Health Care for All : How do we get there?

Health Care for All : How do we get there? Deborah Richter, MD drdebvt@sover.net

Vermont Act 48-An act relating to a universal and unified health system“Single Payer” was never implemented

State vs National Reform • They are not mutually exclusive • Better chance at state level

State vs. National Reform • Publicly fund a sector of care and make it universal • Medicare started this way

UNIVERSAL PRIMARY CARE: The Vision • Every Vermonter will have free primary care- including mental health and substance abuse services- with no cost sharing • Private insurance covering primary care will no longer be necessary • Primary care practitioners will be paid on a risk adjusted capitation model • The first step in building a health care system for EVERYONE UNIVERSAL PRIMARY CARE: THE VISION

Why Start With Primary Care ? • Primary care practices provide 50- 60 percent of all daily patient contacts in the US. • Primary care provides most of the care to most of the people most of the time

Benefits of Primary Care • It is the only sector of health care that has been shown to improve population health • Increases life expectancy • Lowers infant mortality • Lower rates of all causes of premature mortality • Lower heart disease mortality • Lower cancer mortality • Lower premature mortality from asthma and bronchitis, emphysema and pneumonia, SOURCE: Contribution of Primary Care to Health and health Systems http://www.commonwealthfund.org/usr_doc/Starfield_Milbank.pdf

Primary Care: a Big Bang for the Buck Primary care including outpatient substance abuse and mental health services will comprise less than 6% of total health care spending in 2017

Value of Primary Care If there was a drug that saved this many lives, helped us live longer AND saved us as much money as primary care does , we would not think twice in investing in it

Obstacles Universal healthcare system • Profit • Politics • Paranoia • Perception

How to Begin Find your allies Get to know the political landscape Get referrals- who are the powerful?

Political Reform Educational phase -Build your base Political phase

The 80/20 rule • Who are the influential folks ? • Business • Health professionals • The religious community • School board and other town officials • Labor • Retirees

Medical Community They are fed up They will have more freedom under a universal health care system We don’t need to give up our “freedom of prescription” Patients can have choice They need to know it isn’t going to get better without radical change

Labor Appeal to their self interest-they don’t want to give up benefits or increase their cost sharing so that others can have health care (truth is, they already are) The rest of the discussion is the same as for business Emphasize, it will only get worse for them

How to talk to business It’s costing them big bucks and they need to know why Lack of a system and ability to control costs It’s not because of individuals “abusing” healthcare We are already paying the whole bill Affects their competitiveness It’s not going to get any better Keep in mind - they don’t trust the govt.

Approach to these folks • One on one is best • Ask for other contacts • Ask for advice • Give factual information and know your stuff • Keep an open mind- we can learn from others

Other opportunities • Medical conferences • Rotaries • Town meetings • School board meetings • House parties • Use the 80/20 rule-go to meetings that are already organized

The Message Appeal to people’s self interest Avoid the moral high ground being your only approach Common ground: funding the health care services and then giving everyone access to them This is not just an issue of coverage- it is also one of cost containment and limits We need a health care system

Essential Features of a Universal Health Care System • Everyone Included • Public Financing • Public Stewardship • Global Budget • Public Accountability

Presentations • Different groups need different emphasis but keep 3-4 prevailing concepts in each • Most of health care is a shared service with mostly fixed costs (the sick keep the bed warm for you) • It is expensive and used by very few at any one time • If we want it there for ourselves we have to pay for those using it now by spreading the cost • We are already paying the whole bill one way or another anyway(business, employees, taxpayers and individuals) • *Things will only get worse without radical reform

What I have learned • Know the political landscape • All politics is local • Sign people up every chance you get • Use the 80/20 rule as much as possible • Keep your friends but court your enemies • Passion , persistence and a willingness to change will rule the day • In the end you still need luck

Health Care for All : How do we get there?