 Good evening and welcome back to Byline. This is a public affairs show of the Amherst League of Women Voters and Amherst Media. And we're using this show over the course of this year to help people understand how our new government is coming together. And most of our guests are members of the government, either town councilors or staff or people who serve on specific committees. But today we're taking a little bit of a left turn and that's not a political statement. It's a turn of a bit, a different kind of show because we have two guests from the Amherst League of Women Voters. But there is a connection to our new town government because this is the first time we've interviewed anybody on the show who's using provisions of the charter that relate to citizens coming forward and presenting resolution to our town government. It's not the first resolution that they will have been taking up, but this is the first time we've had the opportunity to talk with some people about their effort before the town council. And so we'll talk about the substance, but we also want to talk a little bit about the process because we want people to understand how to use the tools of our local government. But in order to really get the context and the frame of reference here, we should start first by knowing who you two are, Diana Stein and Barbara Pearson. And you're both members of the league. You've both been in town. You've been in town for many, many, many, many years and you've been in town for less, but not that many, not none. And you've both been active in around town. So let's just take a minute here and Diana talk a little bit about what you've done in town government because you've served in town government. And your role in the league. Okay. In terms of town government, I started with town meeting. I was on the select board for six years. I am also was a member of the Charter Commission that helped draft this charter that's running the town government. And currently I'm a member of the Community Preservation Act Committee, which I love being on. In terms of the league, I have been a member of the Health Care Committee probably for 20 years. And I currently am that the League of Women Voters Health Care Committee is working now with other members of Western Mass Medicare for All. We are part, Barbara and I are part of the hub, it's called, for the Amherst area. So you've been active in town and you've been active in the league for many years. Barbara, you're newer to town but you've been active with the league and your affiliation, you're retired from the university, is that correct? And so tell us a little bit about. So I retired from the university about a year and a half ago and I had been following my neighbor, Jackie Wolf, whose name is synonymous with single-payer health care in Massachusetts. And I had looked forward to, I actually joined the meetings a little bit before I retired into it. And so I joined the league a year and a half ago so that I could work on the health care committee with Jackie Wolf, who then moved. Who then left town. And so I was willing to, I was still very enthusiastic about it and so I've taken over the chairmanship of the league's health care committee. But as Diana said, we now ally ourselves with a more, a broader grassroots organization. So you're part of a larger coalition here in the region and across the state. Also not quite the same. Working on this concept of single-payer and now Medicare for All. And we'll talk a little bit more about that in the distinctions and if there is a distinction that you want people to understand. But let's also take another minute. That's good. So we'll dig into that in a minute. But let's also take a minute and refresh people's minds, especially for those who may be younger and may have never heard of the league or those who have not been involved. So the league is quite a senior, mature organization. Indeed. It formed as soon as the right to vote came to women. And we'll celebrate its 100th year anniversary next year. Very good. And the Amherst League is 80 years old this year. So we started roughly 20 years after this movement became a national movement. And the purpose of the league is to encourage voting. That's a primary one. But we study issues and develop our programs based on that. We are nonpartisan. We do not support candidates. That's an important thing to know. But when we study an issue like health care and decide that the appropriate way for a country or a state like ours to carry out health care is through a single-payer system that came to be, actually, it's even a statewide position. And they've become much more directed saying that they support the bills that our resolution supports. That is related to that. And when you say nonpartisan, it doesn't mean that members of the league have to register as independent voters. But you have to check your party affiliation at the door so that you can engage in a robust conversation with your friends and neighbors. And your differences may be rooted in ideology and party, but you're not there to promote your party's interests. Barbara? Well, the current theme for the league is making democracy work. So doing whatever we can to make democracy work. When I was deciding, well, where was I going to put my focus and all that energy that I had since I wasn't working, I saw health care as a kind of a way to make sure that we could make democracy work. And in fact, I'm on the national committee for health care reform. In the league? In the league. Okay, good. And we have a, it's not a bumper sticker, it's a slogan. It's a slogan. It's a bookmark. And it says, healthy people for a healthy democracy. And we just don't know which way it goes. Healthy democracy for healthy people or healthy people for a healthy democracy. But it seems to me that it's integral. So with the, yes, I'm sorry, please. Well, it hits on social justice and racial justice and disparities and corporate malfeasance and all kinds of things that we would be very incensed about. So in a way, if the government and society can produce the health care access quality affordability that people need, then they know that their governmental system is working. Well, then we'll have a more democratic system. And that's a small D again, not big D because it's a nonpartisan organization. And so the effectiveness of government affects how people think about their government and therefore how they will either participate or not. Which is all part of small D, democratic engagement. So now we should talk about the resolution. Well, we'll talk about that in just one minute because I want to know why you decided to file a resolution and what did you learn by reading the charter and working on understanding what the benefit would be of taking this resolution to the town council. Well, the first thing is in terms of the charter, you've covered it. This is a free petition. That's the aspect which allows citizens to bring in issue and it really can be a single person. You don't even have to be a group like us according to the charter. Why are we bringing this to, we had a change in government from town meeting, which I might say right now supported this single payer Medicare for All back in 2000 and 2006 again. And the town voted 88% in an election on a nonbinding ballot question favoring single payer health care, Medicare for All. So this is something that town has cared about for a long time, but with the change in government, we wanted our town council to be on board as well. Excellent. And the process for doing that was? To draft a petition resolution, which we have. And you're going to be describing that in just a minute. I agree. Yes, indeed. And when you draft that, you submit it, do you need a certain number of signatures that you just submitted? No. And when you submit it, it starts the process in the council? No, what will happen was we find a counselor who agrees with us and is working with us. The draft is 95% complete. We are still tweaking it. And then you decide when you want to bring it to the council. And we want to make sure that we have dotted all the i's and crossed all the t's. So we, at this moment, haven't set a date. But probably sometime this fall, we will bring this resolution to the council to asking them to support and endorse an act establishing Medicare for All in Massachusetts, which is the title of a bill, S683 and House Number 1194. And that's what the purpose of this resolution is to get them to support. And so now walk us through the. I should have one other thing. Encourage our state legislators to work on this issue. And we're lucky in that our Mindy Dove, our representative, and Senator Joe Cumberford support single payer health care and Medicare for All. Terrific. So why don't you start to walk us through the content of the resolution so we understand the arguments, because I assume there's a bunch of warehouses. There are. Okay. There's more warehouses than you want to hear today. But give us the highlights. Okay. Because we need to talk to the public needs to understand what is the reason we should be supporting this. Sure. I think we should start by clarifying whether it's single payer or Medicare for All. That seems to be a big confusion. Okay. People ask it all the time. Well, single payer is that a system under which the health care bills are paid out of a single trust, just like Medicare bills are paid for out of a single trust. This would be a state trust in which all the funds would be gathered and the bills would be paid from it. That's what a single payer system is. The point that I want to make is that although the bill says establishing Medicare for All in Massachusetts, it should, in my mind, be read as improved Medicare for All. And the reason is that a lot of people say, but my Medicare only pays 80% approximately of my bills, and I have to pay for an expensive Medicare insurance policy. If this is gone under the bill, okay, you would have all of your medically necessary bills paid for by this trust. You would not have to buy a Medicare insurance policy, and it covers far more than the current Medicare does. It covers vision and mental and dental and hearing aids and long-term care even. So it's a very comprehensive bill that is described. So do you know why people shifted from just talking single payer to starting to use the nomenclature of Medicare for All? Because I found that confusing myself, understanding and having sponsored and supported legislation around single payer, and I understand Medicare, I understand Medicaid as a former legislator, and I was just puzzling because I think it added confusion to the debate rather than made it easier. The idea was to add clarity or to add something that people could relate to and understand and recognize. So, for example, the Canadian system, helpfully or not, is called Medicare, and we are very familiar with Medicare, and it's the mechanism of Medicare where you get to choose your doctor. You choose your doctor, you don't have to worry about an insurance company telling you which doctors you can go to. And what services they can provide. And what services they can provide or not provide. Cosmetic is not going to be included medically necessary. But acupuncture is even in the bill. But if cosmetic were necessary as a result of an illness, it presumably would be covered because there are diseases in medical condition exactly that would produce a situation where for the health of the individual you would need to do some reconstruction, and that can be cosmetic. Sure. So people don't really understand our system. For example, when I worked at the university, I really wasn't aware how much the university was paying on my behalf. I knew how much I was paying, and if you had asked me, how much does your insurance cost? I would have given you what I pay. Your share, right. I pay four times as much, which turned out to be a huge percentage of my very low salary. But people don't really understand, they don't know what a single payer is, and don't really appreciate that we have a multi-payer system. I mean, not just a multi-payer system, a mega-payer system. But they do appreciate Medicare, and when there were the debates going on about the Affordable Care Act, people would say, I don't want the government to my Medicare. I mean, it showed their love for it, but also an ability to really understand it. And that's also another distinction. A lot of times people say, I don't want government doing this. But we're saying, okay, right now we have a good portion of our health care is provided through public funding, and another portion through private funding. So we've got that distinction. If somebody wants to say, I don't want a government run one, well, I personally don't want a corporate run one, because a corporate one has to worry about their shareholders more than they worry about me, their patient. And profit-driven. I mean, people have to understand having profit-driven health care means you're paying a lot of money for something that doesn't deliver any improvement in health care at all. And I just would like to set the stage a little bit in that the U.S. as a whole is doing very poorly in terms of health care if you take the statistics. For example, life expectancy. There are countries that are living where the people have a life expectancy four and five years longer than we do in the United States. And as Barbara will tell you, it's going down. It's not going up. It should be improving. And part of that relates to what percentage of the people actually are covered as well as the availability, the access, and the quality of what they're receiving. And when you have 10 percent of the population uncovered in a particular jurisdiction or in the country, nationally what do we have 15 percent uncovered at this point? And we're much lower here, but we have another huge percentage who are underinsured. Underinsured, right, as well. So we have somewhere between 150,000 and 200,000 people who still aren't covered, even in Massachusetts, which does better than a lot of other states. But the point that Barbara raised is this underinsurance thing is terrible because the way you make insurance policies cheaper is you increase the deductibles. So if somebody has to spend $5,000 out of their own pocket, a lot of people just don't bother to get the health care until they end up in the emergency room, which is the most expensive form. And it also goes to your point earlier about equity. And because if you have insurance, but you can't get the level of service you need, it's going to affect our overall data. Because let's face it, in a community of this nature that we're living in has a very, very high level of insurance, high quality insurance. So you see people are living very long and productive lives. The number of people over 90 that I associate with now is stunning. But that's in part because they have such good health care. And they take care of themselves, and they have the income, and they have the insurance. And so if you don't have... But it's costing the state big time. The amount, the proportion of the state budget that has been going up from I think 2001 to now has gone from 30% of the state budget spent on health care to 45%. And every time you do have that kind of an increase, money gets pulled away from the infrastructure, education, and so on. When I went into the legislature, we were spending about 18% to 20% of the state budget. And at that point, it was a fraction of what it is now. I'm going to say it was about 17 or 18 billion. We're now over 40 billion, and it's closer to 42, 43, 44%. Exactly. I haven't checked it in a while, but you see that. And it's of a much larger number than a much larger percentage. And in terms of the inequality. So one of the things about the profit motive of the, even for insurance companies that are non-profit, which just means they don't pay taxes, they still have huge salaries, they still have advertising, they still have all these other things. But it doesn't, it seems that the whole country, not just Massachusetts, but Massachusetts as well, doesn't cover the rural areas very well because it's not profitable enough. And so they're really pulling back on that, and it just keeps getting worse and worse. What would be the benefits to the town and the town's residents that the town council would consider as they're trying to decide what to do about this resolution? Barbara would be really good to speak on this issue because she has studied the finances and it's astonishing how much of a help it would be. To help us understand what that looks like for the residents and the town of Amherst. Well, as you know, we want to save money. And the corporations, for example, who are doing this, they don't care if they charge more for health care because they have no incentive. You charge more, then you pay more in premium. But we have to put, you know, the town has to take out of our $85 million dollar budget. Currently they're taking out a little over 10%, about almost $9 million dollars. If we follow the law on the books, just for the active employees, the teachers and the government workers, not the special funds and stuff like that, we would save more than half. We cut it in half. More than half. And that's money that could go to, we have big capital needs there. When you cut it in half, if you're uneducated about this, you might think, well, if you cut it in half, we're going to be losing something. No. No. So how do you cut it in half without losing something? You have a more rational system, a more efficient system, a system that doesn't waste almost a third of your medical dollars on non-medical things. So you have to have, I mean, you can't just... So advertising and promotional and... And price increases are outrageous and the state legislature tried to get some controls in place. And that failed due to lobbying. Anyway, so tell them about some of the other things. Some of the other things, my goodness. So it's basically, there will be significant savings and there's data and studies to back up, back this up. And it's actual savings from the beginning, not just savings from increased saving, a percentage of the increased cost, it starts right from the beginning based on your analysis. But it has to have strong cost containment. So you can't just, like ACA, you can't just expand who gets health care if you can't rein in the costs. So that's why you want to have the single payer because you have more control over that. And so a big portion of what you're going to save relates to things that are non-medical. Absolutely. And in fact, you'll have better, in fact, we're not talking about the nine million dollars that I mentioned, that's for insurance. That's not necessarily for health care. So we're talking about paying half that for all of your health care. And that's a different proposition. And other points that- Well, one of the points of the wastage that Barbara referred to is the number of billing clerks that a practice or a hospital or such as Mass General has to hire to put the right codes in and send the bills to the right insurer. It's outrageous to me that Mass General has as many billing clerks as patients, 450. And a similar sized hospital. That's waste. That's just total waste. And then there's the drug situation. I have to go back to it. In Minnesota, they took a bus of patients who require insulin and drove it up to Canada because the insulin up there was something like $32 of whatever the aliquot is. In our country, it's 10 times as much. That's just profit. And I read of another drug that's $50 that they're now charging $20,000. That's got to stop. It's just we cannot go on doing this. So that's got to be attacked through policy because the federal government in particular, but also state governments, have to do what needs to be done to control that no matter what the system of delivery. But the single payer system allows negotiation of veterans administration hospitals pay 40% of what we pay in the industry. And again, that's the policy at the federal level ridiculously says you can't negotiate over seniors drug prices. Exactly. And there are drug prices for the veterans. That's absurd. So meanwhile, we have 30 seconds for you to make that final point. Did you lose it? I think I lost it. But it was about the fact that people think it's a free market. Oh, we have a free market. And what you just mentioned, it's absolutely not a free market. We don't have any of the market forces for competition or anything for for drug prices is a great example, but also for well, on that note, I'm going to thank you both for being here. And I want to thank you not only for the work and explanation that you're doing around our health care costs, but also helping us all understand how to use our town charter to bring an idea to the town government and our elected officials so that they can make a public policy statement in support of the kind of change that you envision as local residents you'd like to see happen. Thank you for giving us the opportunity. Great. And thank you for joining us and we'll see you again soon.