Making Democracy Work

Health Roundtable

The health roundtable was reinstituted March 13th 2018. Please come to the next meeting and add your thoughts to help us advocate for improving our healthcare. system. We are planning monthly meetings and additional working subgroup meetings.

Roundtable Events

Next roundtable meeting: Monday, September 2 (Labor Day) at noon at Deep Roots. Please bring your lunch or better yet, buy it there. We will make plans for further educational activities. Please see the documents developed by Laurey Solomon with facts and FAQ's for use in educating the public regarding the advantages of a single payer medical system.

Contact Us

Contact us by email hrt@lwvpt.org.

Chair Person

Laurey Solomon

Roundtable Goals

Proposed goals:

In keeping with the League of Women Voters of the United States health care goal to 'promote a health care system for the United States that provides access to a basic level of quality care for all U.S. residents, including behavioral health, and controls health care costs' the League of Women Voters of the Piedmont Triad Health Roundtable will focus on two goals. Our goals for 2018-2019 are for specific advocacy and education.

We resolve:

1) To educate the public regarding the extent to which our health care system is underserving particularly the poor and financially stressing the entire society.

2) To seek to encourage legislators to move first toward "Medicaid expansion" and then eventually toward a program of "Medicare for all."

The 2016 - 17 public policy statement of the League of Women Voters of the Triad under social policy, health care was, "Promote a healthy community that recognizes the importance of social, geographic, political influences. Promote a health care system for the Piedmont Triad that provides access to affordable, quality care for all residents, including prevention of disease, primary care (including prenatal and reproductive health), acute care, long-term care, and mental health care (including substance abuse treatment). Promote control of health care costs, equitable distribution of services, efficient and economical delivery of care, advancement of medical research and technology, and a reasonable total expenditure level for health."

Health Events

Candlelight vigils for Medicaid Expansion will be held June 5 at 7 pm at two locations in the Triad. One in the Plaza in front of the Melvin Municipal Bldg in Greensboro and one at Winston Square Park in WS.

On April, 8th Wendell Potter spoke at the Lane's residence on the need for Medicare for All from the perspective of a former health insurance company executive in charge of spinning their increasingly onerous contracts so that the public would not protest too much.

On March 26, 2019 at 7:30 PM in Greensboro, Jonathan Oberlander, PhD. professor at the University of North Carolina presented "Unfinished Journey: The Future of Health Care Reform" at Union Square Campus.

The March 19, 2019 Lunch with the League related to universal health care coverage.

October 21, 2018 we had a booth at the Greensboro PRIDE festival and handed out over 200 of the League's voter's guides along with our bookmarks related to improving access to healthcare.

Meeting Notes

Piedmont Triad League of Women Voters Health Round Table Monday, July 8th, noon + approx 1:30 Deep Roots Conference Room Submitted by Jessica Goodman with minor edits by Laurey Solomon

Present: Laurey Solomon, Anna Fesmire, Barbara Carter, Jessica Goodman, Rob Louisana, Tim Lane, Robin Lane, Wayne Hale, Shirley Carr and Mary Eubanks

Talking Points LWVUS stance on healthcare: Every resident should have access to healthcare, including birth control and reproductive choices. Morally right Insured people pay for others anyway when hospital ER's are required to stabilized everyone regardless of ability to pay Democrats are split Access to the ACA is based on social equity politics Mention of racism as it relates to lack of health care in US (remember the 3/5ths compromise in 14th amendment Define "resident" as used in the LWVUS' "Impact on Issues". Laurey will ask a RT member to research this.

Laurey shared two handouts she intends for members to use to advance discussions that promote health care for all. These also informed the one-sentence/short blurb signs she created. Regarding those handouts: Suggestions that were shared in the meeting: Add a Title, created date and edited date Keep Big Picture and purpose of document in mind as we edit First point: "long-term goal of many and a demand centuries old" Change "general income or payroll taxes" to just "taxes" Possibly clarify "socialism" through public vs. private options (i.e. Post Office vs. FedEx) Cite sources Will need to get the document approved by the board This task was taken on by Tim, Robin, and Laurey (with Rob's added talking points) Make your own edits and share with the RT before the next meeting.

Laurey's second handout was tabled for the next meeting. Robin Lane has agreed to become the point person for HRT's goal of Medicaid Expansion. "Healthcare Can't Wait" Initiative described by Robin Lane Effort to extend healthcare to everyone Robin (and initiative) are asking that we send a nonpartisan statement to the Guilford Delegation in order to overturn Governor's veto of budget SB681 or the "rural healthcare stabilization plan" Robin and Barbara will add this to the League Action Alerts

Jessica had to leave early, this is as far as her record goes.

Health Actions

Letters to the Editor:

Greensboro News and Record, May 2019, Wayne Hale Rising Deductibles Threaten U.S. Health

Last December it was reported that life expectancy in the U.S. decreased for the third year in a row. Canadian women now live 3 years longer and their men 4 years longer. Drug overdoses and suicides receive the most blame, but a growing contributor will be avoidance of preventive health care. The Los Angeles Times recently reported that medical insurance deductibles have quadrupled since 2006 so that on average insured people have to pay $1350 out of pocket before their medical costs begin to be covered. Since only half of non-elderly single households have liquid assets above $2000, it is very likely that a colonoscopy or stress test will be delayed if it is done at all. Increasingly, employment based health care is becoming catastrophic care, since the avoidable cancer or heart attack will result in expensive emergency care. The deductible will be met, but irreversible damage will have been done. That money may not be spent if the insured person dies, but the company's CEO certainly won't tout that cost-saving measure in the annual report to shareholders. Anxiety from being underinsured is a stressor that itself will contribute to the declining health of our nation.

Greensboro News and Record, March 17, 2019, Wayne Hale Healthcare Spending is Unsustainable

"The U.S. federal government is on an unsustainable fiscal path. ... The thing that drives our single unsustainability is health care spending. We spend 17% of GDP, everyone else spends 10%. ... It's not that benefits themselves are too generous. We deliver them in inefficient ways." You might guess that Senator Bernie Sanders said this, but it was actually Jerome Powell, Federal Reserve Board Chairman. Could that extra 7% of GDP be spent on providing services to patients, rather than on CEO salaries, excessive drug prices, middleman services, and shareholders? Healthcare costs were at the top of voters' concerns according to exit polls during the 2018 elections. The League of Women Voters of the Triad's Healthcare Roundtable is working to prepare voters for candidates' proposals related to delivering healthcare services so that they would be universally available to our population. On March 26, 2019 at 7:30 PM in Greensboro, Jonathan Oberlander, PhD. professor at the University of North Carolina will present "Unfinished Journey: The Future of Health Care Reform" at Union Square Campus at124 E. Gate City Blvd. Attendance is open and free to the public. Let's figure out how to provide effective healthcare to everyone!

Greensboro News and Record, April 15, 2018, Laurey Solomon Medicaid Expansion is the right thing to do.

A 30 year old single adult in Guilford Co whose income is $12,070/year can choose from among 6 policies that cost between $0 and $56.42/month because that person will be eligible for a subsidy under the Affordable Care Act. Someone who makes $12,050/year or less will have to pay between $225.21 and $598.42/month for the same coverage. (The threshold for eligibility for a subsidy is $12,060.) It makes no sense for someone who has less income to have to pay more for health insurance. Obviously, no one whose income is less than $12,060 can afford even the cheapest insurance available to them at $225.21/month. The Affordable Care Act was designed to offer Medicaid to people whose income was below the threshold for a subsidy. Since each state helps pay for Medicaid, the Supreme Court said each state can choose whether it does extend Medicaid to its low income residents. At the present 32 states and Wash DC offer Medicaid to people who can't afford a subsidy. North Carolina does not. And it needs to.

Letter to the Editor Greensboro News and Record April, 2018 Wayne Hale

"Save Our Medicare" The above statement is commonly seen at rallies on both sides of the political spectrum, but the sign bearer is likely unaware of the true threat to Medicare's perpetuation. Medical care costs continue to grow faster than the GDP. America spends about $5000 more per person on health care than other rich countries, but our outcomes don't make the twenty best on most measures. Since 1997 Medicare Advantage plans pay insurers a premium to keep subscribers healthier, though that result has not been proven. Meanwhile mergers give ever-larger health system businesses more clout for bargaining with other entities. E.g., CVS merging with the insurer, Cigna, purportedly will be more efficient, but shareholders rather than payers will likely reap the benefits. When have monopolies ever lowered costs for consumers? Health care will become more cost-effective when many of these unnecessary and costly middlemen are removed. Traditional Medicare has kept overhead costs under 3%. Providing Medicare for all as Canada does (for under 2% overhead) is the best way to streamline our system. Otherwise, we are just giving Paul Ryan reason to propose Medicare cutbacks because the expenses are too high to be supported by the new tax plan.

Health Resources and Links

Health Care for All FAQ'S 07/29/19

Won't my taxes go up? Yes. But you won't pay any more insurance premiums, deductibles or copays. As a result, most families will spend a lower percentage of their income on health care. In our present system where most of us get our health insurance through our jobs, the lowest paid employee in the company pays the same insurance premium (and deductible and copays) as the highest. Therefore, lower paid employees spend a higher percentage of their income on health care. This is especially true for families since family coverage is much more expensive than employee only. If we have health care for all paid for by taxes, lower and mid level earners would actually save money. A Rand Corp study commissioned by the state of New York in 2018 to consider a single payer system for the state concluded that only those earning $134,000 as individuals and $276,000 for a family of 4 would pay more for health care as a result of the tax increase.

Why should I pay higher taxes so other people can get health care? You already pay for other people to get health care, in the least beneficial and least efficient way. When people can't pay for preventive and/or ongoing care, they end up going to hospital emergency rooms, where they know they can get some help without paying for it. Guess who does pay for it? You. Hospitals increase what they charge you and your insurance company to cover treatment of the uninsured. You also pay in many overarching, indirect ways like increased costs of goods and services due to lower worker productivity, poorer overall public health, and increased burdens on several public services.

Won't I have to wait longer to see a doctor and to have elective procedures and surgeries? If we try to answer this question by comparing current wait times in the US to current wait times in countries that provide health care for all, we can't. Not all countries measure wait times. (France, whose health care system is ranked #1 by the World Health Organization, does not even measure wait times.) The ones that do measure wait times don't use the same standards and methods so we can't legitimately compare their results. We simply can't answer this question. One thing we do know is the wait time for people who have no health insurance will improve dramatically.

Isn't this socialized medicine? Of the 32 developed countries that have health care for all, most do NOT have socialized medicine. Socialized medicine means the government owns the health care facilities and employs all the people who work in them, like in the UK and a few others. The rest of the developed countries each have a system that works best for them. Some require everyone to buy health insurance through either their employer or the government. Some collect taxes and then pay private providers to deliver health care. Some have a system that combines both methods by taxing people to pay for basic services and if people want additional care they can buy insurance to cover it or pay for it out of pocket (at much lower costs than the US). Socialized medicine is only 1 way to provide health care for all, it is not the only way and most countries do it differently.

We have the best health care in the world. Why mess with success? Actually, we don't. We have excellent care in some areas but we fall behind many countries in others. Several organizations have researched and rank ordered the health care systems of developed countries based on factors like life expectancy, access, efficiency, medical errors, cost, and prevention. The US doesn't rank in the top 10 in any of the studies!

Will I lose the ability to choose what doctor I go to? Most health care for all systems allow people to choose their doctors.

Will health care be rationed? At first glance, this seems like a straightforward question but it's not. If we agree that rationing involves deciding how to use limited resources, that already happens in every health care system, including ours. There are several ways insurance companies in the US practice "covert rationing" (meaning they don't want you to realize they are doing it). One example is when they create "in network" and "out of network" providers. "In network" providers are those that the company has negotiated with to accept lower payments for their services. You can still go to an "out of network" provider but you will pay more because that provider won't accept payment at the same rate as "in network" providers. Another example is when an insurance company refuses to cover a drug or treatment because they label it "experimental". Or when an insurance company gives its clients a list of "approved" drugs for various illnesses and conditions. That is rationing and it already happens in the US. These are just a few examples among many. Under health care for all, any rationing that occurs will not be a new concept or practice.

References: Rand Research Report: An Assessment of the New York Health Act, A Single Payer Option for New York State, Jodi L. Liu et al 2018

http://www.ncbi.nlm.nih.gov/books/NBK221654/
http://www.verywellhealth.com/difference-between-universal-coverage-and-single-payer-system

http://thepatientfactor.com/canadian-health-care-information/world-health-organizations-ranking-of-the-worlds-health-systems/
http://www.sciencedirect.com/science/article/pii/S0168851013001759 http://www.beckershospitalreview.com/quality/among-11-countries-us-ranks-last-for-health-outcomes-equity-and-quality.html interactives.commonwealthfund.org/2017/july/mirror-mirror/ www.medscape.com/slideshow/2019-compensation-overview-6011286#3 http://www.verywellhealth.com/what-is-healthcare-rationing-2615389 www.forbes.com/sites/robertpearl/2017/02/02/why-healthcare-rationing-is-a-growing-reality-for-americans/#10822ff2dbad

Health Care for All Facts 07/29/19

In 1948, the World Health Organization of the United Nations declared health care a human right. 

Reference: Article 25 of the UN's Universal Declaration of Human Rights

Of the 33 countries widely considered developed/industrialized, 32 have health care for all. Only 1 does not. Ours.

Reference: http://www.thebalance.com/universal-health-care

When government both pays for and provides health care services, that is socialized medicine. However, most of the countries that provide health care for all do NOT practice socialized medicine. Most countries tax the population and deliver health care by private providers. Some countries require everyone to buy health insurance through either their employer or the government. Some countries use a combination approach where people are taxed to pay for basic services and can choose to buy insurance for additional care, or pay for it out of pocket at much lower costs than we have in the US. The specifics of how health care for all is paid for and delivered are unique to each country and more complex than it is reasonable to explain here.

Reference: http://www.verywellhealth.com/difference-between-universal-coverage-and-single-payer-system

What they have in common is that they spend approx. half of what Americans spend for health care. And while Americans pay twice as much for our care, some of which is excellent, the World Health Organization ranks our health care system 37th in the world.

Reference: http://www.reuters.com/article/us-health-spending

4 main things account for Americans' high costs: Drugs cost much more in the US, where average profit margins are twice as high as all other industries (except software). 1 in 4 diabetics report they ration insulin because they can't afford to pay for their prescribed amount. need. Other countries negotiate lower prices and then regulate them. Administrative costs account for a much higher percentage of health care expenditures than other countries due to the numerous and complex insurance and billing systems in the US. Medically unnecessary testing is routinely conducted in the US (often called "defensive medicine"). Specialty care and newer forms of treatment and drugs are frequently used, at higher cost, when primary care doctors and older forms of treatment and drugs are just as effective. A Harvard ethics center and independent teams of doctors and pharmacists in several countries have concluded that most new drugs are not better than existing ones while they are much more likely to have serious side effects.

References: law.stanford.edu/2018/01/10/new-gao-report-on-drug-industry-profits/ http://www.americanprogress.org/issues/healthcare/reports/2019/04/08/468302/excess-administrative-costs-burden-u-s-health-care-system/ http://www.cnn.com/videos/health/2017/09/19/why-us-health-care-so-expensive-orig.cnn news.yale.edu/2018/12/03/one-four-patients-say-theyve-skimped-insulin-because-high-cost

ethics.harvard.edu/blog/new-prescription-drugs-major-health-risk-few-offsetting-advantages
http://www.drugwatch.com/featured/misplaced-trust-fda-approval-concerns/

Possible questions/concerns about health care for all:

Taxes. Yes, taxes will go up. But insurance premiums, deductibles, and copays will disappear, offsetting the tax increase for all but the wealthy. Families in low to middle income brackets are projected to actually save money. In addition, the cost of health care services will decrease under a much more efficient system. Will wait times for visits to specialists and elective procedures increase? We don't know. Location and socioeconomic status already affect wait times in the US. Studying and comparing wait times in countries with health care for all is NOT simple or straightforward because they don't all use the same standards and methods to measure. Some don't measure at all. Those who tell you wait times will increase if the US achieves health care for all cannot make that claim for the simple reason that they cannot compare "apples to apples". However, the 14% of Americans who have no health insurance will see their wait times go from forever to at least sometime. And the 30% of American working adults who have gone from traditional insurance to high deductible plans in the last 10 years (because they can no longer afford traditional health insurance) will see their wait times go from "a long time because I can't even afford my deductible" to at least sometime. Rationing. At first glance, this seems like a straightforward subject but it's not. If we agree that rationing involves deciding how to use limited resources, that already happens in every health care system, including ours. There are several ways insurance companies in the US practice "covert rationing" (meaning they don't want you to realize they are doing it). One example is when they create "in network" and "out of network" providers. "In network" providers are those that the company has negotiated with to accept lower payments for their services. You can still go to an "out of network" provider but you will pay more because that provider won't accept payment at the same rate as "in network" providers. Another example is when an insurance company refuses to cover a drug or treatment because they label it "experimental". Or when an insurance company gives its clients a list of "approved" drugs for various illnesses and conditions. That is rationing and it already happens in the US. These are just a few examples among many. Under health care for all, any rationing that occurs will not be a new concept or practice.

The transition will be not be quick or easy, however we all know health care costs are rapidly spiraling out of control. We already spend a lot more per person on health care than any other country while we have less people covered and poorer outcomes. Those 3 facts are easily verified and undeniable. The countries who spend less and have better outcomes all provide health care for all.

References: http://www.sciencedirect.com/science/article/pii/S0168851013001759 http://www.cdc.gov/nchs/products/databriefs/db317.htm Rand Research Report: An Assessment of the New York Health Act, A Single Payer Option for New York State, Jodi L. Liu et al 2018 http://www.nytimes.com/2019/04/29/opinion/medicare-for-all-cost.html

jamanetwork.com/journals/jamainternalmedicine/fullarticle/191209
http://www.verywellhealth.com/what-is-healthcare-rationing-2615389
news.harvard.edu/gazette/story/2018/03/u-s-pays-more-for-health-care-with-worse-population-health-outcomes/
www.forbes.com/sites/robertpearl/2017/02/02/why-healthcare-rationing-is-a-growing-reality-for-americans/#10822ff2dbad

We believe health care for all will:

Increase Americans' life expectancy
Increase public health
Increase economic productivity
Encourage entrepreneurship
Stop the leading cause of personal bankruptcies
Keep smaller hospitals open in small towns and rural communities Raise the US up to the moral standard recognized by the entire rest of the industrial world

North Carolina needs to expand Medicaid

"Rebounding with Medicare, Paul Starr<http://www.princeton.edu/~starr/articles/articles18/Starr_Rebounding-with-Medicare_JHPPL.pdf>

A New Strategy for Health Care, Paul Starr

The Jonathan Oberlander presentation from March 26, 2019 is available for viewing on You Tube

The presentation was co-sponsored by the Cone Health Foundation, Health Care for all NC, and the Sally Austin Project of the LWVPT Education Fund.

The presentation was co-sponsored by the Cone Health Foundation, Health Care for all NC, and the Sally Austin Project of the LWVPT Education Fund.

The Medicare for All Continuum: A New Comparison Tool for Congressional Health Bills .

How Will Medicaid Work Requirements Affect Hospital Finances?

The North Carolina Medical Insurance Gap: A Problem for Everyone

Kaiser Family Foundation

List of primary care sources in the Piedmont Triad

Fixit Healthcare

Benefits from ACA Medicaid Expansion

Updated

Page last updated August 8, 2019.