cut $1 billion from health care. Community health centers are consequently seeing a massive increase in patients. They cannot be turned away, but where will we get the resources?

Private insurers are not interested in the most vulnerable, who can’t afford it anyway.

David McLanahan, M.D., Physicians for a National Health Program

Single payer activists—the Baucus 16—were arrested at the Senate Finance Committee. A majority of Americans support single payer, but the powerful have a chokehold on politicians. To change this, we need campaign financing reform.

The change we need must come to Washington, not from Washington. The President has punted to Congress.

Still, we have taken a significant step forward for single payer. The Baucus committee protest has engendered much publicity and now Ed Schulz of MSNBC is promoting it.

The medical industrial complex says it will voluntarily reduce costs, but where are the changes in their business practices to offer to the sick, not just to the well? There are no specifics, or enforcement, or accountability. Is this a smoke screen behind which Congress can hide? Is it the death knell to the public option?

After Watergate, Congress reformed presidential campaign finance, but not congressional campaign finance. Kerry and Obama didn’t even take public money. Only the people can get campaign financing done. Congress won’t do it. It will have to be done locally, by initiative.

F. Questions from the audience:

Q. How should the state and the federal governments work together on health care reform?

A. Senate Bill calls for implementation by 2013. You have to keep the heat on Congress. You need to make full use of the Internet to keep the pressure on. The demise of newspapers is a real problem. We need investigative reporting. And it has to be beyond just the state level. California keeps trying, but hasn’t made it yet. Community organizations around the country have to band together to keep pushing.

Both Washington senators, Murray and Cantwell, head key committees for health care reform. The Governor needs to work with them. But each person must learn what’s going on and contact their congress/senate representatives.

The original goal was 2012, now it’s 2014. In the last two years, single payer bills have been introduced, but now we have the budget crisis, and although still on the table, they’ve been sidelined.

We’re in a situation where it’s “pay me now, or pay me later.” There has to be a federal income tax increase on the wealthiest. Making medical school free is an investment. We can nvest in highways, but not in people.