National – HR 676/S 703 State – SB 810 Presented by Rose Roach

1. We Need a Single Payer, Doctor/Patient Health Care System to achieve “Health Care for All” National – HR 676/S 703 State – SB 810 Presented by Rose Roach

2. “Some people are very generous with other people’s suffering.” Senator Paul Wellstone

3. “The United States stands almost alone in the world in its failure to recognize health care as a human right. Instead we consider health care as an economic commodity. If you can afford it, you can get it. If not, you’re out of luck.” Robert H LeBow, M.D.

4. We need health care not insurance coverage • “Coverage” instead of “care” means that you might not get the type of care you need if it’s not “covered”. Basic care like maternity care, or diabetes care, or cancer treatment, may often be excluded from coverage. No one can know what they need until they need it. • “Coverage” instead of “care” means you are at risk of medical bankruptcy if you need more care than you are covered to receive. • “Coverage” instead of “care” means you can lose your coverage if you lose your job, or if your insurer drops you. • “Coverage” instead of “care” means you can’t choose your own doctors and hospitals because your coverage decides who you can see. • This concept of “coverage” forces us to waste 30% of our health care dollars on needless bureaucracy instead of simply providing the health care we need when we need it.

5. Some Significant Cost Drivers • Exorbitant increases in insurance company profits – over 400% between 2000 and 2007 • Wasteful administrative costs - $.31 of every health care dollar • Extraordinary compensation for industry CEO’s - Jay Gellert – Health Net, $11,639,834; William McQuire – United Health Group, $10,697,442; Larry Glasscok, Wellpoint (Blue Cross) $8,523,139; Edward Harnway, Cigna, $12,373,300 • Unexplained cost variations in hospital charges – chest x-ray at Doctor’s Memorial, Modesto = $1500; at San Francisco General approximately $200

6. Providers trying to get paid and payers trying to avoid paying

7. Lobbying“The aim of the lobbying blitz is simple: to minimize the damage to insurers, hospitals and other major sectors while maximizing the potential of up to 46 million uninsured Americans as new customers. Although many firms have vowed to help cut costs, major players such as PhRMA, America's Health Insurance Plans and others remain opposed to the public-insurance option, a key proposal that President Obama has endorsed.” • $126 million in the first quarter of 2009 • $1.4 million per day • 350 former government aides, each representing an average of four firms or trade groups • PhRMA led the pack in spending and employs 49 former government staff members among its 136 lobbyists • More than 50 former employees of the (Finance) committee or its members lobby on behalf of the health-care industry, records show. The Washington Post, July 6, 2009 - Familiar Players in Health Bill LobbyingBy Dan Eggen and Kimberly Kindy

8. Proposed by Richard Nixon in 1971 to block Edward Kennedy’s National Health Insurance proposal Government uses its coercive power to make people buy private insurance Employer Mandate Managed Care / Care Management Expanded Medicaid-like program Free for poor Subsidies for low income Buy-in without subsidy for others “Mandate” Model for Reform

9. Massachusetts 2006 “Every uninsured citizen in Massachusetts will soon have affordable health insurance and the costs of health care will be reduced. Gov. Romney.” “The bill does what health experts say no other state has been able to do: provide a mechanism for all of its citizens to obtain health insurance.” Sources: Wall Street Journal 4/11/06 and New York Times 4/5/06.

10. Massachusetts Health Reform New Coverage < Poverty - Medicaid HMO 100% - 300% poverty - Partial subsidy > 300% poverty – Buy Your Own • Average Annual Cost for Health Care Premium Single Person: $5,640 Family of 4: $14,900 (27% of income for family of 3 at 300% FPL)Costs higher based on # kids, age, health, pre-existing condition, etc.

11. Crimes and Punishments in Massachusetts

12. Massachusetts 1988 “I am very proud of the fact that Massachusetts will be the first state in the country to enact universal health insurance.” Gov. Dukakis` “Massachusetts last week ventured where no state has gone before: it guaranteed health insurance for every resident.” Sources: New York Times 4/14/88 and 4/26/88

14. Oregon 1992 “Today our dreams of providing effective and affordable health care to all Oregonians has come true.” Gov. Roberts “The most far-reaching health care reform in the nation.” Sources:Washington Post 6/9/92 and 3/20/`93

16. Tennessee 1992 “The most radical health care plan in America.” “Tennessee will cover at least 95% of its citizens with health insurance by the end of 1994.” Gov. Ned McWherter Sources: Federal & State Insurance Week 4/12/93; and NY Times 9/16/94

18. Vermont 1992 “This is an incredibly exciting moment that should make all Vermonters proud.” Gov. Dean “Governor Howard Dean, the only governor who is a doctor, signed a law here today that sets in motion a plan to give Vermont universal healthcare by 1995.” Source: New York Times 4/12/92

20. Minnesota 1992/1993 “Minnesota is enacting a program that will be the most sweeping effort yet to provide health insurance to people who lack it . . . the first complete reform proposal in the U.S.” “Minnesota is about to embark on a plan to solve the health-insurance crisis that could hold lessons for other states and the nation.” Sources: New York Times 4/19/92; and Richard Reece, Medical World News 7/1/92.

22. Washington 1993 Washington state “passed one of the most aggressive health care experiments in the nation, a program that would extend medical benefits to all 5.1 million residents of the state . . . .” Source: New York Times 5/2/93

24. Maine 2003 “It’s bold and comprehensive, and it’s now the law of the state.” Gov. Baldacci “Maine has just become the first state in the union to approve a plan to provide universal access to affordable health insurance.” Sources: AP Newswire 4/25/06 and Ellen Goodman, Washington Post Writers Group 7/7/03.

26. “First you start with the most desirable, I thought to myself, and it is only later on that you work out what is politically feasible. I refused to admit defeat before we had even begun to fight…”“The Conscience of a Liberal” Paul Wellstone Senator Wellstone On Health Care Reform

27. Senator Baucus’ proposal: • Reprises the key elements of schemes that have failed again and again in states across the nation. • Can only add coverage by adding costs. • Expands the role of wasteful private insurers • Does nothing for the tens of millions who are under-insured • Foregoes the $400 billion in annual administrative savings that could be achieved under single payer. Baucus’ approach – even if passed - would quickly flounder as costs continue to rise at unsustainable rates. • Still says taxation of health care benefits is “on the table”

28. Why have incremental reforms proven so ineffective in practice?

29. Single Payer Health Care System aka a true Doctor/Patient Health Care System How Do We Get It HR 676 SB 810

30. Time Line and Work to Do to Achieve Single Payer in CA • 2009 – insist that federal legislation DOES NOT ban states from implementing a single payer system; allows for federal waivers on ERISA, Medicare and Medicaid funding • 2010 – elect a 2/3 majority in the legislature; elect a Governor who will sign SB 810 • 2011 – pass SB 810; Governor signs it into law • 2012 – November ballot initiative to fund the single payer system; potentially fight against a ballot initiative to repeal SB 810 • 2013 and 2014 – two year transition period as outlined in SB 810 needed for transition from our current system to the new single payer system • 2015 – A FULLY FUNCTIONING AND IMPLEMENTED SINGLE PAYER HEALTH CARE SYSTEM IN CA – EVERYBODY IN, NOBODY OUT!

31. Financing Single Payer Health Care Medicare Single payer health care fund $$$$$$$$$$ Rx Eye Care Medicaid Employer payroll tax Doctor Employee payroll tax Hospital Lewin 2004

32. Think about Single Payer as an Investment Model for Health Care • Assumes healthcare is a public good and invests in the needed services for the whole population • Pays for people who are sick now • Pools money and pays for health care directly • Efficient allocation of health care dollars (gets rid of fragmentation and administrative waste) • Not Socialized Medicine - Just a “re-allocation” of dollars (Medicare is a similar system)

33. Something to Ponder…….. • We have a publicly financed military to protect us • We have publicly financed police and fire to keep us safe • We have publicly financed education to provide education to all children • Why don’t we have publicly financed health care to provide health care to all? Can We Do It?

35. “The history of great social achievement is rife with instances in which the forces of institutionalized power told social movements - as they now tell this one - that what they wanted was too much, or too fast, or too soon. I think, of course, of the abolition of human slavery, the enfranchisement of women, the Civil Rights Movement, Social Security, the minimum wage, an end to child labor. In each of these instances, social movements held fast to their principles and soon discovered that what they had been told was “politically unfeasible” one moment was political reality the next.”Nicholas Skala is a former senior research associate Physicians for a National Health Program. He is currently a Juris Doctor candidate and Harry L. Kinser Scholar for Health Law at Northwestern University School of Law.

36. What you can do • Check out these websites: • www.healthcare-now.org • www.pnhp.org • www.medicareforall.org • Contact Senators Boxer and Feinstein and your Congress Member and tell them: We need real health reform now! Please support [any or all of these]: •  A single payer system for everyone •  An amendment to protect states rights to establish a single payer system that includes waivers for ERISA, Medicare, Medicaid and SCHIP funding •  Add To Quad Caucus members: Thank you for standing with the Quad Caucuses on health reform! • Add To Blue Dogs and New Dems: Stand with your constituents, and urge the Blue Dogs/New Democrats to do the same. • Add To some of both or neither: Stand with your constituents and the Quad Caucuses. • - and tell them why you care!