09/07/2010

I. Present: Jim Scott, Kris Alman, Steve Weiss, Paul Gorman, Peter Mahr, Sam Metz

II. Work Session

1.PNHP Portland Leadership Changes:

Peter will be away for 6 months volunteering at a small hospital in rural Sierra Leone.  In the meantime Sam Metz, Kris Alman and Paul Gorman will prepare and run the PNHP Portland Meetings.  This will start with Sam Metz chairing the 11/10 meeting which will likely be changed to the second Tuesday of the month so that we can debrief the PNHP national Meeting which is being held the first weekend of November.

2. PNHP Portland Focus: We agreed to focus on 3 things for the next 6 months.  First continue our work helping write and introduce a single payer bill for OR. Second participate in and help prepare for a statewide single payer conference which will be held in early 2011.  Third, continue outreach and presentations to interested groups when available.

3.Chapter growth and recruitment: we lament that there is such a small group of us for such an important issue.  We will not focus on recruiting more members.  We will continue to ask for support and volunteer help from our members especially in the core activities mentioned above.

4.Budget: We have $1200 to spend. We are using $600 to help fund a feasibility study of the single payer bill.  We will help support the single payer conference.  We decided to award a scholarship to an OHSU medical student PNHP member to attend the national meeting in November. Paul Gorman will coordinate this.

III. PNHP Portland Updates.

1. State of Oregon Single Payer Bill: Kris Alman reported that she continues to work with a group from Jobs with Justice, Health Care for all Oregonians, PNHP Corvallis Chapter and others to write a single payer bill for the State of OR.  The timeline is to finish writing the bill by October and have it introduced by its sponsor, Michael Dembrow, later this year..  The group has hired an economist to do a feasibility study of the bill as well.  An important victory for true single payer advocates is that there is no Taft Hartley exemption written into the bill at this point and Kris feels that this will stand.  The funding mechanism is yet to be determined. We anticipate that we will need help in educating and advocating for this bill both publically and directly to our legislators.  There are also likely to be hearings on the bill in which we will need PNHP volunteers to testify and attend. Please let Kris Alman know if you want to get involved.

2. The Oregon Single Payer Conference: Sam Metz is on the committee to plan and prepare for a grand state-wide event: a single payer conference for all Oregonians. The national Presbyterian Church awarded Jobs with Justice and PNHP a $2000 grant to pull this off.  The committee will be meeting the first Tuesday of every month. Their first meeting was 9/7/10.  They anticipate a full day event on a Saturday inn January with 3-4 speakers, 3-4 panels and featuring the single payer bill prominently.  They really want to involve people and groups from Eastern and Southern Oregonians well as student groups at PSU and OHSU.  We need volunteers for this event. Please help. Contact Sam Metz to get involved.

3. OHSU PNHP chapter: the students are active. Paul Gorman reports that they have finished their VACUUM project which a web site is featuring the stories of those who are uninsured or underinsured. Check out more information at this site: http://www.ohsu.edu/xd/education/schools/school-of-medicine/about/voicesofuninsured33010.cfm

They are also working of student surveys demonstrating student support for access to health care services for all.  Paul is running another health reform class this semester.

IV Upcoming Events

1. The Oregon Health Policy Board is holding 6 hearing around Oregon to take public comment on the implementation of PPACA in OR especially focusing on the exchange.  We strongly ask for PNHP members to come to the Portland  hearing on Monday 9/13/10 at 6-8 PM University Place, Columbia Falls Room, 310 SW Lincoln St.

More info at:

http://www.oregon.gov/OHA/features/community-meetings.shtml

Please come ready to ask a version of the following pointed questions:

-How is an exchange better than single payer?

-How does an exchange prevent medical bankruptcy or underinsurance?

-How does an exchange prevent unaffordable co pays, deductibles and coinsurance given that 25% of all businesses are offering health plans with $1000 deductibles and the cost to employees of employer-based insurance rose 14% last year and is now $4000 a year for simply the premium?

How will an exchange protect someone from losing access to health insurance upon losing a job?

– How many of you in this room would prefer a single payer health program to an exchange featuring private insurance?

2. PNHP National Meeting:

November 5^th and 6^th, Denver. More info at: http://www.pnhp.org/about/annual-meeting-leadership-training

3. Mad As Hell Doctors CA Tour: 9/23 to 10/10.  Please donate money for this tour to support single payer in CA.  Also please inform your friends and colleagues in CA about these events.  Go to http://madashelldoctors.com/ for more info and a map detailing the tour dates and stops.

V. Next Meeting: 10/5/10 8 PM.

I. Present: John Nichols, Peter Mahr, Sam Metz, Jon Partridge, Steve Weiss

II. Updates

1. Leadership Issues: Peter Mahr will be on sabbatical from 10/1/10 to 4/1/11 working in another country.  He will be unable to lead PNHP Portland during this time. Discussion was held as to whether PNHP Portland wants to change leadership now and have a rotating leadership as we move forward.  Sam Metz felt that he was not available to lead the chapter but he was able to pitch in and help run meetings and possibly cover emails in Peter’s absence.  It was felt that a more formal meeting structure with meeting rules is not needed at this time. More discussion and a final plan for PNHP leadership in Peter’s absence will finish at the 9/7/10 meeting.

2. OR SP Conference: there will be a SP Conference held this fall with funding from the Presbyterian Church.  There is a survey being sent around by Jobs with Justice asking for input on ideas/themes/presenters/location etc for the conference. If you would like to participate or return a survey please contact Peter.

3. State SP Bill for OR: Kris Alman is working with Jobs with Justice and others to craft a single payer bill that will be introduced in the state legislature.  Mitch Greenlick will hold hearings once the bill is introduced.  Kris sent me an email with an update which was shared with the group. There are individuals and groups assigned to different aspects of the bill like schedule of benefits, revenue, board responsibilities, governance etc. At this time it appears that the bill will likely allow a Taft Hartley exception and Kris notes that PNHP must decide whether to endorse the bill with the TH exemption.  Sam Metz and Peter Mahr agreed that we should endorse the bill even if it has a TH exemption as primarily it will present an opportunity for us to be heard on the state level and to provide the economic figures that so heavily favor SP.  Also TH plan may fade as SP takes off.  There seem to be few downsides to endorsing the bill even though there may be a TH exemption.  All agreed that benefits should be broad and comprehensive.  Strict limits to coverage like the current OHP will likely turn off many from the bill.

4. Economics of OR SP: Sam brilliantly researched the health care numbers for OR and I have attached his spread sheet.  He found that in 2009 total health care spending in OR was $25 billion.  $12 billion was spent via existing state and federal funds.  He concluded that a state SP bill would, therefore, need to provide revenue of $13 billion per year. (He acknowledged that likely spending would increase as access increased but felt that reduced administrative costs and increased primary care access would counteract the increase in spending from newly insured patients.)

He proposed a progressive business payroll tax split 70/30 between employer and employee and rising based on size of the business. He found that, on average, we could fund OR SP by generating $7,500 per worker:  or $2,229/ yr ($186/month) payroll tax deducted from each employee and $5,200 ($430/month) deducted from the employer payroll tax for each employee.  He felt that since the average premium for single employee is currently $4,400 per year and $12,000 per family, that these numbers would be gladly accepted by businesses and individuals, especially since they would now be “buying” comprehensive, low deductible, low co-pay insurance as opposed to the high deductible, hi cost-share insurance plans available to businesses now.

5. Speakers Bureau: no updates. Gene Uphoff is planning to speak to the Kiwanis Club this month.  Peter has been invited to address the Oregon Associating of Nurseries at their annual convention in September.

III. Presentation: presentation on small business and single payer was postponed until September.

By John Geyman
Professor Emeritus of Family Medicine at the University of Washington School of Medicine
The Huffington Post
July 27, 2010

Our last four posts have examined the PPACA from the perspectives of the four main goals of health care reform — cost containment, affordability, improved access and quality of care. Here we draw these goals together in asking whether this legislation delivers enough to be worth the $1 trillion investment over the next 10 years and whether it will really work.

On the positive side of the ledger, the PPACA brings some welcome changes:

• Will extend health insurance to 32 million more people by 2019.
• Provides subsidies to help many lower-income Americans afford health insurance.
• Starting in 2014, expands Medicaid to cover 16 million more lower-income people.
• Provides new funding for community health centers that could enable them to double their current capacity.
• Eliminates cost-sharing for many preventive services.
• Phases out the “doughnut hole” coverage gap for the Medicare prescription drug benefit.
• Will create a new national insurance plan for long-term services: Community Living Assistance Services and Supports (CLASS) program.
• Will establish a nonprofit Patient-Centered Outcomes Research Institute to assess the relative outcomes, effectiveness and appropriateness of different treatments.
• Initiates some limited reforms of the insurance industry, such as prohibiting exclusions based on pre-existing conditions and banning of annual and lifetime limits.
• Contains some provisions to improve reimbursement for primary care physicians and expand the primary care workforce.

On the negative side of the ledger, however, these are some of the reasons that the PPACA will fall so far short of needed health care reform that it is not much better than nothing:

• Surging health care costs will not be contained as cost-sharing increases for patients and their families.
• Uncontrolled costs of health care and insurance will make them unaffordable for a large and growing part of the population.
• At least 23 million Americans will still be uninsured in 2019, with tens of millions more underinsured.
• Quality of care for the U. S. population is not likely to improve.
• Insurance “reforms” are so incomplete that the industry can easily continue to game the system.
• New layers of waste and bureaucracy, without added value, will further fragment the system.
• With its lack of price controls, the PPACA will prove to be a bonanza for corporate stakeholders in the medical-industrial complex.
• Perverse incentives within a minimally-regulated market-based system will still lead to overtreatment with inappropriate and unnecessary care even as millions of Americans forego necessary care because of cost.
• The “reformed” system is not sustainable and will require more fundamental reform sooner than later to rein in the excesses of the market.

How did this latest reform effort get so far off track? Here are three of the major reasons:

• The issues and policy options were framed as the political process was hijacked by the very interests that are largely responsible for today’s cost, access and quality problems in health care. As examples, the drug industry lobbied successfully to avoid any price controls of drugs, as the VA does so well; the insurance industry avoided real rate controls over their premiums and ended up with other loopholes to game the new system; and all of the corporate stakeholders will gain subsidized new markets without significant regulation of the market.

• The quest for bipartisanship was futile as reform got run over in the middle of the road. The big questions cannot be answered in the political center, such as whether health care should be a right or a privilege, or whether health care resources should be allocated based on ability to pay or medical need.

• Market failure was not recognized as the wellspring of our system problems. When it was agreed to “build on the strengths of the present system” instead of more fundamental reform, corporate stakeholders and their lobbyists found willing legislators to craft centrist “remedies” which could be sold to the public as  reform. But the various incremental tweaks of our existing system, such as employer and individual mandates, have failed over the last 20 or 30 years to remedy cost, access and quality problems.  In the absence of real health care reform, we can now expect these kinds of unfavorable outcomes in coming years:

• Soaring costs without effective price controls throughout the system.
• Managed care fails to control costs or improve quality.
• Persistent financial and other access barriers for many millions of Americans.
• Growing backlash by physicians and consumers.
• Gaming of private plans and adverse selection in public plans.
• Consolidation among hospitals sustaining high prices.
• Increased cost-sharing for employees as employers cut back benefits.
• Continued high levels of inappropriate and unnecessary care.
• Added bureaucracy and waste in an even more fragmented and dysfunctional system.

We have yet to learn that an unfettered health care marketplace can only perpetuate our problems, not fix them. Most industrialized nations have learned this many years ago, and are able to achieve better quality of care with improved outcomes for their populations even as they spend much less on health care than we do. We have to conclude that a larger role of government will be required to assure real and sustainable health care reform.

There is a fix in plain sight for our problems — single-payer financing coupled with a private delivery system. The private insurance industry has outlived its usefulness, and is only being kept alive by government subsidies, whether by overpayments of private Medicare plans or this latest provision in the PPACA to pay out nearly half of a trillion dollars in subsidized premiums for their inadequate coverage.

When will we have the political will to face up to our real problems in health care and show that the democratic process can still work?

Adapted from “Hijacked: The Road to Single Payer in the Aftermath of Stolen Health Care Reform,” 2010, with permission of the publisher Common Courage Press. http://commoncouragepress.com/index.cfm?action=book&bookid=402