Welcome to a Fireside Chat on Single Payer Healthcare

1. Welcome to a Fireside Chat on Single Payer Healthcare

2. How do I put this information into a context that I can explain to others?

3. Can we agree on a set of universal principles? • Everyone should be treated by a doctor if they are ill • Medical care should be returned to the hands of doctors, not insurance company bean counters • No one should profit from people’s suffering

4. Can we agree on a set of universal principles? • Pricing for hospitals and doctors should not be a secret • We should not be herded to a “panel” of physicians because an insurance company has a financial incentive to do so • No one should pay more than 10% of their income on healthcare • If we continue to allow insurance companies to underwrite health insurance, they will “cherry pick” good risk (those of us who are sick are called “Medical Losses”)

5. 75 69 68 66 66 63 60 50 25 0 2000 2001 2002 2003 2004 2005 Percent of Firms Offering Health Benefits Declined Over 2000–2005 Percent of firms offering health benefits Source: Kaiser Family Foundation, Employer Health Benefits 2005 Annual Survey.

6. 2005 47 Million Uninsured Americans Number of uninsured, in millions 56 60 45 44 43 44 42 41 41 40 40 40 40 39 40 35 35 33 33 31 20 0 2013 1987 1987 1993 1996 1999 2002 2005 2008 2011 Projected Note: Projected estimates for 2004–2013 are for nonelderly uninsured based on T. Gilmer and R. Kronick, “It’s the Premiums, Stupid: Projections of the Uninsured Through 2013,” Health Affairs Web Exclusive, April 5, 2005. Source: U.S. Census Bureau, March CPS Surveys 1988 to 2005.

7. Per Capita Spending on Health Care – 2004(How Does GM Compete In A Global Market?) $7,000 $6,102 $6,000 $5,000 $4,077 $3,966 $4,000 $3,159 $3,165 $3,041 $2,825 $3,000 $2,546 $2,249 $2,000 $1,000 $0 U.S. U.K. Switz Japan Nether Canada Norway Sweden Germany S Source: Organization for Economic Co-Operation and Development (OECD) Health Data 2006 (in U.S. dollars adjusted for purchasing power parity)

8. Increases in Health Insurance Premiums Compared to Other Indicators, 1988–2005 Percent Source: KFF/HRET Survey of Employer-Sponsored Health Benefits: 2005 Note: Data on premium increases reflect the cost of health insurance premiums for a family of four. Historical estimates of workers’ earnings have been updated to reflect new industry classifications (NAICS).

9. Compensation Kings • Jay Gellert – Health Net, $11,639,834 • William McQuire – United Health Group, $10,697,442 • Larry Glasscok, Wellpoint (Blue Cross) $8,523,139 • Edward Harnway, Cigna, $12,373,300 • Insurance Company profits increased 234% from 2000 to 2004 Modern Healthcare: April and July Issues 2006

10. Germany 1883 Switzerland 1911 New Zealand 1938 Belgium 1945 United Kingdom1946 Sweden 1947 Greece 1961 Japan 1961 Canada 1966 Denmark 1973 Australia 1974 Italy 1978 Portugal 1979 Spain 1986 South Africa 1996 Thailand 2006 When did other countries implement universal healthcare?

11. What is to be done? • “I don’t believe there’s any problem in this country, no matter how tough it is,that Americans, when they roll up their sleeves, can’t completely ignore.” • George Carlin

12. How’s your current health plan working for you? How has it impacted salary? Who in your Chapter is hit the hardest? Health care rates have gone up 87% over the last five years A family of 4 will cost $23,000 at an 8% inflation or $27,000 at a 10% inflation Can you bargain this amount of money? I have a good health plan now If nothing is done, will only the rich be able to afford health care?

13. WAGE BASE PREMIUM @ 8% GROWTH PREMIUM @ 10% GROWTH $45,000 $40,000 $35,000 $30,000 $25,000 $20,000 $15,000 $10,000 $5,000 $0 2004 '05 '06 '07 '08 '09 '10 '11 '12 '13 2014 GROWTH IN HEALTH INSURANCE PREMIUM RELATIVE TO WAGE BASE, 2004 - 2014

14. Health Care For All • 840 is a policy bill: • Allows us to talk about single payer • Allows us to build public support • Allows us to educate our communities before the insurance companies start attacking (remember Harry and Louise)

15. When we pass Clean Air Legislation, build roads, or open new schools it’s for everyone in our community Immigration is a federal issue Covering undocumented workers actually improves California’s rates Public Health Risk Providing preventative care is less expensive than treating someone who is very ill Only 6% of the uninsured population are immigrants 85% of the uninsured are people who don’t get health coverage from their employer Only $11 per household per year is spent on taxes to cover care to undocumented workers Immigrants Ultimately, you will decide

16. The masses will move to Californiabecause we have healthcare • SB 840 requires residency • California was the first state in our nation to pass Social Security • Will the masses move here from other states? (think about it!) Tactics used to scare us

17. Student loans Doctors spend years in school Important jobs Anesthesiologists $425,000 Specialists $274,000 General Practitioners $173,000 Earnings roughly twice as much as elsewhere –incomes 6. 6 times greater than the average patient $58 billion in excess income after loans are paid off $8 billion as investors in diagnostic labs and outpatient surgical clinics Doctors will leave Tactics to Scare Us!

18. Retirees – SB 840 • Early Retirees: • If the CBA calls for the employer to provide health care after you retire, the payroll premium get paid to the health trust (just like an insurance premium) • Medicare Retirees • Under SB 840 you will be covered just as you are now (Medicare $$$ come into the State)

19. California’s tax payers paid $32 million dollars in uncompensated care for Wal-Mart in 2005 Shared responsibility – Government, Employers and Individuals Should a small business have to pay what McDonalds or Wal-Mart pays? Senator Kuehl wants small business at the table Howard Schultz (Mr. Starbucks) Every American should have healthcare No one should have to pay more than 10% of their income Business should be insulated from excess health inflation to remain competitive Small business? It’s American for everyone to pay their fair share

20. Eureka City Schools – $1.5 to $2.6 million Salinas UHSD -$4 to $6.5 million Stockton USD- $9.9 to $17 million San Diego USD- $15 to $41 million Elk Grove USD- $2 to $12 million LAUSD- $127 to $279 million Long Beach Combined Employer and Employee Savings of $22 million Colton- USD $2.7 to $6.6 million Capistrano- $2.5 million to $10.9 million Visalia USD- $8.7 to $12.8 million What does single payer save schools? Assumptions Use payroll tax rates suggested by the Lewin Report, 8.17% for employers, 3.78% for employers, for a combined 11.95%

21. 1848 – First Women’s Rights Convention held in Seneca Falls, New York – 1972 The Equal Rights Amendment is passed by Congress 1831 Nat Turner leads a slave revolt in Virginia – 1964 Civil Rights Act is enacted Late 1940s – 50s Congress debates Medicare – Signed into law July 30, 1965 20?? – The great nation of America provides health insurance to all Cornerstones Of Our Democracy

22. Doctors Hospitals Providers Business Voters need to provide politicians a safe haven so they can do the right thing JMTs JPAs CalPERS Health Plan Building Trades Unions Public employee unions and employers What will it take to win?Everybody in one risk pool! YOU and your family and friends!

23. What do we need from you? • Talk about this with your community • Get the stories of those who are struggling (human tragedy) • Fill out the cost calculation • Pass Resolutions • Recruit volunteers • Participate in 365 Campaigns

24. Democrats lost the House in 2004 "Harry and Louise" was the name of a television commercial funded by the Health Insurance Association of America (HIAA), a health insurance industry lobbying group, in opposition to President Bill Clinton's proposed health care plan in 1993. The ad depicted a middle-class couple, portrayed by actorsHarry Johnson and Louise Claire Clark, despairing over the allegedly bureaucratic nature of the plan and urged viewers to contact their representatives in Congress. It was widely credited as being a major factor in the plan's ultimate defeat, and is often cited as a landmark moment in the use of public relations techniques for lobbying.

25. Chapter 58 Signed Into Law on April 12, 2006 Both State Houses Were Democrats Massachusetts Health Care Reform

27. Personal Responsibility Expanded Public Coverage

28. EXPECTATION Tennessee 1992 “Tennessee Gov. Ned McWherter unveiled… ‘the most radical health care plan in America’ and claimed it would become the national model. The Tennessee plan would gather nearly 1 million current Medicaid patients with 500,000 uninsured Tennesseans into a single managed care program called TennCare.” Gov. Ned McWherter “TennCare will cover an additional 300,000 currently uninsured in the first year. The number of uninsured enrolled in the program could reach 500,000 in the second year.” Sources: Federal & State Insurance Week 4/12/93; and PR Newswire 11/19/93.

29. REALITY % of Uninsured in Tennessee 1987 - 2005 TennCare 16.6% 15.5% 16.3%

30. TennCare Outcomes • TennCare covered up to 400% of poverty line; had $2 in matching federal funds for every $1 spent; TennCare has added over 400,000 new people to the state program, and by 2005 1 of every 4 residents were on Medicaid. • In its first year, percentage of uninsured plummeted from 14.7% to 11.2% of population. But rose to 16.4% the very next year. In 2005, 16.3% of population was uninsured. • Collapse of the TennCare system is imminent. Under Democratic Governor, TennCare’s annual report for 2004-2005 states: “2004 represented the year the state could no longer ignore the impending fiscal crisis that TennCare threatened if left unchecked. If left unchecked, TennCare would consume 91 percent of all new revenue growth by 2008, essentially eliminating the state’s ability to fund other state departments and priorities.”

31. Why AB 8 Won’t Work • Does not actually require the employer to purchase health insurance • Provides for HSAs • No cost containment

32. Why have incremental reforms proven so ineffective in practice?

33. “You Can’t Cross a Chasm in Small Steps” – David Lloyd George

34. Something to Ponder…….. • We have a publicly financed military to protect us • We have publicly financed police and fire to keep us safe • We have publicly financed education to provide education to all children • Why don’t we have publicly financed health care to provide health care to all? Can We Do It?

35. “First they ignore you. Then they laugh at you. Then they fight you. Then you win”! “Gandhi”

36. Questions