 Hey all, we're here with Physicians for a National Health Program. We're going to be talking about the future of US health care. Sit back and enjoy. Greetings. I'm Betty Keller from the Vermont Physicians for a National Health Program. We're all in this together and today we'll be talking about learning about health care reform. I'm really excited to have four interns with me today. The Physicians for a National Health Program is a national organization. Vermont has a chapter and we educate about health care reform and specifically trying to get an efficient health care system for the whole country and advocate for it as well. But the education part is really critical because people won't understand what the different options are and why having an integrated coordinated system is so much more efficient. It provides better care, better access, better outcomes at lower cost. And until we really educate people about that, we're going to have troubles achieving it. So we have an internship in the summer that is usually focused on having medical students because students will finish their first year of medical school and have a summer off before they go back to the classroom. And then after that, they're in the clinicals and they will not have a summer off again on the Philly books. But I'd like to introduce now our interns this summer. We have three from medical schools in Louisiana and one from a medical school in Arkansas. So Gregor Dierks is on my immediate left. He is from the Louisiana State University in Shreveport, but actually from Oregon. And that's what does is from the Arkansas College of Osteopathic Medicine and actually from Arkansas. Thank you for being here today. Siobhan Temple is from Louisiana State University in Shreveport and actually from Louisiana. New Orleans. New Orleans. It's different. Oh! Okay, great. And also we have Benjamin McMahon who is studying at Tulane University and from Florida. Thank you for being here today. So I'm going to start off with just first asking if you could be thinking about how did you happen to hear about the internship and what made you decide to follow up and apply for it? Maybe we could start with Benjamin, do you could speak about that? Sure, yeah. I mean my experience and to keep it kind of brief, I did a lot of research after undergrad clinical research. And within medical school there isn't a lot of health policy education. There just isn't so much time for the first two years. We're learning a lot of the aspects and basic sciences of being in a position. So I kind of wanted to spend the summer learning a bit more about health policy and specifically single payer, learning more about what that entails and becoming an advocate of it. How I heard about it, Tulane sent out an email. Betty here has reached out across the nation I think to get some of the most qualified candidates to join. And I would really appreciate of that. But yeah, really kind of just down from Betty to my school. And I was like, you know, it's a good opportunity to learn more about how I want the future of healthcare to look. Thank you, Benjamin. Jevon, do you have any comments? Yes. For me, I will, so I heard about the program via my email server because Dr. Keller emailed out, reached out to a bunch of schools. As soon as I saw the opportunity, I was like, you know, I wanted to jump on it because as Ben said, we don't get to learn about health policy while in med school for real. And it's a subject dear to my heart because I've had two young friends that have been, I don't know if I should call them victims of the system, but like have been affected gravely by the current healthcare system. And one has led in a death and the other has led in her almost going bankrupt at 28. So, you know, I really, it means a lot to me to like, you know, learn how to become a better advocate so we can really, you know, because we need a change. I think that's obvious. Thank you. So I heard about like PNHP just through the Twitter space, like Dr. Adam Gaffney is really big on that. And so follow him and check him out. But and so then I went on the website and for under Arkansas, it says so I just contact the home like the headquarters. So I just shot a brief email and I guess they just forwarded to Betty. And so then I got in contact with Betty. Yeah. Same story as everyone else. Pretty much I got an email from our school seemed really interesting. It was like a rerouted email from Betty and Siobhan and I had like just been talking about what we wanted to do for the summer. Got an email. We both signed up immediately. And I also feel very passionately that our current system is just embarrassingly broken. So we need something new and I think a single pair is kind of the way to go. Thank you. Thank you. So maybe you could talk a little bit more, Gregor, about what experiences have you made decide made you decide that our current system is broken. So I've probably won in this circle. I've talked about this before, but I volunteer. This is one example I volunteered at Mission of Mercy. Everyone on screen watching should all do it. It's dental. It's not medical. So it's a little bit different, but basically it's the three days leading up to Thanksgiving. And it's all free dental care for about 12 hours a day for those three days. Everything from teeth pulling, teeth cleaning to more, more intense stuff like implants and all that. And ensures and everything else. And so all of these people that come in are either completely uninsured or totally underinsured, which is essentially sort of the same thing as being uninsured. You can't use your insurance because it's too expensive. So you end up seeing the patients at their absolute worst rather than allowing them to come in regularly and get their teeth cleaned, get whatever needs fixing early when it's a minor issue. And then you see these patients coming in and their teeth are literally like literally crumbling out of their skull. You can take pliers and pull their teeth out without any anesthesia because they're completely rotten. And so that is sort of just a little window into if you treat people not frequently and their most extreme and worst state, that it ends up costing a lot more time-wise, commitment-wise, money-wise than if you just treat them early and give everyone equal access to care. And what you actually, in that case, you have worse outcomes because they also don't have any teeth at the end. They're using dentures instead of having fixed their teeth earlier. Right. And so most people are underinsured for dental care because they don't have dental insurance coverage. On most policies it's actually very uncommon. You should have to pay for additional dental insurance on top of your other insurance. Saswad, do you have specific experiences you care to share about what made you decide to be following Adam Gaffney? I mean the biggest one was so after Obamacare I was allowed on my parents' insurance plan until 2006. But my dad actually went down to Texas and got a job with Texas. And so his insurance plan switched and I obviously switched because I wanted to be under my parents because this is much better than what I could find. But the problem which I eventually found out was in my network since I'm in Arkansas the nearest primary care doc is three hours away from me. And so it's basically like having no insurance since I can't see a doctor. To be in network. Oh my God. Because he has a mostly Texas network rather than in Arkansas way. So that's interesting. So when people talk about oh, we want choice. We want to have choice in our, what are they talking about? Their health care? Their insurance company? Can you talk a little bit about that? Yeah, I think right now when we hear about freedom and choice people immediately think like health care insurance but there's kind of a disconnect between health care and insurance. So when you talk about choice, is it the choice of like what card you have, what color that card is, stuff like that? Or is it the choice of what doctor you want to see, where do you want to go for your care, things like that? And so I feel like a single payer actually gives people more choice rather than less choice because you're allowed to just go into a clinic. I have to look up which clinic I'm allowed to go to. Otherwise I'd have like a thousand dollar bill that I just can't pay as a student. And can I add on that really to let Ben speak about it, but we just experienced being up here that type of situation. Yeah, so I likely contracted Lyme disease. We're up here. I'm an outdoor person. So we had a long day yesterday and Gregor graciously drove me to the clinic to go and get my prescription that was filled by one of the physicians here. So we go there and I have my insurance with Blue Cross, Blue Shoot and Louisiana. And I'm a student as well, so phones are tight. So it's for doxycycline, which is very cheap to make. Not specific numbers, but... It's been around a long time. Yeah, very standard antibiotic. And so we got to the pharmacy and they said, oh, we don't accept that insurance here. I'm like, okay, great. How much is that going to be then? For a two week regimen, $75 for doxycycline. Yeah. And so it's the irony there. Thanks for the lead in Chavon. The irony is just, wow, I'm not going to pay that. And it's for the most routine antibiotic we have. And so having this private insurance choice for your father to buy the insurance plan at work, for instance, and in your case, having your insurance in Louisiana. Well, and so Sasswell spoke to under-insurance, which is a whole other issue too. And this could be an example of under-insurance, or it could just be a product of the confusing, convoluted system we have. And that's also kind of why we're here is it's easy to see, it's too expensive. It's easy to see people. We all have examples of it not working. Part of the reason why I'm here is it's just so confusing our system we have now. You might be able to pay for it, but you have no idea where you can go, who you can see, what it's going to cost. When you go to the emergency department, you get a surgery. Is this surgeon on my network? Are they here? How much is this going to cost? And I think it's just, it takes so much mental energy that we're losing resources, not just financially, just in productivity in our daily because people have no idea where they can go. Thank you for mentioning the drain on us as individuals that nobody in Canada, France, UK, Taiwan, Australia, Germany. None of those people have to worry about is this doctor in network or not. None of them, as far as I know, none have deductibles. In your studies, if you found that any of the countries that you studied had anything called a deductible. It's totally a product for the United States insurance companies to figure out how to collect your premiums and then only pay out after you've paid for most of your health care yourself and like limit the likelihood of you actually wanting to get health care because you can't afford the health care until you meet your deductible. So it's really a way to maximize their profits, collecting your premiums and minimizing how often they actually have to pay out on something they call a medical loss. To provide you the product that you've paid for, they call it a medical loss and they're trying to limit their medical losses. Yeah, and even to speak on my experience, like I went to the doctor earlier, well I went to the doctor last year and I ended up getting a bill. And mind you, I'm in medical school, I'm swamped, so I kind of put off calling the insurance company. I finally do that. I was on the phone with them for maybe an hour and a half only to then have to get off the phone to call my doctor to tell them they coded the ICD code wrong. And then they're busy, so they're like, okay, well handle it. So like now I think six months have elapsed and I had to like beg the insurance company to not put this on my credit because like I can't help the doctor. Like I can't do anything about the code. So even frustrations like that and I'm an educated person, like you know, and I'm in medical school and I'm like frustrated with the situation. I can't imagine, you know, your average person who doesn't even know what an ICD code is and like, you know, feels hopeless and like doesn't know what to do. Is there anyone we should know where to go? Yeah, and we don't know where to go, so there's clearly a problem. Oh my gosh. So on the same vein, I was going in for routine, annual, physical, getting the normal things that women get. And as well as the tests like cholesterol, that sort of thing. And looked up in advance which things were supposed to be covered and also called my Blue Cross Blue Shield to see what other things they covered. But there's a difference between, oh, is it covered as preventive care that you get for free under Obamacare? Or is it covered by your health plan that it goes toward a deductible first? And when I was communicating with the billing and the lab and the doctor's office, they were all using the word coverage differently. And I basically came away believing that the things the doctor was ordering were going to be covered under the preventive care. And another study that is age-based, but my insurance company said that it's covered, but not until you, but it goes toward a deductible and the preventive doesn't cover until you hit a certain age. It was older than what my doctor thought. So they come away with hundreds of dollars of bills that you're not expecting. Ah, dear. So I think everybody's had a chance to talk a little bit about then some experiences of where you felt it was broken. So how would you like to improve our system? Sadist, what would you like to start with that? Yeah, so part of our internship, we got to study different countries and kind of how they were able to do it. And one of the countries I chose to study was Taiwan, which is a pretty recent phenomenon. They only changed it in 1992. So not that long ago compared to like the NHS, which is like a hundred years, and Germany with another hundred years. So like if we wanted to transition today, they would probably be the best example of the most recent transition in like our current times. And they were able to do a single pair without, you know, the fears of Canada being like, oh, wait times because they virtually have no wait times. It's probably the least in the entire country. Their administrative cost is only 2% compared to our like ridiculous number because of just how much technology they had at the time. Kind of just learning from other countries that I've tried. And I think that's something important for us to look at is looking at other countries because the US healthcare system is just not working. And hasn't been working for a long time now. So I think it's time to start looking at other examples. I think Taiwan is really interesting because most of the other national healthcare services across other countries have kind of grown organically. And Taiwan was like a calculated, they brought in experts to do research. They compared a whole bunch of other countries. And all these people made a task, a literal task force to implement decisively the best healthcare that they possibly could give the information that they had. Right. So some people in Vermont may remember that we had Dr. Xiao come and assess how much it would cost to do a single-pair system in Vermont. And he had been one of the experts brought in to help design the program in Taiwan. Right. So you were talking about the administrative cost being only 2% in their system. One of the valuable things of looking at other countries is that whenever there's an argument that it's not very fact-based or there are people pulling out facts that disagree with each other. A recent fact that's been thrown around is the facts people have been throwing around have been around how much does Medicare cost to administer? And how much does private health insurance cost to administer? And numbers have been thrown around between 2% and 5% for Medicare and then scare about, oh, but that doesn't cover how much they do for this or that that comes from other places like, oh, the legislators, you should take a percentage out of theirs. And one of the arguments was you should take out 10% of the legislators' salaries and consider that toward how much it cost to run Medicare. It's like, you think they spend 10% of their time on Medicare seriously? And somebody wrote a rebuttal about the fact that, oh, the collections and the fraud stuff is actually built in to the numbers that Medicare says it spends. But if you're having confusions around that, you can also look at what other countries do and when they seriously only have one payer so they don't have to have all the administrative waste in the hospitals, in the doctor's offices, in the businesses with their HR departments trying to help their employees get their actual coverage after they have gotten paid for their insurance. All that extra administrative waste isn't even counted when you're talking about administrative waste in America. And if we would have the guts to look at other countries and say, well, if Taiwan can do it for 2%, are we not as smart? Are we not as honest? I mean, what is it that we can't do as well as them? I also think it might be important to explain a little more what administrative waste really is because it is a word, a phrase that's thrown around a lot, but it's hard to really see the dollars where that is. So just for example, I think when you go to the doctor's office and you go to pay your bill, there can sometimes be six or seven people dedicated to working with different insurance companies, Humana, Blue Cross, Blue Shield and a litany of them. So on salary, those people are being paid to then deal with you with your BCPS to go and fax that and deal with that company. While you have six other people on payroll just waiting to deal with the other company. And I think it's important to realize that's where this waste is coming from is so many resources dedicated to all these different companies, both from financial and just a confusing aspect of this too much. Like it's just too much going on and with a single-payer system, it's streamlined. And just a little bit more with the financial aspect. Yes, taxes go up a little bit. I'm sure we'll detail that in a bit. They inevitably will have to. But administrative costs go down because if you're going to see the doctor goes down, you can see the doctor more often. So I think it's really important because it's always, especially with the debates going on. They say taxes will go up. You'll pay more. Not really. You'll pay more a little bit in that initial statement, but then you won't when you're going to see the doctor. Well, there's a big point, though. This may want to speak to your taxes will go up, but what will go down? Yeah, your premium costs. And that's what I was going to mention. And the money going towards health care. Like right now our health care, what is it, 18.6 GDP, whatever it is, it's high. And a lot of that money doesn't even go to adequate health care. We still have poor health outcomes. We have the highest maternal mortality rate. Of the developed countries. Of the developed countries, yeah. And the highest medications and like paying for diabetic medications or whatever medications have you. Our life expectancy is going down. Other countries are life expectancy going up. And ours is going down. Yeah. And that money, a lot of that money is going to like, you know, the administration and the insurance companies, but not to our better health care. So like that is another thing to talk about as well. The money should be used for us to make sure our health care is like efficient, efficient system. And like the multi-payer system clearly is not doing that right now. Or the for-profit insurance companies are not doing that. So does somebody want to talk about all the different places that we spend our money right now that goes toward health care? I'm even not asking that in a very good way. I mean, we can just start listening to things. Obviously, you're going to spend your money in health care on like actual health care. So like your hospitals, your clinics, your doctors, nurses, staff, things like that. But then there's also this huge other bubble that we spend our health care pharmaceutical companies that make huge profits. All the insurance companies when we pair premiums deductibles, like the profits that every insurance company makes, all of their staff, all of their workers. And not only that, but then you have like in the doctor's office, people that can like bill all the billing that's done since every insurance company is like different. So you still have to get training and then all the coding that you have to do and all these other, especially if anyone else wants to mention. So even outside of that health care realm there, if you're looking at your family budget, where else is money paying for health care? So for instance, when you're paying your property taxes, when you're paying your property taxes, you're paying for the town employees, their health insurance. And the school employees, all those teachers, we have all those negotiations around health insurance. Those negotiations would go away if they all had health insurance. You wouldn't have teachers striking over their health insurance. Are you familiar with other places? How about when you're purchasing products? So say you're buying a car. A certain percent of that is to pay for all the health insurance for all those employees. So our prices higher on our cars that we're competing with other countries. Yeah, Dr. Debra Thur was talking about that yesterday. And I didn't understand that. Like I remember she was saying property taxes would go down, but I didn't understand that component that you're explaining right now. Right, because you're not paying for the teachers. And how about car insurance? Right now you have car insurance that pays for replacing the car. If somebody hits your car and your car is totaled, but how about your health care? You don't have to worry about whether they did or didn't have good car insurance. You can still get your health care. And when you're buying your insurance, you don't have to pay extra for all that amount for comprehensive in case you hurt somebody because they'll be covered. And workers' cop will go away too then. Absolutely, right. So there are many places, and also of course on your paycheck, they take away the Medicare and Medicaid expenditures to be collecting for the system. So there are many places that you're paying for health care already, but you're just not... You don't know it. We don't think about it like that. You're paying for all this health care for so many people. And in your taxes, you're paying for all the great health care that the senators and representatives get and the president gets. I don't even know whether they have deductibles. What they do is probably very lower than maybe they have second-year insurance, but they have excellent health insurance. And we're paying for them to have great insurance on our taxes, but we still aren't getting good insurance. And then, yes, you mentioned all these different aspects, but another thing is small businesses that have to cover their employees. If the government funds that, then that's a huge tax break to the small businesses as well. And they can do however they see fit. Wages can go up. And they can give it to workers and actually have money to spend. I learned that we can't negotiate wages right now because we're paying so much money in health care that premiums keep going up. Well, premiums keep going up. And if your employer is paying part of that for you, then you can have more wiggle room to negotiate raises and wages. What would have been your raises actually just paying for? It's going to your health interest. People think even with their good insurance, I'm sure there's still a lot of issues with it that they might not necessarily be aware of. Right. So when the moderator on one of these debates asks, so as a candidate for the President of the United States, would you force everybody to go on a government-run plan or would you still let private insurance happen? What do you think about the language that they're using when they do that? They're clearly painting the government plan in a kind of a negative light. And so we have this whole idea of the free market is the best place, like the jungle for creating the best products and the best care and all that stuff, but it really doesn't apply to health care as far as market economics is concerned. But the language is always geared towards putting down the government plan, which is strange because people love Medicare, right? I was going to say, and the other thing is, they're always saying abolish private insurance, but then if you look at any of the single-payer proposals out now, it's like the private insurance system still exists. It just can't compete and cover the things that the Medicare, improved Medicare would cover. So it would still be like a supplemental like for cosmetic surgeries or maybe like any other thing. Oh, for things that are not going to be based on services. Anything that's not something you necessarily need, you can still buy insurance. Right. But you don't get the savings of the single-payer insurance, single-payer system if you have multiple competing insurances for those basic health care needs because you're still having all that administrative waste behind there. So for the things that are covered by the public plan, and we used to always call it public, it's a new thing to call it like new in the last 20 or 30 years since the insurance companies did surveys and messaging and trying to figure out how can we taint people's feelings about public health care like Medicare. Are you saying they use rhetoric to sway public opinion? Oh, they purposely do. Really? Not actual facts? Yeah. Yeah. And so just to use the word government run and compare that to private insurance is already tainting it because you should say publicly run and private insurance or you should say government run and corporate run because that would be a more fair comparison. Government run or corporate run. Something where you have some control and some transparency and accountability or corporate run where you have no control. Yeah. Or no transparency at all. Right. The transparency is a huge thing and that would be important and if we do get a when, when we do get a reasonable health care system, we will still need to be making sure that it's transparent and accountable because you could certainly make a corrupt system that didn't meet our needs and have the good outcomes and low cost that we're looking for. So we just have a little bit of time left. I'm wondering, do any of you have a last thing you wanted to make sure you said here on our show today? No, I don't know. I'll go for it. Okay, thank you. So we talked about if health care is a right or not and that's something you have to decide within yourself and we've been considering it over the past four weeks, I think and we've sorted to do so with an American health care system right now to live is a right. To put an example to that, if you have a catastrophic event and ambulance will pick you up and take you to the ER and you'll live but getting better is not a right in the American health care system. All the other places, you have the right to get better. You have the right to not worry about finances and access to both live and improve your health. Here right now, they say, oh yeah, ambulance will pick you up, you'll survive that heart attack. You'll stop that bleed but we can't control your diabetes which we know you will die from if you don't have access to help. We can't, you know, if you can't afford the chemo, sorry, I mean take it out of your grandchildren's budget. Take it out of, reduce your savings, get on Medicaid, do your best. Or they'll do it like you have the heart attack and you go to the hospital and you get this triple bypass surgery and then you're left with this huge bill that you can't afford to pay and you either foreclose your house or like again with my friend who I can speak about who had cancer, you know, people think like oh it'll help the poor people but she was a middle working like, you know, making at least like 50,000 working at Enterprise and got cancer, breast cancer, went through chemo. Chemo calls her not to be able to work anymore. Her job laid her off so she no longer had insurance, couldn't get Medicaid because she didn't qualify for Medicaid and was left with this huge bill like at 28 years old and now like, you know, she was unattractive buying a house, can't do that anymore like, you know, and it's just unfortunate that that places our youth even in situations like this, not to mention people with families and, you know, I really think that should speak on like we have to do something like it's affecting everyone. It's not just like the poor, like it's your middle class person, it's your neighbor, you know. Thank you so much all of you and thank you for your time. Thank you. Thank you. Thank you for listening. I hope this was informative. If you have any questions, please visit pnhp.org and healthcare-now.org.