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Healthcare for ALL Myths, Frames & pipe dream? Parker Duncan, CaPA Fellow, Capa.fellow@gmail.com MS4, UC Irvine ; MPH, CSULB; PRIME-LC, inaugural class CaPA Medical Student Fellow for Healthcare Reform ( MSF ), 2008-2009 Pisacano Scholar, 2008 Pduncan@uci.edu

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Healthcare for ALL Myths, Frames & pipe dream?

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Healthcare for ALL Myths, Frames & pipe dream?

  • Parker Duncan, CaPA Fellow, Capa.fellow@gmail.com

    • MS4, UC Irvine; MPH, CSULB; PRIME-LC, inaugural class

    • CaPA Medical Student Fellow for Healthcare Reform (MSF), 2008-2009

    • Pisacano Scholar, 2008Pduncan@uci.edu

Thursday, 29 January, 2009

AMSA - Seacouver

www.capa.pnhp.org


Goals

FRAMING

UHC/HCA

Concepts:

Incentives

Social INS

IOM GP 5

MYTHS


Pre-Quiz

NUMBER of people in the US without health insurance? (age <65 = 250M)

  • <50M

  • 60-70M

  • All 250M

  • It just doesn’t matter!


Pre-Quiz

NUMBER of people in the US without health insurance? (age <65 = 250M)

  • <50M(US Census Bureau, 2007: 47M, all or part of year)

  • 60-70M(the UNDERinsured)

  • All 250M(IOM: predictably affordable, automatic & guaranteed, high quality & comprehensive)

No one <65 in the US has “health security” !!


IOM GP5

Definition

EBM


Consequences of UNinsurance, ‘01-04

www.iom.edu/uninsured


IOM Guiding Principles (‘04): “U-CASH”

  • Universal – everyone in, NOBODY out

  • Continuous – ‘womb-to-tomb’

  • Affordable – to individuals & families

  • Sustainable to society

    • ALL contribute; all benefit

    • SIMPLE: -- Eliminate complex billing & underwriting requirements

  • High-quality care

    • Effective, efficient, safe, timely, patient-centered and equitable

www.iom.edu/uninsured


HI  HEALTH & care

IOM, “Insuring America’s Health”, p.152


Goals

FRAMING

UHC/HCA

Concepts:

Incentives

Social INS

MYTHS


Social insurance

$$

Financing

CARE

WALL

Healthy - wealthy

Sick – “poor”


Health Insurance – unique model

  • Healthcare is Costly

  • Uneven distribution

  • Unpredictable – “predictably unpredictable”

    • When YOU need it, YOU want it to be there!


WHY HI: Uneven & Unpredictable

73%

Percent

of

health

Care

Expenditures

70% of us < 10% of hc spending

~ $1000/person

13%

6%

4%

0% 0% 0%

1% 1% 2%

Source:Agency for Healthcare Research and Quality

MEPS, 1999


WHY HI: uneven & unpredictable

73%

20% of people account for 86% of the hc costs

Percent

of

health

Care

Expenditures

13%

6%

4%

0% 0% 0%

1% 1% 2%

Source:Agency for Healthcare Research and Quality

MEPS, 1999


Goals

FRAMING

UHC/HCA

Concepts:

Incentives

Social INS

MYTHS


Myth(understanding)s of True UHC

6600  1

PHI


“Market” bureaucracy

  • How much of each PHI $ to clinical care?


PHI = $1,000,000,000,000

Marketing

“Cherry pick”

Profit

PURPOSE !!

Administration

2-sided

62%


Government: VA & Medicare?

VA = 1-2%

Medicare = 2-3%

NO Marketing/PR

Take ALL applicants

NO Profit incentive

PURPOSE: Health!!

Administration

Electronic; integrated

ONE-system

>95%


$350B of excess paperwork

PNHP

NEJM 349(8) Sept. 21, 2003


“Excess Spending” -- $2000/p

$600 B

ADMIN -- $150B

Cost

Tech

Tort

Uwe Reinhardt, http://graphics8.nytimes.com/images/blogs/economix/EconomixGraphUve.jpg


Myth(understanding)s of True UHC

6600  1

PHI

Jobs!?


PHI via EBI: BAD for US business

COST of healthcare to company / vehicle

$1400

Source: Modern Healthcare 10/24/05: 14


PHI: BAD for Business

  • Job-lock

    • Stymies workforce

  • Lost potential economic productivity

    • > COST to insure ALL !

      (http://www.iom.edu/CMS/3809/4660/5404.aspx)


Myth(understanding)s of True UHC

$1,000,000,000,000 !!

6600  1

PHI

Jobs!?


“Work with” current “system”


“Work with” current

Bureau of Labor Statistics


Many proposals; 2 plans

“Work with” current

IOM-consistent

UNIVERSAL

Guaranteed & continuous

Lower cost

Better inflation-control

Focus: CARE

EQUITABLE

  • NOT universal

  • NOT continuous

  • Higher ADMIN costs

  • Focus: ‘coverage’

  • NOT equitable – tx NOT based on dz

TD

Boston, MA


Myth: NOT Politically Feasible

  • MOST of us want it

    • Public – 60-75%

    • Physicians – 59%, 2008 (Annals, 1 Apr 2008)

    • US Conference of Mayors – June 2008

  • Already paying for but NOT getting

  • GOOD for economy

    • 2.6M jobs; $300B stimulus, nationally1

  • ONLY method control HC cost increases

  • 1 http://www.calnurses.org/research/pdfs/ihsp_sp_economic_study_2009.pdf


    Goals

    FRAMING

    CA UHC

    Act

    Concepts:

    Incentives

    Fin v. Care

    MYTHS


    Align Incentives for HC financing

    ?

    FOR-profit

    for-HEALTH

    $$

    WHO: Social insurance


    WHO would YOU insure?

    73%

    Public Programs

    Percent

    of

    health

    Care

    Expenditures

    PHI

    13%

    6%

    4%

    0% 0% 0%

    1% 1% 2%

    Source:Agency for Healthcare Research and Quality

    MEPS, 1999


    Myth-understandings

    • One plan = NO choice

      • CA UHC is REAL, full choice – of healthCARE provider

        “The CARE we need, when we need it”

      • “Choice” of coverage is FALSE choice

        • Past health status no guarantee of future!

    • Moral Hazard [i.e. buffet table analogy]

      • WHO spends leisure time at hospital?

      • We get HALF the care we need (Rand. McGlynn et al., NEJM 2003)

    • Bootstraps [“Not MY responsibility to pay for anyone else!”]

      • You already are

      • Risk pools lower costs: You can’t do this alone!

      • HI premiums in CA rising 5x faster than wages


    Myth-understandings

    • Increase in taxes

      • A shift in funding mechanism

      • NO net increase in spending

    • Socialized Medicine

      • Clarify: Social insurance (World Health recommends)

      • Quality, comprehensive health insurance to ALL

      • “Patriotic medicine”; “Freedom & equality medicine”


    Goal of HCA: “Hello, neighbor”


    Framing

    Don’t Think of an Elephant, George Lakoff; thanks to Kao-Ping Chua, AMSA JRF, 2006

    • A conceptual structure

      • Your THINKING

    • Psychology: “schema”

    • A story


    The “elephant” frame

    Big

    Elephant

    Animal

    Grey

    Floppy ears

    Frame = story. “Elephant” tells story of a big, grey animal with floppy ears.


    Framing


    RE-framing

    • If a new species of pink elephants evolved…

    Big

    Elephant

    Animal

    Pink

    Floppy ears


    RE-framing

    • Or if term “pink elephants” became popular…

    Big

    Pink

    Elephant

    Animal

    Grey

    Floppy ears


    FRAME trumps FACTS

    “If the truth doesn’t fit the existing frame, the frame will stay in place and the truth will dissipate.”

    -- George Lakoff

    • The TRUTH only matters if it fits the frame

      • Not only WHAT you say; but also HOW

        • “What frames am I activating with the way I’m talking about my issue?”


    Messaging vs. reframing

    REFRAMING

    MESSAGING

    • Deeper –

      • changing one’s relationship & thinking about the world

    • Use message to associate positive values with the frame of your issue


    Anti-UHC Frames

    • Government can’t do anything right

    • “Free” market more efficient

    • Individual responsibility (ownership society)

    • Anti-freeloading/anti-welfare

    • “Just desserts” aka bootstraps

    • American exceptionalism

    • Tax affliction


    Engage these Frames

    • Economic efficiency

    • Security

    • Family Values

    • Patriotism

    • ??


    Framing comparison

    Healthcare for ALL

    Cover UNINSURED

    46M uninsured

    22,000 die prematurely each year

    Only cost $B more to ‘cover’ them….

    • Increasing costs place all at risk

    • We’re all 1 pink slip away

    • We all want health security in order to care for our families


    Framing comparison

    Cover EVERYONE

    Cover UNinsured

    Universal

    Health care

    Universal

    health care

    Everyone

    benefits

    Only

    benefits

    uninsured

    I’m affected

    Family’s

    affected

    Welfare

    Self-interest

    Free-loading

    Enables laziness

    Family values


    ReFrame this!


    Is it Time Yet?

    “Healthy citizens

    are the greatest asset

    any country can have.”

    -- Winston Churchill


    Is it Time Yet?

    “You can always count on Americans to do the right thing - after they've tried everything else.”

    -- Winston Churchill


    What is the CA UHC Act?

    Health students’ Lobby Day for CA UHC Act, 12 Jan 2009


    Educate, Educate, Activate

    • Educate

      • QOTD – Best 2 min of health policy (www.pnhp.org)

      • Join CaPA – www.capa.pnhp.org

  • Educate your group

    • Have healthcare reform discussion w/your GROUP

    • Book me! Capa.fellow@gmail.com

  • Activate!!

    • Have your GROUP Endorse CA UHC Act & 676

    • Visit Legislator/Congressperson


  • Myth: partisan issue


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