 your family back here. Aloha. Welcome to another episode of Think Tech Hawaii, Movers, Shakers, and Reformers, Politics in Hawaii series. I'm your host, Carl Campania. Thanks for joining us today. Sorry, I have a little bit of a cold, so my voice is gonna be a little off today, but I'll do the best I can. Today, our guest is Ms. Marshall Rose Joyner. I'm thrilled to have her here. She's an advocate of many, many things, a fierce advocate of many positive, good progressive issues, good Democrat issues. She's also a grassroots maven. She knows how to organize. She knows how to bring people together. She knows how to get people out to vote, get people registered to vote, and she's someone that we all can and should learn from the policy politics world. So with that, I welcome you to the show. Thank you, Marcia, for joining us. And where do I mail the check? Ha ha ha ha ha. Think Tech Hawaii. Think Tech Hawaii. No, I truly appreciate that. And I think I'm one of the people who believes that we need to make sure that we are all at the table. What, you did this 40 years ago. You know, you're doing that today. Today, today. You were active and busy today. And you know how to do it from 40 years ago. So you know what? We need to be able to listen to you and learn from you. For the people who are just starting now, we need to make sure there's continuity in what's happening and how. Yes, yesterday is over. Yesterday won't come back. No, no it won't. But just to let your audience know, I have not missed an election since 1958. And yes, there was such a time as 1958. There was a 1958. There was a 1950. Yes, yes. And I call me a political junkie. I've never seen a cause I didn't like. So yes, you're right. Fiercely out there. Absolutely. Making sure that people are taken care of, making sure communities are taken care of, making sure that people's voices find a channel, find a path. And that's so huge. It is. Too many people don't take advantage of that. And that's where I'm always grateful for the people who know how to get more people going. So I think that's great. So now we're going to transition. Seriously, the way do I mail the check? We're going to transition now to what we're going to talk about today. Today we're going to talk about what I refer to as life planning and then Medicare for All and how that comes together from a policy perspective. So just to start it off, when I think life planning, I think from the time you're in high school, from the time you're going to school and you're thinking about everything from education to finances, to career planning and all of those goals, to family planning. And that brings you right up to end of life. End of life planning. And oh, please jump in from there. And one of the things with life planning, as you mentioned, all of those have choices. Now we come to the state who says, we don't have a choice at the end of life. Ah. And that's the policy piece we're at right now. That's the policy piece where we're at. We all should make those plans, make those choices when you're healthy, with your family, with your doctor, with your minister or spiritual guide and make those plans now. Make those choices now. Be aware of what those possibilities are. Know what your insurance possibilities and other benefits are. Know how each, as we look at all of it, each phase of life planning impacts you and impacts your family. So we have to look really at the end of life. And that's my big issue now is end of life. When you get to be 78, the end of life looks like any day. I was never going to age you. I was never going to age you. Any day now. Any day we got to deal with this. The point that I'm getting at is that when the state can determine what you can and cannot do at the end of life, therefore we need to make those choices. We need to tell the state to back off, this is my life, I need to choose. And part of that choosing, we need to be aware of the finances involved at the end of life. You can't have one without the other, as we know. Because of the ripple effect. Yes. If you are hooked up on these machines in the hospital at $10,000 a day, and you leave a person hooked up like that, then all of grandma's estate is gone, and you are left with the bills. And then when it comes time for you to think about your children in college, that's gone. This ripple effect. If you talk about it earlier, and you plan for it, then not only are you financially, well, hopefully, more financially prepared, you are also, you start to get more mentally and emotionally prepared. Because the whole, because that's one of the things that happens. I know that with my mother and my father when they passed, myself, my brothers and sisters, we thought about it and we went through the whole process. No one ever wants to let go. You want them to stay there because you don't want to let them go. And that's one of the things that you go through, the grief process, how you finally make it OK for yourself to let go. And it is more about you than them. Than them, exactly. It's more about, whoa is me. How am I going to live without you? Oh, you hear all of us, somebody done somebody wrong songs, right? How am I going to do it? It's not about the person. It's not about the survivors. Yes. And we need to think about it from the perspective. Yes. And going back to a big sense of politics theory, we talk about every life matters, all lives matter. We talk about sanctity of life. We talk about all of these, well, none of that suggests how we are addressing end of life. Well, for me, yes, the end of life should be as sacred as the beginning of life. It makes sense. It should be. And culturally speaking, throughout the generations, thousands of millennia, people have had those ceremonies in the beginning and at the end. And we do have those ceremonies today. But it's an emotional ceremony. It's a religious ceremony. It's not otherwise personally avoided. Yes. And for most funerals, it's for the living. Yeah. And it comes after. After Bishop Eric Montemoto was telling us that they have, he's a Buddhist, they have an appreciation ceremony before the person passes. So the person gets to say goodbye. And how wonderful it was having you in my life and all of those things. I think that is such a great idea before. Before? Before. Yeah, and give them a chance to go through their process. Not everybody has that chance. Sometimes it's much quicker. Oh, sometimes it's an accident, yeah. We all know what happened with some of our beloved actors and actresses and performers this year, how quickly these things can happen. Carrie Fisher and Debbie Reynolds, two people that have impacted so many people in their own ways and have them just like that. Gone, yes. And it's like, okay, that family had really no opportunity. And when Carrie Fisher goes and then, because of a heart attack at age 60 and then mom the next day. She willed herself into that one. And that's one of the questions. You look at it and it's like, well, okay. How did that happen? Well, her son said that, I'm just going about what he said. Yeah, exactly. And you can do that. You can see that. You can see sometimes that when my father passed, my mother immediately was like, well, okay, he's gone, when do I get to go now? And we're like, hey mom, how about you stick around for us for a while longer? You're healthy, you're fine, you're doing great. Time went by, another 12 years goes by. And now her life is beginning to degrade such that, okay, she's not all there with every faculty that she needs. Much harder for her to get through her day. She needs a lot more care and support. Well, were we prepared for that? Well, we were more prepared for that for her than we were for my father. But she tried to will herself into it. But you know what, that's not how that works. You don't have control over that as much as you might think sometimes. I guess maybe depending upon age, I don't know. I don't know. We had my mother at home for the last year of her life with hospice in my home. And one day everything was fine. The next day I'm a caregiver. I was like, oh, now what do I do? And no one's ready to, and no one's prepared for that. No idea. No one knows what to do. And then all of your life gets turned upside down because now what do we do? Now what do we do? And I now have to figure out how to, I thought I was done with daycare. Now I have to go back to it. Yes. And so, and if you're not ready for it, if you haven't been planning, if you haven't been thinking about it ahead of time. No, no we haven't. So you had mentioned, and I wanna jump into this a bit more and see what we can pull out. You mentioned the state, I guess nationally and then from the state level. We get to end of life and we don't have choices. Right. Tell me about those choices and tell me about where we currently are with policy and then what we might want to be looking to achieve. Okay. If we look at compassion in passing and for the state to get out of the way. Right now we're looking at a bill. I don't know what the name of the bill is that allows us to make choices at the end. If you want the, you are terminally ill, your faculties, I mean you know exactly, you're not handicapped, you're not just, it's not something they wanna get a bit of grandma but you know that this brain tumor is not gonna get any better, the lungs aren't gonna breathe any better and you're really suffering. So you wanna have a choice. Do I take medication? Do I stay on this life support system and run up the bill or can I have some kind of a cocktail to everything it is? So right now we don't have that choice. Right now it's sorry. Sorry you can't do that. The doctor say, the doctor first of all will keep you, apologize for my voice again, the doctor will keep you plugged in for lack of a better word until the family says, okay, we put them plugged. And that's all there is to it. And honestly, I don't know that I could have pulled the plug on my mother. Well she wasn't hooked up. But what I'm saying is that now I get to choose the moment of death. Why can't you, the patient choose that moment? Why can't, you know, what is it that we don't allow that person, that option? Right, why are we not recognizing the value of that choice? Why are we not appreciating that person's life? Respectfully, yes, the death with dignity thing, but we can set that aside because it becomes jargon. Oh I can't, I don't like that phrase. Exactly, it's appreciating that person's life and recognizing it and valuing it in a ceremonial sense and recognizing, okay, not only is this probably better for this individual, it's better for this individual's family. Yes. And then a bigger picture going back to policy. It's actually better for the state and for the US government because of the costs. As we're looking at Medicare and Medicaid and how that balloons up. That's for a person in the hospital, it's $10,000 a day. That it's largely covered by Medicare or Medicaid and or insurance and then whatever's left over the family. Family gets to pay. And that's a big piece of that. So we have to take a quick break. So we're gonna take a quick break and then we're gonna come back and we're gonna talk more on how that feeds into Medicare for all and we're gonna go from there, okay? Thank you. Thank you for joining us. Sorry, this is Think Tech Hawaii's Movers, Shakers and Reformers, Politics in Hawaii series. Our guest today is Ms. Marcia Rose-Joyner and we'll be back in one minute. Thank you. Aloha, my name is Josh Green. I serve as Senator from the Big Isle of the Kona side and I'm also an emergency room physician. My program here on Think Tech is called Healthcare in Hawaii. I'll have guests that should be interesting to you twice a month. We'll talk about issues that range from mental healthcare to drug addiction to our healthcare system and any challenges that we face here in Hawaii. We hope you'll join us. Again, thanks for supporting Think Tech. Hello, my name is Crystal. Let me tell you, my talk show, I'm all about health. It's healthy to talk about sex. It's healthy to talk about things that people don't talk about. It's healthy to discuss things that you think are unhealthy because you need to talk about it. So I welcome you to watch Quok Talk and engage in some provocative discussions on things that do relate to healthy issues and have a well-balanced attitude in life. Join me. Aloha, welcome back to Think Tech, Hawaii's mover, shakers and reformers, politics in Hawaii series. Once again, my guest today is Ms. Marjoros Joyner. And we've been talking about life planning and as we transition towards end of life planning. And now we're going to transition and see how that fits into our concept of Medicare for all, which also gets used in various different terminology, whether it's universal healthcare, single payer, however you want to phrase it, it's how we can better address the nation from a state-by-state and the nation perspective from a healthcare perspective and how end of life can fit in. So thanks again for joining. Well, that's how it fits into end of life. How it fits into end of life. There you go. Okay, see, I'm very happy to learn. When you look at this estate that you may or may not have, let's assume you do, in Hawaii, there's no house under a million dollars, right? None. So you may have only $10 in your pocket, but on paper, you're a millionaire. Or however much you own your house still. Yes, or whatever the banks is. Anyway, if you are in a hospital at $10,000 a day, that eats up all of those things that you had planned, all of the things that you had planned for the end of life, for your children, for them to go to college, for this beautiful retirement you were gonna have. And now what do we have? This $10,000 a day is eating it up. Is $10,000 a day state of Hawaii cost? Is it national cost? That's a national, that's an average. That's an average. Okay. That's an average. And I don't know what it is today in the state of Hawaii. I know that according to the state, there are 300,000 people in the state of Hawaii who are on Medicaid, that's the state's portion. Right. 300,000. 300,000 people. That's a quarter of our population is on Medicaid. And that's the state. And we know, just because that's the way life is, that 300,000 people will pass. Exactly. Yeah. We know that. Within the next few years. We know that. That's a given. Exactly. So, what that's costing is about, of course no one knows the exact figure, about $50 million. About $50 million. Yes. There were other statistics we were talking about before the show started that a quarter, 25% of the Medicare national budget goes towards- The end of life. The last year of life. So the last year, 25, so wrap our head around this for Medicare perspective. The last year of life on an annual basis for people who die in that year is one quarter of the cost of our annual Medicare budget. That's significant to understand. It is. So, locally we're looking at a bill, hopefully, I don't know that there a bill exists, at looking at universal health care and that is what some people call single payer. The single payer just means that instead of the insurance companies, you know the insurance companies are gonna work hard to kill this, but instead of the insurance companies calling the shots, you have a single place that the money goes to. It would save the state an incredible amount of money by having this one source, one place. So if the state, for instance, had this universal health care and they had, what, a million of us that live here? A million plus, right? 1.2. Okay, 1.2 million. Then if we were paying a premium, paying just that and not all this other, we would save money and the state then becomes big enough that they can negotiate, they can negotiate the cost of prescription drugs. Because that's what the VA has, what they can offer because they have that power because they're so big. So the state would have that same option with, they would have to create an entity that would be a state entity. And so, well yes, you would pay more in tax, but you'd pay less in your health care bill. So it would kind of even out. Yeah, so that would have to be done on an actuarial basis to see how that goes out. And so, okay, there have been bills that have come up both for end of life care, as well as single payer, these things have come up. And the bills have come to the state level, they've come at the US level. I think it's important to recognize the costs. And that's why we bring up a quarter of Medicare. We bring up how Medicaid comes in and that's the state level and how if we could reduce those costs. And that goes, that also applies, by the way, to our unfunded liability aspect, as well. We talk about $18 billion of unfunded liability for all of our state employees and union employees that we have to continue paying after retirement. That's the unfunded liability part. Well, you know what, if we have a plan, if we actually address it from the medical side, if we address it from the policy perspective insurance side, if we create a single payer system that can step in and fit in. And this is what you're saying, that can help alleviate some of those costs. Yes, and then your out-of-pocket is different. Yes, you will pay more than in taxes, absolutely. But you will also not be paying what the insurance company is asking you to pay. And that's one of the other things. Now you know the insurance company's gonna fight hard. Well, the insurance companies fight this because they know they're in charge of all of the medical charge. Right now they're in charge. And that's what the Affordable Care Act, Obamacare, was trying to do is make an adjustment. And one of the interesting challenges with those people who want to repeal Obamacare is for all of its flaws that can be worked on, it was actually able to get all of the parties at the table to agree. All of those special interests within the medical world to agree so that it could pass. So that is an interesting perspective from a policy side. Now what I want to understand better is, and this is something that we'll explore a little bit now but then in future shows, is how end of life and how single payer and how the repeal, potential repeal of Obamacare and how that all comes back to the impact in Hawaii. Yes, and it does. Because we can't think of end of care without thinking of the cost. You just can't, I mean, they are real. They are. They are very real. Anyone who has had to experience it knows the shock. Yes. And so that we need to, I don't want to call them companion bills, but they are because they affect our daily life. They affect our day to day living. And we need to see that they do. I know most people- We need the single payer or Medicare for all. We need that to be able to better address the end of life needs. Needs. Because you're, you know, we're looking at that last year of life that the majority of the money, and who knows where that goes? That's just, I don't know who pays that. It's just somehow it gets paid. It gets paid through Medicare, Medicaid, insurance, and then out of pocket. Out of pocket. Yeah. Mainly, but it's the out of pocket that just stuns you. I've known people that knew that Uncle So-and-So was going to have to go to a nursing home. And in order to pay the nursing home, they had to sell all of his property. So that that didn't take- We had to go through that. When my father passed, and when we, before he passed, it took him three and a half years for his pulmonary fibrosis. He had his own business that he was running. He was running a trucking company. So we had multiple trucks. As we went through that process, we had to sell off a truck and then another truck, and then sell off the business. And then we had to go through this process to make sure that everything was covered so that he was as comfortable as possible. And he wasn't on a ventilator. He wasn't on any of that stuff. It was just the doctor saying, we don't know. We don't know how long it's going to take. So that's my next question. We say, okay, the last year of life is the most costly. How do we know, and how can we know, and how we best, the doctors have to come into play here, when do we know that, okay, now we've reached what we think is the real last year? I don't know. I don't know. Like I said, one day everything was fine. Next day, I'm a caregiver. Yeah, yeah. I don't know. You don't know. She did last a year. But even that was amazing. And watching her struggle, she had an emphysema. Watching her struggle, every breath. And it was really hard to watch. She's the strongest woman that ever lived. You know, she raised the sun and the moon and the stars at night. And then to see her struggle, to see this. Yeah. See, this was, I don't know. How do you know when the last year? It's heartbreaking. It's demoralizing. But that's where, that's the last place you wanna then start thinking. Yeah, you can't. About how you're gonna pay for this, how you're gonna address this, how should I address this? So thinking about it ahead of time, having some policy in place that can give you options so you can start to include that. She was in the hospital in Baltimore because that's where the accident happened. And so my daughter and I are off to Baltimore. And my cousin said to me, sell while she's in the hospital now. And we kept asking the hospital to keep her, keep her. And it took us three weeks to pack up everything, to sell off everything, to give away everything. He says, because he had been through it. He said, sell while she's still in the hospital, while she can still make the decisions. But she will never, ever be able to be alone again. Right. Right. So, and again. Three weeks, we had the same time. We don't have an opportunity to plan ahead. If we don't bring in these possibilities and try to address that sort of, those costs of end of life care. And the planning that has to happen from the medical side, from the family decision-making side and everything, if we're not, if there's not something in place to help us make those decisions earlier, because otherwise, yeah, it can happen a little sudden. Or it can even be prolonged. But in either case, you're not in the right place mentally necessarily to make solid, reasonable choices all the time. So, okay, we only have a couple of minutes left. Okay, Friday, this, today's Wednesday. Friday. Friday. That's what I wanted to bring up here. Friday. So Friday, January 6th, there is a meeting regarding and to discuss universal health care. And it is at the Democratic Party of Hawaii office, main office, which is 627 South Street, suite 105 here in Honolulu. And it's to engage in the conversation to talk about universal health care and how it can support end of life, how it can support life planning and how we can really approach. And I think we do need to consider the whole picture from a Medicare for All and as we think about all of these costs throughout your life, but then also how all of these issues that are coming up in the repeal of health care, how everything can impact the state of Hawaii and what we need to do to accommodate that. Because we have to remember, of course, is that we're the only blue state out there. So we can't expect that the... I call us a blue state. No, we're blue in terms of what we elected. And what we elected based on what people said they were. And yeah, a whole different thing. Unfortunately, we're out of time. We're out of time. We can always go on for another three hours. Thank you for joining us. This is D.Tech Hawaii's Movers, Shakers, and Reformers. Many thanks to my guest today, Ms. Marshall-Roth-Joyner. And you didn't tell me where to mail the check. D.Tech Hawaii.