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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

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

Thursday, 29 January, 2009

AMSA - Seacouver

www.capa.pnhp.org

goals
Goals

FRAMING

UHC/HCA

Concepts:

Incentives

Social INS

IOM GP 5

MYTHS

pre quiz
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 quiz4
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

IOM GP5

Definition

EBM

iom guiding principles 04 u cash
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

slide8

HI  HEALTH & care

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

goals9
Goals

FRAMING

UHC/HCA

Concepts:

Incentives

Social INS

MYTHS

social insurance
Social insurance

$$

Financing

CARE

WALL

Healthy - wealthy

Sick – “poor”

health insurance unique model
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
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 unpredictable13
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

goals14
Goals

FRAMING

UHC/HCA

Concepts:

Incentives

Social INS

MYTHS

market bureaucracy
“Market” bureaucracy
  • How much of each PHI $ to clinical care?
phi 1 000 000 000 000
PHI = $1,000,000,000,000

Marketing

“Cherry pick”

Profit

PURPOSE !!

Administration

2-sided

62%

government va medicare
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
$350B of excess paperwork

PNHP

NEJM 349(8) Sept. 21, 2003

excess spending 2000 p
“Excess Spending” -- $2000/p

$600 B

ADMIN -- $150B

Cost

Tech

Tort

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

phi via ebi bad for us business
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
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 uhc27
Myth(understanding)s of True UHC

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

6600  1

PHI

Jobs!?

work with current
“Work with” current

Bureau of Labor Statistics

many proposals 2 plans
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
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

goals33
Goals

FRAMING

CA UHC

Act

Concepts:

Incentives

Fin v. Care

MYTHS

align incentives for hc financing
Align Incentives for HC financing

?

FOR-profit

for-HEALTH

$$

WHO: Social insurance

who would you insure
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
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 understandings37
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”
slide39

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
The “elephant” frame

Big

Elephant

Animal

Grey

Floppy ears

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

re framing
RE-framing
  • If a new species of pink elephants evolved…

Big

Elephant

Animal

Pink

Floppy ears

re framing43
RE-framing
  • Or if term “pink elephants” became popular…

Big

Pink

Elephant

Animal

Grey

Floppy ears

frame trumps facts
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
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
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
Engage these Frames
  • Economic efficiency
  • Security
  • Family Values
  • Patriotism
  • ??
framing comparison
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 comparison49
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

healthy citizens are the greatest asset any country can have winston churchill

Is it Time Yet?

“Healthy citizens

are the greatest asset

any country can have.”

-- Winston Churchill

slide52

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

What is the CA UHC Act?

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

educate educate activate
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