 This is Stink Tech, Hawaii. Community matters here. I'm Marcia Joyner and we are navigating the journey. For those of you that have been with us the last two years, you know, we talk about our wishes and our desires as we move through life toward the end of life. And I'm 80, so the end looks really close. But there's one part about that journey that we somehow don't talk about, and that is the cost of medical care. My friend, Alan Burdick, is here because he is an advocate for universal health care, and all of the... He gave me something here just a minute ago that was unbelievable. Hawaii health insurance premiums are projected to skyrocket to $14,000 per person. Now, most of us don't make $14,000, and $42,500 for a family of four in the next eight years. So Alan, talk to us. Tell us, what do we do? Where do we go from here? Okay, well, this is a problem that I've been looking at for a while, starting with my focus from a while back. First, I want to thank you very much, Marcia, for the opportunity to speak on this. I've been looking at health care issues with some degree of concentration since the time that Obama pushed through what we now affectionately call the Obamacare law back in 2010, which was, to my mind, an extreme disappointment because what it did was locked in the kind of health care that we have had, some of the worst parts, some very good parts, though, but based on employment-based private insurance, although the key thing that he did do that has been helpful, if you're not in a Republican state, is increasing the ceiling of eligibility for people to get Medicaid from the federal government. And Medicaid, in a very, very gross kind of way, can be equated to Medicare. Well, let's just add this one caveat. Medicare is the fed, and we pay into it out of our social security. Medicaid is the state. That comes out of the state's budget, and the feds kick in X number of dollars into that. But we have 350,000 people in Hawaii on Medicaid, and that does not come out of your social security. That is correct, but what I'm looking at is- No, I'm just- The benefits. No, I'm just talking about the definitions. So as you talk, people understand what we're talking about. Okay, yeah. I mean, what we're looking at is whether people are covered for medical needs and for people who are covered by Medicare, which is, of course, a pay-in system. That's why it's an entitlement. We are entitled to Medicare benefits because we have pay-in. That is something that we get benefits from. Conversely, people who are on Medicaid, which is- There's a lot of federal money in Medicaid, and it's administered by the states. It's a weird form of federalism, and that's where the Supreme Court was able to, you know, trip up Obama's plan there and basically allow governors and or legislatures that are hostile to what Obama was trying to do to basically veto the expansion of Medicaid into their states, and that's why half the country does not have Medicaid expansion. We're getting a little sidetracked here, but the basic point is this, that what we have had continues to be employment-based private insurance unless you've got Medicare or Medicaid to protect you. And what we need to do is get beyond that. And it's amazing that- and it's really important to recognize that- and this is really one of the good things that has come out of Obamacare- is that attitudes have changed very rapidly. It was barely two years ago that Hillary Clinton very fiercely stated- in January of 2016- that the United States will never, ever have single-payer. Never, ever. Okay, now what is single-payer? Well, single-payer is- and I don't want to get hung up because we get technical difficulties in 14-foot notes on what it is, single-payer is, for many people, a way of saying Medicare or anything else where a single agency pays the bill. For example, as with Medicare, when you have a claim, it is paid ultimately by the government. Although, yeah, recently Medicare, because of things like Advantage and so on, you wind up having private insurance in there in complicating the thing. But the basic idea was the notion- I mean, single-payer gets somewhat equated with the notion of universal care. The idea of universal care is everybody gets covered. Everybody in, nobody out. And that's what we're looking for. Currently, in the United States as a whole, we have, I forget the number, something like 30 million people are still not insured, even though Obamacare has been on the books for something like eight years. How is it that they're not covered, at least partially? Well, partly because the Supreme Court let Republican governors and Republican legislatures veto the expansion of Medicaid. And those people who are not covered by that expansion of Medicaid are often completely out of luck, because they simply cannot afford private insurance. I don't understand how a governor could veto that. And what happens to their people? They suffer. Ask Republicans. I know that you can't answer that, but it just seems strange to me. Anyway, that's the, so we are going to, now you are advocating for, let me read it right, healthcare planning. What is, okay, what we're trying to do is this. On the state level, we are trying to follow through in one way or another to get the state government to focus on the need to get up to speed on universal health coverage and be ready to get on board with universal coverage once it becomes possible. And basically with the kind of control that's happening in Washington D.C. at the present time, that's not going to happen. But we're hoping for some changes very soon. And we need to be ready in this state, and we are not by any means. Back in 2009, the legislature passed over a veto by Linda Lingle a bill that eventually became a very short chapter in the Hawaii Revised Statutes. It's chapter 322H that creates the Hawaii Health Authority. Hawaii Health Authority is simply a board that's supposed to have nine members, that's an advisory board, that is supposed to have a planning role, an advisory role to help the state, particularly the legislature and the governor, prepare for the creation of universal health care at the state level. And obviously alternatively at the national level, if and when it comes, and you know, merge these concepts together depending on what's coming down the pike. The problem is that the health authority barely got off the ground when it sort of crashed into Obamacare, which was happening basically at the same time that the health authority was being launched in 2009, 2010. That was the time Obamacare was happening nationally. And the legislature was, and Governor Abercrombie at the time, were focusing far more on how to deal with Obamacare, how to deal with the expansion of Medicaid in our state. And as you point out, we have approximately 350,000 people, which is a quarter of our state population, is on Medicaid here in Hawaii. So that's where the focus was. It's sort of like we can only look at one thing at a time. And the Hawaii health authority has been rather ignored. And instead of having nine people, it's now down to three. And they're not active at the present time other than to say, hey, what about us? And that's all they're able to do. So we feel it's time to either revive the health authority or create a new agency with roughly the same mandate as the health authority has had and get up and running in terms of planning. Okay, so this is a planning committee. Right. And so they would look at all this data here and put together a plan of how we move forward. Is that it? That would be the idea, or perhaps a series of options. If A, then B, if C, then D, and so on, depending on what's coming from Washington. That's a scary notion. That's right. The problem is we're not doing anything now. Nothing. What's happened in the last couple of sessions of the legislature is that the state has sort of imported pieces of the Obamacare law into the state law, as state law, so that if Trump and company destroy Obamacare at the national level, we have certain pieces still preserved at the state level, such as, for example, preventing private insurance companies from borrowing health insurance coverage for pre-existing conditions. Right. Or discriminating on basis of gender, because it used to be that coverage for women would be higher than for men in the same age group, and so on, things like that. Those various general protections, about a dozen or so, were put into state law and they're there now as parts of state law, so that, as I say, if Obamacare is destroyed at the federal level, they are part of state law. But that's it. Yeah. Okay. Now, we are going to take a break, and we will be back in a minute, and then we will talk about where do we go from here. Okay. How do you see us proceeding, okay? We'll be right back. This is Think Tech Hawaii, raising public awareness. If you're not in control of how you see yourself, then who is? Live above the influence. Hey, baby, that's you. I want to know, will you watch my show? I hope you do. It's on Tuesdays at one o'clock, and it's out of the comfort zone, and I'll be your host, R.B. Kelly. See you there. Aloha. I'm Marcia Joyner, and this is Navigating the Journey, and we are talking today with Alan Burdick, who is an advocate, and I do say that I mean that, an advocate for universal healthcare. As those of you that have been with us for the last two years, you understand that the last, according to the feds, the last day of life in the hospital, in the hospital, is about $10,000 a day. So that wipes up out your whole, everything. And that was, that was several years ago. Who knows what the cost is now. So Alan is advocating for universal healthcare, planning on how the state can get from where we are to there. Okay. Right. I hope I got that right. That's good. That's where we are, and what we're trying to do is get state legislation that will put an agency in place that will do the planning for this and that will have an open process that will look for feasible alternatives to the current system that we have, which is based on private insurance. And we know we have to go to something like the kind of system that exists in virtually every single industrialized country in the world except the United States. Yes. And Gordon E. Toe's interview, and those of you who are subscribers to the Star Advertiser, you know that the Star Advertiser search engine is terrible and you can't find it outside, but you go to January 21, 2018, and look for the Gordon E. Toe interview, and you might be able to find it. That's the one where we said it was $14,000 per person. $14,000 per person, just for health insurance premiums. But we're not even talking about deductibles and copays. All right? And that's what Mr. Ito is predicting, or $42,500 for a family of four, as those would be the average premium level in eight years from now. And these are obviously not sustainable numbers. No. And so, if I am... Now, I say this all the time, nobody, none of the legislature, members of the legislature, have ever made a payroll, so they have no idea how to do that and what comes out of the payroll. So, by law, if I'm a small business owner, I have to pay because of the prepaid healthcare. Now, if the premium is $14,000 per person, what is that going to do to small business? They can't do that per person. They can't stay in business, pay all the other things that the state requires to pay, plus your salary, you know? Yeah, right. Where we go? That is total bankrupt. I mean, small business would have to disappear. Well, that's the problem is that if we continue the way we are now, we will continue burying our heads in the sand. We need to have a group of people, you know, who are smart and understand these kinds of issues and face them and focus on them and say, how can we do this in an affordable way that will work and do it? Yes. Now, there is one issue. It's not mentioned here, but it's real, and that is the cost of medical, of what do you call it? Your medicines, your pharmaceuticals. Now, the VA, unlike Tripler, because they're separate entities completely, the VA managed to work out a plan that they buy in bulk, they buy in bulk and therefore their cost is different than, but Tripler is under the Department of Defense. The VA is a separate entity totally. So they get to buy this way. Tripler does not because it's the federal government and the federal government just opens the door and whatever the price of the drug is, that's what it is. So that comes back to our planning. That comes back to our planning because so often the insurance company gets to say, oh, you don't need that. The insurance company decides, my daughter is a nurse and she used to work for an agency where she had to deal with the insurance company. The insurance company is on the mainland. They've never seen a patient and they said, oh, they don't need that. They made the decision. And now we see how many women in America die at childbirth because the insurance company says, you get to stay in the hospital so many hours and then you go home, whether you need to or not. So hopefully, hopefully in your planning, your organization that's planning universal health, that we deal with the insurance companies. Absolutely. It has to be. And the idea is that the council or whatever this agency gets to be called, and this is an agency that presumably the governor would establish these kinds of minimum levels of care and so on as part of an overall strategy of the kind of medical care that would be proposed for the state. And what we are looking at is basically starting off with HR 676, which is the expanded and improved Medicare for All Act that's been introduced. No, that's the federal law that we refer to in the draft bill that we've been working on for the state. That's this draft bill. We're working on a draft bill to ask legislators to introduce in the state legislature. And that draft bill refers to HR 676, which is the sort of gold standard bill, if I can use that term, that has been around and is constantly improved from every two years. It gets revised and reintroduced. It's been reintroduced from a number of years with John Conyers while he was in the U.S. Congress and will be reintroduced by someone else. In the current session of Congress, it has over 120 cosponsors. And it's gaining a lot of power. It has the advice throughout from the Physicians for National Healthcare Program and National Nurses Association. This is a well-thought-out bill. This is not something slapped together. But it's quite brief, simple, and straightforward. And what it does is it attempts to take Medicare, take the warts off it that have been added on by Congress since Medicare was initially enacted, clean it up, add things that are not there in Medicare now, like long-term care, vision, dental, and so on, make it a better product. And nationally, that would be for the elder people. We want it for everybody. But, you know, if you remember the Union, they get, in their medical care, they get eyes and dents. For the rest of us, that's separate. We don't get that. I know. And, you know, we got to pay all these extras. So, now, tell me, what would you like us to do? Now, I want you to look over here and tell the audience what you want us to do. And as we are voters, we are taxpayers here in Hawaii, what do you want us to do? Okay, first, I'd like you all to get up to speed on this. Google HR 676 and read up on the basic elements of HR 676 expanded and improved Medicare for all. So, you have an understanding of what we're trying to do nationally. Look at the Hawaii Health Authority. And when you have a chance to talk to your legislators or candidates for the legislature, ask them point blank what they are going to do at the state level. Ask Governor Ege or Andrea if you run into her. What are they going to do at the state level to deal with the crisis in healthcare finance and healthcare delivery in this state? And think on that and make sure you make that part of your decision-making process when you vote. Start with those things and keep at it because this doesn't end on election day. This will continue when we get into session in the legislature. We're going to have to ask the legislators, you know, we're going to need a bill. And we're going to need to get that bill passed. We're going to need to get an agency created, whether it's called the Healthcare Planning Council or whatever it's called. And we're going to need to make sure it has the bureaucratic support and the support of the governor to get us started and really ready to deal with this because as Gordon E. Doe says in eight years we're going to be looking at $40,000 for family of four just for the premiums. Yes, just for the premium. That does not include the copay. Or the deductibles. Or the deductibles or the pharmaceuticals. Or payments for the things that are not covered. Yes, so one last thing. Tell people your web page for this information, how they can contact you so they can come on board and make this happen. Well, one of the pages is a Facebook page, Healthcare for All Hawaii. And the Democratic Party, Kupuna Caucus has a Facebook page and a web page also and we will have material on those web pages as well. So we can contact them and make this happen. That's right. And Kupuna Caucus is having a meeting on Tuesday, October 2nd at six o'clock. So you're inviting everybody to show up. Sure. And we have four working groups and one of them has healthcare as its main task in its portfolio. Right. Thank you so much for being here, Alan. I really appreciate it. And so we're asking everybody who absolutely come on board make this happen. This is for all of us. Democrat, Republican, independent, it doesn't matter. In fact, you don't have to be a Democrat to belong to the Kupuna Caucus. So show up and stand up. Take a stand. We need you. Thank you, Alan. And thank you all for being here. And we'll see you next time. Thank you very much, Marcia. It's a pleasure seeing you again. And a pleasure to be on this show. Aloha.