Thursday, September 03, 2009

09/02/2009 - Meeting with Carper - Cleaner Wrap Up

My take on the ‘listening session’ with Senator Tom Carper on 9/2/2009—Paul Baumbach

We met in a large meeting room at Arsht Hall on UD’s Wilmington campus. There were about 7 Carper staffers, including Racquel (spelling?), his health care ‘expert’. There were about 30 other folks, including representatives from many health-related organizations. Many doctors were there and represented (EMCO, emergency medical group—ER docs, medical society of Delaware, DE society of clinical Oncology, Nemours hospital for children, DE dietetic association, DE academy of family physicians, DE orthopedics, etc). There was an insurance broker (arguing for going much slower, ‘breaking down the walls between the states’, going the regional pool direction). There were some non-profits—American Cancer Society, ARC of DE (serving those with intellectual disabilities statewide), Easter Seals. There were two companies represented, Shoprite and WL Gore. And there were two PDDers, Kris Muto and myself.
Carper started with ten minutes or so of opening comments. He noted how he has been hearing from a very large number of people—10,000 in two conference calls, 22,000 or so emails and letters, thousands of phone calls, on the phone with Senate colleagues, etc.
His main pitch was reform must happen and will happen, however it will not meet any single person’s vision of what needs to be done. In his closing comments he noted that 80% of the bill is uncontroversial, and is terrific—making it illegal to refuse to cover pre-existing conditions, dropping someone after they get sick, etc. He did (in response to my statement) address ‘the public option’. He notes that there are a slew of models for a public option—the VA, Medicare, the Federal Employees Health System (operated by OMB, 3% annual overhead, but providing a menu of choices from private insurance companies—perhaps both for-profit and non-profit), also the Mayo/Cleveland Clinics, Peugot Sound health system, etc. ‘The Exchange’, a regional or national purchasing pool offering plans from private companies, would have lots of small businesses eligible, individuals also, the uninsured, and the poor would have help from tax credits using a sliding scale (disappearing at $60K in annual income).
The questions were typically local (one of the five versions of the bills doesn’t cover ER enough, or cancer enough, or nutrition enough, or prevention enough, etc, etc, etc). At least one doc whined about malpractice costs and the need for tort reform (using what has been working in California for years, is what he claimed).
A subset of my comments: “This year the President and Congressional Democrats have put forward key points of their vision for health insurance reform. One key point is a robust public option, the ability for Americans to choose a public health insurance option. Our soldiers, seniors, and Senators have a public health insurance option, one that doesn’t double premiums in under 10 years.

Now we find that this reform, this robust public option, is being held back by many senators who campaign as Democrats.

Our state elected you as a Democratic Party candidate. Our state elected President Barack Obama. When will you stand with your fellow Democratic Senators and champion a robust public option?”
It felt quite good to call Carper out as being a sorry excuse for a Democrat. I was pleased that in his closing comments shortly afterwards he did some backpedaling, noting that he is certainly open to a ‘public plan’, but noting that there are many ways of accomplishing this (such as watered down regional pools of private insurance offerings). He also noted, with no disparaging comments, the work of the Progressive Democrats.
Kris offered her very compelling story of the need for health reform now, and called attention to the moral and economic imperatives that require this. The woman from ARC also effectively tugged at the hearts of those in the room. I liked that these two emotional presentations came near the wrap-up, so that is what you remembered, more than the doctor whining about malpractice rates.
Carper stayed 2 hours despite only promising 90 minutes, and heard from everyone. His staff seemed attentive and helpful throughout. It is nice to be around friends, and thus I would have liked to see more advocates at this meeting, but it is also nice to be able to ‘howl at the moon’.

Wednesday, September 02, 2009

09/02/2009 - Meeting with Senator Carper--Part Deux

Here are my raw notes. TC is Tom Carper, Q is someone else (a Questioner)

TC: focus on stuff we agree upon.

EMCO, small business council of America
doctors for emergency services (Ers)
med society of DE
american cancer society
de society of clinicial oncology
cigna benefits, but here as person
nemours hospital children
de dietetic association
de academy of family physicians
wl gore benefits
de orthopedics
arc of de (intellectual disabilities)
easter seals

many aides to carper

one of 3 listening sessions, met with newspapers throughout state, chambers of commerce, electronic town hall, he plans to listen and ask a few questions, but try to answer some questions, 22,000 or so emails and letters, and thousands of phone calls, spent time on phone with committee colleagues, september 15th is 'drop dead date' for bipartisan bill, else will proceed on own ways, may go through reconciliation (as does budget) to resolve disparities between various versions—reconciliation is designed for budget not issues such as healthcare—he hopes we don't have to go through this. Colleague in TN used conference call with 1400 people. Last tuesday's call had 4000 people, 400 stayed on the line afterwards to raise questions. Aarp hosted another one this past monday night. Over 6000 people.. phone calls had been mean a month ago—the tenor is changing, more positive, more constructive.

To not do something constructive would be a big mistake. We spend much more than peers (16% gdp), and many measures get worse results. 14000 people will lose benefits daily. 45Million have no coverage. Corporate bankruptcy in some cases is caused by healthcare costs. Doing nothing worsens an already bad fiscal trend. Why cant we have your health insurance? Federal employee health benefit plan (all 3 branches, and retirees and dependents, 8 million), one of largest pools, run by OPM, offer choices from private. $5000 average costs. Admin costs 3% of premiums. Why not expand this?? good idea, at least to replicate. National exchange, purchasing pool, or regional purchasing pools (de pa nj) several million folks strong, national would be tens of millions strong. Lots of small businesses would be eligible, individuals, uninsured, poor folks would have help from tax credits sliding scale (disappear at $60K), private plans are underlying feature, though.

Medicare prescription drug plans, compromise has hybrid, some states, with no competition, has public plan (fallback plan), most states have fine competition. 85-90% of users like it and most often makes a profit.

Would like to use federal employee health benefit plan as model for direction he would like to see
q: why are people so scared? Fed govt has failed to sufficiently fund medicare, medicaid, this leads to skepticism. Insufficient funding lead to reduced quality and availability.
tc—states are laboratories for fed govt. he asks colleagues to find models that work. De has panel that has cut malpractice suits by 50%, not by forbidding suits, but having a first step of presenting case before going to court. Obama has ideas on this.
Q: typical er patient 20 year old, complete dental decay. Insurance card is not going to fix that. Infrastructure in primary care is insufficient in massachusetts. Portability and pre-existing condition issue must be addressed. We need to remove fear. We must hold patients, doctors, and insurance firms accountable.
Q: we all agree that the system must be fine tuned if not overhauled. Federal plan has large base, better to expand it than start new pool—better to blend than create. Public option has been polarizing. Bill roth suggested expanding federal health plan. When does a proven experiment become usable? Tort reform in CA has worked for years and years, but malpractice insurance is 3x more in DE, and 6x more in PA, than in CA.
Tc mayo, cleveland clinic, and many others, are not fee for service, but primary wellness, etc, malpractice is paid by employers q to win war against cancer, we need good strong healthcare reform, we need coverage for all. Pre-existing and caps are death knell. Affordability hasn't been nailed down yet. Please keep this in mind.
Q: oncology—great progress has been made. Economically viable universal healthcare for cancer patients in DE now. Crisis is coming in medicare. (colleague begins) access to healthcare is problem, when funding is considered. To control costs, reimbursement coding is changed, to disproportionately affect populations differently. 20-40% cuts coming. Move from local locations to hospitals (which don't have capacity) for chemotherapy.
Q: supports fundamental change to how healthcare is delivere4d in the US.
Q: (Kinney family from shoprite). Playing field—if walmart supports the bill, this will likely give them a further competitive advantage. Shoprite pays 50% towards healthcare (payroll $80K per week in new store, $40K per week for health benefits). Asking shoprite to pay more (8%) for recent part time employees, is escalation and non-competitive move. This is in addition to recent de changes. Support solution for healthcare for un- and under-insured.
Tc senate committee (Kennedy) put forward bill. Safeway (200,000+ employees, union), kept hc costs flat, due largely to prevention
q: health of population will improve when we change financing system and culture of healthcare and health. Culture of prevention, personal responsibility, and having a medical home (partner). System for providing healthcare to uninsured must work in concert with private plans.
Tc Lean Act—prevention--every restaurant chain much have calories on menus or at least posted.
Q: nutrition services is foundation of culture of health.
Q: CBO judges prevention to be not cost-effective. Dieticians disagree (therapy for pre-diabetes rather than amputation later). Coverage desired for diet services.
Q; de medical society head—need for tort reform (experiments have proven effective). Prevention and exercise is key to future health. Take offense on our rating compared to other countries. More fair is 'after cancer is identified, what is the result in the US'. Must reign in the insurance industry. Physicians are forced to kowtow to insurance companies, force to drop long-term patients.
Q: more backbone is needed for more universal care in the US. We must have strong primary care base.
Q: his organization (AEFP) is very supportive of the bill. Policy has always supported universal healthcare, also supportive of primary care. DEFP urged to work locally. nutrition—quality food is too expensive (calories per dollar). Choices being made are often economic.
Q: (WL GORE) 8600 employees worldwide, 5000 in the US, 13500 covered by US health insurance plan, $44m/yr. Working on meaningful health improvement for employees. (colleague)
q: (shoprite) food industry perspective—cost for employees to go from public (medicaid?) to private, concern with employer mandate and 8% surcharge, could be incentive to go from private to public (only pay 8% to cancel current private plan).
Q: personal stories are available as resource to carper
q: people closest to problem are best able to solve the problem. Skeptical that the solution can come from washington. Concern for shift of power from senate to executive branch. Checks and balances should not be surrendered. Incentives are better than mandates. Standalone public option is not going to be workable. Incentive for small businesses to drop coverage.
Q: 25+ yrs insurance advisor. Clients all say we're all americans, not republicans, democrats, etc. we want to move forward. Going to be ongoing process—wheres the rush. Lets walk forward, avoid disasters. National exchange is not well understood. He prefers breakdown state by state walls for insurance companies, prefers regional pools/exchange.
Q psb, and kris—fear that reform will be scuttled and dilluted.
Q Mother of 3, husband, engineer, with preexisting condition, lost job at age 55, must borrow to pay cobra. Moral imperative, economic imperative for real health insurance reform.

09/02/2009 - Meeting with Senator Carper--Part I

Kris Muto and I attended a 'closed door' listening session with Senator Carper this morning. There were a slew of doctors and healthcare folks (nutritianists, oncology folks, those who advocate for the disabled, medical society of DE, etc), a few corporates (Shoprite, WL Gore), and two PDDers. We were limited to a minute or two (except the first three ER docs who took about 5 minutes each).

My statement:

Due to the direction of the country following the 2004 elections, the Progressive Democrats of Delaware formed. One issue that upset us greatly was the ongoing occupation of Iraq. So we worked to get a majority of Democrats in the Senate in the 2006 elections. We learned that this was not sufficient as a majority of Democrats in the Senate with a Republican President could continue that occupation.

So we worked harder, and cut the number of Republicans to 40 in the Senate, and worked very hard to get Barack Obama elected as President. We assumed that this meant that core parts of his, and the party’s platform, would become enacted. A core plank is universal healthcare, or at least quality healthcare available and affordable to all Americans.

This year the President and Congressional Democrats have put forward key points of their vision for health insurance reform. One key point is a robust public option, the ability for Americans to choose a public health insurance option. Our soldiers, seniors, and Senators have a public health insurance option, one that doesn’t double premiums in under 10 years.

Now we find that this reform, this robust public option, is being held back by many senators who campaign as Democrats.

Our state elected you as a Democratic Party candidate. Our state elected President Barack Obama. When will you stand with your fellow Democratic Senators and champion a robust public option?

I will next post my (ugly) notes.