** * #328 1. LA Times 11/3/02 Measure 23 article From: mark lindgren ________________________________________________________________________ ________________________________________________________________________ Message: 1 Date: Mon, 04 Nov 2002 10:13:15 -0800 From: mark lindgren Subject: LA Times 11/3/02 Measure 23 article ELECTION 2002 Surprise Contender in Oregon: Health Care for All Full-coverage measure faced long odds because of tax increase but also taps deep frustration. By Peter Y. Hong Times Staff Writer November 3 2002 EUGENE, Ore. -- On a crisp fall morning, Dan Isaacson and Britt McEachern walk door to door in a neighborhood of tidy bungalows, eagerly selling their health insurance plan. They promise a health care paradise: no deductibles or co-payments, free prescription drugs, choice of any doctor, free mental health care, dental, vision and long-term care. "This is not an HMO," they tell anyone who will listen. "The only one who will say you can or can't have a procedure is your doctor." The catch? Oregonians would pay for that care through new income and payroll taxes. And the state would manage all medical coverage. Isaacson, 22, and McEachern, 23, are managing a ballot initiative campaign to make Oregon the first state to guarantee medical coverage for everyone. Oregonians -- who already are voting by mail -- will decide by Tuesday whether to adopt Measure 23. Because it calls for new taxes, Measure 23 faces long odds. But with roughly 13% of Oregon residents without health insurance (close to the national uninsured rate of 14.6%), frustration over health care runs deep in the state. A recent newspaper poll found the health plan trailing by just 3 percentage points, within the poll's margin of error. The plan's sponsors, a grass-roots group calling itself Health Care for All Oregon, achieved that statistical dead heat despite being outspent 20 to 1 by the opposition, which is funded mostly by insurance companies. Health Care for All Oregon was created by a handful of volunteers, including retirees, physicians and community activists. With a campaign headquartered in Isaacson's 10-year-old Dodge Spirit and 3,000 volunteers, the plan's backers have stunned their opponents, who thought the measure would never get enough signatures to make it onto the ballot. If the measure passes, Oregon will accomplish what the Clinton administration failed to achieve nationally when its health-care reform plan -- spearheaded by Hillary Rodham Clinton -- was shot down in 1994. Under Measure 23, private medical insurance in Oregon would disappear. The state would pay medical bills, which are expected to total about $20 billion in 2005, when the program would begin. Oregon's state budget is $16 billion. To finance the program, individuals would pay up to an additional 8% in income taxes, capped at $25,000. People with income at or below 150% of federal poverty guidelines would be exempt. Employers would face a new payroll tax from 3% to 11.5%. Backers of Measure 23 contend that the new taxes would be largely offset by eliminating insurance premiums, deductibles, co-payments and out of pocket drug costs. Opponents say the mere specter of tax increases will be enough to defeat the measure. Even liberals routinely vote against tax increases in a state without a sales tax, said Mark Nelson, the lobbyist chairing Oregonians Against Unhealthy Taxes, the campaign against the initiative. Nelson said eliminating private insurance would be too radical for most voters. "Everyone believes we should continue to find ways to further cover the uninsured, but their method is to toss out the entire system," he said. Measure 23's opponents also have warned that sick people from other states would move to Oregon and wealthy individuals or businesses would move away to escape higher taxes. Isaacson and McEachern, hired to drum up support for the health plan, contend that Measure 23 would cut health-care costs through preventive care and lower administrative expenses. They say private insurance companies waste money on high salaries and extravagant offices. The charge that out-of-staters would flood Oregon is pure speculation, they say. They nevertheless face constant reminders of the public's suspicion. During an appearance on a conservative talk radio show, "one person said we are Satan and Measure 23 is the apple," McEachern said. But even those critics, he said, will give the devil his due. "They'll say that, but they won't say the current system is working." If anything is more frightening to the public than a new government bureaucracy, it might well be the health-care industry. Measure 23 is offered at a time when health insurance and drug companies are routinely cast as villains in movies, television shows and books. "People may not like us, but they hate the insurance industry," Isaacson said. McEachern likened the behavior of insurance companies to free advertising for Measure 23. "The insurance companies end up becoming our biggest supporters. Every time they cut benefits and raise premiums, it helps us." By election day, insurers and other health industry donors will have spent about $1.3 million to defeat the health plan, Nelson said, adding that his group was late to begin fund-raising because its backers thought the measure would not get enough signatures to qualify for the ballot. Isaacson and McEachern have less than $50,000 -- raised mostly from individuals -- to run their campaign. They say they've been paid about $1,000 each for their work over the last three months. Dissatisfaction with the status quo is obvious in Isaacson and McEachern's visits to homes, even in the affluent, somewhat conservative Eugene neighborhood they visited recently. Some told the pair they were unwilling to pay more taxes, but many others, such as Paul Armstrong, 60, spent more time talking than listening. "I had 58 stitches on this hand and I paid for it myself," said Armstrong, holding up a hand with faint scars running across his fingers, the vestiges of an accident with a table saw. A retired builder, Armstrong said he spent so much on medical coverage for his 24 employees that he could not afford insurance for himself. Armstrong, a Republican, said he will take a chance by voting for Measure 23 because the risk of higher taxes and more bureaucracy seems less worrisome than the current system. "It will be topsy-turvy getting it organized, but somebody has to start it. A lot of people now have no means whatsoever and really need help," he said. To turn the disgust with the system into votes for the initiative, the campaign is relying on personal contacts by volunteers. Their plan is to speak in person or by phone to 300,000 voters. Although confident the measure will fail, Nelson acknowledges that it "sounds very enticing" to many voters. Senior citizens whose health-care costs are high, but whose incomes are low enough to be exempt from the new taxes, for instance, are potential supporters. "When you put different populations together, you'll have a sizable group of people," he said. ** * #329 Message: 1 Date: Wed, 06 Nov 2002 14:07:42 -0800 From: mark lindgren Subject: Thank you! Now the people of Oregon have spoken. It would be easy to think of Measure 23 as defeated, but hundreds of thousands of Oregonians voted to change the way healthcare is delivered in this state and in this country. Many other innovative public policies such as Medicare and Social Security took many years of debate. While it would have been wonderful if Measure 23 had passed, the campaign has achieved‹indeed, surpassed‹my personal goals. While other organizations have only complained about the problems with the current health care system and suggested band-aid solutions, we put a concrete proposal on the table, a proposal that will have to be part of any discussion of health-care reform in this country in the future. And we have done so not only in Oregon but across the country through the attention that the campaign received in the national media. Our campaign has given fresh hope and excitement to health care activists around the U.S. We will analyze the Measure 23 campaign and share what we have learned from Oregon¹s campaign with them. The public debate over the last few months has generated valuable feedback on what Oregonians want in their health care system. Even some opponents encouraged us to modify Measure 23¹s language and to try again. Single-payer was not taken seriously when we began this campaign. The success of the Measure 23 campaign means that organizations which did not return our calls last time will do so in the future. It is my hope that in the coming months, key stakeholder groups will work with Health Care for All-Oregon to shape legislation that will overcome the millions of dollars that the insurance industry will throw at a Son of 23 in 2004. My thanks and gratitude go out to the thousands of Oregonians who gave of themselves to get this campaign this far. Over several years, many Health Care for All-Oregon volunteers spoke with countless Oregon labor, civic, senior and other citizens groups around the state to shape and promote the prescription for secure, affordable health care for all Oregonians that eventually became Measure 23. Volunteers gathered thousands of signatures to put Measure 23 on the ballot and set a record in gathering enough signatures to place eight Arguments in Favor in the Oregon Voters¹ Pamphlet. They staffed phonebanks, canvassed and distributed literature at public events. They contributed financially whatever they could. Our work to achieve secure and affordable health care for Oregonians has just begun. Mark Lindgren Chair, Health Care for All-Oregon P.S. A physician supporter recently reported he had treated a couple "No on 23" campaign workers who did not have health insurance at the free clinic where he does volunteer work. He said they felt terrible working to defeat Measure 23, but they needed the work. ** * #332 Message: 3 Date: Wed, 13 Nov 2002 00:13:33 -0800 From: Marc Shapiro Subject: Re: health plan idea Gary, 1. Who ever's ox is getting gored will generate the money to fight any plan that is proposed. 2. Insurance companies, both profit and non profit consume a large part of the health care dollars. In Oregon, the Medical Insurance sales agents have a $350 million payroll that makes no contribution to health care. In 1990, it required 1.7 clerical workers to support each doctor. In 2002, that number has grown to 4.2 paper-pushers per doctor. All the money spent on those clerical workers and the space and equipment they require makes no contribution to health care. 3. Hospitals have a paper work overhead of about 30%. That probably could be cut in half by a single payer plan that did not involve insurance companies. The money saved could be spent on health care. 4. Insurance companies, hospitals and health care practitioners spend vast amounts of money on advertising that would not be necessary under a universal single payer health care delivery system. The money saved could be used to provide health care. 5. There are over 500 companies in Oregon that self-insure saving vast amounts of money over what the same coverage would cost them. That savings is small compared to what they would save under a single payer system. 6. As you have noted, companies would not be put at a competitive disadvantage by providing health care under the charges of a reasonable system which does not include the waste caused by insurance companies. Competitors would be in the same situation. Companies operating under a plan such as what we had proposed would finally be able to compete internationally, where universal health care is the rule, not the exception. No matter what plan you devise, someone must pay. That someone is always the consumer. It doesn't matter how you mask it, the consumer always pays the bill. However, at this time, 2/3 of all health care is paid for by tax dollars. In spite of that fact, 470+ Oregonians are without coverage, 420,000 are on the OHP, and 25,000 apply each month, most of which are turned down because there are insufficient funds to provide the coverage. Countless people are trapped in poverty buy the rules of the OHP which cut paraticpants off if the earn $1 too much. Based on data from the Legislative Revenue Office, under the Plan we proposed employers would have been taxed according to the following table: PAYROLL ($) Payroll Tax 0-100,000 3% 100,001-500,000 6% 500,001-1M 7% 1M+ - 2M 8% 2M+ - 3M 9% 3M+ - 5M 10% 5M+ - 10M 11% 11M+ 11.5% please not that for a small employer having a payroll up to $500,000 , the 6% payroll tax represents the $2.00 per hour you propose on a wage of $33 per hour. Most large employers are presently paying between 10 and 20 percent of their payroll for health care benefits. Those numbers will inflate easily by 30 percent by 2005 when our plan would have gone into effect. There was a viable plan on the table. The insurance companies scared the voters away. Had it passed, it could have been adjusted to make it work. That opportunity is no longer there. There is nothing else on the table. There will be nothing else on the table, because there is no mechanism available to get it there. The insurance companies have no incentive to put themselves out of business or even correct the way they do business. The legislators will not take any action that does not support the insurance companies, because so many are well paid by the insurance companies to keep the money flowing as it is. It will be two years before another initiative can be placed on the ballot. No matter what it is, it will meet the same opposition, because it can only work if it eliminates the middle man. In this case the middle man has unlimited funds to defeat what ever the measure is. Only when a large enough part of the society is really suffering, which will be in the near, not distant future, will it force people to look beyond the lies in negative advertising and take a chance on what works everywhere except in the US - please note, there are UHC plans in effect in Puerto Rico and Hawaii. Marc ** Message: 1 Date: Sat, 9 Nov 2002 19:05:38 -0800 From: "Lynn Porter" Subject: Today's meeting I thought we had a lively meeting today, with about 20 people present, but I don't know where we're going at this point. I don't think people have had enough time to think about it. Maybe it will get clearer at the next meeting. There seemed to be a consensus today that we want to try again, but we're not sure with what. It sounded to me like a majority want to do a singlepayer initiative. There seemed to be a difference as to whether it should be simple or complex. Below are my notes from the meeting. MEETING NOTES -- Nov. 9, 2002 Bill -- Work towards a national health program. Set up committees of correspondence to pull it together. He will contact unions. Ellen -- Observing. We should have talked to blacks at the beginning, before M23 was written. Blacks don't like whites coming to them with solutions to their problems. Joan -- Modify the initiative. Talk to Oregonian to see what they would support. Poll the electorate, find out what they're thinking. We had no effective response to tax increase charge during the campaign. Carol -- We can do it. Charlie -- Ran for something on socialist ticket, talked to people. Says our supporters are young, under 30, have low paying jobs without medical insurance. Hard to get them to vote. Walt -- Work on voter registration, newsletter, raising money. Be a little tougher on politicians who should be supporting us but aren't. A lot of apathy in the black community. Sally -- Words like "affordable" and "socialist" are hurdles for some people. ? -- Need a national health plan. Local newsletter. Measure 23 offered everything, pie in the sky, need to restrict coverage. Jack -- Get allies lined up ahead of time, build our strength. ? -- We've just begun. Roberta -- M23 was too complicated, too big. Need to work with Democrats, work on voter registration. A lot of felons don't know they can vote. Donna -- Need to do evaluation of M23 and the campaign. Mobilize the disenfranchised. Focus on our organization, need to be more organized, waste too much time at meetings floundering around. Didn't like resistance in our group to the state HCAO campaign plan. Kate -- Need to recreate the state organization. Has lost faith in the "home office". M23 was too complex, need simple initiative stating everyone in Oregon is entitled to health care, and instructing state legislature to come up with a plan to cover everyone by a certain date. Let the legislature work out the details. Robert -- Work on voter registration and outreach. Need to disconnect medical insurance from work because you get dumped when you need insurance. Barbara -- Delink employment and healthcare. Need to excite people in Portland. Get out from under the thumb of the state HCAO organization. Should not have had $25,000 income tax cap in M23 because it increased rates for those who are not rich. Measure was too vague -- we couldn't tell people how much it would cost them. We have to be able to do that. Richard -- Legislative director for postal workers union. Will try to get on AFL-CIO state health task force. Need snappy slogans, outreach, coalitions, campaign finance reform. AFL-CIO will only support 80/20 percent employer/employee payment of healthcare premiums. A lot of people don't realize what they're paying for healthcare. Initiative needed stronger cost containment. For canvassing, need precinct walking lists so we can target Democrats and Greens. [Max said voter registration lists are very expensive and Democrats would not share with us, even though they endorsed the initiative. -- L.P.] Lynn -- We did the right thing with M23 but would not do the same thing again because we got stomped. Prefer a much simpler, more limited initiative aimed at those who are feeling the most pain -- expand Oregon Health Plan to include everyone who has a job and doesn't have insurance equivalent to OHP, tax on employers not providing equivalent health insurance to pay for it, allow self-employed and unemployed to buy into OHP at cost. Most people in Oregon -- 58% -- have employer provided insurance and aren't feeling enough pain to support radical change. They will vote for economic justice tax if most of them don't have to pay it. Impossible to explain complex initiative in a campaign. Needs to be so simple it doesn't need explaining. We need to organize individuals, build our organization, rather than trying to get support from other groups. Need to be better organized. Dale -- Stick with single-payer, repackage, don't buy into incrementalism. Steve -- No minorities in this room. Need to contact black churches, do outreach, raise money. He will contact blacks. Ruth -- Not happy with people hired by state Steering Committee to run campaign. Fundraising started too late. Cherie -- Very unhappy with lack of support from other progressive groups, especially labor. When she tried to get signatures or leaflet at black community events, or outside the Oregon Food Bank, she was told she was "inappropriate". Feels we didn't get adequate support from KBOO or the Alliance. Before we commit to doing another initiative we should find out who is willing to commit to work on it. Says labor was given the opportunity to be involved in writing the initiative and they would not participate. Max -- "Crushed" by vote. Would not support incrementalism or expanding the Oregon Health Plan. Believes Measure 23, with minor modifications, is still the best way to go. Pat -- Contact black state commission. ----- Original Message ----- From: To: Sent: Tuesday, November 12, 2002 8:03 AM Subject: [HCAO_Portland] Digest Number 75 Message: 1 Date: Mon, 11 Nov 2002 19:41:56 -0800 From: "Richard Lochner" Subject: Re: Digest Number 73 Lynn, thanks for writing up the meeting notes, they'll help. Some small revisions on my notes: 1) The only thing the AFL-CIO, I believe it was President Tim Nesbit, threw out as a possibility was the 80/20 plan, which I believe was very standard in labor contracts in the good old days. What, if anything, the AFL-CIO would support for single-payer financing in the near future is unknown, but it wouldn't hurt to check on this concept, which is not a bad start as far as I'm concerned. 2) I believe we can obtain walking lists from county elections offices. I don't doubt they're expensive, but I believe very useful, which brings us back to the problem how to run a much better funded campaign next time. Richard Lochner ----- Original Message ----- From: To: Sent: Monday, November 11, 2002 7:52 AM Subject: [HCAO_Portland] Digest Number 74 Message: 2 Date: Sun, 10 Nov 2002 21:56:39 -0800 From: "Lynn Porter" Subject: Fw: expand OR Health Plan? This is a response I wrote to questions from Kate Applegate. -- L.P. (1) If we were to try to expand the Oregon Health Plan, would you want to have the HMOs & insurance companies in the plan? To what degree are they involved in the Oregon Health Plan at present, & how might that be modified? No, although we might not have the power to kick them out. Actually I don't think they're much involved now. I'm on the OHP and in Multnomah county there is no HMO option at present for new or renewing applicants. I have an "open card," meaning I can go to any doctor. HMOs have been dropping out of OHP because the reimbursement rates are too low and they can't make money. A lot of doctors won't take OHP patients for the same reason, likewise Medicare. Congress is considering raising the reimbursement rates, which they've cut in the past. Recently I called four clinics, looking for a primary care physician, before I found one that would take OHP. But at least I found one. OHP seems like the best politically acceptable alternative that already exists. People are more likely to vote for something familiar. (2) Did you say something about extending the plan to the WORKING lower income people? How does that compare to what exists now? What about self-employed & fixed income people? I would extend it to everyone who has a job, full or part-time, who is uninsured or underinsured. Underinsured would be defined as insurance not equivalent to basic OHP. Employers not offering equivalent insurance would have to pay a tax so their employees would be covered by OHP. I would also offer the unemployed and self-employed the option of buying into OHP at cost. I don't know what that cost would be but I figure it would be less than what the insurance companies are charging. It seems to me that OHP is a very limited, at present, single-payer plan. (3) Community College students say that the worst part of the plan is the paperwork & having to continually reapply. Processing such red tape must divert money from health care. Would you want to address that problem in a revision of the OHP? No. I would expand it first, to give it a larger constituency, then later maybe work on improving it. I don't like having to reapply every six months, but that's kind of the least of my worries. I need very expensive medical care about every 3 years to survive. I think we should look at survival for the most people, rather than building the perfect system. The voters just rejected our perfect system. Lynn ** * #339 Message: 1 Date: Fri, 22 Nov 2002 11:59:37 -0800 (PST) From: Mike Beilstein Subject: Thoughts on Measure 23 Hello Mid Valley health Care Advocates- Sorry, this message is long. Delete it if you are not interested. If you don't want further communications about the universal health care campaign, let me know and I'll remove you from my address list. I forwarded a physician's note about Measure 23 to interested people in Corvallis as a starting point for discussion on the future of the universal health care campaign. Following that message I have compiled responses from individuals. I eliminated their identifying information to protect privacy. I assume most people want to share their ideas. Here they are. Mike Beilstein, chair Mid Valleyt Health Care Advocates Charlotte, I hope the stress of the election disappointment is wearing off. At any rate I am writing to let you know that I appreciate how hard you must have worked for something you believed in so strongly. There really are a number of MDs, like me, who support universal coverage but could not support the details of this one, In the Drs dining room I never heard any comments complaining about income hits or even tax hits. The general concern was that there was no mechanism to in any way control utilization- ie shared responsibility. The lack of any sort of co-pays... even means based sliding scale ones for visits or meds was widely seen as a fatal flaw. No- one could visualize a system with this problem surviving in the long run. We all have experiences with patients who for whatever psychological reasons wanted daily visits, endless tests, the latest and greatest meds when they were not indicated-- you get the picture. This is just one concern that was voiced and I'm sure you have heard before. At any rate, if you ever have the energy to attack this cause again, I would be happy to talk more with you - that is, if you want. Be well. M i agree with this, although i voted for the measure anyway. I think copays discourage people from thinking health care is free and therefore taking it for granted. I want the copays to be small so that poor folks won't be discouraged from seeking healthcare. Perhaps even a sliding scale, as she suggested. Ideally there would be no copay for those who can't afford a copay. But for those who can, i think an affordable copay is a good way to discourage "abusing the system". I've heard others say that a copay would have made it easier to vote for the measure. ~m I think a lot of people-- maybe most people in the US-- cannot imagine anyway of controlling utilization without co-pays or deductibles. Measure 23 lacked these because we wanted to make the administrative costs as low as possible. I think we either need to include co-pays and/or deductibles, or we need to explain some alternative utilization controls in great detail. The problem with the co-pays and deductibles is the cost of the means testing needed to determine who would be excused from paying these charges. I have often wondered if we couldn't just use the means testing that has already been done-- tax returns. We have already determined who was below 150% of the federal poverty level. Maybe they could also be the people who wouldn't have to pay co-pays and deductibles? R I have been thinking about the Initiative quite a bit and have some thought to share with you. 1. From the beginning it seemed too broad, too good to be true. That's what I heard other people saying to me. With health care costs going up so much, how can this plan cover everything for everybody without any co-pays? 2. I felt I needed more information from the leaders. I was not part of the writing and researching process and just had to trust that others had it all covered. It kind of felt that we were hanging out here on our own. 3. We need a well known person/s to be a spokesperson. No one, including the two governor candidates, supported it. I don't know how to reach business people. Betty and Don Miller had spoken with HP some time ago, but it seemed to be hard to get them interested. Now with Republican control and majority, it might be even harder. Well - just some thought to add to the kettle. M that was the issue with a lot of my friends and acquaintances who didn't vote for 23 either. i think we should look at all the complaints objectively and see where the measure could be improved. R I feel that the point is well taken on the co-payment issue. As long as no child--or family anywhere-will be denied medical services because they do not have the $2.00 for a co-pay---or even an office or meds/RX service fee...There may be many studies(as cited by Jim Ramsel) that co-payments are a bad idea)...but,I know that the psychology of "someone getting something for FREE" in this country is bad politics..!!!! There is no reason why most individuals cannot pay a service fee at point of dx or office visit..What may not be a really rigorous means of "cost control"--is however a psychological barrier for many who would vote for Universal Health Care ...I think there are a lot of things that need to be thought out..and discussed..AGAIN.. The voters have spoken...and it seems up to us to do a little more listening...and a little more coalition building with those in Medicine & nursing...Controlling costs--HOW?? This needs to be examined more completely...We were vague on this issue. We also will need to clarify "medically necessary" ...AND shed more light on Alternative licensed professionals...The aroma therapy thing got a little out of hand.... We need to coordinate with Washington & California on their HEALTH CARE FOR ALL strategies... J In re: Measure 23 The people I talked to had these reservations: 1. No deductibles... Most people thought that it would mean unlimited visits to health care professionals and be very costly. 2. No residency requirements.... The people I discussed this with decided that people would move to a state that had health care. Also, that the health care would those who are illegal aliens, a rather touchy subject today. This was a big issue. 3. Unlimited types of medical/alternative care........ That the measure included too much care that was yet unproven. Even close family and friends who voted for this measure because I asked them to had serious reservations and if they had thought that it could pass they would have voted against. E I would like to respond to the letter from the physician that you forwarded yesterday. My first response was that it was a ridiculous reason not to vote for the Measure, my main points being: 1. The kind of people who would abuse health care coverage in the manner described must be a very small percentage of the population. The Dr. was describing hypochondriacs--most of us do not suffer from that mental illness 2. More importantly, that is a DOCTOR PROBLEM NOT AN INSURANCE PROBLEM. It is the responsibility of the Dr. to not prescribe unneeded drugs/treatment to patients, not the insurance company's job to try to put up roadblocks that will affect everyone, but are only needed in a few cases. 3. I am totally against co-pays in any form--that is one of the reasons we need Universal Health Care--so it ACTUALLY PAYS FOR OUR HEALTH CARE!! The argument that if there is Universal Health Care then people will overuse it is insulting to the vast majority of Oregonians. Most of us will go to the Dr. only when necessary. Measure 23 will not turn us into a state of hypochondriacs. I think you need to address this issue more in the future. Thank you for you time, N Mike, I too heard this complaint quite often. I think it could only strengthen the program and its chances for passage as well as for long term viability if there was a system of sliding scale co-pays. I am not aware of the specific reasons for leaving it out, but I think it would be good to consider including it -C Glad to see you are still working this issue. I read the doctor's note to you and agree totally with the one example she used. So, why not ask her and some other friendly doctors, clinic administrators, and hospital administrators to work with you to develop a new single payer package? J Mike, I concur with Charlotte's opinions. Although I supported this measure just to get the ball rolling and to shake up the insurance companies, I too feel it was fatally flawed. I simply hoped the legislature would fix it once it was in place. I too believe there need to be effective price caps. Some co-payments for hypochondriacs is a start. Not all forms of health care providers should necessarily be included, nor should all medical treatments. I think the most rational approach is one modeled under the current Oregon health plan for low income individuals and the ranking of drug effectiveness. Specifically, expert panels should be convened to evaluate all medical providers, all medical treatments, and all drugs on the basis of scientific evidence for efficacy and cost/benefit analyses. The providers, treatments and drugs should then be ranked as to how likely they are to help patients and how expensive they are. The first ranking and reimbursement rates should completed, publicized, and evaluated by the public (with thorough estimates of financial impacts to state budgets and individual & business tax rates) before the plan is implemented by a second vote. These rankings should be reevaluated annually on the basis of new scientific evidence and evolving accepted medical practice. Based on ranking results, payments for treatments could be divided into something like the following categories: 100% coverage for preventative health care, highly effective treatments and drugs, or very inexpensive treatments with possible benefits. 80% coverage for effective restorative health care that is not inordinately expensive. 60% coverage for less effective restorative care that is expensive.... etc. You get the idea. Or even come up with an objective formula that incorporates every combination of provider, treatment, (and possibly drug), and reimburse recise sliding scale that takes into account available tax Allow individuals to earn extra coverage percentages for treatment of life-style related diseases by completing health education courses or life-style change programs. Allow wealthier individuals to purchase additional coverage under the plan, but only at prices and to the extent that covered treatments do not detract from the common financial resources available from taxes. Individuals may also purchase additional private insurance, and businesses may provide employees with additional coverage, but like public schools, they may not opt out of paying taxes for the public plan. The plan should exercise the option to reimburse only central or regional medical facilities for use of expensive equipment that would be duplicative and underused in other locations, but use this power to insure that transit times do not unduly imperil the health of emergency patients in rural locations. Perhaps the plan could subsidize rapid emergency transit to regional treatment centers in lieu of expensive equipment in rural locations. The plan should provide malpractice insurance options to medical providers, or cap pain and suffering reimbursement amounts, or provide mediated conflict resolution, so that malpractice suits do not make it impossible for health care providers to provide service at a reasonable cost. Criminal liability should not be restricted with these measures. Mechanisms should be put in place from the very beginning to evaluate the efficacy of the plan, identify and remedy problems, provide ethical oversight, and report to the public and state legislature annually. This should be done by an entirely independent commission that may have advisors, but not representatives or lobbyists, from the affected providers and drug companies. _______________________ I could probably think of more items if I continued Mike, but the bottom line is that the system, whatever is proposed has to have logical and fair mechanisms for cost control, extreme accountability to the public and businesses, and some burden of responsibility on the users, or it will never fly. Sincerely, D Mike, I have lots of opinions but I'll try to stick to health care here. I am always concerned about wasting doctor's time, my time and money no matter who's it is so this issue didn't really sink in until last week. I talked to a friend who couldn't understand why I didn't check into emergency when I had a stomach bug and when I look back at previous conversations I realized that she does indeed check into emergency for every little thing. She and her family practically live in emergency and she figures that as long as the insurance company is paying for it, why not? So, I think it is a valid concern since there will surely be others like her. I'm also sure that in her case she does have a copay and it doesn't make a difference. I can't even guess at a solution for this, so I'm not going to try. J Hi Mike. I teach the course in our curriculum that deals with this subject and I too voted against 23 for the reasons listed by the physician, plus many more. 23 would have generated out of control spending while producing marginal increases in patient health status for many individuals. I have numerous examples if you would like to discuss this further. Another factor that also would have imploded Oregon's economy would have been the movement to Oregon of America's uninsured who are ill and want, but can not afford treatment. Currently, there are 43 million uninsured in America and I don't know how one would structure a state level, stand alone, universal system that is capable of effectively addressing this issue. Hawaii has had employer mandated, universal health insurance since 1975 and it has worked well. However, the inward population migration is not an issue in their case. The issue of universal coverage must be dealt with at the national, not state level. To do otherwise will bankrupt whatever state implements such a program while simultaneously driving out businesses and individual taxpayers who are needed to pay the bills. If 23 would have passed, I was prepared to transfer my residence to my farm in North Dakota and I was not alone in my thinking regarding such a drastic action. Great idea, wrong approach. L ** * 340 There are 3 messages in this issue. Topics in this digest: 1. Re: Thoughts on Measure 23 From: "William Lucas" 2. M23 From: "Dr. Joseph Eusterman" 3. California news From: Peter & Paulina Conn ________________________________________________________________________ ________________________________________________________________________ Message: 1 Date: Sat, 23 Nov 2002 08:27:42 -0800 From: "William Lucas" Subject: Re: Thoughts on Measure 23 Although, as a physician, I have been an advocate for a single payer universal health care system for many years, I did not vote for measure 23 for many of the reasons given in your message. There is one more that I haven't seen addressed, and this is a major reason why doctors in Oregon would be at a real disadvantage in an Oregon only plan. Medicare reimbursment in Oregon is one of the lowest per capita = significantly less than half of the top end, such as areas of Florida and New York. This means, relatively, less money from Medicare and more required from Oregon taxpayers. Until this is fixed, or until we have a national single payer plan, plus many of the other changes suggested, an initiative like 23 will have a great deal of trouble getting much support from the medical community. I urge continued strong support for a national plan. ________________________________________________________________________ ________________________________________________________________________ Message: 2 Date: Fri, 22 Nov 2002 13:10:07 -0800 From: "Dr. Joseph Eusterman" Subject: M23 I was very dismayed not to have heard about M23 until I read - and studied it carefully - in the Voters Pamphlet. I would have liked to support it to the max as I felt then, and still do, that it was an excellent first effort to solve the horrific health care situation we have here and throughout the country-both in personal health and workers comp care. I disagree with the criticism of the $25k income tax cap. If any one person or group - including business - feels they will be gouged or paying an unfair share, you will never gain their support for single payer. The built-in mechanisms to tweak, correct or improve it were adequate in my opinion. I have been a registered independent - a growing constituency - for 30 years. All single payer needs to succeed over the monopsony of insurance companies is to keep the true health ("mangled care") care horror stories before the voters over time. If Al Gore finally "gets it", so can the majority of voters! I am convinced that if the voters had read - and studied - and understood - the info in the Voters Pamphlet, admittedly a very tall order, it would have passed. It is a complex issue and will require a huge educational effort. There is no quick fix. I DO KNOW that in spite of the marketing effort of "complementary, alternative" care methods to the medically ill-informed, only adhering to paying for science/evidence-based care in single-payer will stand the test of time and help to win the day. Many people do justifiably fear a system that pays for anything and everything that Madison Avenue and health fraud promotes. (See http://www.quackery.com) Joseph H. Eusterman,MD,MSMed,FACOEM,CIME 851 A Ave, Lk. Oswego,OR 97034-2946 Ph/FX 503-699-9534 Cell: 503-803-0846 jhewoems@msn.com www.ethical-services.medem.com www.imenet.com ________________________________________________________________________ ________________________________________________________________________ Message: 3 Date: Fri, 22 Nov 2002 15:26:41 -0800 From: Peter & Paulina Conn Subject: California news Dear Single Payer Advocates in Oregon, I have appreciated getting all the evaluations of your recent and continuing campaign in Oregon. Health Care For All - California will continue our campaign of 7 years. In the upcoming Legislative session a single payer bill will be introduced by State Sen. Sheila Kuehl, based on single payer proposals recently evaluated in the Health Care Options Project. I invite you all to keep track of us via our website http://www.healthcareforall.org. The letter below was written in response to an article our paper ran concerning specialists being unpaid for services in the ER and increasing deficits in ER budgets. One proposal is to use Tobacco settlement money, which of course takes money away from prevention. LA County is proposing an increase in property taxes to avert closure of some of their trauma centers. My point in sending the letter to you is to encourage you to use every opportunity (and there will be no lack of them) in the media to point out the failures of the present system and how single payer would remedy the situation. We must educate one on one, but also through the media. As the current system falls apart, I hope all players (doctors, hospitals, consumers) will see the logic, the morality, the economic and social good of single payer. Peter Conn Chair, Santa Barbara Chapter HCA - California Santa Barbara News Press Editorial News LETTERS TO THE EDITOR 11/22/02 Single-payer health system has the cure Regarding the local manifestation of the health-care crisis in our emergency rooms, if everyone had comprehensive, affordable health coverage there'd be fewer ER visits because everyone would have access to a primary-care physician at the early stages of an illness; the chronically ill would have access to a physician outpatient case manager; patients would take medicines as prescribed rather than skipping doses or skipping purchase. And, there'd be no unpaid ER doctors. Under a universal single-payer health system, shown in numerous studies to cost less than the present system, no one would be without coverage; no one would get a free ride; no one would have health care delayed or denied; no one would be bankrupted by illness; billions now siphoned off for administration would be used for care; health cost inflation could be reined in; and no doctor or health facility would go unpaid. The present system doesn't work for increasing numbers of us, and expanding it without reforming it is unaffordable. Let's get serious about fixing the system in a way that benefits everyone, and stop letting vested interests scare us with myth-information. Meanwhile, expect things to get worse as we use band-aids to try to fix a severed limb. Peter Conn, Santa Barbara ** * #341 Message: 1 Date: Sun, 24 Nov 2002 15:12:48 -0800 From: "Donna Cohen" Subject: Relationship of Portland HCAO with state On Saturday at the Portland HCAO meeting we passed this motion to give to the state steering committee: "not to continue with the state organization as it is now structured" We added..."we would consider a state structure that is a coming together of local organizations as equals with no hierarchical structure, but only to have a facilitator, and possibly run on consensus." Donna Donna L Cohen, MLIS, MEd d. l. cohen information services Portland, Oregon 503-774-1413 dcohen@dcoheninfo.com www.dcoheninfo.com [Each month new resources for information access, retrieval and management.] ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Managing your organization's knowledge via virtual library design, website design, and in-depth Web search training. ________________________________________________________________________ ________________________________________________________________________ Message: 2 Date: Sun, 24 Nov 2002 02:21:37 -0800 From: "Mike Morin" Subject: 5 Principles of Health Care Reform I, also, believe that a single payer on a national or international basis is the best idea. I'd like some feedback on the following principles of health care reform: Ed. Note: This was written a couple of years ago during the Clinton Administration. With Respect to Health Care and Health Care Reform By Mike Morin It is painfully evident that the current health care system in the United States is inadequate at best, and more accurately fundamentally flawed. Tinkering with the current system is and will be increasingly unacceptable. Yet, this is what our legislators "on both sides of the aisle" and our current administration continue to recommend and propose. Fundamental reassessment of the health care system based on perspectives of health maintenance, public and environmental health, the study of comparative health systems, and the best organizational models currently operating in the United States, needs to occur. As a veteran of health care finance, and a student of health systems and organizations with significant familial and personal experience with delivery systems, and with currently no special interest in any aspect of the involved "industries" (and they do call it that), I believe myself to be an objective analyst. Health maintenance and illness prevention should be the first priority. Logically, this leads to an analysis of the larger economy and its relationship to environmental health. I guess I'm not telling most of you anything you don't know, but the current GNP indicators of economic health measures the production of toxins and the cost of their treatments (and much more rarely, cure). Labor Unions and leftists tend to advocate universal health care, and I concur. However, most of these advocates want to have their cake and eat it too. That is, they want to maximize production at all costs to the environment and public health, and they want to organize and grow the labor movement within the health care "industry". There's one major problem with such a perspective. Who pays for it? Health care costs are right up there with the cost of housing, out of sight. Consequently more and more people are falling out from under the umbrella of coverage as parent corporations downsize, reduce or eliminate benefits, and increasingly employ contract labor. Health insurance has, for a long time, been unaffordable to small firms, families, and individuals. Health care reform should probably be best viewed as not separate from fundamental economic reform. But, focusing on the issue I recommend five basic principles of health care reform that may serve as the beginning of productive discussion and constructive action. Perhaps what is needed most, besides an adequate vision and paradigm, is the courage to commit to the objective and challenge the entrenched interests of the status quo. I propose the following fundamental principles of health care reform: 1.) The requirement that all citizens of the United States and workers who are striving for such citizenship be enrolled in an HMO Risk program by a certain target date. An HMO Risk program essentially budgets health care costs. A fair program would make allowances for contingency costs and be restricted to cooperation with group or staff model HMOs. Regulation of contingency reserves would be required. HMO Risk programs have some experience with Medicare (and perhaps Medicaid) populations and with private payers. Because the Medicare population is very high risk (and that is the very reason that private insurers dumped it on the government), such programs have not been very popular with health care delivery providers. Yet, blank check indemnity programs for the elderly and disabled is devastating the Medicare program despite what Mr. Clinton tells the American public what they want to hear. Also, the current Medicare program is a nightmare of bureaucratic paperwork and shifts the burden for reimbursement to the individual and/or their advocates. Medicaid, as you are probably aware, is available only to those with no (reported) resources. Thus, it is fundamentally wrong to isolate the risk and lucratively fund the poor and elderly populations while a great many working people and unemployed (yet not yet impoverished) remain uninsured. 2.} The requirement that all entities participating in the finance and delivery of health care be restricted to or re-established as non-profit organizations or mutual "insurance" companies. 3.) That premium rate structures be required to be progressive or at least flat relative to income, independent of age and sex considerations. How worker's injury compensation should be rated is a difficult issue. While the cost of risk of injury should be absorbed by those benefiting from the risk, no injured worker should go without adequate treatment and/or compensation. This gets into very difficult questions related to what is a justified risk. 4.) That physician education and placement be coordinated and financed by society; setting target levels of physicians by specialty and geographical location in cooperation with the health care delivery and finance organizations. By "financed", I mean that physician education, beyond the undergraduate level, be paid for by society, and not in the form of loans. These principles should be considered for other health care professionals as well. Notice that I said society and not government, unless there be consensus that government can ACT as representatives of the interests of society. 5.) That tobacco and alcohol taxes be raised substantially (e.g. to the effect of raising the price of a pack of cigarettes to about $8.00 at the site of manufacture) to discourage the health effects and societal costs brought about by use of such products. The money collected in such a tax program could be earmarked to trust funds to help leverage the reinvestment in alternative, more productive uses of valuable farmland and industrial development and for the development of new jobs for displaced workers. I know full well that implementation of a plan based on such principles would certainly be a difficult undertaking, and that it requires fundamental rearrangement and perturbations within the existing "industries". However, as stated before, it is painfully apparent that the current system in the United States is inadequate at best... ** * #342 Message: 1 Date: Sun, 24 Nov 2002 22:25:57 -0800 From: "Ruth Duemler" Subject: Re: Thoughts on Measure 23 studies have shown that co-payments are too expensive to collect and limits the medical care to the very poor---maybe we could have those doctors who want co-payments collect on their own with a cap amount-----Ruth D ________________________________________________________________________ ________________________________________________________________________ Message: 2 Date: Mon, 25 Nov 2002 18:51:35 -0800 From: "Lynn Porter" Subject: Initiative proposal OREGON HEALTHCARE EXPANSION PLAN ELIGIBILITY 1. Oregon residents who: * Are U.S. citizens * Have established permanent residency in Oregon, through home ownership or rental * Are not eligible for the Oregon Health Plan or Medicare 2. Their domestic partners who are not eligible for the Oregon Health Plan or Medicare. 3. Their dependants who are not eligible for the Oregon Health Plan or Medicare. COVERAGE 1. Medical, mental health, dental or vision care provided by a licensed: * Medical doctor (MD) * Mental health care provider * Dental care provider * Vision care provider 2. Doctor's office visits, outpatient treatment, hospitalization, prescriptions, tests. 3. With such exclusions as may be specified by the state legislature. FINANCING 1. A tax on employers of $____ per month per employee eligible under this Plan. 2. A monthly tax on employees, eligible under this Plan, according to their gross yearly income range, as listed below. 3. These rates could be changed by the state legislature if necessary. $_____ - $_____ -- $____ $_____ - $_____ -- $____ $_____ - $_____ -- $____ $_____ - $_____ -- $____ $_____ and up -- $____ GOVERNANCE Put it under the same state department that now runs OHP, FHIAP and other healthcare finance programs, some of which it would replace. COST CONTAINMENT 1. Medical treatment and prescription copays equivalent to those required under OHP. Not required for those with gross incomes equal to or less than 150 percent of the federal poverty level. 2. Yearly deductible of $100. Not required for those with gross incomes equal to or less than 150 percent of the federal poverty level. 3. The same voluntary drug formulary (recommended list) now used by OHP. Research a similar list for treatment procedures. 4. Bulk purchase of prescription drugs by the state for those covered under this Plan. 5. Administrative costs would be capped at the same percentage as OHP. HEALTH CARE PROVIDERS REIMBURSEMENT For patients served under this Plan, health care providers would be reimbursed by the state for their services at a rate equal to their costs plus ___ percent. NOTES This proposal is designed to remove all the clubs our opponents used to beat up on Measure 23, and the reasons that otherwise sympathetic people voted against M23. It is also designed to be simpler, and to remove vagueness. ELIGIBILITY U.S. citizens: I believe that resident noncitizens should be covered, but I think a lot of voters disagree. Residence: I think people want a tighter definition of residency than we had in M23, although this probably isn't substantively different. Sounds better. I've read that the M23 residency definition was chosen to agree with Medicaid (OHP) rules. If we exclude OHP we don't have to worry about that. Homeless people should be covered under OHP. Excluding OHP & Medicare: This removes one of the main objections people had, that they didn't think we could get the waivers for those two programs, to funnel their money into our plan. I think we didn't really know, and that could have shot down the whole program, if M23 had passed. The purpose here is to cover those who aren't already covered by a single-payer plan - which OHP and Medicare are. Both have problems, but I think most of those problems need to be fixed at the federal level, since they're federal programs. If we exclude them it makes this much more doable. COVERAGE The main club used to beat up on M23, and the main objection of a lot of would-be supporters, was that M23 was too expansive in benefits. So this proposal cuts back to what I think is essential. Also, OHP, or at least the more generous part, provides these benefits. (OHP is in the process of being split into two parts, with the current benefit level for the more vulnerable recipients, while cutting dental and vision for the rest. This was done to expand the number of people on OHP.) I don't believe a majority of the voters will vote for coverage of alternative health care. Next time I don't want to see editorials and letters to the editor claiming that we're trying to cover massage therapy and marriage counseling. Allowing the state legislature to specify exclusions - which power of course they have anyway - might answer objections from people who believe we should not cover cosmetic surgery, etc. OHP and private insurance have such exclusions. An alternative would be to say that OHP exclusions apply, or to specify exclusions. FINANCING With the same coverage and administrative costs as OHP, we might be able to get financial estimates from what it costs OHP to cover each participant, and then split that cost between employer and employee, possibly using the 80/20 percent formula that has been suggested as traditional. We should try to make the employer tax less than they're now paying, on the average, per employee, for medical insurance. The employee income tax, I believe, needs to be stated as a flat amount, rather than a percentage of taxable income. I don't think most people even know what their taxable income was last year, unless they look it up. Then if they have to guess at a percentage and apply that to taxable income, it isn't going to happen. They have to know what they're paying or they won't vote for it. And it has to be the same or less than what people are currently getting deducted from their paycheck for medical insurance, at least on the average. Which means we have to find out what the figure is. This is what people will compare our tax with. They won't compare it to an average - I believe it was over $4,000 - which people pay per year in total medical costs. People, other than healthcare activists, don't think that way. The average is skewed by heavier costs in the later years of our lives. I didn't pay much for medical care until my first serious illness at age 57. Younger people aren't going to buy that total health costs figure. Also, if insurance covers it, most people don't even know what their total health costs are. Or probably even keep track of their out of pocket costs. If people have to get out a calculator to figure out whether our proposal benefits them, they won't. They'll just vote no. We could stick the rich with a somewhat higher tax than the others, but most people will have to pay the same or less as their current paycheck deduction. We need a simple table we can put on all our literature, or list in a letter to the editor, that gives 4 or 5 gross income ranges and the monthly tax for each. This would be progressive. But we shouldn't use that word, because I don't think most people know what it means. Just use a table or list to SHOW them. GOVERNANCE Under M23 the program was to be run by a public nonprofit corporation. I don't know what that is. I doubt if many people do. We don't want to activate people's "huh?" reflex. I would keep it simple next time and just fit it into existing state government organization. That should also prevent people from claiming we're creating a vast new bureaucracy. COST CONTAINMENT M23's cost containment mechanisms were convincing to me, but not I think to most people. This is one of the main objections we got. I think people are more impressed by the kind of cost containment they're used to, even if it doesn't work very well. So I've added copays and a deductible to this plan, but made an exception to both for poor people. According to an article in The Oregonian, the drug formulary list is already pulling down OHP drug prices. Kulongoski proposed bulk purchase of prescription drugs in his campaign. I don't know what the administrative costs of OHP are, but I figure they've got to be less than that of commercial insurance. HEALTH CARE PROVIDERS REIMBURSEMENT One of the main objections we heard from doctors is that they were afraid M23 would be financed in part by reimbursements to health care providers below their costs - as Congress has done with Medicare and Medicaid, which is why many doctors won't take patients on those programs. So I think our initiative should seek their support by guaranteeing them reimbursements of costs plus some reasonable percentage of profit. ** * #343 Message: 1 Date: Tue, 26 Nov 2002 06:57:51 -0800 From: "Donna Cohen" Subject: More on PDX decision about state committee Someone asked me to clarify/expand on my thoughts about our motion for re-organizing statewide and here is my personal response for your consideration. First off, I can't speak for the Portland group beyond stating the motion. My message to the list was simply a reporting of the motion we passed - which was, however, created as a result of my thoughts combined with another person's at the time of the meeting. I officially joined the campaign last fall but it was not until winter/spring that I became more active. I know there is a long history to this effort and admire the work that has gone on. I am amazed at what our group has accomplished in spite of its limited resources. In my time with the group I have heard much dissension about the state committee/campaign. In trying to be objective about my assessment of the steering committee I must say that my knowledge of its actions has been limited and the actions I have seen appear to be mixed positively and negatively. My feelings about a re-org stem from what I see as: - little support by PDX for the state committee as is. - what appears to be a lack of effort [or perhaps communication about, which can be just as serious] and intention to "start fresh" on the state level with a new state structure. Coming in as an "outsider" has its pluses and minuses in my perspective. But, it seems to me that the specific "campaign" is over and it is appropriate to not carry over any systems without clear support for them. Therefore I think the only job of the state group now, and the only democratic approach, would be to: 1. solicit and propose to every person associated with Health Care for All in the state options for how to _structurally_ continue statewide, 2. steward the entry of whatever structure emerges as desirable, with no pre-determined roles for anyone on the current steering committee in the ensuing structure. - the current hierarchical structure based on individuals who make what at times have seemed to be unilateral decisions that affect all groups in the state. This seems to have been the source of many problems. A preferable structure is more a "federation" of HCAO around the state that would participate based on what they see as the best approach for their organizations [in my opinion, I would like PDX's goal to be statewide univeral health care and education as one of the strategies]. Each group would be an autonomous organization; those strategies upon which all agree would be taken on statewide. Agreement for state actions would be made using a consensus model. As you see, I have spoken of a model for a structure for a statewide group. I have not discussed what specific approaches to health care reform should be undertaken. This is because without an adequate structure no valid decisions about strategies can be made. What will those decisions be once a structure is in place? It cannot be known. Yes, at that time we may find that local groups will choose to go in separate directions. And, that is just fine for now because: -this is a time for renewal and none of us really has figured out which direction to go in. Those who feel they have "figured out what to do" will go nowhere alone. The healthiest approach might be for local groups to work out/ try out their own strategies for awhile. The state "federation" could hold a series of meetings in which local groups share their ideas and experiences. Local orgs could set up "expert" subcommittees to focus on specific approaches to health care change. [And, a statewide database could be used to collect the info.] As one of our members suggested, a health care "summit" could be called to share ideas. -committments will come from the grassroots. Fewer actions done by a smaller number of committed people will yield more results than more actions attempted by a larger group of folks who may not be committed to specific strategies and who may not feel that they have ownership of these decisions. -strategies by different groups can be complimentary Ultimately, I feel we will need to come together for a statewide effort. But, if we don't build a better sense of, for lack of a better term, "loyalty", among all parties we won't accomplish our goals. In spite of the great work we all did I feel that better organization, on the state and local level [at least for PDX], would have taken us even further along. I say this not to denigrate what has come before but in the hope that we can improve on past efforts to accomplish even more in the future. Donna Donna L Cohen, MLIS, MEd d. l. cohen information services Portland, Oregon 503-774-1413 dcohen@dcoheninfo.com www.dcoheninfo.com [Each month new resources for information access, retrieval and management.] ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Managing your organization's knowledge via virtual library design, website design, and in-depth Web search training. ________________________________________________________________________ ________________________________________________________________________ Message: 2 Date: Tue, 26 Nov 2002 19:31:39 -0800 From: "Lynn Porter" Subject: Fw: Digest Number 342 - Initiative Proposal ----- Original Message ----- From: DonTerwill@aol.com To: Lynn Porter Sent: Tuesday, November 26, 2002 11:07 AM Subject: Re: [HCAO] Digest Number 342 - Initiative Proposal Lynn, I really like what you've put in your draft OREGON HEALTHCARE EXPANSION PLAN. It gives me hope again after being very discouraged with the Measure 23 landslide. I agree that if we go back to voters with another Oregon healthcare measure in 2004 it should be absent the M23 obstacles as much as possible. Have you thought of informally floating your proposals by newspaper editors and other critics to see if they would support it, and if not, why not? Call their bluff, since they all said universal coverage was the right goal? I think an incremental step like you describe is more likely to succeed than trying to educate enough people to pass a M23 clone in 2004. And it will allow Oregon to move forward independent of discussions about a single-payer plan for the whole country that is likely to be part of the presidential campaigning (by Gore et al.) Nicely done. Regards, Don ________________________________________________________________________ ________________________________________________________________________ Message: 3 Date: Tue, 26 Nov 2002 19:45:55 -0800 From: "Lynn Porter" Subject: Covering resident noncitizens Christine, I agree with you and possibly our initiative, if we do one, should cover noncitizens. However, it seems to be a red flag for voters. I don't think they realize that -- at least some -- resident noncitizens pay taxes. At public events where we passed out literature people asked me if Measure 23 would cover Mexicans. Meaning they didn't like the idea. I don't know if Mexican farmworkers pay taxes. Or domestic workers paid under the table, etc. My feeling is that anyone who does work in the state should have medical care, but passing an initiative isn't about what I feel, it's about what the voters will vote for. And educating them is an uphill battle for which we don't have the resources. A similar issue is whether Washington residents who work and pay taxes in Oregon should be covered. I don't think the voters would go for that either. But also, we may be flying blind here. I think we need to do some focus groups and ask people what concerns they have about medical insurance and what solutions they would vote for. If we offer another initiative we should know that it would pass before we put it on the ballot. It's too huge an effort to guess. Lynn ----- Original Message ----- From: "christa153" To: Sent: Tuesday, November 26, 2002 2:35 PM Subject: I am a resident non-citizen and a TAXPAYER and I doubt I will be exempt from having to pay taxes for this program should it come to pass - so why shouldn't people like me not be covered? Nobody has any problem collecting taxes from us!!! Sincerely, Christine Waterman ** * #344 Message: 1 Date: Tue, 26 Nov 2002 19:21:54 -0800 From: "etsachs" Subject: Pharmaceutical industry Did anyone catch this? Maybe this is the way to go, to get factual information out to the public at minimum cost. =========================================== As most of you probably know the pharmaceutical industry's primary purpose is to make profit. They accomplish their goal by alleviating pain with their drugs. Where could one find a better business, to make high profits, than one that makes it possible to take advantage of people with pain, who are sick or otherwise suffering. Unfortunately, all their products have adverse reactions. The marketing term side effects appears to minimize these sometimes lethal adverse drug reactions. The industry gets a lot of help from our government - it cares more about industry than it does about citizens needs. The government gives away research information on new drugs and allows pharmaceutical companies to patent them. The government allows patents to be extended on drugs for what appear to be frivolous reason, or other, so that the profits will continue to roll in, otherwise they could become generic and profit would be lost. It blocks foreign drugs for diseases, that domestic pharmaceutical companies are researching, from entering the country. Drug companies do many other things to enhance their profits. They say, how can we squeeze more money out of our products. Shall we now expand the marketing of a drug previously directed at adults to children? In a pure capitalistic society profit is the goal; service is incidental to that. Think of that, profit is the goal; !!taking advantage!! of human need is probably the most efficient way to make it. Of course Pharma doesn't want to lose any of their profit. See how they protect their greed in the following letter to the editor. jim r Congress Protects Industry The Homeland Security Act was passed by the U.S. Congress. Sadly, because of an amendment attached to The Homeland Security Act, the pharmaceutical industry will dodge a potentially massive law suit. Evidence is mounting that the ethyl mercury that pharmaceutical companies used as a preservative in some vaccines caused neurological damage in children. The Oregon Legislature recently made it illegal to use vaccines with ethyl mercury (thimerosal). Many scientists suspect the thimerosal preservative as being a major cause of autism, attention deficit disorder, and attention deficit hyperactivity disorder in children in our society. The amendment now frees the pharmaceutical companies from liability caused by this product. Obviously, the pharmaceutical companies recognized the liability and sent their lobbyists to work. If the scientists find the thimerosal caused autism, ADD and ADHD the victims will have been poisoned by the vaccine additive and left hanging by their own government. ANTHONY DeSIENA, Eugene, Oregon Published on The Register Guard newspaper's editorial page 11/24/2002 ===================================== ________________________________________________________________________ ________________________________________________________________________ Message: 2 Date: Mon, 25 Nov 2002 19:33:50 -0800 From: "Lynn Porter" Subject: Fw: Conyers bill draft ----- Original Message ----- From: "marklindgren" To: "HCA-O steering comm., & others" Sent: Thursday, November 21, 2002 3:42 PM Subject: Conyers bill draft Draft of The "United States National Health Insurance Act," ("Expanded & Improved Medicare For All Bill") *to be introduced by Cong. John Conyers, 108th Congress Who is Eligible . The United States National Health Insurance Act establishes an American national health insurance program by creating a single payer health care system. The bill would create a publically financed, privately delivered health care system that uses the already existing Medicare program by expanding and improving it to all U.S. residents, and all residents living in U.S. territories. . Every person living in the United States and the U.S. Territories would receive a United States National Health Insurance Card and i.d number once they enroll at the appropriate location. Social Security numbers may not be used when assigning i.d cards. No co-pays or deductibles are permissible under this act. Benefits/Portability . This program will cover all medically necessary services, including primary care, in patient care, outpatient care, emergency care, prescription drugs, durable medical equipment, long term care, mental health services, dentistry, eye care, chiropractic, and substance abuse treatment. Patients have their choice of physicians, providers, hospitals, clinics, and practices. Conversion to a Non-Profit Health Care System . Private health insurers shall be prohibited under this act from selling coverage that duplicates the benefits of the USNHI program. They shall not be prohibited from selling coverage for any additional benefits not covered by this Act; examples include cosmetic surgery, and other medically unnecessary treatments. For- profit HMO¹s and other health care providers incorporated before 2003 may participate in the program, but only until 2003. Cost Containment Provisions/ Reimbursement . The National USNHI program will annually set reimbursement rates for physicians, health care providers, and negotiate prescription drug prices. The national office will provide an annual lump sum allotment to each existing Medicare region, which will then administer the program. This includes fee for service, global budgets, and salary ranges, after close consultation with regional and state USNHI directors, and the annual meeting of the USNHI program Advisory Board. . State Directors of the National Health Insurance program, appointed by the Governors of each state, will work with the regional Medicare For All offices to coordinate the reimbursement of physicians and providers through a state based electronic reimbursement system. Former private sector companies and agents that worked in billing and reimbursement who contracted their services with the Medicare Program shall be given first preference to perform similar work in the USNHI program. Funding & Administration . The United States Congress will establish annual funding outlays for the United States National Health Insurance Program through an annual entitlement. The USNHI program would operate under the auspices of the Dept of Health & Human Services, and be administered by the new expanded and improved Medicare program. All current expenditures for public health insurance programs such as S-CHIP, Medicaid, and Medicare will be placed into the USNHI program. . A National USNHI Advisory Board would be established, which would include representatives from organizations such as the National Institutes of Health, the National Medical Association, AMA, The American Public Health Association, The Centers For Disease & Control, The Agency For Health Care Research & Quality, AHRQ, the Physicians Payment Review Committee, and nursing organizations in order to ensure input from health care professionals and patients who"work on the ground" in the health care field. Funding For The Program . 7% payroll tax. 2% progressive income tax. 2% health tax on individuals who make over a million dollars in income each year. 2 percentage point increase in the Corporate minimum income tax from 30% to 32%, called a "corporate health tax." A $1.10 tax on cigarettes, 30 billion dollars, the closing of corporate loopholes such as depreciation write-offs . The United States National Health Insurance Act would save approximately $100 billion dollars annually in over-all health care costs from reduced paper work and administration. A middle class family of three would pay about $739.00 in out of pocket costs per year, versus the $7,000 dollars per year paid out in monthly health insurance premiums and out of pocket costs. For more information, contact Joel Segal, legislative assistant, Rep. John Conyers, at 202 225-5126, or e-mail at Joel. Segal@mail.house.gov ** * # 345 Message: 1 Date: Thu, 28 Nov 2002 06:33:32 -0800 From: mark lindgren Subject: Problem of Lost Health Benefits Is Reaching Into the Middle Class Thanks to Steve Weiss for passing this on. The New York Times Nov. 25, 2002 Problem of Lost Health Benefits Is Reaching Into the Middle Class By John M. Broder This article was reported by John M. Broder, Robert Pear and Milt Freudenheim and was written by Mr. Broder. Diane MacPherson, of Lowell, Mass., lost her job at a relocation management company last November, and with it the health insurance for herself, her husband and their 4-year-old daughter. Her husband works in construction and does not have access to health care coverage at work. Continuing her family health insurance under the federal Cobra program would have cost $931 a month, so the couple decided to insure only their daughter, at a cost of $270 a month. Two months ago, when Ms. MacPherson's unemployment compensation payments ran out, they dropped their health insurance altogether. Although her husband earns about $75,000 a year, construction work is seasonal and they could not be assured of enough income every month to pay for health insurance. Then their daughter came down with strep throat. "That was rather humiliating, being in the doctor's office without insurance," Ms. MacPherson said. "You become very obvious to everyone." The family represents a changing portrait of the 41 million Americans who do not have health insurance today. Once thought to be a problem chiefly of the poor and the unemployed, the health care crisis is spreading up the income ladder and deep into the ranks of those with full-time jobs. According to recently released Census Bureau figures, 1.4 million Americans lost their health insurance last year, an increase largely attributed to the economic slowdown and resulting rise in unemployment. The largest group of the newly uninsured ‹ some 800,000 people ‹ had incomes in excess of $75,000. They either lost their jobs, or were priced out of the health care market by rapidly rising insurance premiums, or, like Ms. MacPherson, both. While it is true that the number of uninsured people rises when unemployment goes up, it is also true that the rolls of the uninsured can expand even when joblessness is going down, as it did through most of the 1990's. The numbers of uninsured during the last recession from 1990-92 jumped to 35.4 million from 32.9 million. But the number continued to rise even in the boom years of the mid- to late 1990's, reaching 40.7 million in 1998 before dipping slightly in 1999 and 2000. Labor economists say that much of the job growth during the expansion of the 1990's came in small businesses and in service industries, low-wage, nonunion sectors that are much less likely to offer health insurance as a benefit to new workers. There was also a demographic bulge of young people and recent immigrants entering the work force during the decade, with many of them willing to take jobs that did not offer rich benefit packages. The problem has long been acute among minorities, immigrants, part-time workers and employees in low-wage service jobs. What is different this time, analysts say, is that the problem is hitting middle-income and upper-income families harder because many of the job losses are in high-wage industries like technology and telecommunications. Thirty million Americans in working families today ‹ 16 percent of all those in families headed by a worker ‹ lack health care coverage, according to a four-year tracking study by the Center for Studying Health System Change, a nonprofit research group financed by the Robert Wood Johnson Foundation. An additional 16 million Americans ‹ mostly low-income workers ‹ are offered health insurance through their jobs but decline because they get health care from government programs or it is too expensive, the study found. "The failure of the economic boom to expand employer-based coverage for working families significantly is ominous," the center said in a recent study. It found that the current slowdown and the rising cost of providing health care to employees produced a double whammy: fewer companies are now willing to offer their workers health care coverage, and those that do will demand that employees shoulder a far higher share of the cost. Rising Concerns Policy makers and health care analysts say the United States is again confronting a crisis in its medical delivery system. "The number of uninsured will continue to grow as long as health insurance premiums rise more rapidly than earnings, as they have for a decade," said Drew E. Altman, president of the Henry J. Kaiser Family Foundation, which tracks health coverage trends. "Losing health benefits is becoming a middle-class issue," Mr. Altman said. "If it had not been for expansions in the child health program and Medicaid, we would have 10 million more uninsured." The growing number of uninsured and the rising cost of health insurance have stimulated Congressional interest on a scale not seen since 1993 and 1994, when President Bill Clinton tried to remake the health care system and guarantee coverage for all Americans. The major proposals being debated now fall into two main categories. One approach, favored by Republicans and some Democrats, would provide tax breaks to help individuals, families and small businesses buy health insurance in the open market. The other, preferred by many Democrats, would expand eligibility for Medicaid or the Children's Health Insurance Program to include the parents of some children who are already eligible. Either plan could have eased the situation of Brian and Anna Brooks, who run a small electrical contracting business in Westminster, Colo. They gave up their health insurance for themselves and their 8-year-old daughter this year to keep their business afloat. They had already let go four of their five workers and wanted to maintain health coverage for their remaining employee. Ms. Brooks said that they dropped their health coverage in July after the family premium jumped to $989 a month from $489 a month. Business was slow, and their previous income of more than $60,000 a year had fallen by half. The effect has been immediate. Mr. Brooks, 50, has stopped taking Lipitor to control high cholesterol and has started taking over-the-counter herbal supplements. Ms. Brooks no longer takes Singulair for asthma and has adopted an exercise program intended to regulate her breathing. Ms. Brooks estimates they are saving $150 a month by not using prescription drugs. "We changed our diets a lot in order to help the effectiveness of the supplements, and maybe that's a good thing," she said. They are setting aside $30 a month for their daughter's medical needs, but one ear infection would quickly empty the pot. The federal Cobra program, enacted as part of the Consolidated Omnibus Budget Reconciliation Act of 1986, is devised to provide a cushion for those who have recently lost their jobs. It allows workers to maintain their health care coverage for up to 18 months if they assume the full cost of the health coverage provided by their former employer. But many find the cost prohibitive, and only a quarter of workers say they would keep up their coverage under Cobra because of its high cost, according to a new survey from the Commonwealth Fund, a private research group. Betting on Good Health The high cost of Cobra coverage presents many people who have recently been laid off with a cruel choice. Audrey Robar of Milwaukee, 63, who lost her job at a private social services agency in September, decided to skip the $300 a month Cobra package in the expectation that she would soon find another job. It was a gamble, and she lost. "She was thinking she could get away with it," her daughter, Eva Robar-Orlich, said in an interview last week. In the early hours of Oct. 23, Ms. Robar began to suffer chest pain and dizziness. She called her sister to ask whether she could seek medical care immediately and sign up for Cobra later. Her sister, Alden Egan, urged her to call an ambulance right away, but Ms. Robar set down the phone to look for the Cobra documents. Ms. Egan then heard over the open phone line the sound of her sister falling to the floor and quickly called 911. By the time paramedics arrived a few minutes later, Ms. Robar was dead of a heart attack. "I think the fact that she hadn't paid for Cobra very well could have cost her her life," said Ms. Robar-Orlich. "She deliberated over calling an ambulance at a time when every minute was urgent." Because the insurance crisis has hit high-income families and millions of middle-class Americans with jobs, advocates for the uninsured have expressed hope that Washington will finally resolve the problem. High-wage workers and small-business owners are a much more effective lobbying force than the unemployed, children and the poor. Mary R. Grealy, president of the Healthcare Leadership Council, an industry coalition seeking coverage for the uninsured, said: "We are very optimistic. More and more people say that the uninsured will be a big issue in the next Congress." "Lawmakers have seen the new face of the uninsured ‹ it's not a welfare population ‹ and will seek solutions for the employed uninsured," the many working families who lack insurance, Ms. Grealy said. "This is now an issue for Republicans," she added. "It's not just a one-party issue." Ronald F. Pollack, executive director of Families USA, a consumer group, said that Republicans and Democrats could agree on proposals combining tax credits with some expansion of Medicaid and the Children's Health Insurance Program. On the other hand, proposals to aid the uninsured could easily touch off a partisan brawl, in which lawmakers fight over the merits of government programs versus the private market. President Bush has already proposed tax credits and is expected to offer more proposals to help the uninsured as part of his budget early next year. In his first two budgets, Mr. Bush earmarked a large amount of money for health insurance tax credits: $89 billion over 10 years, for people who are not covered by an employer's plan and not eligible for public programs. The proposal languished in Congress, but Mr. Bush will have a greater incentive to push for action this year. "The president wants to develop a record on health care to neutralize this issue going into the 2004 elections," Mr. Pollack said. The issue is of particular concern to small-business owners, who say they would like to offer their employees health insurance but cannot keep up with the fast-rising premiums. They are a large and influential lobby and an important base for the Republican Party. Martyn Hopper, the California state director for the National Federation of Independent Business, said that 42 percent of the state organization's 37,000 member businesses did not offer their employees health care coverage. He blames rising premiums and the high cost of doing business in California, which has imposed a number of expensive mandates on employers. Big companies, Mr. Hopper said, can move operations to cheaper locations or offshore, but mom-and-pop businesses are forced to lay off workers or make their employees pay an ever-increasing share of health care costs. Tom Lucas, who owns two plant nurseries outside Los Angeles, said that he provided health coverage to his 70 employees until the mid-1990's, when the cost became crushing. Mr. Lucas said that some of his workers have spouses with jobs that provided insurance, some drove to Mexico to seek cheap treatment and drugs, and some did without. He said that health coverage was particularly expensive in California because the legislature had imposed a number of mandates on the policies that employers must offer, including coverage for mental illness, comprehensive cancer screening, substance abuse treatment and weight loss programs. "Health insurance is a luxury I can't afford for my people," he said. "It's a great perk, but in an industry like my own, it's not reality. There's not enough dollars to go around." Roadblocks to a Solution While there is continuing public concern about health care and gathering sentiment in Washington to do something about it, a number of constraints are limiting the likelihood that the growth in the numbers of the uninsured will be reversed any time soon. Growing federal and state budget deficits will make it difficult to find money to subsidize coverage for the uninsured. The president and members of both parties have promised prescription drug benefits to the elderly, who vote in large numbers, and fulfilling that commitment is a higher political priority for most lawmakers than addressing the problem of the uninsured. In addition, doctors, hospitals, nursing homes and other health care providers are demanding higher Medicare payments, which will eat up money that could be used to cover people with no insurance. Medical providers are much more effective lobbyists than are the uninsured. A number of proposals on Capitol Hill would at least incrementally address the problem. One, sponsored by Senators Susan Collins, Republican of Maine, and Mary L. Landrieu, Democrat of Louisiana, would provide tax credits for the health insurance expenses of individuals, families and small businesses; allow small businesses to take a tax deduction for the full cost of their premiums; and allow states to cover low-income parents and legal immigrants under Medicaid and the Children's Health Insurance Program, know as CHIP. The bill would also provide federal money to the states to establish insurance purchasing cooperatives for small businesses and high-risk pools for people who cannot get insurance in the private market because of chronic illnesses. As Congress debates, however, employers and workers continue to struggle with higher costs and more difficult access to health care. Mitch Flinchum, the controller at a highway paving company in Burlington, N.C., sees the problems from both ends ‹ as an executive in charge of benefits and as a consumer. Mr. Flinchum pays more than 10 percent of his $65,000 annual salary for health insurance for his family, but he considers himself better off than most of his company's 350 workers. Only 119 of the employees accept the coverage, and two-thirds of those pay only for themselves and not their dependents. Mr. Flinchum says most of the workers who decline insurance do so because the premiums are costly and the coverage is so meager. "When you look at your benefits, you've got massive deductibles, massive co-pays, and unless you have a heart attack or cancer, which would be devastating in itself, it's like you don't have any insurance," he said. "I don't know where it stops," Mr. Flinchum added. "With a 20 percent increase each year, over time the only two people in this country who will be able to have health insurance are Bill Gates and Warren Buffett. No one else can afford it." Copyright The New York Times Company | Permissions | Privacy Policy ________________________________________________________________________ ________________________________________________________________________ Message: 2 Date: Thu, 28 Nov 2002 13:09:49 -0800 From: "Lynn Porter" Subject: Fw: Greetings to PDX Community Leadership Team ----- Original Message ----- From: "Francis K Johnson" Sent: Wednesday, November 27, 2002 11:15 PM Subject: Greetings to PDX Community Leadership Team This greeting from Betty in Corvallis to PDX friends is addressed to all of the persons who are on my email list...it is not inclusive because I do not have ALL of the CLT on my computer but I hope this greeting will be shared with anyone else who is interested. THANKS to each of you for the tremendous efforts you have made to educate Oregon voters about Measure 23 and to gain their support. I have previously sent a thank you but it warrants saying it again...THANK YOU !! In each of the CLT areas our activists are reviewing what went well, what needs to be improved in the initiative itself and the strategy to get out the vote. We all need to take time to reflect on this powerful experience. Ideas are surfacing about how to proceed, both in terms of the content of the future initiative and the process . We want to consult with all the endorsing organizations and seek their input. We also want to talk to the opponents, learn what we can from them. As someone else has said, we need to find out what will voters support. In this process we will surely be looking at what kind of organizational structure will facilitate a winning effort. We have learned that the job is overwhelming for several hundred individuals who also have to earn a living and have other commitments in their lives...especially without the continuity and support of paid staff . People have laid down their lives and their incomes to an incredible degree and we can all be proud and grateful for their efforts. My greatest hope is that we will all keep talking to each other, try to work together to develop this next winning effort...the initiative, the strategy and the organizational structure. We need to be patient with each other recognizing that EACH person is sincerely motivated to achieve universal health care even tho' we may differ in our views on HOW best to achieve it. One reason it takes us so long ( YEARS to draft Measure 23) is that we talk and talk trying to arrive at what is best for the common good. Some people have left HCA-0 because they want to move faster, and we would all like to do that, but we can't listen to various points of view if we hurry. THANKS again for all you have done and will do....best wishes for a happy day as we enjoy our families and give thanks. Betty Johnson Please pass this on to other pdx friends who are not on my email list. ** * #346 Message: 1 Date: Thu, 28 Nov 2002 20:12:07 -0800 From: "Lynn Porter" Subject: Fw: Re: OREGON HEALTHCARE EXPANSION PLAN ----- Original Message ----- From: Message: 2 Date: Mon, 25 Nov 2002 09:23:52 -0800 From: Bill Michtom Subject: Re: OREGON HEALTHCARE EXPANSION PLAN Initial comments: I don't think people were against M23 for reasons other than the lies perpetrated by the opponents; primarily the successful - though false - impression that the taxes would be *in addition to* current costs. Second: M23 was outspent by a factor of around 50, as I understand it. If you don't think this is *the* most important factor, think again. Now, more particular items: >ELIGIBILITY >1. Oregon residents who: > * Are U.S. citizens > * Have established permanent residency in Oregon, through home > ownership or rental All residents should be eligible, regardless of citizenship or residence (i.e., homelessness should not be a bar to coverage). > * Are not eligible for the Oregon Health Plan or Medicare I know there is a question about getting the waivers, but we should write the measure to assume the waivers, but with a fallback position in it that deals with not getting the waivers. >2. Their domestic partners. >3. Their dependants at or below the age of 21. Would people over 21 be covered anyway? >COVERAGE >1. Medical, mental health, dental or vision care provided by a licensed: > * Medical doctor (MD) > * Mental health care provider > * Dental care provider > * Vision care provider >2. Doctor's office visits, outpatient treatment, hospitalization, >prescriptions, tests. Alternative care is covered in more and more current health plans. We should not leave it out. >3. With such exclusions as may be specified by the state legislature. This is a sentence that gives a hostile legislature a chance to exclude the entire idea. And we have a hostile legislature. >FINANCING >1. A tax on employers of $____ per month per employee eligible under this >Plan. >2. A monthly tax on employees, eligible under this Plan, according to >their gross yearly income range, as listed below. >3. These rates could be changed by the state legislature if necessary. Anything that gives the legislature openings into the plan should be rigorously defined. >COST CONTAINMENT >1. Medical treatment and prescription copays equivalent to those required >under OHP. No co-pays!!!! I do not think that people are going to swarm healthcare providers if they don't have a $5 co-pay (which is what I have now). People will seek healthcare when they need it - or they won't (as is often the case now). But we should not be putting any financial barriers in their way. >2. Yearly deductible of $100. No deductibles!!!! Do we have any hard evidence to indicate that people are profligate about seeking healthcare when they don't pay? If so, show me, then let's talk about this. >3. The same voluntary drug formulary (recommended list) now used by OHP. Is this the same formulary as, say, Kaiser? If I remember correctly, When I was on OHP, it was more limited. >5. Administrative costs would be capped at the same percentage as OHP. IS this more, less, or the same as these costs were in M23? >HEALTH CARE PROVIDERS REIMBURSEMENT >For patients served under this Plan, health care providers would be >reimbursed by the state for their services at a rate equal to their costs >plus ___ percent. "Cost plus" reimbursement is a formula for theft (see Pentagon purchasing). Is there some other approach we could propose? >NOTES > >This proposal is designed to remove all the clubs our opponents used to >beat up on Measure 23, and the reasons that otherwise sympathetic people >voted against M23. It is also designed to be simpler, and to remove vagueness. As I noted above, the weapons our opponents had were money, more money, and even more money. They could say anything they wanted without being challenged. The next measure should not start until we have at least a million dollars in a campaign chest. This might be possible by going to George Soros - who funds things like this - and others like him (there are at least two other million- or billionaires who funded medical marijuana initiatives along with Soros). >ELIGIBILITY > >U.S. citizens: I believe that resident noncitizens should be covered, but >I think a lot of voters disagree. This is another point where we can win people over if we have access to TV advertising. Resident non-citizens pay taxes and contribute to the economy in all the ways citizens do. >Excluding OHP & Medicare: This removes one of the main objections people >had, that they didn't think we could get the waivers for those two >programs, to funnel their money into our plan. I think we didn't really >know, and that could have shot down the whole program, if M23 had passed. As noted above, I think we can write language into a new measure that will cover it with or without waivers. Something like: "If waivers are not issued, the following alternatives will be implemented." >The purpose here is to cover those who aren't already covered by a >single-payer plan - which OHP and Medicare are. The purpose is also, I thought, to establish coverage that is the same for everyone, regardless of income, that does not depend on private (and especially for-profit) HMOs and insurance plans. OHP still is part of the private provider system. We have even less chance of getting action at the federal level now - with a completely reactionary government - than we did before the election. >COVERAGE > >The main club used to beat up on M23, and the main objection of a lot of >would-be supporters, was that M23 was too expansive in benefits. The main club was that it was too expensive - PERIOD. This was not based on anything more than deception: encouraging people to think of the new taxes as added on to what they are already paying, and that Oregon would be flooded with people coming here for free care. This was the same thing they said about Death With Dignity and that didn't happen either. I think a clear residency requirement is a good thing, but, somehow, it must include the homeless. >(OHP is in the process of being split into two parts, with the current >benefit level for the more vulnerable recipients, while cutting dental and >vision for the rest. This was done to expand the number of people on OHP.) OHP will continue to be cut, especially when so much more public money is being diverted to the military and the wealthy (no more estate tax; making the tax cuts permanent - which WILL happen). We cannot afford to depend on OHP for that reason and because it is tied into the private sector, with all of its wastefulness. >An alternative would be to say that OHP exclusions apply, or to specify >exclusions. This is the way to go. And better to specify, I think. If we stick with OHP exclusions, we encourage a 2-tier system again. >FINANCING > >We should try to make the employer tax less than they're now paying, on >the average, per employee, for medical insurance. This shouldn't be difficult, considering the much larger administrative and PR overhead of the private sector. >Which means we have to find out what the figure is. This is what people >will compare our tax with. They won't compare it to an average - I >believe it was over $4,000 - which people pay per year in total medical >costs. If people have to get out a calculator to figure out whether our >proposal benefits them, they won't. They'll just vote no. I strongly agree with this. Specific numbers will be of great help. >We need a simple table we can put on all our literature, or list in a >letter to the editor, that gives 4 or 5 gross income ranges and the >monthly tax for each. Or put in a 30-second TV spot!!!! We MUST do this. >GOVERNANCE > >Under M23 the program was to be run by a public nonprofit corporation. I >don't know what that is. This is not so difficult to get examples of - Elders in Action, for one. >That should also prevent people from claiming we're creating a vast new >bureaucracy. The "vast new bureaucracy" lie is another thing we will be able to fight ONLY if we have enough money to use TV, billboards, full-page newspaper ads, and substantial mailings throughout the 3-week voting period. >COST CONTAINMENT > >M23's cost containment mechanisms were convincing to me, but not I think >to most people. This is one of the main objections we got. ... So I've >added copays and a deductible to this plan Another item we can counter IF we have campaign money (and good, clear numbers). >Kulongoski proposed bulk purchase of prescription drugs in his campaign. This is something anyone can understand: "the purchasing power of three MILLION people." >HEALTH CARE PROVIDERS REIMBURSEMENT > >One of the main objections we heard from doctors is that they were afraid >M23 would be financed in part by reimbursements to health care providers >below their costs - as Congress has done with Medicare and Medicaid, which >is why many doctors won't take patients on those programs. So I think our >initiative should seek their support by guaranteeing them reimbursements >of costs plus some reasonable percentage of profit. As noted above, we need to be VERY careful using "cost-plus." Bill ________________________________________________________________________ ________________________________________________________________________ Your use of Yahoo! Groups is subject to http://docs.yahoo.com/info/terms/ ________________________________________________________________________ ________________________________________________________________________ Message: 2 Date: Wed, 27 Nov 2002 09:45:27 -0500 From: Joanne Landy Subject: 12/3-Conyers Speaks w Transit Workers re: Health Benefits PNHP-NY Members and Friends, Below is an invitation from Transport Workers Union Local 100 to a Dec 3 event describing the union's view on the health benefits issue. U.S.Rep John Conyers will be the keynote speaker. Solidarity Meeting on Labor Health Benefits-Tuesday, 3 December 2002 10:am to Noon NOTE NEW TIME OF EVENT: CONYERS GUEST SPEAKER Local 100, Transport Workers Union, 80 West End Avenue, at 64th Street Roger Toussaint, President of Local 100, Transport Workers Union is inviting health policy leaders, professionals and activists to hear the most up to date information on the union's health benefits negotiation with the Metropolitan Transportation Authority [MTA]. The labor contract deadline is December 15th. U.S. Congressman John Conyers will be speaking on his Universal Health Care proposal. Congressman Conyers is also the senior ranking Democratic on the House of Representatives Judiciary Committee. He is a specialist on the anti-worker provisions of the Homeland Security Legislation. The MTA has not committed itself to serious negotiations in general; and, the Health Benefit Trust in particular. Everyone agrees that the HBT 's in serious trouble. The health care and prescription drug costs crisis is out of control. It is hitting the TWU's HBT and threatening all members and their family's well-being. The newspapers and other media will be filled with information in regard to the negotiations that won't be accurate. This meeting is meant to make sure that everyone concerned about maintaining a strong worker-oriented health benefit fund is invited and will be receive accurate information. Please bring your colleagues and friends. You are just asked to RSVP to make sure the union knows who is attending. Call: 212-873-6000 and register for the Health Benefit Trust Meeting. [Note: For those registering, a description of the union's proposals will be sent via hard mail and/or e-mail. Be sure to list your e-mail and address when you RSVP.] ** * #347 Message: 1 Date: Sat, 30 Nov 2002 14:18:56 -0800 From: "Joan Binninger" Subject: Finding out how people will vote To all sharing thoughts and ideas through the many emails, To find out how the people will vote on any of the ideas put forth, it is critical to do a poll designed by a professional who understands how to poll on political issues. Making good guesses simply doesn't work. I think we saw that this time. People are still guessing that "this idea" might change minds or "this twist" will be accepted. You don't know until you have a professionally designed poll interpreted by the professional pollster. In the '80's and '90's I worked on several political campaigns which were on very controversial issues. We could never have won those campaigns without the expert knowledge, design and interpretation of Tim Hibbitts. It is sometimes possible to cut the cost by using volunteers to do the phoning and using the phones of a business or union. During the campaign other issues or ways of looking at the idea often come up. Then it is time to poll voters again. They are the only ones who know how this ides or that will affect their vote. You also explore any variables around a particular issue to see what is acceptable. When the opposition brings in distortions, it is time to poll again. Polls cost a lot of money if they are done professionally by someone with political experience in polling. In one of the recent emails there was a suggestion to raise as much money as possible. Excellent idea. In fact, I believe it is the only way to win on a ballot measure. If there are people who could give large gifts that is wonderful. One might even be willing to pay for a poll or two. All of the people working on the initiative should find a way to raise money. This is an area that needs planning and commitment. Joan Binninger ________________________________________________________________________ ________________________________________________________________________ Message: 2 Date: Sat, 30 Nov 2002 15:55:03 -0000 From: Joshua Dow Subject: the gift of health for the holidays I know email may not seem like much for advocating single-payer, but the following's my suggestion at least for one way to perhaps get people informed & lay the ground work for another try in 2004. It also remarks against copays, but I don't have strong opinions about whether or not they get used for just getting "single-payer" passed. I've sent around all of the following before in pieces--just something you might forward to anyone you know, even outside of Oregon for Congress's current resolution 99, & Representative Conyers soon to be tabled bill for national single payer. Successful chain emails it seems to me ruthlessly play on sentimentality, so this is what I think of as fighting fire with fire--playing on people's instincts 1st, at least before trying to appeal to reason. ------------------------------------------------------------- Something to think about in the season of giving ... --- if this email's been jumbled by >>s, you can get a clean version of it at: http://www.geocities.com/scout431/liver.htm --- This message that went over the staff email system of my hospital, about a really nice & helpful but shy father in maintenance. There's a simple way to help this father+IBQ-it lets you end up with MORE MONEY FOR YOURSELF +ICY without a pyramid scheme. ------------------------------ THIS MESSAGE IS CONCERNING ONE OF OUR FELLOW EMPLOYEES, ..., HIS 15 YEAR OLD DAUGHTER IS IN NEED OF A LIVER TRANSLPLANT. WE HAVE PUT CANS IN THE CANTEEN AND OTHERS WILL BE DISTRIBUTED. ALSO, DENTAL HAS A CAN. YES, SHE HAS INSURANCE, HOWEVER, THE TRAVEL BETWEEN ... AND PORTLAND AND A HUGE CO-PAYMENT IS OVERWHELMING. PLEASE HELP BY PUTTING A SMALL AMOUNT OF SPARE CHANGE IN ONE OF THESE CANS. THANK YOU VERY MUCH. YOUR SUPPORT IS WELL MORE THAN APPRECIATED. ------------------------------ *What would have helped this father is not loose change, but your yes vote on OR's measure 23, non-profit state-wide health insurance +ICY or clicking an email on your behalf to your DC representative for national health insurance for all. *****SEND THIS EMAIL TO ANYONE YOU KNOW. ***** Even if this girl gets her transplant in time, she'll still need health insurance in the future, & maybe Oregon can give that to her one day. That would be the best holiday gift for her. Health insurance companies will do their best to not have to sell her health insurance. *& if you don't live in Oregon, there's also a national effort to help people like this father: http://www.capwiz.com/ams/issues/alert/?alertid=8689&type==CO *Suppose you had to vote between living in our current state or one that had 10% lower wages but also a 50% lower cost of living. Judging from how Oregonian's vote, we would have chosen to not have the lower cost of living, despite how it would leave us with more money overall. Negative ad slogans of "no lower wages" would have been all it took to make us vote that way. *That's how we voted on OR's measure 23, & the insurance companies spent $1.2 million of our premiums to do it. In addition, corporate health insurance also wastes 30% of our health care premiums on incomprehensible bureaucracy, a cost that comes out to $465 billion/yr over the whole US, almost $100 billion more than we spend on national defense. & our decentralized system encourages 3-10% of our health care spending to be fraud, between 45 & 155 billion $, unheard of in other industries. *Basically +ICY A MEDICAL ENRON. (sources for all these facts are at the bottom) *Medical problems cause 45% of bankruptcies+IBQ perhaps where this father is headed. *With bureaucratic & payment delays to the most timely care, this girl may join the 18,000 premature deaths that result from corporate health care each year in the US. +ICY That's right. Corporate health insurance leads to SIX World Trade Centers EVERY YEAR. *What would have helped this father is not loose change, but non-profit, state-wide health insurance for all. It's not socialized medicine, because doctors would still compete in a free market for their customers by giving the best quality care they can. *With 23, yes we would have voted to have higher taxes, but we would spend less money overall, because we wouldn't have had to deal with insurance premiums, copays, & deductibles+IBQ-the US GENERAL ACCOUNTING OFFICE tells us that (see url towards bottom). *23 would have improved on Canada's health care system. While Canada does have an underfunded health care system (they spend less than half what the US spends on health care but many tax payers there would like to see an increase), they still save so much on bureaucracy (11% total costs), that they're able to do more liver transplants per capita than the US & have a higher life expectancy than the US. *That's right. Despite how corporate advertising bashes Canada's health care, CANADA DOES MORE LIVER TRANSPLANTS THAN THE US. That would have helped this father. ------------------------------ Sources for the above facts: -18,000 premature deaths/yr: the National Academy of Sciences and the Institute of Medicine: http://books.nap.edu/books/0309083435/html/index.html Read a Washington Post article on the study: http://www.washingtonpost.com/ac2/wp-dyn?pagename==article&node==&contentId=¥2828-2002May21¬Found==true -how a single non-profit insurance system would cost the US less than what we have now, even with insuring everyone & providing better care, EVEN with NO copays or deductibles: The US GENERAL ACCOUNTING OFFICE+IBQ the NONPARTISAN research arm of the US Congress: http://161.203.16.4/d33t10/147386.pdf http://161.203.16.4/d20t9/144039.pdf http://161.203.16.4/d31t10/145910.pdf http://www.gao.gov/ -30% administrative costs for US health care: The Archives of Internal Medicine. 5/13/2002. p. 973-975. http://archinte.ama-assn.org/issues/v162n9/rfull/icm10047.html -for how it's with our CURRENT system that 3-10% of our health care spending is fraud: http://www.msnbc.com/news/833915.asp?0dm==N1BOH -for how medical problems cause 45% of bankruptcies, the book "Bleeding the Patient" (back cover); & for how Canada does more liver transplants than the US, the book "Universal Health Care: What the US can learn from the Canadian Experience" (p 82). -a very short powerpoint slide show on what's up with our health care system: http://www.pnhp.org/publications/HCpowpt.ppt -& finally for the truth about measure 23: http://www.healthcareforalloregon.org/FAQ.htm -a booklet for discussing 23, what it meant, & how it was covered by the media: http://www.everybodyinnobodyout.org/Downloading/ORdiscn.pdf ____________________________________________________________________ ** Message: 1 Date: Sat, 30 Nov 2002 19:57:49 -0800 From: "etsachs" Subject: Re: Digest Number 346 Second: M23 was outspent by a factor of around 50, as I understand it. If you don't think this is *the* most important factor, think again. **Is it possible to turn this around by using the Internet with short, factual snippets about M23...short and to the point. -eral ________________________________________________________________________ ________________________________________________________________________ Message: 2 Date: Sun, 01 Dec 2002 13:24:19 -0800 From: Marc Shapiro Subject: An Eppilog to Measure 23 Friends, I write this in response to what I have seen in the "Email dialog". As you know, I placed myself on the firing line in the measure 23 campaign. Although I didn't really keep track of the numbers, I believe I participated in, something like, ten debates and countless presentations. I had the pleasure of responding to all the accusations that were made against us and the measure. My rhetoric tends to be sardonic, but when I say "I had the pleasure", I really mean it. To digress for the moment, I have spent my life in three main areas. My formal training is in electrical/electronic engineering. My father was a devoted medical diagnostician and researcher. He was responsible, among other things, for the concept and research that provided "Cumadin", the world's leading anticoagulant, and the discovery of Sickle Cell Anemia. He was called upon to diagnose and treat many notable people all over the world. In the bizarre political twist, when President Eisenhower had a heart attack, he was asked to prescribe his treatment. However, he was not allowed to examine him, because my father was a Democrat, and, as you know, Eisenhower was Republican. So Colonel Pulluck, one of Ike's personal physicians came to NY to visit and consult with my father to determine Ike's treatment. As you can see from this, the stupidity of the US political system has a long history! As a result of growing up in a medical environment, the first work I did after graduating from engineering school was in Medical Electronics. I find myself, 38 years later, again working in medical electronics. My activities outside of engineering, though never divorced from it, included a heavy involvement in politics. I ran for public office six times and I apprenticed in legitimate theater and have been involved in the performing arts for most of my life. My mother was a concert pianist and my wife is both a musician and play director. With the above background, Public Speaking on behalf of a cause I believe in, and UHC certainly fits all the requirements, is something that I do easily. Based on my perception, and what I have been told from the audiences, both on and off the air, I believe I won all the debates on Measure 23 in which I participated. Which is to say, I was able to effectively present and defend the positions we took in writing Measure 23, almost without exception. This is not to say that there are not some areas that could be improved. However, the concepts imbedded in that document were based on the results of many credible studies and intense debate and soul searching by those responsible for the measure's creation. Those who had the opportunity to hear me speak on the subject would have heard me state that there can be no "perfect" measure. NO TWO PEOPLE THINK ALIKE! No matter what document may be created, virtually everyone who analyzes it will find some fault with it. It, therefore, is not a matter of creating the "perfect" Plan, but rather to make the public and those politicians, who are capable of rational thought, accept that no plan will be without fault. My words, repeated many times, in response to the statement "This plan is faulty." were: "And what we have now isn't?"! How absurd. With a health care delivery "system" so faulty that it is crumbling around us, how can one, rationally, have rejected Measure 23 because it is "faulty"?! Measure 23 was "statutory" legislation. It could have been and would have been modified to make it work as best as possible. DO NOT BE FOOLED INTO BELIEVING THAT SEEKING "MEDIOCRITY" IS A SOLUTION TO ANY SOCIAL PROBLEM. We have allowed our society and our government to embrace mediocrity as an ultimate goal. The more we achieve that goal, the more we erode very fabric of the society! The two main principals of Measure 23 are: 1. The provision of needed care to all residents and 2. The substantial increase in the economic efficiency in the delivery of that care by the elimination of the "middle man", the insurance companies. Please do not be deluded. In all the alternative concepts I have seen proposed in Email in the weeks since the election, I noticed NONE that would keep the insurance companies in place to continue to drain the economic "life blood" from the system and the society. If any of you believe it is worth perusing another initiative, be assured that the insurance industry will again expend as much money as it deems necessary, without limitation, to defeat any measure that will put it out of business. We knew, and we stated repeatedly at our meetings, that we COULD NOT win this battle in the world of media advertising. Only by obtaining the necessary resources to mount an enormous person to person campaign would an initiative have any chance of passing. The voters need to understand, from personal contact, that the negative advertising is/will be a distortion of the facts and should be ignored. Without a plan to achieve such a goal, an initiative campaign is an exercise in futility. Conversely, with such a plan in place, it would be possible to win. I believe it would be foolish to pursue anything other than a comprehensive, single payer, UHC system. While I commend those who have been willing to invest the time and thought into proposing alternative Plans, these people are, for the most part, working without the background of knowing the thought process that went into what was written in Measure 23. The diverse talent, knowledge, training and backgrounds of the people who created Measure 23 is unprecedented. While we know, as a result of all the dialog that has taken place in the last year, that there are some needed improvements, Measure 23 is an incredible document. Before anyone chooses to compromise its intent, he should make sure he knows the reasoning that went behind what was written. I am in no way proposing that we embark on another initiative campaign. Without the necessary resources it would be another exercise in futility. Though I don't claim that it is possible, I believe we need to create a coalition of forces backing single payer, comprehensive, UHC. It must be so inclusive and diverse that it will cause the politicians to believe, in spite of their political views and the paid influence of the insurance industry, that their failure to enact the legislation that we propose will lead to their losing their elected positions. I hope you will take the time to consider what I have said. I thank you all for the time, energy and enthusiasm that you have brought to our campaign. The windmills remain standing, but they must ultimately fall. Marc Shapiro ________________________________________________________________________ ________________________________________________________________________ Message: 3 Date: Tue, 26 Nov 2002 19:25:29 -0800 From: "etsachs" Subject: Madison Ave. Has Growing Role in the Business of Drug Research Madison Ave. Has Growing Role in the Business of Drug Research Melody Petersen New York Times, November 22, 2002, page A1 http://www.commondreams.org/headlines02/1122-04.htm This article reports on ways in which the pharmaceutical industry has managed to produce medical research that helps to promote its drugs. This includes paying researchers to write articles touting the benefits of their drugs. In some cases, these articles are ghost written by the company's writers, with researchers accepting a fee to put their names on the article. These sorts of abuses are exactly what economic theory predicts would occur when the government grants a patent monopoly. ** * 349 Message: 1 Date: Mon, 2 Dec 2002 19:40:06 -0800 From: "Lynn Porter" Subject: Fw: Miller proposal -- Transition to Universal Health Care by 2008 ----- Original Message ----- From: "marklindgren" To: "HCA-O steering comm., & others" Sent: Monday, December 02, 2002 11:27 AM Subject: Miller proposal FYI, here is a proposal submitted to HCAO from Tim Miller, staffer at Oregon Health Action Council (OHAC). I have concerns about ensuring a quality proposal from the proposed commission and the short transition period, but thought the HCAO steering committee should consider it as part of the mix of proposals that we will be looking at. Mark Lindgren Transition to Universal Health Care by 2008 In 2004 we submit a referendum to the citizens of Oregon asking them to direct the State government to provide X amount of money to fund a commission that will submit a transition plan to obtain Universal health Care for all US citizens and legal immigrants within the State of Oregon by the year 2006. In 2006, the Transition plan is submitted to the population for a yes or no vote. By 2008, all US citizens and legal immigrants who are Oregon residents will transition from whatever health insurance plan they had to the new Oregon Universal Health Plan. The reasons we use this approach are ­ 1. Assuming we can convince the population to vote in favor, we will build momentum towards 2006. 2. A referendum may not be as threatening to the opposition as an actual vote to establish OUHP, they may not feel the need to put in as many resources to stop it, thus making the playing field a little more even and requiring us to raise less money. 3. Between now and 2004 we approach all those who say they are in favor of OUHP and invite them to be part of the team to pass the referendum and more importantly to conspire with us as to how pro-OHUP forces can dominate the Commission which will write the transition plan. We also approach groups that should be on our side but who are not (Hospitals, medical professionals, whoever) to talk with them about just why they are opposed and to see if there is some way to gain their support or at least neutralize them. For some, this will tie them in as partners and supporters broaden our base, increase possibilities of receiving both funds and a larger core of volunteers. For others, we will force them to either take a stand in favor or show us their true colors. 4. A referendum will eliminate most of the arguments the opposition has made against us last time. The Commission will handle the details of the OHUP, how extensive coverage is, how much taxes will be increased, who pays, what happens to the undocumented and out of staters who may move to Oregon, to what extent alternative health treatments are covered, etc. All we ask is the people take a stand, much easier to defend and pass. 5. We gain time to prepare for the arguments the opposition will use against us in 2006, but this time we will have a broader base of support and more extensive funding and volunteer base to fight back and counter their propaganda with. Between 2004 - 2006 ­ 1. Make sure the Commission is composed only of those people who have been in favor of Universal Health - there could be room for appointed consultants, such as various government of business representatives, but these people have no vote as they will serve in advisory or research roles only. We do not need a bunch of uncommitted assholes sabotaging the plan from within the Commission. 2. Create a plan that is doable and passable, we can always expand it later on as the economy improves, we work out the bugs, and as support for the plan increases among the population. 3. Drop the undocumented and put limits on out-of-staters moving to Oregon, especially if they have pre-existing conditions. Not that this is right or just, but it will make it more likely to pass and eliminate some of the opposition¹s major agruments. We can change it later as the plan is established. 4. Create a plan that starts off with basic services and expands to cover more as Federal waivers are obtained, alternative funding sources found, economy (and tax revenues increase), etc. This may also help neutralize some insurance company opposition as there will still be a market for supplemental insurance (less insurance jobs lost, more time for businesses to adjust, still room to make a buck). 5. Create a plan that will encourage non-insurance businesses to participate, show them how/why it is good for them, their employees and get their political and economic support. 6. If Transition plan is passed, everyone will get immediate coverage, but for the first two years, coverage may come from a variety of sources (private insurance, work, etc.). By 2008, all these plans will be transitioned into the OUHP and everyone who is a US citizen or legal immigrant will be covered under the OUHP. What do you think? Of course it will need a lot of work, this is only a draft of an idea. ** * #350 Message: 1 Date: Tue, 03 Dec 2002 15:12:19 -0000 From: Joshua Dow Subject: an HMO ambulance? (joke ****) maybe this one for anyone who wants to try shorter, to the point, chain emails? before the election I sent it around to people I knew, but couldn't send it via hcao since the post doesn't allow attachments. it only occurred to me now to just make it into a url: http://www.geocities.com/scout431/hmo.htm ____________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Message: 2 Date: Tue, 3 Dec 2002 22:44:13 -0800 From: "Lynn Porter" Subject: Fw: Steering Committee minutes 11/12/02 These are the minutes from the last meeting of the state HCAO Steering Committee. ----- Original Message ----- From: "marklindgren" To: "HCA-O steering comm., & others" Sent: Monday, December 02, 2002 9:23 PM Subject: Steering minutes 11/12/02 HCAO Steering Committee Salem OHAC Office 4:30-7:30 p.m. Tuesday, November 12, 2002 Minutes In attendance: Don McCormack, Phil Dreyer, Ruth Duemler, Betty Johnson, Estelle Womack, Bob Cassidy, Max Wilkins, Walter Brown, Mary Brown, Don Terwilliger, Marc Shapiro, Carmel Decroos, Herb Matthews, Tim Miller, Charlotte Maloney, Sen. Bill Morrisette, Mark Lindgren, Dan Isaacson, Britt McEachern. Announcements: Carmel has asked about recycling signs, stakes, and hardware. 1) Minutes- Act on 10/29/02 minutes, review and modify agenda. Betty Johnson moved and Charlotte Maloney seconded that we accept the minutes as suggested. 2) Financial report- Charlotte Maloney, Treasurer Loans, Late November fundraising letter to supporters? A little over $4,000 in the checking account. We are expecting funds to come in from the website, but the exact amount isn¹t yet known. The Executive Committee will deal with paying off campaign debts as money comes in. The Executive Committee will also discuss fund raising. 3) Post-election campaign analysis -- Where Do We Go From Here? Campaign Mechanics . Shoestring campaign . Need a source of funding so we can do it right so we can have a staff that can make it happen . Need to have a way to reach the voters independent of the Media . Need comparatives ­ cost now, what the new system will cost and also look at coverage now and coverage under the plan . Few politicians or newspapers were supportive. . Need someone behind us ­ for example AFL-CIO, ASCME, Teachers Unions . Without AFL-CIO support, it was going to be hard to pass this. . Supporters are not voting in the numbers that our opposition votes. . Large unions felt that they had already negotiated a better package than our plan would have offered and that costs would shift from employer to employee. . Unions did not want more than 20% of the funding to come from income taxes. . Unions didn¹t trust that they would be able to get employers to pay the employees part. . Labor will do this for themselves when they have to but they won¹t support us. . The title was hard to overcome. . Corruption in the Secretary of State¹s Office . No cost controls in the initiative . Needed doctors as spokespersons . Dan drove just under 20,000 miles in the last 5 months. . We had trouble with the possibility of not getting Federal waivers and the plan basically imploding. . Lot¹s of letters to the editor ­ second highest number of letters received at the Register-Guard . Uninsured people don¹t vote and don¹t give money . Taxes was difficult drumbeat to fight against this election cycle . We did a great job raising awareness of Universal Health Care. . We went about it the right way ­ the full package, fight one battle other than many (incremental) battles . We got away from our grassroots support . A lot of things go back to having so little money . We did the best we could with what we had to work with, but what we had to work with was inadequate . The uncertainty of the Health Care Boards made it easy to vote against us . We were covered by every major national news source Language of the Initiative . Personal income tax wasn¹t progressive enough. . Alternative therapies were a liability ­ what exactly would be covered? . What were the cost controls? . Residency . Need some sort or progressive co-pays Where do we go from here? . Unions are suggesting that they will be working for universal healthcare for children in the next election cycle. . Rather than being proactive, we need to be reactive to what comes next. It¹s going to be hard to do anything until people are hurting more. . Exclude union members from the plan. . We need to be able to fund what we want to do. . Don¹t eliminate segments of the population ­ this would destroy the purpose of the plan. . Deal needs to be made upfront. . Put off the Initiative to 2008. . Should ask every member of House and Senate to agree to have Universal Health Care by 2004. . New name ­ Universal Healthcare Coalition . We need to outmaneuver our opposition . We should be on cable access ­ maybe a general health show . Get by-in from medical care providers . Watch what is happening at North Clackamas School District on their health plan ­ they¹ve cut out the middleman . What exists now in Puerto Rico and Hawaii? . Work with Hispanic organizations . Consider municipal resolutions . Use stepping stones to do it a piece at a time ­ incremental approach . Campaign Finance Reform needs to happen before we can get anywhere . We need to have a representative from other organizations working on this topic . Are we open to change? If so, then we should ask our supporters/endorsers what they think. We should outline the questions (substance, strategy). We should also go to those that opposed us as well. Also volunteers. Also stakeholder groups. . Don Terwilliger is willing to help on the website? . Incremental steps can be flanking maneuvers designed to build our support base and weakening our opposition . Kulongoski was interested in the concept of Universal Health Care in the 70¹s. . We¹ve got to have money so that we can hire staff. . We could raise money by canvassing. . Link up with Tribes for funding for town hall meetings or something like that ­ help raise the issue. . We need to use the momentum of people now that this initiative has generated. . We need to keep alternative/complementary care in the mix. . Use interns. . We should use the names from petition signers to build our volunteer base. Walt moved and Charlotte seconded a motion to lobby the Oregon legislature to get them to pass a resolution supporting the Health Care Access Resolution. It passed with no opposition. Brown committed to lobbying. ** * #351 Message: 1 Date: Wed, 4 Dec 2002 11:17:24 -0800 From: "Dr. Joseph Eusterman" Subject: thoughts Lynn, Appreciate and agree with Marc Shapiro's comments. If you watched "Benjamin Franklin" on OPB last week you know how little concensus there was even on the Constitution. As I said earlier, I thought M23 was very well done and an excellent first effort amenable to appropriate improvements over time. Attached find comments from Wm. Jarvis, PhD (from U of O) in health education, now retired faculty of Loma Linda U. and founding principal of the National Council Against Health Fraud (www.quackery.com). His wife is Canadian and they live part of the year in Revelstoke, B.C. He has much experience with Canada's Medicare. Joseph H. Eusterman,MD,MSMed,FACOEM,CIME 851 A Ave, Lk. Oswego,OR 97034-2946 Ph/FX 503-699-9534 Cell: 503-803-0846 jhewoems@msn.com www.ethical-services.medem.com www.imenet.com Bill, Thank you for another thoughtful reply which helps clarify where you're coming from. Your concepts certainly have the merit of "virtus in media res", virtue lies in the mean, moderation in all things; always a wiser path than the extremes and still allowing/encouraging people to improve their life position. Guess like a lot of people, I'm very frustrated by the current state of health care. In the good old days of private practice fee for service, people's health insurance limited provider payments and balance billing was not allowed. Seemed a good system to me until my office overhead went from 35% to 65% of payments and I refused to give my patients less time/visit or checkup by doing assembly line care, as now my colleagues choose to do or be forced out of the HMO. Boeing came to my rescue and I was able to hold things together and get the kids educated, thank the Lord. Would you permit me to fwd your comments to the HCAO (Health Care for All Oregon) (probably would then get to other like-minded groups) or would you rather save them for an NCAHF treatise (which I think would carry some weight to help correct the problem)? Joe ----- Original Message ----- From: William Jarvis Sent: Thursday, November 28, 2002 8:42 AM To: Dr. Joseph Eusterman Subject: Re: Fw: The Future of Health Care in Canada Please do not think that my disappointment with socialized medicine is an blanket endorsement of private enterprise in all its forms. I think that managed care has been a disaster. Just as we discussed before, it is founded upon commercialism, not professionalism. But, socialized medical systems, such as the Canadian, have been based upon equalitarian ideologies that are oblivious to the realities of human nature. What I am concerned about in so-called "single payer" systems is that the single payer is usually the government. Government bureaucracies have a pretty consistent record of becoming cumbersome, inefficient, insensitive dinosaurs. I believe that there is a great need for experimentation with a variety of approaches. If I were King of the World (ha), I would mandate a system on the federal level that would include basic care, and would require the states (or regions if several small states wished to work together) to implement the programs. This could be through privatization, state-run, or a combination. I have the feeling that state-run systems could work if they are small enough to still be responsive to consumers and professionals. I would not be enthusiastic about any system that prohibits professionals from offering private practice medical care on their own initiative. By the way, another factor that made the Canadian plan a success was its very low paper work requirements. Our system has become overburdened with paper work. Of course, the Canadians do not have the huge number of attorneys that we do, nor is there a culture of litigation there as here. On the malpractice litigation side of the picture, the Canadian system enjoyed the advantage that medically-injured patients do not merit the high monetary settlements because they cannot argue that their future medical care will be excessively expensive (since the system would be handling their medical needs). ________________________________________________________________________ ________________________________________________________________________ Message: 2 Date: Tue, 03 Dec 2002 09:43:21 -0800 From: mark lindgren Subject: employer mandate in public debate San Francisco Chronicle December 2, 2002 The Mounting Crisis in Health Care Universal medical coverage needs universal commitment By Bruce G. Bodaken, Chairman, President and CEO of Blue Shield of California Hardly a day goes by that we don't hear a story about turmoil in California's health-care system: the collapsing trauma network in Los Angeles; hospital overcharges in Redding; bankrupt medical groups in San Jose or nurses on strike in the East Bay. Health-care costs are rising at astronomical rates, thousands are losing their insurance and the state government is too broke to adequately fund health-care programs for the poor. This unequal and inefficient system must be changed. A new model should be based upon individual, corporate and societal responsibility. Here's what we should do: -- Build upon the existing employer-based system: Preserve a paradigm that has successfully insured a majority of American workers and their families for six decades. Require employers, except smaller companies, to offer coverage or contribute an equivalent amount toward an essential benefit package for each employee. -- Promote state programs: Enroll every eligible Californian in Medi-Cal or Healthy Families. The state and private sector should work together on creative and effective marketing and outreach strategies. -- Require coverage: Require those who can afford insurance to buy it. Others would be subsidized based upon documented need. -- Define essentials: Provide an essential benefits package, designed by independent medical professionals, that would guarantee preventive care, physician services, hospital care and prescription drugs. -- Encourage savings: Achieve savings through expanded preventive care, earlier treatment of the formerly uninsured, reduced use of emergency rooms and more secure financing. -- Establish tax-based funding: Supplement the additional business and individual contributions to the insurance pool with a modest, broad-based tax or fee as needed. http://www.sfgate.com/cgi-bin/article.cgi?file=/chronicle/archive/2002/12/02 /ED52155.DTL Comment: To say that there is a tide of support for an employer mandate for health care coverage with a public program for low-income and uninsurable individuals would be a gross understatement. That tide is a tsunami that will soon engulf California. The employer mandate is now supported by politicians, business, labor, organized medicine, hospital administrators, consumer organizations, and the insurance industry. In March, the RWJ Covering the Uninsured campaign will unleash efforts to align public opinion in support of this model of reform. It is likely that this year the employer mandate will cross the threshold of political feasibility. California will serve as a testing ground for political solutions for our health care crisis. Sen. Jackie Speier will be introducing legislation in support of the employer mandate/public insurance model, and Sen. Sheila Kuehl will be introducing legislation supporting a single payer model. Both are vast improvements over our current fragmented, wasteful and inequitable system. But there are major differences. The single payer model has the advantage of reducing administrative waste, allowing more funds to be directed towards a more equitable system of health care. It would provide economic mechanisms to slow the escalation of health care costs. The employer mandate/public insurance model would perpetuate both administrative excesses and the inequities of a system in which multiple health plans game the system to shift costs. And the public insurance component inevitably would be underfunded as it would be perceived to be a "welfare program." But the employer mandate/public insurance model has one overwhelming advantage: political feasibility. Our task is to make every effort to be certain that the public understands all options available. The other vested interests understand the issues and realize that the employer mandate/public insurance model comes closest to meeting their collective needs. The task to educate the public will be monumental. But the Canadian Romanow study confirms that a public that has decades of experience with a single public model emphatically rejects the suggestion that our system of private and public health plans would be preferred. For the democratic process to function properly, it is essential that we have an informed electorate. Since the vested interests profit by disinformation, it is our task to be sure that the public really understands all options. Immediate initiation of massive grassroots coalition efforts is mandatory. The alternative is a system, by default, that primarily caters to the vested interests of those with money and power, relegating patients to a secondary position. ** * #352 Message: 1 Date: Thu, 5 Dec 2002 12:40:12 -0800 From: "Lynn Porter" Subject: Fw: M23 post-mortem From Portland HCAO email list. ----- Original Message ----- From: Message: 1 Date: Wed, 4 Dec 2002 18:14:44 -0800 (PST) From: Roberta Palmer Subject: M23 post-mortem I missed the post-election discussion due to computer problems, so hope this is not repetitious. Here is my 2 cents. In May, 2001, I was excited to learn re the measure in spite of reservations about the financing. Oregon's income tax is already considered high, and I thought we would have a better chance with a sales tax. Yes, a sales tax is regressive and has been rejected in Oregon about 9 times, but we have never been offered a ST dedicated to HC. As an incentive, the income tax could have been slightly reduced and used more for schools. Social Security and Medicare are both funded by the regressive payroll tax. Not since Kennedy lowered the marginal income tax from 90% to 70% have the affluent in this country paid their fair share. Of course, the measure could not be changed, and I was assured that only those near the top income of $312,000 AGI would be taxed at 8%. That was fine, but a few months before the election, 8% fell at around $70,000 AGI, changed by a factor of four! A fatal problem in using the income tax is that it is an unstable source of revenue and accurate projections cannot be made for the individual taxpayer. Public services in the other developed nations are mostly financed with the Value-Added Tax, a type of consumption tax. It has the advantage of being widely spread throughout the economy, brings in tons of revenue, and lacks the clarity of an annual bill. To obtain broad-based support, a state-wide effort should take HC off the backs of employers. Not only would employees be freed from job-based HC, but we could gain the support of business: a win-win situation. Oregon is not Saskatchewan in the '40's, though. Medical technology had not exploded and drugs were cheap. The Canadians were not doing coronary bypasses on 85-year-olds, and their HC is still not as "aggressive" as ours. National Health Insurance or bi-partisan efforts such as the Wyden-Hatch Act are our best bet. The federal level is where the money is, and federal legislation can be more vague re taxation and the details than a local bill. I intend to work for the Democratic candidate in 2004, who will undoubtedly run on the HC issue, and will not bang my head against the same wall again. Peace, Roberta Palmer ** * #353 Message: 1 Date: Fri, 6 Dec 2002 11:11:20 -0800 From: Richard Lague Subject: Single payer on Fresh Air I just heard that Quinten Young of the Physicians for a National Health Plan will be on Fresh Air today. This program will be on Oregon Public Broadcasting today (12/6/02) at 2 pm and 7 pm. It is 550 AM in the Willamette valley. Rich Lague ________________________________________________________________________ ________________________________________________________________________ Message: 2 Date: Fri, 6 Dec 2002 11:25:27 -0800 From: Richard Lague Subject: Correction-Single Payer on Fresh Air They just announced on the radio that Quinten Young and the Single Payer discussion will NOT be on today. That will be on Monday's program. So, we will have more opportunity to spread the word. Rich Lague ________________________________________________________________________ ________________________________________________________________________ Message: 3 Date: Fri, 22 Nov 2002 23:12:13 -0800 From: "Lynn Porter" Subject: Fw: The Future of Health Care in Canada ----- Original Message ----- From: "Jim Ramsel" >From esfarley@facstaff.wisc.edu Fri Nov 22 11:09:27 2002 Subject: Notes for Remarks by Roy Romanow, Commissioner-Commission on the Future of Health Care in Canada Every American should read this. It is an outstanding statement by the individual assigned to study and recommend changes in the Canadian Health Care system. Gene --------------------------------- SPEECH Notes for Remarks by Roy Romanow, Commissioner Commission on the Future of Health Care in Canada The Canadian Club of Winnipeg Winnipeg, Manitoba November 20, 2002 And thank you to the Canadian Club for your generous invitation to join you today. As we get closer and closer to the release of our Report, I expect these kind of opportunities for fine dining will be coming my way somewhat less frequently, so I am delighted to be here today! It was just over a year and a half ago that the Prime Minister established the Commission on the Future of Health Care in Canada and gave me the honour of serving as its sole Commissioner. My mandate was as broad as it was clear: to review medicare, listen to Canadians and make recommendations to enhance the system's quality and sustainability. When I agreed to serve, I promised that my recommendations would be based on hard evidence and rooted in Canadian values. I have kept that promise. Over the past 18 months, we have completed a rigorous research program and exhaustive consultations, involving tens of thousands of Canadians - health experts and ordinary citizens, Health Ministers and Premiers, researchers and health care workers. Canadians, from sea-to-sea-to-sea, have contributed to our deliberations. Indeed, in just 12 months, our web site has logged over 24 million hits from people interested in our work! These consultations have given me some real insight into the values that Canadians cherish. My goal, through both the research and consultations initiatives, was to cut through the rhetoric and find the reality, to determine the true state of affairs and decide on the best course of action. CANADIANS REMAIN ATTACHED TO MEDICARE Throughout those many months, I heard Canadians, again and again, express their strong attachment to - as well as their very real concerns over - our health care system. And I was reminded again of just how deeply committed Canadians remain to the core values that lie at the heart of a system which has served them so well in the past. What I can say today, having examined the research and heard from Canadians, is that this system can continue to serve Canadians well in the future. But - and it is a significant but - only if we make some important changes. The fact is that medicare is as sustainable as Canadians want it to be; that the system itself needs fixing, not replacing, and that medicare remains a strong foundation on which to build. I have spoken a great deal over the past 18 months about the importance of values in any evaluation of our health care system. I have done so and I now strongly believe that any reform that does not resonate with the values Canadians hold will never attract the support such reforms must have. These values are equity, fairness and solidarity. VALUES & NOTIONS OF CITIZENSHIP These values are not abstract concepts - they are tied to our understanding of citizenship, to our common resolve to share the burden when illness strikes and to our determination to make our national policies reflect our national character. These values also have direct implications for the policies we pursue and the kind of health care system we create. If equity and fairness are to have meaning, then access to medically necessary treatment cannot be a product of wealth or status, but a right of citizenship. And if solidarity is a basic principle, then medicare itself must be national in scope, even if it is delivered locally. That, in turn, means governments must act together, working for medicare, not fighting over medicare. I can also say, without any hesitation, that the health care system our values have inspired is one of the world's best and perhaps, in this imperfect world, the world's best. That will no doubt surprise those who have been caught up in the over-heated rhetoric about costs, effectiveness and viability. SUSTAINABILITY & FEDERAL FUNDING Indeed, when we look at the evidence, we see that medicare has consistently delivered affordable, timely, accessible and high quality care to the overwhelming majority of Canadians. It has contributed to our competitiveness on the world stage and to the high standard of living we enjoy. Nonetheless, Canadians still have been exposed to an increasingly divisive debate about medicare's sustainability. We've been told that with escalating costs, an aging population, increasing expectations and ever more expensive technologies that we're headed for a brick wall; that we just can't keep going the way we've been going. So what's the reality? Is medicare sustainable? I've concluded that it is if we want it to be and we have the foresight and dedication to make it so. Let me explain. Governments tend to talk about sustainability in terms of costs - and in particular, who pays those costs. They don't look at the overall level of spending. As a result, we overlook some pretty basic facts, for example: health spending in Canada is not out of line with wealthier countries of the world and substantially below that in the United States. In fact, we are actually spending less on health care as a percentage of our GDP than we did a decade ago. So let's be clear: health care spending in Canada is not out of control in comparative terms. Perhaps what's more distressing about the debate on sustainability is the notion that our health care system is somehow on auto-pilot, beyond our ability to change its direction or reduce its costs. But I believe that the imagination and the ingenuity which that has helped to define us as a nation can also be applied to our health care system; that we can choose how and where to invest; that better management, a stronger focus on prevention, better institutions, and more effective use of technologies can both improve the health we enjoy and reduce the amount we pay. Does that mean that no more money is needed? I wish I could say that were so. But the fact is the system does need more money if it is to meet today's needs and if it is to successfully transform itself for the future. While recent federal budgets have seen the beginning of improved funding, the federal government still contributes less than it did - and less than it should. I therefore believe there is considerable merit in having a minimum threshold of federal funding established - a floor - below which it should not fall. Fiscal reality may dictate that this floor may not be reached overnight, but we should move toward it and make some targeted investments immediately. While it is a beyond my specific mandate, I have also been convinced by the presentations of many provinces that consideration of equalization bears directly on the sustainability of health care programming. In this regard, we should build on the commitments set out at the First Ministers Meeting in 2000. TIMELY ACCESS FOR ALL CANADIANS Before leaving the sustainability issue, let me point out that individual Canadians view it from a very different perspective. The issue for them is not "what does it cost?" but it also is: "will it be there for me and for my family when we need it?". The two issues are intertwined. These questions are already very real for Aboriginal peoples and those living in rural or remote areas, where care is not always available, certainly not in a timely way. Let's face the facts: across the system we have significant gaps in supply and demand, resulting in unacceptably long waiting lines for many medical procedures. These problems threaten to undermine public confidence, and when that goes, the siren call of privatization begins to sound as a panacea for all of our problems. But in my view, the suggestion that greater private sector participation in our health care system is the solution to the problems of timely access and waitlists defies logic. And, why? Because the solutions sometimes advocated amount to a cannibalization of the public system. What do you think will happen to waitlists if we reduce the supply of health professionals practicing in the public system to allow more of them to practice privately? Great Britain has tried this, and the result has been even longer wait times in the public system. Some argue that allowing more private delivery of care- the creation of a parallel system- will relieve pressure on the public system. How? * Will they process patients more quickly? It's hard to see how this can be achieved unless they cut corners or fail to follow standard medical procedures. * Will they focus more on prevention? If the discipline of market forces is indeed the rationale for allowing more private delivery, what incentive would private practitioners have to reduce demand? * Will they work longer hours? Possibly. But this can also be arranged in the public system. And what happens when a patient who has received care from a private provider falls ill as a result of failed procedure? They end up in a hospital emergency room and are treated by the public sector! Where does the private provider's liability end under these circumstances? All this suggests that we'll still need to have the public sector around- but a diminished one- to provide a back up to the private sector (and to pick up whatever high cost or high risk procedures it is uneconomic for the private sector to deliver). Friends, the proposition that more private care will magically solve the access problems confronting our health system just doesn't add up. The evidence just isn't there, and neither is the logic. In my final report, I will be proposing solutions to tackle the issue of timely access to quality care for all Canadians, including those residing in rural and remote communities and for Aboriginal peoples. These solutions will be consistent with the spirit and intent of the Canada Health Act. I will also be making recommendations to encourage a national approach to health human resources planning. NECESSARY EVOLUTION: HOMECARE & PRESCRIPTION DRUGS One of the most basic challenges we face in reforming health care is to bring it in line with today's realities. When medicare was established, health care meant doctors and hospitals. That's no longer true. New drugs have replaced surgery. New surgical techniques have shortened hospital stays. And more and more of the burden of care has fallen on families - especially women. As a result, homecare has become a critical part of the equation, but we haven't made it part of the health care system. Similarly, new drugs are undeniably welcome, but they can also be unbelievably expensive, especially for those who don't have a drug plan. Many families, struggling to juggle jobs with the provision of homecare and drug therapies to loved ones are facing real financial pressures. And some are going bankrupt trying. That's not Canadians' idea of fairness. That's not Canadians' idea of equity. I believe that priority must be given to establishing a national platform for homecare services delivered by the provinces as well as short-term measures to improve catastrophic drug insurance coverage for Canadian families. The details of both cannot be revealed until later next week. I know that proposals in these areas will be controversial, especially from those who want to see "less government" and less public money. But they miss the point. They're only looking at the cost to governments, not to Canadians. Sure, we could narrow medicare and spend less, but that would only pass the buck to individuals and ask them to bear the cost of critical services. That's not the Canadian way. That's not consistent with the values and vision of medicare. And that's not the way to build a caring, compassionate society. And while passing the buck may seem advantageous for governments in the short-term, it would likely be more expensive for our society as a whole in the medium and long-term. A NATIONAL APPROACH I mentioned a moment ago that Canadians view health care as a national program, even though it is delivered locally. I wish to stress this does not mean that the federal government should intrude into areas outside of its jurisdiction. Nor does it mean that we can adopt a one-size-fits-all approach, or that experimentation and innovation must be discouraged. In a country as diverse as ours, and with the relentless pace of scientific and technological advance, such rigidity is neither feasible nor desirable. But the opposite danger is equally real: that medicare will fragment into 13 or more separate health care systems, each with differing methods of payment and each with its own list of covered services. The most important point of all is this: quality care for all Canadians may be compromised. Today, we are seeing this very trend develop. Provinces and territories - sometimes by design, sometimes by financial necessity - are increasingly willing to go it alone. This trend is divisive. It offends the notion of equity. And it is no way to renew a program of such immense national importance or to strengthen the foundations that unify us as a nation. I will be recommending a series of measures aimed at modernizing the legislative and institutional foundations of medicare so that governments have the tools they need to move forward together and provide Canadians with the quality health care they want. TOWARD A REAL SYSTEM Throughout the course of our consultations, one of the recurring themes was the need to do a better job of integrating all of the various elements of health care into a true "system" of care. Because as much as we talk about a health care "system", what we really have is a series of isolated islands of service, often with no bridges between them. Patients are forced to navigate a complex labyrinth of services and specialists; required to find the nearest facility, the best treatment; to repeat lab tests and retell their medical history over and over, all because the various parts of the so-called "system" aren't connected to one another. Take the elderly person who is discharged from hospital and can't find the home or community services they need, or, if they can find them, can't afford them. Or women - one in five - who are providing care to someone in the home, an average of 28 hours per week, half of whom are working, many of whom have children, almost all of whom are experiencing levels of stress that cannot be countenanced and must not continue. Or health care professionals, working longer hours, and being asked to perform tasks ill-suited to their training. This is more than a formula for frustration, it is a recipe for destroying the confidence of Canadians in a system that does not meet their needs. I will be recommending a series of measures to create a more comprehensive system, whose component parts work together, to serve Canadians better. INFORMATION & ACCOUNTABILITY Another concern that struck me as I began my work, was the lack of information about how our health dollars are spent. Publicly and privately, we spend more than $100 billion on health care in this country and yet no level of government has done a very good job accounting for how effectively that money is allocated. The data we do collect is haphazard. We gather information on some health issues and not others. And much of the information can't be properly analysed or shared. How can we hold health care managers accountable if what they're managing is not being measured? And how can we make evidence-based decisions if we don't have the evidence? What's more, Canadians demand - and certainly deserve - a much fuller accounting of how the health care system is operating. They have a right to know if things are getting better or getting worse; what's happening with waiting lists; what's going on with respect to the number of hospital beds, doctors and nurses; whether gaps are being closed, or community care is being strengthened and whether the number of diagnostic machines is adequate. Quite simply, the time has come to give Canadians the facts! So, we need to improve transparency across the health care system, to make decision-making structures more inclusive and to accelerate the integration of health information, including the development of a secure electronic health record for Canadians that fully respects and protects their right to privacy. I will deal with all of these areas in my report. MAKING CANADIANS THE WORLD'S HEALTHIEST PEOPLE During the course of our public hearings, many presentations focused on the need to improve our understanding of the determinants of health. What factors contribute to the health we enjoy? How much is genetic and how much environmental? What roles do education and income play? What's the connection between spiritual, emotional and physical health? These issues are vital to the long term sustainability of medicare. They also speak to concerns for social cohesion and a sense of inclusion. They will lead to the kind of services and infrastructure - such as public housing, a clean environment and education - that will enable Canadians to make healthier lifestyle choices. I will make recommendations that address these issues. In particular, I think we need to place greater emphasis on prevention and wellness, and new resources for research into the determinants of health. Ultimately, the goal is to make Canadians the healthiest people in the world. PRESERVING MEDICARE Friends, early in my mandate, I challenged those advocating radical "private" solutions for reforming health care^×user-fees, medical savings accounts, de-listing services, greater privatisation, a parallel private system^×to come forward with evidence that these approaches would improve and strengthen our health care system. The evidence has not been forthcoming. I have also carefully explored the experiences of other jurisdictions with co-payment models and with public-private partnerships, and have found these lacking. There is no evidence these solutions will deliver better or cheaper care, or improve access (except, perhaps, for those who can afford to pay for care out of their own pockets). More to the point, the principles on which these solutions rest cannot be reconciled with the values at the heart of medicare or with the tenets of the Canada Health Act that Canadians overwhelmingly support. It would be irresponsible of me to jeopardize what has been, and can remain, a world-class health care system and a proud national symbol, by accepting anecdote as fact, or on the dubious basis of "making a leap of faith". Tossing overboard the principles and values that govern our health care system would be betraying a public trust. Canadians will not accept this, and without their consent, these so-called "new" solutions are doomed to fail. Canadians want their health care system renovated; they don't want it demolished. Some have described it as a perversion of Canadian values that they cannot use their money to purchase faster treatment from a private provider for their loved ones. I believe it is a far greater perversion of Canadian values to accept a system where money rather than need, determines who gets access to care. My final report will address this issue in very direct terms, and in a way that is consistent with what Canadians want and expect from their health care system. CONCLUSION Canada's journey to nationhood has been a gradual, evolutionary process, a triumph of compassion, collaboration and accommodation, the result of many steps, both simple and bold. This year we celebrate the 40th anniversary of medicare in Saskatchewan, a courageous initiative by visionary men and women that changed us as a nation and cemented our role as one of the world's compassionate societies. The next big step for Canada may be more focused, but it will be no less bold. That next step is to build on this proud legacy and transform medicare into a truly national health system that is more responsive, comprehensive and accountable to all Canadians. Getting there requires leadership. It requires us to change our attitudes on how we govern ourselves as a nation. It requires an adequate, stable and predictable commitment to funding and cooperation from governments. It requires health practitioners to challenge the traditional way they have worked in the system. It requires all of us to realize that our health and wellness is not simply a responsibility of the state but something we must work towards as individuals, families and communities and as a nation. The collaborative system I speak about is clearly within our grasp. Medicare is a worthy national achievement, a defining aspect of our citizenship and an expression of social cohesion. Let's unite to keep it so. Thank you. ** * #354 Message: 1 Date: Fri, 6 Dec 2002 21:23:46 -0800 From: "Lynn Porter" Subject: Re: questionnaire final draft I would back up further and ask if people even want to do another initiative. Some of the people in Portland are proposing other alternatives: focus on public education, focus on federal legislation, have a state-wide healthcare summit. Then I would ask those who do want to do another initiative if they want to do a simple one -- ask the state legislature to extend medical insurance coverage to everyone -- or a complex one. If complex, list briefly some of the very different alternatives that have been proposed on the email list. This questionaire includes too many assumptions about where people are at. I don't think fine tuning Measure 23 is a likely strategy. In Portland people are all over the place. There is no consensus yet. Also, I think you need to wait for each local group to decide what they want to do next, before there is any basis for a statewide effort. This may take a few months. You're trying to move too fast. I believe this is a time for bottom up organizing rather than top down organizing. It's time to listen. Lynn ----- Original Message ----- From: "marklindgren" To: "HCA-O steering comm., & others" Sent: Friday, December 06, 2002 2:13 PM Subject: questionnaire final draft Attached is the final draft of the questionnaire that Betty Johnson developed. Jo Alexander improved the layout and did further editing. Please let me know within a couple days if there is anything you think needs revision before we send it out to everyone. Thanks, Mark ________________________________________________________________________ ________________________________________________________________________ Message: 2 Date: Fri, 6 Dec 2002 23:32:25 -0800 From: "Lynn Porter" Subject: Bill Clinton on healthcare speech by Bill Clinton, salon.com http://salon.com/politics/feature/2002/12/06/clinton/index.html You can't just attack the other guy's ideas unless you have something to say. The same thing is true with health care. You know, the victors always get to write history, so they performed reverse plastic surgery on my health care proposal. The real thing that was wrong with health care is I should have resisted the people in my party, who said we had to present a plan and I should have given some general principles and let Congress write one because the Republicans had the filibuster and we were never going to pass any health care plan. Senator Dole said, no go ahead and send a plan and then we'll write one together. Then somebody told him that was no way to get elected president, so we never got anything done. But I would remind you when I proposed my plan, most of the experts said, it's not too complicated and it's a moderate plan. Then the health insurance companies didn't like it, so by the time they got through advertising against it, it was really an ugly thing. The fundamental thing I tried to deal with is this: we spent over 14 percent of our GDP on healthcare. You can't provide the quality health care we provide with all the technology if you don't spend about 11 percent. Even the Canadians spend ten and they've got backups. So, we have to spend that much. The problem is we spent over 3 percent of that 14 percent of our GDP on administrative costs. It's a huge amount of money. Administrative costs of Medicare by comparison are 1 percent. Two percent of our gross domestic product is a huge amount of money. If we could figure out how to reconcile the various interests in America and free up some of that money, we could provide health insurance to uninsured people at a cost we could support without gagging. That's a discussion for another day, but we Democrats and especially the DLC ought to be on the side of thinking about ways to stop all these people from losing their health insurance because in times like this, employers on the margin find it more and more impossible to pay health insurance premiums. We got all the savings we could out of managed care, then natural inflation sort of took over again. So you got a lot of people left out in the cold again. We have a responsibility here. ________________________________________________________________________ ________________________________________________________________________ Message: 3 Date: Sat, 7 Dec 2002 23:39:09 -0800 From: "Lynn Porter" Subject: Fw: Single payer on Monday radio ----- Original Message ----- GOOD NEWS ...you won't want to miss this radio talk....Betty Johnson Dear Health Care Activist, Monday December 9 at 1pm, 7pm and at 10pm with Michale Krasney On KQED 88.5 radio NPR Questin Young, MD (president of Physicians for a National Health Plan) and Marcia Angell, MD (former editor of the New England Journal of Medicine) will discuss the case for a national, single payer health system on NPR's Fresh Air with Teri Gross. Spread the word. Don Bechler Heatlh Care For All San Francisco 415-695-7891 ** * #355 Message: 1 Date: Sun, 8 Dec 2002 17:41:50 -0800 From: "Lynn Porter" Subject: Measure 23 followup questionnaire Below is the questionnaire previously referred to. Also a response from Betty Johnson about the purpose of the questionnaire, which I had not understood when I wrote my comments. Apparently this questionnaire will be sent to other organizations, not to HCAO members. -- Lynn Measure 23 followup questionnaire l. What do you think were the three most positive components of the language of Measure 23? _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ 2. What do you think were the three most positive aspects of the Measure 23 campaign? _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ 3. Are there changes to the measure that you think are critical to winning next time? _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ 4. Do you think the taxes to fund the health system could have been better structured? If so, how? _________________________________________________________________________ _________________________________________________________________________ 5. Please check the following components of the initiative which you think should definitely be retained in the measure: __ universal coverage __ no co-pays or deductibles __ single payer __ prescription medication coverage __ coverage of mental health services __ coverage of long term care __ coverage of alternative health care __ $25,000 cap on tax on taxable income __ some board members elected and some appointed by governor __ other __________________________________________________________________ 6. Is your organization willing to become an active, participating member of the Health Care for ALL Oregon Coalition, designating a member to participate in monthly strategy sessions and reporting to your board? __ yes __ no 7. Is your organization and/or membership willing to help with voter education? __ write letters to the editor once a month __ make a commitment to help canvas selected neighborhoods __ designate members to speak before community organizations __ other __________________________________________________________________ 8. Will your organization make a pledge to support the important work of HCA-O over the next two years? __ we will contribute $ ___ per month __ we will contribute $ ___ per quarter 9. What else do you want to tell HCA-O about what future direction YOU want the campaign for universal health care to take in Oregon? _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ HCA-O contact person: Name: __________________________________________________________________ Tel no. _________________________ Email __________________________________________________________________ Person interviewed Name: __________________________________________________________________ Title __________________________________________________________________ Organization ____________________________________________________________ Tel no. _________________________ Email __________________________________________________________________ Title Recommendation for follow-up _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ 12/02 Lynn, THANK YOU for your comments on the questionaire. The primary purpose of the questionaire is to use it as a guide as Steering Comm. members and others contact all the endorsing organizations and selected opponents, eg. Hospital Assn., to LISTEN to their comments The S.C. wants to collect information from as many groups as possible before charting a course of action. We hope this will be a time of productive listening. -- Betty Johnson ________________________________________________________________________ ________________________________________________________________________ Message: 2 Date: Sun, 8 Dec 2002 22:22:27 -0800 From: "Lynn Porter" Subject: Fw: NPR/Fresh Air: Station & Broadcast Time Details fyi Dear supporter of universal health care:Update ----- Original Message ----- From: Tom Holser To: mahols@efn.org Sent: Sunday, December 08, 2002 8:47 PM Subject: NPR/Fresh Air: Station & Broadcast Time Details fyi Dear supporter of universal health care: We just learned that this Monday December 9 NPR (National Public Radio) has a program you may want to hear or tape: NPR's Fresh Air with Teri Gross will discuss the case for a national, single payer health system with guests Quentin Young, MD (president of Physicians for a National Health Plan) and Marcia Angell, MD (former editor of the New England Journal of Medicine) Fresh Air is broadcast more than 294 National Public Radio (NPR) stations across the country, as well as in Europe on the World Radio Network! The show will be broadcast Monday December 9 in Oregon on the following OPB (Oregon Public Broadcasting); KLCC (Lane Community College Radio), JPR (Jefferson Public Radio) and KUNM (Lower Columbia Public Radio) stations as follows. KUNM-FM 91.9 Astoria 4:00 - 5:00pm KOAB-FM 91.2 Bend 2:00 - 3:00 pm (OPB) KOAC-AM 550 Corvallis 2:00 - 3:00pm; 7:00 - 8:00pm (OPB) KLCC-FM 89.7 Eugene 3:00 - 4:00pm (LCC) KAGI-AM 930 Grants Pass 3:00-4:00pm / 6:00pm-7:00pm (JPR) KLCO-FM 90.5 Newport 3:00 - 4:00pm (LCC) KRBM-FM 90.9 Pendleton 2:00 - 3:00pm; 7:00 - 8:00pm (OPB) KLFR-FM 89.1 Reedsport 3:00 - 4:00pm (LCC) KTBR-AM 950 Roseburg 3:00-4:00pm / 6:00pm-7:00pm (JPR) KOPB-FM 91.5 Portland 2:00 - 3:00pm; 7:00 - 8:00pm (OPB) KSJK-AM 1230 Talent (JPR) 3:00-4:00pm / 6:00pm-7:00pm (JPR) -------------------------------------------------------------------------------- If you miss the show you may listen "on demand" at no charge using the Fresh Air-NPR website at http://freshair.npr.org/. To listen you must have Real Player Audio (also available at no-charge). If you would like assistance downloading or using Real Player, feel free to contact Tom Holser at mahols@efn.org or 541-343-5132. Please spread the word to those not on email, Thanks Health Care for All-Oregon -------------------------------------------------------------------------------- NPR affiliated stations in Oregon may be linked at: OPB: Oregon Public Broadcasting http://www.opb.org/; KLCC Lane Community College http://www.klcc.org/; JPR Jefferson Public Radio http://www.jeffnet.org/; KUMN Lower Columbia Public Radio http://www.kmun.org/ ** * #356 Message: 1 Date: Mon, 9 Dec 2002 18:28:46 -0800 (PST) From: Roberta Palmer Subject: Call your Congressmen! Dear HCAO, This Jan. several HC bills will be presented to Congress: the Wyden-Hatch Act and John Conyer's bill to establish National Health Insurance. This is a good time to call your Congressmen and urge their support. Sen Smith is the Senate's Republican leader for HC, so he in particular should be contacted. If you are at a loss for words, say something like this: I want to let Sen Smith know how concerned I am about the health care crisis. Over 18,400 Americans died last year for lack of health insurance. I'm sure that as a Christian the Senator aggrees with me that to do nothing to provide universal HC is not a moral position. I hope that he will support the Wyden-Hatch Act and other legislation that gets us to the goal of universal HC that every American can afford. Sen. Smith: 503-326-3386; www.senate.gov/~gsmith/webform.htm World Trade Center, 121 S.W. Salmon St. #1250, Pdx, 97204. Thanks, Roberta Palmer ________________________________________________________________________ ________________________________________________________________________ Message: 2 Date: Mon, 9 Dec 2002 12:22:31 -0800 From: "Lynn Porter" Subject: Fw: comments on miller proposal ----- Original Message ----- From: Message: 1 Date: Sun, 08 Dec 2002 14:17:18 -0800 From: Bill Michtom Subject: comments on miller proposal >2. A referendum may not be as threatening to the opposition as an actual >vote to establish OUHP Not to put too fine a point on this, but I think this is delusional thinking. 1) The opposition owns the legislature. 2) The opposition will fight this - as it will anything remotely threatening to its monopoly - tooth and nail. >3. Between now and 2004 we approach all those who say they are in favor of >OUHP and invite them to be part of the team to pass the referendum and more >importantly to conspire with us as to how pro-OHUP forces can dominate the >Commission which will write the transition plan. 1) the opposition owns state government. When the state (the gov? the legislature?) appoints the commission, you can be certain it will not be composed of friends of UHC. >4. A referendum will eliminate most of the arguments the opposition has made >against us last time. The arguments against UHC boil down to one: Insurance companies do NOT want to give up their hold on the system. As you may notice, this is not really an argument against UHC, merely a reason why millions of dollars were spent to defeat M23. There is NO reason this would not continue to be the case. This is not about arguments. It is about money and power. >The Commission will handle the details of the OHUP Exactly the problem. This commission will not be under our control and the people who have control (our opponents with all the money) will make sure that the devil is in the details. >5. We gain time to prepare for the arguments the opposition Re: arguments, see above >we will have a broader base of support and more extensive funding I am not sure why this would be true, but, unless the funding is at least $1 million, we can forget about winning the PR battle. >1. Make sure the Commission is composed only of those people who have been >in favor of Universal Health And exactly how will this be accomplished? >2. Create a plan that is doable and passable Passable and doable are not the same thing. M23 was doable. No plan will be passable unless we have the money to respond to the lies of the insurance companies. >we can always expand it later on as the economy improves, 1) At the rate things are going, the economy will not be improving within the time frame being discussed. The whole point of the Bush/Republican economic program (which includes the "war on terrorism") is to starve social services of any funding. This includes health care, schools, mass transit - you name it. 2)The reality is that UHC SAVES money, so doing it in bad economic times makes more sense than waiting. 3) "We can always fix it later" (fill in the blank) was the mantra of Clinton and the Democratic Leadership Council Dems that brought us "welfare reform" and a variety of other Republican ugliness that is hurting millions now. >3. Drop the undocumented and put limits on out-of-staters moving to Oregon, >especially if they have pre-existing conditions. This is just what insurance companies do now. If we start doing things like this, we might as well not bother. >Not that this is right or just, but it will make it more >likely to pass and eliminate some of the opposition¹s major >arguments. We can change it later as the plan is established. See all my previous statements. >4. Create a plan that starts off with basic services and expands ... See all my previous statements. >This may also help neutralize some insurance company opposition See all my previous statements. >5. Create a plan that will encourage non-insurance businesses to >participate, show them how/why ... Once again, this does not require a new plan. Rather, it requires adequate funding for the campaign. And adequate funding means substantial broadcast TV PRIME time (not the middle of the night, which is pointless and a waste of any money that is spent for it), major mailings, billboards, and full-page ads in the Oregonian and every other newspaper of consequence around the state, >What do you think? Of course it will need a lot of work, this is only a >draft of an idea. Let's stop talking about the problem of poverty - and start talking about the problem of richness. - Satish Kumar The two greatest obstacles to democracy in the United States are, first, the widespread delusion among the poor that we have a democracy, and second, the chronic terror among the rich, lest we get it. Edward Dowling, Editor, Chicago Daily News, 28 July 1941 ** * #356 Message: 1 Date: Mon, 9 Dec 2002 18:28:46 -0800 (PST) From: Roberta Palmer Subject: Call your Congressmen! Dear HCAO, This Jan. several HC bills will be presented to Congress: the Wyden-Hatch Act and John Conyer's bill to establish National Health Insurance. This is a good time to call your Congressmen and urge their support. Sen Smith is the Senate's Republican leader for HC, so he in particular should be contacted. If you are at a loss for words, say something like this: I want to let Sen Smith know how concerned I am about the health care crisis. Over 18,400 Americans died last year for lack of health insurance. I'm sure that as a Christian the Senator aggrees with me that to do nothing to provide universal HC is not a moral position. I hope that he will support the Wyden-Hatch Act and other legislation that gets us to the goal of universal HC that every American can afford. Sen. Smith: 503-326-3386; www.senate.gov/~gsmith/webform.htm World Trade Center, 121 S.W. Salmon St. #1250, Pdx, 97204. Thanks, Roberta Palmer ________________________________________________________________________ ________________________________________________________________________ Message: 2 Date: Mon, 9 Dec 2002 12:22:31 -0800 From: "Lynn Porter" Subject: Fw: comments on miller proposal ----- Original Message ----- From: Message: 1 Date: Sun, 08 Dec 2002 14:17:18 -0800 From: Bill Michtom Subject: comments on miller proposal >2. A referendum may not be as threatening to the opposition as an actual >vote to establish OUHP Not to put too fine a point on this, but I think this is delusional thinking. 1) The opposition owns the legislature. 2) The opposition will fight this - as it will anything remotely threatening to its monopoly - tooth and nail. >3. Between now and 2004 we approach all those who say they are in favor of >OUHP and invite them to be part of the team to pass the referendum and more >importantly to conspire with us as to how pro-OHUP forces can dominate the >Commission which will write the transition plan. 1) the opposition owns state government. When the state (the gov? the legislature?) appoints the commission, you can be certain it will not be composed of friends of UHC. >4. A referendum will eliminate most of the arguments the opposition has made >against us last time. The arguments against UHC boil down to one: Insurance companies do NOT want to give up their hold on the system. As you may notice, this is not really an argument against UHC, merely a reason why millions of dollars were spent to defeat M23. There is NO reason this would not continue to be the case. This is not about arguments. It is about money and power. >The Commission will handle the details of the OHUP Exactly the problem. This commission will not be under our control and the people who have control (our opponents with all the money) will make sure that the devil is in the details. >5. We gain time to prepare for the arguments the opposition Re: arguments, see above >we will have a broader base of support and more extensive funding I am not sure why this would be true, but, unless the funding is at least $1 million, we can forget about winning the PR battle. >1. Make sure the Commission is composed only of those people who have been >in favor of Universal Health And exactly how will this be accomplished? >2. Create a plan that is doable and passable Passable and doable are not the same thing. M23 was doable. No plan will be passable unless we have the money to respond to the lies of the insurance companies. >we can always expand it later on as the economy improves, 1) At the rate things are going, the economy will not be improving within the time frame being discussed. The whole point of the Bush/Republican economic program (which includes the "war on terrorism") is to starve social services of any funding. This includes health care, schools, mass transit - you name it. 2)The reality is that UHC SAVES money, so doing it in bad economic times makes more sense than waiting. 3) "We can always fix it later" (fill in the blank) was the mantra of Clinton and the Democratic Leadership Council Dems that brought us "welfare reform" and a variety of other Republican ugliness that is hurting millions now. >3. Drop the undocumented and put limits on out-of-staters moving to Oregon, >especially if they have pre-existing conditions. This is just what insurance companies do now. If we start doing things like this, we might as well not bother. >Not that this is right or just, but it will make it more >likely to pass and eliminate some of the opposition¹s major >arguments. We can change it later as the plan is established. See all my previous statements. >4. Create a plan that starts off with basic services and expands ... See all my previous statements. >This may also help neutralize some insurance company opposition See all my previous statements. >5. Create a plan that will encourage non-insurance businesses to >participate, show them how/why ... Once again, this does not require a new plan. Rather, it requires adequate funding for the campaign. And adequate funding means substantial broadcast TV PRIME time (not the middle of the night, which is pointless and a waste of any money that is spent for it), major mailings, billboards, and full-page ads in the Oregonian and every other newspaper of consequence around the state, >What do you think? Of course it will need a lot of work, this is only a >draft of an idea. Let's stop talking about the problem of poverty - and start talking about the problem of richness. - Satish Kumar The two greatest obstacles to democracy in the United States are, first, the widespread delusion among the poor that we have a democracy, and second, the chronic terror among the rich, lest we get it. Edward Dowling, Editor, Chicago Daily News, 28 July 1941 ** * #357 HISTORY and ANAYLSIS OF HEALTH CARE FOR ALL-OREGON By Mary Ann Holser, PhD, MPA, MSW December 05, 2002 THANK YOU Kudos to Mark Lindgren, for his excellent analyses of our efforts, Ruth Duemler, and others for their positive and useful suggestions for forward motion. I would like to add some comments that could be useful in our considerations for continued action. The various critiques in no way denigrate the efforts of all our tremendous volunteers in writing the initiative and carrying out the petition campaign through talks, signature gathering, meeting and leadership tasks. Our campaign directors, Dan Isaacson and Britt McEachen, boosted us to national recognition. Surely, we have started something for the nation as well as Oregon. I just returned from the 130th National Convention of the American Public Health Association in Philadelphia where I presented a paper on the success and failures of Measure 23 and the Oregon Health Plan and where we go from here to see that universal health care is achieved in Oregon, and the nation. An exciting part of the conference was the opening speaker, Vermont Governor Howard Dean, who announced that he is running for the 2004 Presidency on the issue of universal health care. A standing audience of about 10,000 cheered him on. Conversations with conference goers revealed strong support for universal health care Oregon health care reform efforts. I distributed our brochures and summaries widely, hoping that others would pick up on our ideas. HISTORY OF OREGON HEALTH CARE REFORMS To put our efforts in perspective it might be useful to look at the history of efforts to achieve universal health care in Oregon. In the spring of 1998, I received a call from Betty Johnson of Mid Willamette Valley Health Associates asking me to gather some Lane County people concerned about access to health care in Oregon. Groups in Salem had been holding educational meetings and gathering support for access to health care. Portland also had an ongoing group, Single Payer Action Reform Committee (SPARC). In the early 1980's, 10 state legislators, including current state Senator, Bill Morrisette and current State Democratic Chair Jim Edmunson, had sponsored a single payer bill. Oregon Fair Share, a chapter of a national consumer action group, had done door-to-door canvass indicating that lack of health insurance was a major issue with respondents. Dr Michael Garland, at OHSU, and others had set-up statewide focus groups to explore health care needs. Interest in accessing Oregonians to health care was high. The Oregon Health Plan Then Senate President, Dr John Kitzhaber, had his own plan for expanded coverage, which attempted to cover more people than traditional Medicaid through a prioritized list of effective treatments and a mandated employer insurance plan. The legislation also included insurance reforms to encourage small business as to provide health insurance. Kitzhaber's Oregon Health Plan prevailed, and passed after much controversy and opposition from conservatives. Some moderate Republican leaders eventually supported the plan. The employer mandate was blocked by the federal "Employee Retirement Income Security Act (ERISA), and small businesses did not respond by buying the "basic" health insurance package offered in the reform. However, a strong administrative organization to run the program was included in the legislation. Under the strong leadership of Oregon Health Plan director, Vicki Gates, insurance companies and provider organizations were brought into the planning. In the better economic conditions of the 1990's, the plan brought health care to many previously uncovered Oregonians. It should be noted, that conservatives, from its inception, have continued to oppose the plan, always wanting co-payments, larger deductibles, and lower asset requirements to limit eligibility for the plan. They believed that low-income people should not receive benefits equal to those offered in the private sector. Even in good times, general fund support was not budgeted to meet the growing need. As the economy slowed and businesses cut back, it only got worse. When citizens voted to impose a cigarette tax to go to the plan, the legislature reduced the state funding in the amount the tax raised, thus defeating the citizen attempt to expand the plan! Insurance companies, hospitals and health systems, though originally supporting the plan, were unhappy with cost controls. Current Situation of the Oregon Health Plan With the last two Republican controlled sessions, the giveback of the earlier budget surpluses and the slowed economy, the state experienced a budget shortfall. The health plan's response is to add co-pays and deductibles in a two-tier plan called OHP basic and OHP plus, supported by doctors as the "Cadillac and Chevrolet plans". Is there such a thing? Is "Cadillac" a room with a view or a liver transplant; tests for the cause of symptoms or use of the newest advertised prescription drugs? Is mental health treatment "Cadillac?" It is not in the OHP "basic" plan! Will defining such a distinction be made, by need, by providers or by administrators? As incremental reforms continue the OHP is restricted; Measure 23 has failed at the polls, and 400,000 Oregonians remain without health insurance and/or very limited access to charity care. HEALTH CARE FOR ALL-OREGON FORMED In the spring of 1998 when Betty Johnson called, I had been following the OHP for a book I was writing and was concerned about the fact that, despite the efforts of Governor Kitzhaber, we still had 400,000 uninsured and were struggling to adequately cover those fortunate enough to be eligible. In Eugene, about six of us organized a countywide meeting in September 1998. State Representative Bill Morrisette and then County Democratic Chair, Jim Edmunson, both supporters of universal health care, spoke to a well-attended interested audience. From this small beginning we eventually organized a Lane County leadership team and joined with other groups to form a statewide organization, "Health Care for All-Oregon." Representatives from local groups around the State formed a State Steering Committee. Groups in Ashland, Corvallis, Lane County, Portland, Roseburg as well as the state Green Party joined us. We were health professionals, citizen activists, political activists, retired folks, working folks, religious leaders, consumers and Oregonians who care about each other. Eventually we became a political action group in order to write a statewide initiative and you know the rest! Plan, Language, Stakeholders and Commitment We struggled for 4 years to come up with the outlines of a plan. We formed a language committee to work out a specific universal health care initiative, consulting with sympathetic legislators, State officials, political leaders, and health professionals. We obtained the best advice we could, as a volunteer lightly funded grass roots group without major power brokers. We attempted to enjoin statewide organizations concerned with health and welfare in an active coalition. We were met with some support, but with a general reluctance to openly and actively participate. We had to do it ourselves and we came up with a plausible, unique, and attainable plan. Consulting health economists did the best to estimate financing. Far from vague, our initiative legislation had more detail than many other initiatives seen on State ballots. It is true that outside groups were not involved in the writing, but many appeared not interested in active involvement at the time. We worked with labor directly and did change language responding to their concerns, but their opposition was not related to language, rather to their own perceived interests at the time. We might have worked harder on this, but the pressure of deadlines for the initiative and the continuing worsening of the health access situation loomed large for our small volunteer group. Although our endorsements indicated general support from many important statewide organizations, it was not backed up with adequate funding, person power or organizational efforts from these groups. As others have said, we will need to line up these groups with strong active commitments behind their verbal support before we proceed with our next move forward. Good news is that some organizations now want to talk with us. The failure of the initiative may actually wake up stakeholders to more actively support their stake in Oregon's health. BARRIERS TO ACHIEVING UNIVERSAL HEALTH IN OREGON AND THE NATION Financing Outspending us 20 to 1 opponents (all health insurance companies and current health systems) used television, print and paid employees to distribute distortions and outright lies about the nature of the initiative and it's financing, scaring an economically frightened Oregon public. Although truths were presented in opinion editorials and letters to the editors, they were drowned out by messages that played on personal fears with misrepresented information on taxes, nature of the plan, and prediction of health care chaos. We lacked funds to effectively counter these messages on television. Increasing Corporate Control of Legislation and the Media The nation and the State are experiencing a swing to the right with elected representatives increasingly beholden to corporations and their lobbyists for campaign financing. The media depends on corporate advertising as well. The networks themselves must respond to their advertiser's interests. Some major networks are invested in the health care market, a conflict of interest for opposing opinions on health care. Citizen groups cannot match the high costs of television time that corporations can buy. Health insurance and pharmaceutical corporations have become part of this corporate control of important health policy decisions. These corporations will resist any reforms that loosen their control of the health care market with well-financed opposition. The competitive market model of health care delivery, widely touted by conservative economists, has failed to lower health care costs and increased the numbers of those without access to health care they need. In this David and Goliath situation, individuals and families are at the mercy of large health care corporations. Campaign finance reform should be part of our strategy to enable constituents to have a real voice in electing policy makers who will consider the nation's health important enough make necessary changes. An American Ethic Underlying most overt criticisms of our single payer plan and other attempts at a universal health care system is a strong American belief in individual personal responsibility. In contrast, older western industrialized democracies hold their governments more responsible for the general welfare of their citizens. For these countries, the nation's health is considered a state asset, rather than a personal responsibility. Our individualistic belief supports the idea that if one pays for it, that person will see the value of the service and be more responsible in using the service. Being made aware of the cost, the person will be able to evaluate the necessity of buying the service. This works well in many consumer products, but not in health care delivery. For the market to work, the buyer needs the same ability as the seller to evaluate the service. This cannot happen in health care, where the patient is dependent on the much more medically informed providers to determine what care is needed. Balance is needed for the market to work. Our opponents made good use of this personal responsibility ethic emphasizing: Flaws and Utilization Problems "Flaws" was a general often used derogatory word not supported with specific examples. Utilization control criticism emphasized the need for cost control through premiums, co-pays, deductibles and other transfers of health care costs directly to the user of health care. The assumption is that people who don't pay because they are poor will use too much health care because it is free. Not free, initiative health care costs are shared in a large risk pool, a principle of insurance. The assumption that people abuse health care by too many doctor visits is not supported by research, only anecdotal reports. If medical visits are prompted by psychological or other non-medical needs, patients should be referred to counseling or alternative resources. Utilization is already controlled by ability to pay rather than need. Estimates of average U.S. doctor visits per year vary from 5 to 8. In countries with universal coverage the range is 10 to 13 visits, but these countries rank higher than the U.S. on all indicators of health status. This proves the value of increased access to health care. Our low ranking in general health is the result of utilization control by ability to pay. In the end, those who neglect (rather than abuse) health services due to financial barriers end up costing us more in acute care and worsened general health status. LESSONS LEARNED, WHERE TO GO FROM HERE My view is that the structure of the present corporate/legislative power system combined with our individualist ethic preserves the status quo and holds individuals totally responsible for their health, housing and quality of life. The present war mentality can enhance that notion. Despite my grim view, we must continue. There is no alternative. What can we do? Meeting Criticisms As others propose, we should meet with supporters and opponents to determine their real and specific concerns and improve language. We can hope for cooperation and compromise toward the goal of universal health care. We can better define alternative care, now accepted as "complementary alternative medicine" by allopathic physicians. We can find a way to define residency or explain how it would work. Other legitimate critiques can be fully explored. Financing We should obtain updated economic analyses provided by credible sources if we can fund them. Other states have funded studies or found grants to support them. Good studies already exist and more should come, especially with reference to our initiative. However, studies can be a way to delay action. Forming Coalitions We should certainly try to align support early on. As a veteran of the civil rights and anti-Vietnam war movements, I know that this is a long hard struggle, but we can start now. Lack of health care is a serious problem in our state and country that is not going away or being solved by pouring health dollars into large corporations. COMPROMISES WITH POWER AND PRINCIPLE This is a tough one. For example, the only reason for agreeing to payments as utilization control, rather than budget and need, is to compromise with a political ideology in order to achieve legislation. We may have to agree to it. The results should be studied. The idea of a public corporation, independent of the State legislature remains a great idea. Hopefully we can get support for that. We must decide what we can give up and what we can keep to move toward universal access. In our individualistic belief system, even low-income persons who cannot afford care also believe that others, not like them, are irresponsible, not deserving, and probably abusing care with unnecessary visits. Medicare passed because the old were seen as vulnerable; Medicaid because the very poor needed charity care; and Children's Health Programs, again because children are seen as less responsible. Insuring the entire population is seen as an assault on our national ethic of individual responsibility. We will need strong leadership to transcend and change these attitudes. We can also compromise and get something done; hoping that once achieved, like Medicare, people will accept community responsibility for health care into their value system. Hopefully these changes will happen. Mary Ann Holser 2620 Cresta De Ruta Eugene, Oregon 97403 541-343-5132 mailto:mahols@efn.org ** * #358 Message: 1 Date: Fri, 6 Dec 2002 21:25:50 -0800 From: "Lynn Porter" Subject: Fw: 30 Single payer policy questions from CA ----- Original Message ----- From: "marklindgren" To: "HCA-O steering comm., & others" Sent: Monday, December 02, 2002 9:26 AM Subject: 30 Single payer policy questions from CA 30 Single Payer System (SPS) Policy Questions Prepared by Judy Spelman, RN, Health Care for All-California Policy Director 1. Publicly-funded socialized medicine vs. publicly-funded private medicine. Should the government take responsibility for finance, administration and delivery of health care (socialized medicine model where government owns the facilities and trains and employs the workforce) or for health system finance and administration only (publicly-funded, private medicine)? 2. How do assure we accountability in SPS governance? What should be the basic method of health system governance? Which officials should be elected? Which appointed? Should there be an impeachment process? What should be the balance between local, state and regional governance? 3. How do we assure delivery of high quality care to the entire population and redress existing health status and service disparities? The U.S. ranks 37th in the world, well below all other industrialized nations, for the quality of our population-based health outcomes, according to the World Health Organization. Health planning in California is fragmented and no programs reach the entire population. The segregated delivery of "public" and "private" care contribute to poor health outcomes and inequities in distribution of resources. These problems can be greatly ameliorated through the use of global health system budgets and system-wide planning. Some questions are: a. Who should perform health planning? b. How should system-wide standards of care be set? c. How do we identify and prioritize health status and service disparities? d. How do we identify and prioritize overall health system priorities and goals? e. Which risk-adjustment systems will best assure equitable and medically appropriate distribution of resources? f. Should safe staffing rations be implemented for health professionals other than nurses? g. How should we correct nurse shortages: Scholarship support? Facility day care? Bedside nurse career ladder? Phasing in ratios? Increasing training capacity (44% of qualified applicants to Cal. State University nursing schools were denied admission in 1997 due to lack of capacity). h. Should financial incentives be used to accomplish goals of the SPS, such as encouraging more physicians to choose primary care residencies (California ranks 36th in the U.S. in the percent of primary care physicians) or encouraging use of "cost-effective" physician assistants and nurse practitioners? i. Should state health care planners set limits on the number of physician specialists based on system-wide needs? 4. How do we consolidate/streamline administration? (Biggest single cost-saving decision) a. Who decides how we will consolidate administration? b. Which existing agencies should form the core of the new administrative system? c. Can some existing agencies be completely eliminated? d. Which programs in existing agencies can be eliminated or cut back? d. How do we minimize regulatory intrusion? e. How should we provide for workers who lose jobs as a result of consolidation? f. Which displaced workers should have employment priority: insurance workforce or others? g. How do we provide for on-going assessment of the adequacy of administrative consolidation? 5. How so we assure integration of and accessibility to information? How do we create secure information systems? Integration of health care data is essential for effective health system planning. Currently, there are no consolidated databases for any aspect of our health care system, and there are no laws that require such data collection and/or reporting. a. Should the bill mandate integration of health system data and lay out a plan and a timeframe for achieving it? b. What is the best way to assure security of databases? c. What are the priorities in data gathering and analysis? d. Who should be in charge of data gathering and analysis? 6. How do we assure stable, equitable financing and control health cost inflation? Fundamental tasks of a SPS are to assure that: health care is affordable; everyone pays their fair share; health system funding is stable and adequate; and inflation is controlled. The U.S. ranks 55th in the world for the equity of our health system financing, according to the World Health Organization. Currently, health cost inflation is out of control, and California's budget deficit threatens the stability of funding for our public health system. Some questions are: a. What taxation system best assures stability of revenues? b. How can we collect the health tax from the multi-billion dollar "cash" economy? c. Payroll tax: Flat or Progressive? High-end and low-end caps? Low-end exemptions? d. Should "excess" wealth be taxed through an income tax or a tax on unearned income? How much should wealthy Californians pay? e. Should we tax alcohol, cigarettes and sodas? f. Should we require a MOE for counties? g. The SPS will cost less than the current system. What should we do with the savings: Provide a generous benefit package? Pass on the savings directly to California families and businesses? Mandate wage increases commensurate with the money saved by employers when the health tax is less than the insurance premiums currently paid? Finance the Reserve Fund? h. Should growth in health care spending be linked to growth in California's GDP and population? (If the U.S. had implemented this a decade ago it is estimated that health care spending would be 25% lower today.) i. Should we use a sales tax? (This may be the only way very low income Californians contribute.) j. How do we assure that federal health care dollars will be folded in? k. How do we assure that vested retiree health funds will be folded in? l. What physician utilization constraints should be implemented? m. How should fraud be monitored and detected? How should fraud be punished? 7. Should we implement a "pharmaceutical peace treaty"? In the U.S. we pay twice as much for drugs as other industrialized nations pay. A California SPS could use its bulk purchasing power to lower drug costs by 40-50%. Potential pharmaceutical industry losses from lower prices could be offset by expansion of the market to the 10 million Californians who currently have no drug benefit. In other words, we can lower prices without hurting the pharmaceutical industry. The question is: Should we support pharmaceutical industry profit rates (35% on equity, as compared to average profits of 16% on equity across 41 other major U.S. manufacturers) to encourage their endorsement of a SPS? 8. What role should the insurance industry play? In an SPS the government establishes a single health insurance plan that covers all residents. Insurance companies no longer sell insurance policies. What should happen to the industry infrastructure and workforce in a California SPS: Should the industry exit the California market, displacing hundreds of thousands of workers? OR Should we attempt to transition the industry and its workforce to a productive role in the SPS? For example, could the industry provide payment and claims services? Could the industry design and distribute health ID cards? Could industry data systems be used to create some of the needed integrated data systems, etc? There is precedent for this model in other countries, such as Australia. 9. Should we use co-pays? The Lewin Group's findings for the Health Care Options Project (HCOP) demonstrate that using co-pays can lower health system costs by billions of dollars a year. On the face of it, co-pays sound like a good idea. However, co-pays are, in effect, highly regressive taxes that are a burden for low-income persons but are barely noticeable for better-off Californians. Co-pays guarantee decreased utilization of both essential and non-essential health services for low- and middle-income Californians, according to every credible study. Co-pays add up quickly if your are very ill or use many medications. They guarantee that your health care expenses will increase if you become very ill, a questionable public policy. If co-pays are means-tested to protect low-income persons, the costs of administering the means tests may be more than the money collected in co-pays. The World Health Organization concluded that patient utilization is most effectively controlled via macroeconomic approaches, such as treating population health and addressing the socioeconomic causes of disease, rather than by microeconomic approaches such as co-pays. If we use co-pays, we should consider a self-selected co-pay where you have the choice of paying it or not paying it, depending on whether you consider it a hardship. 10. Should we include a stronger environmental health policy? None of the three SPS plans written for HCOP had such a policy. This may be a mistake because there is a growing body of knowledge implicating environmental pollution in many of our worst health problems such as cancer, Alzheimers, Multiple Sclerosis and other neurologic diseases, birth defects, asthma, etc. Should a SPS explicitly acknowledge the problem of environmental pollution as a cause of disease and allocate resources to address it? 11. Should eligibility for long term care (LTC) be limited to those with a minimum California residency of at least two years? Until there is a national health plan that covers LTC for all Americans, it seems fiscally prudent to implement a durational residency requirement for eligibility to this expensive benefit in order to avoid an influx of people needing this service. However, U.S. constitutional protections on freedom of movement may make a durational residency requirement unconstitutional. Are there other equitable ways to control utilization of a California long-term care system? 12. What cultural and linguistic standards should we implement? Among the three SPS plans written for HCOP, "Cal Care" incorporated multiple programs to improve the cultural sensitivity of care. How aggressive should we be in implementing cultural and linguistic standards? 13. Should we implement a primary care ("medical home") system with referral requirements for access to specialists? The Lewin Group's findings for HCOP demonstrate significant savings when everyone has a primary provider and gets preventive care. For example, preventable hospitalizations for ambulatory-sensitive conditions cost a minimum of $4 billion annually in California. Should we require everyone to have a primary care provider and spend the money to implement such a system in anticipation of long-term savings? The Lewin Group's findings also demonstrate significant savings when referrals are required for specialty care. There is a strong argument that patients cannot and should not be expected to know when they need a specialist and what kind of a specialist they need and that they will benefit from having a primary provider who knows when and what type of specialty care is called for. It is also argued that if you extend coverage to the entire population and do not require a referral for specialty care, you will have an inappropriate and costly increase in the use of specialty care. However, Californians object to current HMO and insurance industry gate-keeping (i.e., referral) policies. How do we strike a balance between the health and finance benefits of a primary care system with referral requirements and people's objections to them? 14. Should we call the reform "single payer"? The phrase "single payer" is understood by very few people and has negative associations for many. Should we use a different name for this reform? 15. What should be included in the benefit package? We could cut health system costs by offering a small benefit package. How do we balance cost-effectiveness and political effectiveness in structuring the benefit package? 16. Should we cover "undocumented" Californians? How do we balance finance benefits of covering "undocumented" residents and the political objections? (Background: Only 6% of the uninsured are immigrants, according to the Institute of Medicine. The vast majority, including "undocumented" persons, are tax-paying residents. They paid an estimated $133 billion in taxes of all kinds in 1997. The typical immigrant family and descendants will pay $80,000 more in taxes than they will receive in local, state and federal benefits over their lifetimes. Uninsured people, including "undocumented" immigrants, often get their care in emergency rooms because they often wait until they are very ill before seeking care; they are often hospitalized for illnesses that could have been prevented. This is an expensive, wasteful way to finance health care.) 17. Should we establish a separate Health Care Fund or co-mingle health dollars with the General Fund? 18. Should the state have authority over capital health care expenditure? (Important cost-savings decision) Billions of dollars are wasted annually on redundant and under-utilized capital investments and their maintenance. All SPS regulate capital expenditures in some way to minimize this waste. All SPS ask, "What are the capital needs of our health care system?" It is a question not asked by anyone in our current system. How should we regulate capital expenditures? a. How do we balance the needs of integrated health care systems (such as Kaiser and Sutter) to control capital spending across their own systems with the needs of the SPS to rationalize capital spending system-wide? b. If the state assumes authority over capital expenditures, at what level of capital spending should they intervene: $250K? $750K? $1million? 19. Purchasing Policy: Should California become a Federal Supply Schedule (FSS) client to lower prices of pharmaceuticals and medical equipment? (Important cost-saving decision) Every SPS implements government purchasing policies to control the costs of pharmaceuticals and medical equipment. The FSS is a list of federally discounted prices available to large purchasers and includes pharmaceuticals and medical equipment. Should we buy from the FSS or implement other cost-saving policies, such as direct price setting? Should we buy from the FSS in early years but leave open the option for other purchasing policies in the future? 20. What are the major legal obstacles to implementing a SPS? a. Is there likely to be an ERISA waiver required? b. Which regulations cannot be changed by a SPS because they are federal regulations? c. Vested retiree health benefit funds can only be negotiated into the system. They cannot be mandated in. d . What existing state codes need to be accommodated by the legislation? e. How can the bill protect against legislative or other challenges? f. What is required to facilitate folding in of federal health care dollars, such as Medicare? g. What is required to fold in federally benefited employees? h. What is required to fold in Indian and VA services? i. What is required to include the "state action" exemption? j. Can medical school enrollment and residency slots be regulated? Should this be deemed a useful policy tool? k. Will a waiting period for eligibility to long term care be challenged constitutionally? 21. How should physician utilization be regulated? Every SPS controls physician utilization in some way to prevent and monitor abuses, such as by increasing the number of tests and treatments prescribed in order to enhance income. a. As physician spending approaches global budget limits, should reimbursement levels be dropped? b. Should mandatory CME be utilized to educate physicians about the fiscal impact of their practice behaviors? c. Can peer review systems oversee physician utilization or is state oversight required? 22. Should we implement a state malpractice universal risk pool? In a SPS there are fewer lawsuits because health care is guaranteed. Nevertheless, there will be a need to insure providers for other aspects of malpractice. Canada and France created state-run, universal risk pools for malpractice insurance and dramatically lowered costs. Should California establish a state-run, universal risk pool malpractice insurance program? 23. Should we implement a system of public-private health partnerships? This concept is not new. The question is: Should public-private partnerships be widely used as a matter of SPS policy to enhance fair access to the many business opportunities that will be created by a SPS? Should these partnerships guarantee prevailing union wages and working conditions? 24. How long should the transition period be? How should the transition be funded? Who should be represented in the transition process? It would be technically preferable to have a long transition to a SPS of 3-5 years because the change is a very complex process. However, the longer the transition takes the longer current suffering and waste is prolonged. It is ethically and politically preferable to have a shorter transition, say 1-2 years. Should the transition be funded by a General Fund allocation that is repaid over a specified period of time once health taxes are being collected? How else could the transition be funded? 25. Should the bill include a method to provide immediate coverage for uninsured Californians? Should we ask for a one-time General Fund allocation or should we ask for a one-time donation from California foundations to provide immediate coverage to the uninsured? 26. How should global health budgets be risk-adjusted? In other words, once we know what our health system priorities are, what technical systems should we use to efficiently plan budgets? Should the bill include a special task force to establish workable risk-adjustment systems that will support health-planning goals? 27. Should the health benefit component of Worker's Compensation be integrated into SPS? If so, how should this system be reformed? There is wide agreement that the Worker's Compensation system needs major reforms. For example, 900,000 to one million occupational health illnesses and injuries were reported in 2001, and it is speculated that there is widespread under-reporting. If we integrate WC into the SPS, should the bill include a Worker's Compensation Task Force to recommend a reform plan? 28. What SPS policies used abroad should we consider using in California? Many countries have years of experience with single payer-type national health plans. We do not need to re-invent the wheel in every case. Should the bill include a mandate that we explore SPS policies that are effective in other countries? 29. Should any group be allowed to stay outside the SPS? The answer should be "no," even though some will ask to be excluded. In order to be cost effective, everyone has to be in the SPS. The system must be designed to answer the concerns of those who want to be excluded. 30. Should funding for seismic retrofits be part of the SPS budget or come out of the General Fund? California will be rebuilding a significant portion of its 2500 hospital buildings by 2030, to comply with seismic safety standards set by SB 1953. Major repairs are required even sooner, by 2008. Cost estimates range from $5 billion-$40 billion, depending on whether buildings are retrofitted or undergo more complete modernization. (Estimates from the Shaffer SPS proposal for HCOP). This is a large burden to place on the new health taxation system. It increases the amount that must be raised by the health tax. ________________________________________________________________________ ________________________________________________________________________ Message: 2 Date: Tue, 10 Dec 2002 13:39:47 -0800 From: mark lindgren Subject: Maryland universal health care proposal Maryland Group Unveils Proposal for Universal Health Coverage in State Access this story and related links online: http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=15019 The Maryland Citizens Health Initiative on Dec. 9 introduced a plan to provide health coverage to the state's 600,000 uninsured residents, the Baltimore Sun reports. The plan would require businesses in the state that do not offer health insurance to employees to pay 5% of their payrolls into a fund for the uninsured. The plan also calls for an increase in the state's tobacco tax and funds from other programs to help cover the cost. The plan would encourage businesses to offer health insurance to employees and help individuals purchase private health coverage, the Sun reports. In addition, the plan includes provisions to expand the state's Medicaid program and to establish a new $522 million program, called "MdCare," to provide health insurance to about 170,000 state residents who do not qualify for other coverage. The plan would leave about 80% of Maryland residents with employer-sponsored health insurance. Peter Beilenson, chair of the initiative and health commissioner of Baltimore, said that Maryland must "guarantee access and coverage" to residents. The initiative will introduce the plan to state lawmakers when they return to session in January to address an estimated $1.2 billion budget deficit. State Sen. Paula Hollinger (D) said that although she favors plans to expand access to health coverage, "in a year without money and in the middle of a recession, my guess is that we wouldn't go too far in any direction this year." The plan also faces opposition from business groups. Ellen Valentino, state director for the National Federation of Independent Business, criticized the plan as a "government-run plan financed on the backs of small businesses." Sean Cavanaugh, a lobbyist for the initiative, said, "It's certainly not going to pass this year, but we can do a lot of education" (Salganik, Baltimore Sun, 12/10). ________________________________________________________________________ ________________________________________________________________________ Message: 3 Date: Tue, 10 Dec 2002 19:45:06 -0800 From: "Lynn Porter" Subject: Fw: Re: Clinton's comments ----- Original Message ----- From: From: Bill Michtom Subject: Re: Clinton's comments >The real thing that was wrong with health care is I should have written the insurance companies out of the plan immediately, explained the plan to the American people in clear terms that demonstrated how insurance companies are parasites sucking the financial lifeblood of our healthcare system, and that they must be eliminated from the process. I also should have had the Democratic party invest in substantial TV ads to counter the lies I knew the insurance industry would deploy against single-payer insurance. etc, etc, and so forth. ** * #359 Message: 1 Date: Wed, 11 Dec 2002 19:53:55 -0700 From: Estelle/Jennifer Subject: Re: comments on Miller proposal This Miller proposal has some merit .... I think we need to get something in place and then work to make it better....we need a foot in the door.......Estelle ________________________________________________________________________ ________________________________________________________________________ Message: 2 Date: Thu, 12 Dec 2002 15:40:04 -0800 From: "Lynn Porter" Subject: Fw: General Points/AFL-CIO proposals ----- Original Message ----- From: From: "Richard Lochner" General Points/AFL-CIO proposals Some points on our discussion since the loss of Measure 23: 1) Measure 23 was well-written, visionary legislation I was proud to support. As for losing 4-1: the movements for abolition, industrial unions, Social Security, and civil rights started as embattled minorites too. 2) After these movements suffered setbacks, each movement, while keeping its eyes on the prize, strategized transitional steps that won in the end. In that spirit, I commend the different approaches offered, in hopes of achieving universal care in the medium term. I strongly believe we should not favor just any compromise - - too often in recent decades permanent retreats have been excused as 'compromises.' We should do surveys to find what really will broaden our appeal while still achieving a genuine transition, and gather funds and people power to make it real. Still, I believe the justice and practical gains in healthcare for all are so big that even with some compromises it would still be a triumph. AFL-CIO Proposals The Dec. 6 Northwest Labor Press reports the Oregon AFL-CIO is seriously considering two measures to expand healthcare coverage, for the 2003 Legislature and if necessary as ballot measures. One would guarantee coverage for all Oregon workers and their families, the other all children up to 300% of the poverty line, and children of all Oregon workers. The AFL-CIO Executive Board will decide on the proposals at its next meeting, this Friday, 12/13. Despite my reservations (see below), I believe we should support both concepts, the question is how strongly per how much are they transitions to universal care? The first propaganda advantage to both is relative cheapness on taxes: most workers still have some health care, and children's health costs are generally lower. The AFL-CIO estimates an employer tax under 2% would pay for health care for all children, and it has obvious sentimental appeal. Secondly, depending how strong AFL-CIO backing is, judging from other ballot measures, that would easily add 20% to the 21% we got for 23, and with a well-run campaign they could win. I understand the millions the insurance industry could pour in against, but I believe once you gather a critical mass of activists, funds and skill, millions in ads reaches diminishing returns. The 1996 and 2002 minimum wage measures were outspent 2-1 and won anyway. Thirdly, supporting the AFL-CIO puts us in dialogue with the key ally we failed to win over for 23. So, how transitional would healthcare for all workers and/or all kids be? The problem with anything short of health care for all is that both the justice and practical advantages go quickly. In their day, Medicare/Medicaid and the Oregon Health Plan were promoted as transitions. When no transition to universal care occurred, both were nibbled, and are now being devoured by inflation, price-gouging and cutbacks. Healthcare for all workers, with no other changes, would ease price-gouging and the 25% administrative costs a little, and for all children would hardly ease the burden at all. The gain would be learning by doing: when people see all workers or all children benefitting from a universalistic program, the sell will be easier for the real thing. (I believe healthcare for all children was the transitional step to healthcare for all in Ireland.) The key is to move swiftly before the lesson is lost to cutbacks. So, I would condition HCAO's active support for either measure on the following: 1) We make a short presentation to AFL-CIO leadership why 23 was a sound approach (see below). An apology would be fabulous, but an agreement to disagree would do, with agreement other funding methods are OK, as long as they don't shift costs to workers, such as a consumption tax. 2) We explain the AFL-CIO needs us. Our 21%, including many of the strongest advocates for healthcare and labor, is key to winning anything on either issue. 3) We are clear we will maintain our own organization, and will advocate for the measure as a transition to healthcare for all in the medium term, 4 to 10 years. That opens a measure to insurance attacks it's a stalking horse for the dread universal healthcare, but someone must bell the cat. 4) We commit to dialogue on all the above, and that we will hear their views, and not lecture. 5) I agree, and have explained why anything short of healthcare for all is ultimately useless. However, I think it's incumbent on any who want it all, without transitional steps, to lay out a reasonable strategy for developing the organizational power for such a mighty undertaking. I've done the research, and per figures from the Kaiser Foundation and Bureau of Labor Statistics sites I was right my family's medical costs are close to the Oregon family average, which is around $4267 for premiums, deductibles, co-pays etc, and my employer's $6000 cost is also typical, with both rising fast. The break-even income tax would have been around 6%, I'm sure it would have been lower, and even at 11.5% my employer would save money, which could be passed on to workers by union negotations. I'm sure some workers with high incomes and great medical would have paid more, and single, healthy workers with low premiums, and high unused deductibles and co-pays would pay too. But that's the classic argument labor should not favor the most privileged workers against the most oppressed, non-covered workers. We should admit that the AFL-CIO was likely right that 23 was doomed, even if it had had full union support. I'd appreciate some immediate feedback whether discussions with the AFL-CIO are worthwhile, then after their definite decision I'd like to contact other labor activists who favored 23 for their input. Given our current uncertainty, I think we should take our time making an organizational decision. I very much want organizational unity on whatever approach we ultimately take, as much as possible. I am scheduled to attend the biennial AFL-CIO legislative conference Jan. 11, and would like some guidance by then, but we'll see how it goes. ** * #360 Message: 1 Date: Fri, 13 Dec 2002 10:29:18 -0800 From: "Ruth Duemler" Subject: Re: AFL-CIO initiative proposals I didn't realize that the AFL-CIO was excluding insurance companies---for seniors and those unable to work this would mean they would have no chance at insurance, it would be too expensive---Ruth ________________________________________________________________________ ________________________________________________________________________ Message: 2 Date: Thu, 12 Dec 2002 16:19:42 -0800 From: "Lynn Porter" Subject: Fw: Guaranteed health-coverage plan unveiled -- Maryland ----- Original Message ----- From: "Francis K Johnson" The Baltimore Sun December 10, 2002 http://www.sunspot.net/bal-bz.health10dec10.story Guaranteed health-coverage plan unveiled Firms not offering benefit would pay into a fund By M. William Salganik Maryland businesses that don't offer health coverage for workers would have to pay 5 percent of their payroll into a fund for the uninsured, under a plan unveiled yesterday. Dr. Peter L. Beilenson, chairman of Maryland Citizens Health Initiative, said it was "unacceptable today not to guarantee access and coverage" to all citizens. His group's proposal would cover all of the 600,000 or so Marylanders currently uninsured, he said at a news conference at the Johns Hopkins Bloomberg School of Public Health. In addition to encouraging employer coverage and making it easier for individuals to buy private insurance, the plan would expand the state-federal Medicaid program and set up a $522 million "MdCare" program to cover about 170,000 adults not eligible for other insurance. Beilenson, Baltimore's health commissioner, said the proposal would build on the existing system, leaving about 80 percent of Marylanders covered by private insurance, usually offered by employers. Jonathan Weiner, a professor of health policy and management at Hopkins, said, "Maryland can be a leader with this private-oriented initiative." Under a concept called "play or pay," individuals, as well as employers, would be required to participate or pay into the fund. Individuals who didn't buy coverage would pay about $700 a year. To pay for the rest of the added coverage, the plan would raise tobacco taxes and tap existing programs for the uninsured. In development for four years, the plan will reach Maryland lawmakers next month in a legislative session that is expected to be consumed by efforts to close a projected $1.2 billion budget gap. There's also a more limited plan, which would expand eligibility but not require participation, being drafted by outgoing House Speaker Casper R. Taylor Jr. Like the initiative's proposal, Taylor's plan calls for Medicaid expansion and for a 2 percent premium tax on HMOs (there is already such a levy on other health insurers) to provide funding. State Sen. Paula C. Hollinger, a Baltimore County Democrat, said she's "more than sympathetic" to the goal of universal health coverage - she's tried to develop such a plan herself - but "in a year without money and in the middle of a recession, my guess is that we wouldn't go too far in any direction this year." Sean Cavanaugh, who will lobby for the Citizens' Health Initiative in the legislative session beginning next month, conceded, "It's certainly not going to pass this year, but we can do a lot of education." How far the plan gets this year, he said, may depend not just on the budget numbers, but on the amount of time consumed by budget considerations. The plan also faces opposition, particularly from business groups. "A 5 percent payroll tax - or any payroll tax - on small employers at this time would be devastating," said Ellen Valentino, state director for the National Federation of Independent Business. She criticized the initiative's proposal as "a government-run plan financed on the backs of small business." Small businesses are the ones that aren't offering coverage to workers, most surveys show. According to the Washington-based Employee Benefits Research Institute, 55 percent of businesses with three to nine workers offer health insurance, as do 74 percent of those with 10 to 24 employees, compared with 96 percent of businesses with 50 to 199 workers and 99 percent of those with more than 200. But Arnold M. Jollivet, president of the Maryland-Washington Minority Contractors Association, a member of the initiative's board, said he would tell small employers in his group, "The government has made special programs to help get you on your feet, and you should help your employees." He also noted that while some will object, businesses opposed Social Security initially, but "eventually it got to be part of the tapestry of America." Cavanaugh said the initiative hoped to mobilize large businesses to support the plan, since they would actually save money. Hospital bills in Maryland include a surcharge of about 8 percent to pay for treatment of the uninsured, he said, so if everyone were insured, businesses that provide coverage could save about $200 million a year. Robert O.C. Worcester, president of Maryland Business for Responsive Government, who has worked with Taylor on the more limited plan, said, "The payroll tax would bring about the collapse of private insurance in Maryland," encouraging employers who currently offer coverage to let their workers be covered by the state's plan. According to a survey by the consulting firm Mercer Human Resources Consulting, employers, on average, pay 13.1 percent of payroll for health benefits. Vincent DeMarco, executive director of the initiative, said the plan would include a "firewall," so employers who drop coverage couldn't immediately push their workers into the state-covered pool. And Darrell Gaskin, a health economist at Hopkins who advised on the development of the plan, said existing federal tax deductions for employers that offer health benefits, plus the need to attract and retain workers, would mean that "for most employers, it would be better to purchase coverage through the private market." ** * #361 Message: 1 Date: Sat, 14 Dec 2002 16:53:59 -0000 From: Joshua Dow Subject: The Democracy Owners Manual I imagine someone had forwarded this around before, but I was perusing through old quotes of the day I'd saved from Don McCanne's PNHP post & was struck by the following ... --------------------- Date: Sat, 7 Sep 2002 10:14:46 -0700 From: Don McCanne To: Don McCanne Subject: QoD: A guide to changing the world The Democracy Owners' Manual A Practical Guide to Changing the World By Jim Shultz Another false notion in initiative politics is that initiative campaigns are grand opportunities to shift public opinion to your side, even in the face of special interests opposing you. In fact, initiative campaigns are a poor time to educate the public, especially while you are being outspent ten to one or more. Initiative campaigns are often big-money battles of quick sound bites and images aimed at manipulating voters, not educating them. Most experienced initiative campaigners will tell you that if an initiative doesn't start out with support (as measured by serious polling) in the range of at least 65 to 70 percent, it has very little chance of maintaining 51 percent by election day. In almost every case, the "yes" vote for a measure only falls as the election approaches. Some advocates learn this lesson the hard way. In 1994, California health care advocates qualified an initiative to establish a state-run health care system, despite many polls showing the public's strong skepticism about such a move. Instead of the grand public education effort that proponents hoped would sway voters to their side, they were crushed three to one following a multimillion-dollar ad blitz by health insurers that set the cause backward, not forward. For information on "The Democracy Owners' Manual": http://www.democracyctr.org/resources/manual/index.htm Comment: Most of us are uncomfortable when we read Jim Shultz's words. But reality often creates discomfort. We'd much prefer to live with our fantasies of utopia. But, as long as Jim Shultz has shocked us into reality, let's look at what he has to say. He says that it is absolutely essential for us to understand the processes by which policy is translated into action. Without that knowledge and understanding, many of our efforts are for naught. Jim Shultz is a veteran of the California political scene. He understands how the process works. We don't like to hear about our past mistakes, but we definitely must understand them. We must understand the processes that are likely to bring us success and those that will assure our defeat. "The Democracy Owners' Manual" is must reading for those of us that want to change the world. ** * #362 Message: 1 Date: Sat, 14 Dec 2002 20:02:52 -0800 From: "Lynn Porter" Subject: "Do you want our hospitals to run like the DMV?" street roots, December 2002 Election 2002: The silent majority wins (loses) again By Joshua Cinelli Then there was Measure 23, universal health care for all Oregonians. Before I start in on this I would like to make a tangent, make a small point and then start another tangent. A lot of pundits and editors make a comparison between the United States and the Roman Empire. Especially now that this country seems intent on overreaching the boundaries of military superpower and entering into the dangers of viewing itself as infallible this analogy comes up continuously. What seems odd is there are very rarely comparisons made with other countries today similar to ours in wealth and freedom. Consider Denmark, New Zealand, Sweden and the neighbor to the north, Canada, as possible analogies. All of these countries have universal health care for their citizens. Why do we not? I kept overhearing the same comment when people were talking about Measure 23, "Do you want our hospitals to run like the DMV?" Audible screams responded. Letters to the editors made it sound like the Bolsheviks themselves had proposed the idea. "I once had to wait two hours to get a driver's license, can you imagine if I needed brain surgery." Somewhere the insurance companies cackled. ________________________________________________________________________ ________________________________________________________________________ Message: 2 Date: Sun, 15 Dec 2002 19:32:43 -0500 From: Joanne Landy Subject: Dr Richard Brown's PNHP-NY testimony on drug prices at 12/5/02 NYState hearing Dear PNHP-NY Members and Friends, Below and attached is Dr. Richard Brown's recent PNHP-NY testimony on controlling prices of prescription drugs in New York State. You may want to pass it on. Happy Holidays! Joanne Landy, Executive Director Physicians for a National Health Program-NY Chapter Testimony of the New York Chapter of Physicians for a National Health Program Hearing of the New York State Assembly Committee on Health Prescription Drug Prices in New York State, December 5, 2002 My name is Richard J. Brown. I am a psychiatrist, recently retired, who has been in practice, both institutionally and independently, for over 35 years. I additionally received an M.S. in administrative medicine from a school of public health. My educational and working experiences have led me to look beyond my immediate clinical and administrative activities into the functioning of the health care system. I am on the Board of Directors of the New York Chapter of Physicians for a National Health Program, an organization advocating a publicly funded, publicly administered health care system that provides equal access for all residents to quality, affordable care. Our nation is the only industrialized country that does not provide this for all our residents; more than 40 million people in the United States are medically uninsured, and a similar number are underinsured. It is not that there isn't enough money to provide health care for everyone. Our country spends more on health care (more than 14% of GDP) than any other country (10.5% of GDP is the most that any other country spends.) Yet we are way down on the World Health Organization's performance list - only 37th -- lower than Canada, Japan, and all of Europe. Ours it the only industrialized country without a national health program. I am here to speak about the pharmaceutical industry and the cost of prescription drugs in this country and in this state. The prescription drug industry is costwise the fastest growing sector within the 14% of GDP utilized for health care. Drug spending is rising 15-20% a year - doubling every five years. Part of this increase is demographically driven. We are living longer, growing more numerous, and many of us require medicines for chronic conditions. The increase is also due to advances in the science and practice of medicine, including the development of newer drugs that help to manage high blood pressure, diabetes, elevated cholesterol, infectious diseases including HIV/AIDS, gout, depression and psychoses, among other diseases. But another part of this rising cost is attributable to unconscionable profit-taking and profligate promotional practices. The pharmaceutical industry's average profit after all expenses including research and development, advertising, promotions, lobbying, political campaign funding, contributions to law makers, and anti-consumer lawsuits to maintain uncontrolled prices is 18-19% - that's over three times the profit margins of the other industrial sectors. Looking more closely, we find that drug prices in this country average over twice those of the very same drugs in other countries. How does this happen? In every single country throughout the industrialized world except for the United States, drug prices are government controlled. Let me say that again: In Australia, in Canada, in France, in Germany, in Italy, in Japan the governments control drug prices. Also to be noted is the fact that direct-to-consumer advertising (DTCA) is banned in the European Union and Canada. Europeans visiting the U.S. are startled to see those ubiquitous "Ask Your Doctor" ads we find on TV and radio, in newspapers and magazines, and on billboards. While the industry claims that this advertising is "educational," in yesterday's New York Times it was reported that the General Accounting Office Congress's investigative arm - has found that "drug companies have repeatedly disseminated misleading advertising, even after being cited for violations, and millions of people see the deceptive ads before the government tries to halt them." These ads are hard to escape in the United States, and as I have indicated, are not to be found in Europe or Canada. Promotions include lectures to physicians in expensive restaurants and often include paying the doctors up to $500 to help drive the point home that the drug being promoted is the Rolex of them all. The pharmaceutical industry has thus far been successful in blocking even weak federal legislation that would lower drug prices. These costs are borne by Medicaid, state programs, and private insurers, as well as by individual patients without drug coverage who sometimes have to compromise expenditures on food, clothing, fuel and other necessities of life. So far even modest attempts at reining in drug prices have failed at the national level. We in New York cannot afford to wait until this much-needed national reform is adopted. Other states either singly, or in partnership with other states, are beginning to take measures to control spiraling drug prices. It is high time for our great state of New York to take a leadership role in this endeavor; such a step would offer a decided benefit to our own people and to people around the country. As you review your legislative alternatives, I ask that you consider very seriously the necessity of controlling pharmaceutical prices in order to defend the public coffers and to make affordable drugs available to all New Yorkers. I thank you for this opportunity to testify before this Committee. * * * * * * Physicians For A National Health Program New York Chapter 2840 Broadway, #297, New York, NY 10025 Tel:212 666-4001 Fax:212 866-5847 Email:pnhpnyc@igc.org Web: www.pnhpnyc.org ** * #363 Message: 1 Date: Mon, 16 Dec 2002 11:33:34 -0700 From: Estelle/Jennifer Subject: Re: Labor initiative proposal Hi...re labor proposal....what is the definition of all workers ?? labor union members ? non-labor members ? part time workers ? Estelle ________________________________________________________________________ ________________________________________________________________________ Message: 2 Date: Mon, 16 Dec 2002 21:27:56 -0800 From: "Lynn Porter" Subject: Oregon AFL-CIO to push health care system reforms at 2003 Legislature Northwest Labor Press Dec. 2002 http://www.nwlaborpress.org/12-6-02Briefs.html Oregon AFL-CIO to push health care system reforms at 2003 Legislature SALEM - According to the Oregon AFL-CIO, four out of five Oregon voters said they didn't want to pay significantly higher taxes for a single-payer health care system when they voted down Measure 23 in the Nov. 5 general election. But they didn't get to say what reforms they do want, even though a majority of Oregonians think the nation's health care system is broke and needs fixing. The Oregon AFL-CIO Executive Board addressed that dilemma Nov. 15 by voting to draft legislation for 2003 and potential ballot initiatives for 2004 that will require employers to fund health care for all workers or, at a minimum, health care for all dependent children of their workers. The "health care for all kids" approach could leverage additional federal funds available for covering children up to 300 percent of the federal poverty level and equalize the competitive playing field for all employers by requiring that they cover children in their health plans or contribute to a fund that would guarantee health care for all Oregon children, the state labor federation said. An employer-paid payroll tax of less than 2 percent would be sufficient to finance this guarantee. Research Director Lynn-Marie Crider will prepare the draft legislation and present final options to the Executive Board at its Dec. 13 meeting. For more information, call Crider at 503-585-6320. ** * #364 Dec 19 Message: 1 Date: Thu, 19 Dec 2002 09:56:55 -0800 (PST) From: Mike Beilstein Subject: AFL-CIO Newsletter Hello- This is an excerpt from the Oregon AFL-CIO weekly newsletter (Dec 18). It includes the Universal Child Health Care proposal which they floated earlier. This may be the basis for cooperation on a reform that leads to a societal responsibility for "health care for all." I don't think Health Care for all Oregon is settled on a course of action, but I would favor throwing our support behind these AFL-CIO proposals, keeping in mind that we have a greater goal. Mike Beilstein, chair Mid Valley Health Care Advocates Health Care Reforms Top Our Legislative Agenda… Controlling health care costs topped the list of legislative priorities approved by the Oregon AFL-CIO Executive Board last Friday. And that ranking was re-affirmed by AFL-CIO officials from Oregon, Washington, California and Nevada at a meeting in Portland on Monday, as leaders shared strategies for a coordinated labor agenda in the western states. "Health care reform is the number one challenge for our labor movement at the state level," said Oregon AFL-CIO President Tim Nesbitt. "No one can reasonably expect any meaningful action from the U.S. Congress to control costs or move toward universal health coverage in the near future. In the meantime, health care costs are killing us at the bargaining table and forcing more unrepresented workers to go without coverage. So it's up to us to take on this issue at the state level. We'll bring reforms to our state legislature next year and, if necessary, take them to the ballot in 2004." The Executive Board identified two short-term reforms that would be most effective in reducing and controlling health care costs for insured workers. 1) Force drug companies to give us fair prices for prescriptions drugs. Creation of a prescription drug bulk purchasing entity will enable public and private health plans to leverage lower prices from the pharmaceutical industry, whose pricing is notoriously sensitive to the size and power of its buyers. For example, the federal government pays for its VA hospital patients less than half of what an uninsured individual is charged for the same prescription drugs and 36% less than what most of our own health plans have to pay. 2) Get employers, like Wal-Mart, to start paying their fair share for the health care costs of working families. Irresponsible employers like Wal-Mart force their workers to go without health insurance or seek their health care from taxpayer-supported programs. Unfortunately, it is not possible to simply pass a law to require such employers to provide health insurance for their workers, because of federal preemptions in this area. But states can use tax policy to get employers to do the right thing. An employer-paid payroll tax of just 1.5% of payroll would be sufficient to guarantee fully-funded health care for all children in Oregon up to the age of 21. Such a reform would level the playing field between good employers who already provide such support for their workers and those who don't, and it would take pressure off of us at the bargaining table to come up with the extra money to cover the premiums for full-family coverage. This two-pronged approach could reduce or offload up to 20% of the premium costs now borne by employers and union trust funds that are providing full-family health benefits. And, with all employers participating in a reasonably-priced system, we'll reinforce the principle of employer responsibility for funding health care for their workers, which has been the mainstay of our health care system in the U.S. for more than 50 years.