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
cancer
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
broker
arc of de (intellectual disabilities)
easter seals
shoprite

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.