Health Care for All

Talking points

Some call it Medicare for All, but Medicare and Medicaid can be lightning rods for folks who don’t like “entitlements.”  You choose what you want to call it.  This page will help you have a cogent conversation.

  1. Create a public OPTION that is implemented incrementally over 3 years, preserving the best of the ACA, including essential benefits  (coverage for pre-existing conditions) without increased premiums or out of pocket expenses and using lower-cost pharmaceuticals.
    • Secure the right to affordable health even with pre-existing conditions. 
    • Secure Medicare for all everyone under age 26 and over 50
    • Secure Medicaid for those with low or no income 
    • Secure Social Security
  2. Negotiate all pharmaceutical prices through a government-wide one-price process.
  3. Include access to mental health and addiction care in all health insurance plans, Medicare and Medicaid. 
    • Increase the access to community mental health clinics and all inpatient facilities, and charge based upon income. Use subsidies to assure affordability.
    • Increase the number and access to quality-driven pain centers in each state, and remove the threat of jail for addicted and at-risk patients. 
    • Improve enforcement against clinician-prescribers and drug sellers, including arrests and jail time. 
  4. Make Naloxone available to families and professionals (including law and fire protection) at no cost.
  5. Reinforce the rights of women to make their own health care decisions with their physician and remove the gag clause.

Public Option and Free Markets

The economic costs of health care go far beyond the cost to families and includes tax revenues and community improvement. We are asking the wrong questions and, therefore, getting the wrong answers. Solving for the wrong questions leads to inhumane barriers to health care. Health care for all is buildable and achievable, but it takes time and courage.

Mental health care is under-used and under-funded.  Men commit more gun suicides, domestic violence takes it toll on women and children, and families are paying more than expected after the passage of the Mental Health and Addiction Parity Act almost 10 years ago: up to 45% of mental health care is out of pocket.  Kaiser Foundation on NPR in 2017

Health care spending in the United States is much greater than in other wealthy countries, but U.S. health outcomes are not better.

Analysis finds that for every state, health spending exceeds median per capita spending in each of 10 other high-income countries. In general, research shows that higher spending in the U.S. is attributable to higher prices.

Health insurance is a major determinant of access to both preventive and acute health care. Most Americans rely on employer-provided insurance. Thus, unemployment affects their access to healthservices, due to both loss of employer-sponsored health insurance and reduced income. 

https://www.cdc.gov/nchs/products/databriefs/db83.htm
  • Of the 400,840 employers in Florida, 396,515 employ less than 500 workers. Twenty-eight percent of workers are uninsured.  In Florida, the “face” of the uninsured non-elderly is 47% Caucasian, and 64% are US citizens (Census.gov). They either pay for care out of their pocket or they forego care, become much sicker, and land in the emergency room, the highest-cost site for care.
  • Nationally, more than ¾ of the uninsured are in working families (they don’t qualify for Medicaid as it’s currently structured), and 62% of these uninsured have at least one family member who is full-time employed. The Uninsured: a Primer  KFF
  • More of the cost of insurance has been shifted to workers over the last 12 years.  Surprise costs of deductibles and out of pocket expenses have gone up rapidly with the costs of premiums, and those who work in small business have been the hardest hit. Unaffordability often results in lost work, job loss, medical debt and bankruptcies. (KFF)
  • When unemployment goes up 1%, the uninsured increase 1.1million, according to the Commonwealth Fund National Scorecard 2008. While we have a low rate of unemployment nationally, the rates for people of color are much higher and therefore a bigger burden for health outcomes. 
  1.  Year 1. Do not repeal essential benefits, but pay for them with dollars from employer-employee tax (lower the employer tax credit and direct an equal tax credit to commercial insurers for the essential benefits).
    • Employees will be charged 5% more on their premiums, and employers can offer a split to their employees (2.5% paid by each, similar to social security).
    • Insurance companies agree to no more than $1200/ deductible per person or $2000 per family.
    • Insurance companies and HHS can negotiate single-price fees for pharmaceuticals, medical devices, and treatments for commercial plans and Medicare-Medicaid. 
  2. Year 2. Add to year 1 as follows:
    • Provide Single Payer choices through Medicare for workers aged 40-65, plus children under age 18.
    • Families can upgrade to employer sponsored health plans or market plans.
    • Use 25% of money from employer-employee shared costs (what the employer saved on his/her taxes for providing health care that they now don’t need to provide) to pay for the single payer.
    • Government issues bonds to cover the reinsurance cap for employers, reducing employer burden.
    • States that expanded Medicaid begin to re-subscribe their participants into Medicare for all, with incentives from dollars that are saved by moving to a Medicare plan. States that agree to expand Medicaid eligibility can participate in this shift in a 50/50 split with feds. 
  3. Year 3. Add to year 2 as follows:
    • Removal of Medicaid for low income workers and the disabled ages under 18 and 40-65, and shift of these populations into Single Payer plan or commercial plan.
    • “Medicare Advantage Pronto” plans come forward to appeal to those under 65 who wish to sign up for expanded coverage.
    • Tax reform is implemented to stabilize the revenues and costs of care in the poorest. Additionally, employers lose their subsidies.
    • Employer-sponsored care increases with a 3% tax on premium value for employees,
    • Employers can continue to provide plans or not while employees can buy employer-sponsored or open market.
    • 1% lowering of taxes for one year for upper 20% of earners IF they are enroll in employer sponsored plans for one more year.

 Opioid-Narcotic Epidemic

In 2016, average life expectancy at birth in the United States declined for a second year in a row, driven in large part by a spike in deaths from opioid and other substance abuse as well as suicide.
The combined rate of deaths from suicide, alcohol, and drug use — sometimes referred to as “deaths of despair” — increased 50 percent from 2005 to 2016. Rates rose in all states, doubling or more …


https://www.statnews.com/2018/01/04/life-expectancy-us-health-care 
 https://www.cdc.gov/nchs/data/databriefs/db293.pdf

Opioids and other narcotics have become the biggest health care epidemic in the US, with YOY increases in Florida among the highest in the nation, rising over 30% in 5 years.  Much of the growth started with and continues with prescribed medication from physicians. What begins as relief for pain develops into a narcotic habit that leads to Fentynal, heroin and cocaine, and is now augmented by fake Fentynal from China, causing many more deaths. Opioid victims are arrested and detained, often denied treatment and counseling, all of which can lead to death in jail from rapid withdrawal. Not all counties or cities offer enough counseling and safe houses for withdrawal.  Not all counties train and equip their law enforcement with naloxone (the antidote for opioid heart failure). Success is achieved through mental health counseling, naloxone remedies, and ongoing social supports in the community.

  • In 2015, behavioral care was four to six times more likely to be provided out-of-network than medical or surgical care.
  • Insurers paid primary care providers 20 percent more for the same types of care than they paid addiction and mental health care specialists, including psychiatrists.
  1. Train all law enforcement entities and equip all field patrols and first responders with naloxone.
  2. Make naloxone and similar drugs with proven efficacy legal for family members to store in case of overdose of addicted member.
  3. Create opioid-narcotic clinics in areas of high use, funded through a partnership of state and federal monies for five years. Train certified clinical, mental health, and social services experts to treat and counsel the addicted person for pain modification without narcotics, even including job counseling and placement.  The federal monies would phase out in years 3-4-5.
  4. Increase the discovery of over-prescribers and dealers by increasing law enforcement personnel for 3-5 years, in a financial partnership between federal and state forces.
  5. Assure the use of adequate pain relief for surgeries, cancer care, and other high-pain conditions in a partnership between local hospitals and law enforcement. 
  6. Assure every county or metropolitan statistical are (MSA) establishes a medically-based pain center in which patients are evaluated by clinical, mental and social health professionals who have completed certification in getting people well and back to work.  Hospitals and health systems would act as the hosts for these centers, with oversight by a professional, nonprofit quality-review organization, such as LeapFrog Group (rates hospitals on safety and readmission). 

Women’s Freedom to Choose, Gender-based Care, and Health Justice

Women make most of the health care decisions in the family yet women are often denied personal health choices for themselves. Women’s counseling centers supported by state taxes do little to improve the choices as they typically have no clinical personnel. Add to this the gag clause under which women cannot have an honest discussion with their doctor, and the choices become even more limited. All of these barriers become even more treacherous for folks changing gender assignments or those with HIV or HepC.

  1. Women are guaranteed the right to discuss their choices and choose their health care in consultation with their physician.
  2. Women and people with gender changes are charged the same amounts for care as men.
  3. Persons with HIV or HepC are not denied care nor charged more than other patients for the care.
  4. Patients in custody or in jail must get the medicines they need to take manage their conditions. 

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