HealthCare/Prescriptions for Californians: There Is a Train Wreck Ahead – in fact, it’s here!

1. HealthCare/Prescriptions for Californians: There Is a Train Wreck Ahead – in fact, it’s here! 11/10/2014 Margie Metzler 916-921-5008 margiemetz@hotmail.com Website: www.gpcal.org This program operates under a grant from the California Wellness Foundation

2. -- and how can we talk about it so people “get it?” What is the Healthcare Train Wreck?

3. Just the Facts, Ma’am! • 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://www.who.int/whosis/indicators/2007compendium/en/index.html) • Who gets medical care? (hint: rich, good insurance, children covered by SCHIP, Medicare recipients, Medicaid recipients)

4. Medical Issues • Who doesn’t 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 worse! • Other Prescription Drug Issues: Errors and Collusion

5. Why don’t they get health care? • Working poor • Those who work part-time jobs: temp, teachers, seasonal • Unemployed • People who are really sick

6. 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 people’s suffering • Pricing for care must not be a secret • We should not be herded to a “panel” of physicians because it’s good for insurance company executives

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

8. Per Capita Spending on Health Care – 2004(How Does GM Compete In A Global Market?) $7,000 $6,102 $6,000 $5,000 $4,077 $3,966 $4,000 $3,159 $3,165 $3,041 $2,825 $3,000 $2,546 $2,249 $2,000 $1,000 $0 U.S. U.K. Switz Japan Nether Canada Norway Sweden Germany S Source: Organization for Economic Co-Operation and Development (OECD) Health Data 2006 (in U.S. dollars adjusted for purchasing power parity)

9. Health care costs, vs. earnings and overall inflation Percent 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).

10. Remember Part D? • Did it really work? • Who’s happy now? • Can the mess be cleaned up?

11. 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

12. 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): $8,523,139 • Edward Harnway, Cigna, $12,373,300 • Insurance Company profits increased 234% from 2000 to 2004 Modern Healthcare: April and July Issues 2006

13. Other Issues • No negotiating for best prices like VA and Medicaid • States can’t regulate insurance plans • Late Enrollment Penalty: 1% penalty per month and the penalty lasts forever • Some retirees lost their creditable coverage for good • Originally, insurance companies could change prices, formularies, co-pays, deductibles at will, but not you!

14. Solutions • It’s 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) • Don’t vote for anyone who is not part of the solution!

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

16. 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

17. 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)

18. What is to be done? “I don’t believe there’s any problem in this country, no matter how tough it is,that Americans, when they roll up their sleeves, can’t completely ignore.” George Carlin

19. 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 When did other countries get guaranteed, accessible healthcare systems?

20. Doctors Hospitals Providers Businesses Voters need to provide politicians a safe haven so they can do the right thing What will it take to win? Everybody in one risk pool! YOU and your family and friends!

21. 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)

22. Core Beliefs • Core value – pursuit of American Dream, our country’s destiny, family’s well-being and future. • 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 don’t want to pay for “undeserving”. • Voters want an “American” solution. Skeptical of “government run,” but role as a watchdog.

23. Barriers • 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

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

25. 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 scale Not Wellness But Prevention Not Inexpensive But Smart investments; investing in the future Not Competition But Choice

26. When we pass Clean Air Legislation, build roads, or open new schools it’s for everyone in our community Immigration is a federal issue Covering undocumented workers actually improves California’s rates Public Health Risk Providing preventative care is less expensive than treating someone who is very ill Only 6% of the uninsured population are immigrants 85% of the uninsured are people who don’t get health coverage from their employer Only $11 per household per year is spent on taxes to cover care to undocumented workers Dealing with Barriers:Immigrants

27. 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

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

29. California’s tax payers paid $32 million dollars in uncompensated care for Wal-Mart in 2005 Shared responsibility – Government, Employers and Individuals Should a small business have to pay what McDonalds or Wal-Mart pays? Senator Kuehl wants small business at the table Small businesses? It’s American for everyone to pay their fair share

30. Mr. Starbucks • Howard Schultz (Mr. Starbucks) • Every American should have healthcare • No one should have to pay more than 10% of their income • Business should be insulated from excess health inflation to remain competitive

31. 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 What does single payer save schools? Assumptions Use payroll tax rates suggested by the Lewin Report, 8.17% for employers, 3.78% for employers, for a combined 11.95%

32. 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

33. Will it work again? "Harry and Louise," 1993 Never again!

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

35. “You Can’t Cross a Chasm in Small Steps” – David Lloyd George

36. 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?

37. Gray Panthers Still Supports California’s SB 840, Single-Payer Healthcare! • Security ChoiceComprehensive Benefits hospital, medical, surgical, mental health; dental and vision care; prescription drugs and medical equipments, diagnostic testing, hospice care and more. • High Quality • Efficient Administration • Shared Responsibility • Fair Reimbursement & Cost Controls

38. Maggie Kuehn’s vision • Maggie supported single-payer in 1970… • and Gray Panthers have never wavered since!

39. Senators http://www.senate.gov/ Boxer, Barbara- (D - CA) 112 Hart Senate Office Building, Washington 20510 (202) 224-3553 Web form: www.boxer.senate.gov/email.html Feinstein, Dianne- (D - CA) 331 Hart Senate Office Building, Washington DC 20510 (202) 224-3841 Web Form: www.feinstein.senate.gov/email.html Federal Congress people Representative Find your Congressperson: http://www.house.gov/Welcome.shtml

40. 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 www.calmedicare.org • National Committee to Preserve Social Security and Medicare: http://www.ncpssm.org/medicare/ (a national, nonprofit organization) • Social Security: 1-800-772-1213 or go to www.ssa.gov • Center for Medicare and Medicaid Services (CMS):Call 1-800-MEDICARE or go to www.medicare.gov • Low income subsidy: go towww.ssa.gov/prescriptionhelpor call 1-800-772-1213

41. 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. “

42. …Only fear can stop us!