HCCD Report Pennsylvania 19601

Health Care Community Discussion

December 28, 2008
West Reading, PA

Our group was comprised of 10 females and 3 males in attendance and one additional male who submitted his comments prior to the meeting via e-mail. Of the 13 participating in the group discussion, 2 self-identified as Republicans.

Participants agreed the most urgent problem with health care in this country is cost—both the cost of medical care itself and also the cost of health insurance. This dual problem exists regardless of one’s work status: an employer, an employee with employer-related health coverage, an employee having neither employer-related nor (totally) self-paid health insurance, a self-insured small business owner, or an out-of-work individual who cannot afford COBRA payments. Too frequently people’s health insurance—or lack of it—impacts not only one individual but an entire family.

Increasingly, families are one health crisis away from home foreclosure or bankruptcy with no federal handouts coming to the rescue. Especially during the current economic debacle in this country, not only a lack of health insurance but also the fear of losing one’s job and consequently losing one’s insurance are creating agitation with possibly serious ramifications. It is not a big leap from this unrest to a rise in crime. There are too few food banks and soup kitchens; there are remarkably fewer free medicine cabinets.

One participant pointed out that presumably the most powerful, the most responsible job in the world is being president of the United States. The current salary for this important position is $400,000/year. Yet the U.S. has auto executives who receive in excess of $20,000,000/year compensation even when their companies fail. For decades to come, all citizens—even those without enough money to purchase their own health insurance—will remit taxes that will help repay the federal bailouts. These taxes will be used in part to repay the salaries and benefits of assembly line workers in the auto industry and egregiously to continue health insurance for the industry’s wealthy executives and their families.

Americans pay the highest pharmaceutical prices in the industrialized world (see chart on page 6, “US Dominates Global Market in Retail Pharmacy Drug Purchases,” from speech entitled “The Global Market for Pharmaceuticals and Policy Responses,” given May 9, 2007, by Elizabeth Docteur, Deputy Head, Health Division, Organization for Economic Cooperation and Development [OECD]). One participant in our own discussion has a friend using a contraceptive made by Wyeth. In the U.S., she pays $2.00 per pill when she buys a 56-day-supply at Costco; however, when she visits her family in Mexico, she pays 27¢ (yes, cents!) per pill for the same drug—not for a generic formula but for the same Wyeth product complete with the same Wyeth labeling.

There was loud concern expressed by our participants about linking insurance to employment. The current system is not fair to employers or employees. Especially small business owners find it difficult to be competitive with products and/or services and with recruitment of new employees when the cost of employer-based insurance continues to escalate. A related injustice is that a person with one or more obvious pre-existing conditions is unlikely to secure employment. Others with “hidden” pre-existing conditions, even if fortunate enough to get a job, are not likely keep their positions if their medical bills raise the cost of health insurance for the entire company or worse yet when an insurance company says it will no longer provide insurance for any employee because of the medical expenses of one employee.

Two of the participants in our group have worked unceasingly here in Pennsylvania for legislation to implement single-payer universal health care (see pages 6–10). Governor Ed Rendell has stated that this commonwealth would be “well-served” by a single-payer plan and has pledged that if the legislature passes such a plan, he will sign it into law (see page 8).

The other overriding concern of our group were the questions we received from the Obama Transition Team. The questions lacked specificity especially relating to the stated goals of the President-elect’s Health Care Plan. We found it curious that the current bailouts to the auto industry are given with mandates that companies cannot continue to function as they have been. However, the stated Health Care Plan indicates that Obama wants to “build upon and strengthen employer coverage.” There is no indication that other models will be explored. This is a big concern not only for the persons who have been working for a single-payer plan here in Pennsylvania but also for others in our group who have not yet developed a particular alternative vision for access to health care but who clearly know that “more of the same” is not the answer.

In a similar vein, simply requiring more access to generic medications is not the only solution, or even preferred solution, to the skyrocketing, out-of-reach costs of prescription drugs in this country. Persons in our group are tired of the daily (hourly?) onslaught of expensive television and magazine drug ads paid for with dollars exceeding monies spent on research and development. The money dispensed by pharmaceutical lobbyists, who currently outnumber senators and congressional representatives 2:1 (see Marcia Angell’s The Truth about Drug Companies, Random House, 2004), flies in the face of the President-elect’s oft repeated assertion during the campaign to keep lobbyists at bay. Our group strongly urges the Transition Team to pass legislation placing caps on pharmaceutical drugs rather than stop at requiring more access to generic meds.

Our group encourages the Transition Team to expand exploration of options for health care. We specifically urge the team to include in national discussions about improving access to care not only professional policy makers but also citizens in various walks of life from around the country.

Specific Comments

Costs of health insurance:

Many people are unaware of how much their employers pay for insurance.
If people do not need care immediately, they often do not go out of their way to find out about overall costs of health care.
To bring down costs, our health care system needs to stress prevention rather than primarily treating acute symptoms.
Not only insurance premiums but also high deductibles and co-payments are prohibiting many—too many—persons from accessing health care and prescription medications.

Reasons we need to move away from employer-related insurance:

High cost to employers to provide health insurance for all employees is increasingly unrealistic.
People cannot afford to work for small employers who are unable to provide insurance.
The employer-related model implies that health care is a prize to be earned rather than a basic right of all individuals.

Ways people have paid for care when they did not have medical insurance:

Personal loans
Kindness of family and friends
Let bills go to collection agencies which led to ruined credit ratings
Hospital paid (through funding under the Hill-Burton Act or other pot of money for the uninsured)
Credit cards
Did without other things (e.g., food and heat). This is a particularly dangerous “option” as the efficacy of many drugs is decreased when not taken with specific types of food at prescribed times.
Did without health care itself!

Comments about accessibility to health care:

Placing caps on prices of prescription medications is long overdue.
Most people choose doctors based on word of mouth of others not by TV or magazine ads.
One participant quoted Hillary Clinton: “There is too much access for some people, too little for others. No one has the right amount of access to health care.” For instance, some people have testing done too often while others do not have access to any testing or medical procedures.
The “near poor” do not have access to health insurance (earn too much for Medicaid and too little to pay for insurance themselves).
Although she herself has health insurance, one physician in our group said she will not access care for herself or her children from a doctor who will not see medical assistance patients.
Even one person without access to care impacts a community’s health.

Personal examples of insurance frustrations:

One participant pays two months of her annual income for health care.
Two participants pay four months of their annual income for health care.
A single proprietor pays 25% of his annual income for health care.
One participant lost her job because her employer could no longer afford to pay health insurance premiums for part-time employees and could not justify providing insurance for some people and not for others.
A 60-year-old, self-employed caregiver has not been able to afford health care insurance for herself for the past 10 years.
Despite good insurance, one participant paid $10,000/year out of pocket for her husband’s serious medical condition.
One participant’s husband lost his job because he needed a heart transplant. At this same time, this participant’s adult daughter was underinsured while coping with two serious illnesses of her own.
One participant was refused insurance because of a pre-existing condition.
Several participants felt it unjust that most hospitals and physicians accept “less than billed” as “payment in full” when fees are paid by an insurance company but uninsured persons are required to remit 100% of all charges.
Falling in between are the underinsured A participant could undergo a hysterectomy only after she paid money to the hospital before admission because her insurance would not cover all the expenses of the surgery.

Impact on public health:

Allowing patients to access care (such as flu shots) without going to a health care facility would improve public health. Such services need to be convenient and cheap (such as $25 flu shots in grocery shots). One pharmacy chain in a nearby community offered flu shots this year in their parking lots where people could get an injection without leaving their cars.
In 2004, the U.S. spent 15.3% of our GDP on health care (reported by the National Coalition on Health Care [NCHC]). Excluding the U.S., the median for all other OECD countries was 8.8%.
In 2007, the U.S. spent 17% of our entire GDP ($2.4 trillion) on health care (NCHC); this was 4.3 times the amount spent on defense If we stop our current waste in escalating health care, with the dollars saved annually we can repair our roads, bolster our bridges, strengthen our schools, house our homeless, underwrite our uninsured, energize our economy, improve our infant mortality rate, and properly promote public health.
In 2008, employer-related insurance increased by 5%, twice the rate of inflation. The annual premium in the U.S. for an employer-related health plan covering a family of four averaged nearly $12,700. The annual premium for single coverage averaged over $4,700 (NCHC).
The U.S. spends more on health care than other industrialized nations and those countries provide health insurance to all their citizens (NCHC).
Health care, the economy, and the environment are intrinsically bound together. Unless we simultaneously work to improve all three of these ills, the quality of our public health will continue to suffer.

Suggestions for improving health care delivery and payment for care:

Implement single-payer system for universal health care (see pages 7–10).
Forms and insurance process are much too complicated. If we continue with current model of multiple health care insurers, one claim form needs to be developed and used by all companies. In addition to simplifying the process, one standard form would save much money and time for companies, physicians, hospitals, and patients.
Additionally, having one set of deductibles and co-pays would further simplify the claims’ process.
Owners of small businesses need access to health insurance pools where with other small business owners, they can purchase health care with discounts made available to large businesses.
A physician working in a medical center complex here in southeast Pennsylvania suggests we need a health care system that is patient/community focused rather than insurance company focused. The establishment of health “co-ops” would be backed with federal dollars and yet would keep health care local. This model, which has worked with housing, would switch the focus from satisfying insurance requirements to providing easily accessible and affordable health care with the goal of enhancing both individual and community health.
We need to promote public health at local, regional, and national levels by strengthening departments of health that are effective and which advocate for improved health care, environment, and lifestyles.
State and federal tax dollars are not enough; tax policy which promotes public health needs further development.
Learn from our past mistakes. Many working in public health remember when we became complacent with tuberculosis and closed sanitaria because we were convinced that the disease was eradicated. Then came HIV, and TB latent for decades in many individuals was reactivated. The public health system was not as ready or as funded as it should have been to tackle an old disease with new complications.
With avian influenza, AIDS, and Alzheimer’s disease afflicting our aging baby boomers, we need to become more proactive with public health rather than waiting until new problems—or more old maladies with new complications—emerge and we find ourselves again inadequately reactive.
Former Surgeon General David Satcher observed, “Prevention messages are lost on those who see no future for themselves.” If people fear dying from gunshots outside their homes or freezing to death on the streets, prevention messages about smoking or unprotected sex or obesity or alcoholism have no meaning. Prevention implies there will be a tomorrow.
This circle of needs reinforces the reality that health care, the economy, and the environment are bound together. Unless we simultaneously work to improve all three of these ills, we can be certain that the quality of our public health will continue to decline.