Growing Consensus on Health Care Reform

South Puget Sound RotaryJuly 18, 2008Chuck Cumiskey Kathleen OConnnor, CodeBlueNow!www.codebluenow.org

Past Failed AttemptsCommittee on the Cost of Medical Care: 1932Roosevelt dropped it from Social SecurityWW II: Employers offer health insurance in lieu of wagesTrue Bipartisan Failure: Truman, Kennedy, Nixon and Clinton Johnson passes Medicare and MedicaidNone of current proposals will pass as constitutedHistory of Ideological and political failure

Why Constant Failure? Public Confusion, so Divide and Conquer winsReform proposals ideological and partisanStakeholder oppositionAMA to PhRMAEmployer and labor oppositionComplexity of System Public held at arms lengthNo one trusted voice--yet

ComplexityBenefits defined by employers Employers contract with insurersInsurers contract with providersLarge corporations governed by ERISASmall employers regulated by stateUnion Trusts and labor negotiationsPublic Health programs at state and county levelsMedicare and rate structureMedicaidState and Federal47 million uninsured1300 companies offering health insurance (profit-not for profit)

Consequences of ComplexityStakeholders define problem from their viewEvery group has a different definition of what is wrong and who the enemy isHealth Care as compensation creates use it or lose it mentalityNo one trusted voiceLots of deep pocket oppositionEnough of what is said, rings true

What Other Countries DoGovernment run health care: Britain and ItalyShared responsibility: Germany, France and JapanCanadaAustraliaCommon denominator: Eliminated Administrative/Management complexity

CodeBlueNow! National, nonpartisan, coalition building organization5013Using Consensus building approach to health care reform

Our HistoryFormed in 2003 from a National Contest2004 and 2005 Built Infrastructure2006 Pilot Project in Oregon2007 Market Research in Iowa and WAFunding from individual private citizens and foundations2008: Pulse Partners; Spreading ResultsGoal: 2009/2010 A Bipartisan Voters Health Care Platform

Consensus, Common Ground ExistAccountability: Public Reporting/OutcomesEquity: Universal Coverage/Core BenefitsChoice: Any licensed provider Affordability: New financial incentives Information: Costs, benefits, outcomes Prevention over high tech curesShared responsibility: Employer, individuals, government Efficiency: Enough money if well managed

Universal Coverage

Basic set of Health Benefits

Transparency

Any Licensed Health Care Professional

Prevention

Uniform Standards

Shared Responsibility

Public Reporting like Utilities

Publics Role

Who Would You Trust?

Employer Should Continue Major Role

One Overseeing Organization

Paid by Tax Dollars

Personal Responsibility

Enough Money to Cover All

What Does This Mean?Cant leave health care to the PartiesCurrent proposals as they are presently constituted will not passParties are playing to their base, not the publicIndependents are the key factorWithout Independents none of the proposals will pass

Voters Health Care PlatformEnables us to use the ingenuity of the American public to solve problemsTakes ideas from all sides of the aisleBuilds on Common Ground and ConsensusUses problem solving approach outside of the parties to work on areas where there is not consensusPartner with other nonpartisan nonprofits

What CodeBlueNow! HasVisionDetermination TalentCredibilityExperienceSolid track record of measured growth Statistically valid data for a baselineGrowing numbers of community partners

What We Need For Continued SuccessMembership GrowthStaff GrowthResourcesNonpartisan, workable ideasCredible Partners

Will This Work? Nothing else has since 1932But ConsiderRevolutionary WarCivil Rights movementWomens movementEnvironmental movementThey did not come from the Parties, they came from usUltimately it is up to you.

CodeBlueNow!www.codebluenow.org

*The Committee on the Cost of Medical Care formed as a private group in 1929. It said the reason American health care costs so much: 1932: too many medical specialists; too many infectious diseases (pre wonder drugs); disease based system of care vs. prevention; total lack of community based health care delivery. Stakeholders did not agree and it failed.

Politicization of health care led Roosevelt to drop it. Socialized medicine

WWII--Wage price freezes, but Kaiser shipyards wanted to reward workers who were building ships to win the war, could not get raises, so Kaiser asked to give health care benefits instead and Congress said, sure no problem.

Reform failure has been because of political differences, lack of a champion and simple bad luck.

Clintons plan failed because it was done in secrecy; presented as a 1,600 page bill, that was deferred for a year to deal with NAFTA. A fascinating book on this is Tom Daschles new book: Critical: How to Fix Our Health Care Mess.

The problem with leaving health care the political parties is the not on my watch you dont mentality.

*Trust is a huge issue, especially now. In our survey of Iowans and Washingtonians, academic institutions, elected officials ranked at the bottom of organizations/institutions they would trust.

Oregon focus group members stressed they do not trust elected officials or many current public institutions to solve our health care dilemma.

Asked if we should use a public education model, they replied Are you kidding? Look what shape our schools are in.

If there were trust, it is in health care professionals and a nonpartisan nonprofit with elder statesmen. (62% in WA and 65% in Iowa)

*There no consistent rules.

Self-insured, like Qwest play by one set of rulesState regulated play by anotherLabor unions another dimensionVeterans AdministrationMilitary Health CareThen there is Workers Comp varies state by stateIndividual insurance: good luck

*Because stakeholders define, there is no universal agreement on the problem and therefore the solution.Therefore, everyone else but me/us is the problemThere are hundreds of fingers of blame: greedy insurance companies; stupid consumers; direct to consumer advertising; un-yielding labor unions; pharmaceutical companies; lobbyists; corporate profit needs

The fact of the matter is, AMA and other stakeholder groups have always fought reform. We will soon look at why.

When I was at the University in the 70s and the wage price freeze, when we all waited in line for gas. Nixon had a wage/price freeze to control the situation and we could not get raises at our jobs. So, what did we get at UW? Mental health benefits and dental health benefits,so everyone I knew, including me was getting a crown and seeing a shrink.

There has never been one trusted voice. Not the advocates, not the industry stakeholders, not the parties. Therefore, there is always deep opposition

Because there are so many stakeholder versions, enough rings true that nothing happens. *This is not advocacy, just research.

There is no cookie cutter approach to health care. Everyone came to their system for different reasons and under different circumstances.

Germany was the first--healthy workers are productive workers;

France--they lost 1/4 of their men as a result of WWIpriority--rebuild nation--prenatal, maternity and well child care.

Britain came after WWII with the Labor party--you could put all that money into War, well we should invest in the people as well. I think this is where socialized medicine came from since they converted private doctors and hospitals to government employees and institutions..

Japan did not get universal health care coverage until the 60s, because the small business rebelled because they could not offer health care to their employees even though they had 50% of the employees who contributed to the economy as much as the big guys. So a coverage system was built around the public health system to care for them.

The Canadians had Universal Coverage in the 60sdoctors and hospitals are private, but government sets the rates.

Big picture overview; they have eliminated the complexity. I had an ah-ha moment last weekend. Someone said that about 50% of all health care in the US is from government. But, it is not one government program--city, state and federal programs. And everyone but the VA uses private insurance companies in one way or the other. **We have done focus groups in Oregon

We have an online survey

We have commissioned market research surveys in WA and IA in order to have statistically valid data.

There was only one statistically significant difference between the two states on all our questions. We asked the researchers what this meant: they said that in absence of leadership on health care, the American public has thought about this issue for a long time and has come to some pretty solid conclusions.

We asked our focus groups in Oregon. They said, no negative messages; show me what it could look like; let my voice be heard. Ditto for Kettering and public affairs firms---people will act if they think their voice has been heard.

Key message out there now: Cover the Uninsured (Wrong message--health care is expensive now, cover everyone, and it will cost even more.)*These are the high level of the key core findings. Here are the results. Note the Independents. *These findings are consistent with other national polls from the Commonwealth Fund and the Kaiser Family Foundation. *Public is somewhat divided on this issue. Probably depends on what is standard. **This was the only question that had a statistically significant difference between the two states: Iowans 69% and WA 75%*We have been saying this since 1932 and nothing happens. *This is what the Puget Sound Health Care Alliance is working on, and most of the public does not know it is happening. And many doctors really resist. *This is not unique to CodeBlueNow! A consistent finding from Commonwealth Fund and Kaiser Family Foundation.*********Nearly 30 to 40% of voters describe themselves as Independents or vote varies**Our financial base has been from foundations and devoted personal sponsors.

Or partisan. We think partisans are part of the problem. *We want to work with other nonpartisan, nonproft, or non industry for profit organizations and/ or groups that are not wedded to solutions, but want to be open on how to solve problems.

*We had no business winning the Revolutionary war. We were out monied and out gunned. Brilliant strategies, horrible blunders and sheer blind luck.

Remember, anyone can donate to a campaign. Only you and I can give them their jobs.

I lived thru the civil rights movement. My school in VA was the first to be integrated. The put chain link fence around the school and closed it to the press. So, the Washington Post called the school and my friend and I wrote the article on integration for them. My parents did not want me to do it, because they feared the Klu Klux Klan would burn a cross in our front yard. Right across the river from our nations capital.When I graduated from college there were two columns in classified ads: help wanted men, help wanted women, and all the jobs I wanted were other there.

When I was first married, I could not get credit in my name even though I was the only one employed. Within two years we became the first state in the nation to prohibit discrimination in insurnace based on sex or marital status.

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