A Public Forum "Medicare for All 101: Who Wins, Who Loses?" was held on Saturday, September 11, 2010 at Extraordinary Ventures in Chapel Hill. The forum was sponsored by The League of Women Voters of Orange, Durham, and Chatham Counties and The UNC-CH School of Social Work Clinical Lecture Series.
Presenter: Peter S. Kussin, MD
Associate Clinical Professor, Dept. of Medicine, Duke University Medical Center
Description: At its June 14, 2010 national convention in Atlanta, GA, the League of Women Voters of the United States (LWVUS) rededicated themselves to the fight for single-payer health care by passing a resolution with a wide majority "to advocate strongly for bills that legislate for improved Medicare for all." While many of us would agree that "improved Medicare for all" sounds like an important, universal goal, we may not be clear on what it would entail. Given the current economic climate and the changing demography of our communities, questions of costs and benefits become especially salient. The League of Women Voters of Orange, Durham, and Chatham Counties invited Dr. Peter Kussin to illuminate the issues involved, including who most stands to win and who most stands to lose.
Peter S. Kussin, MD is an Associate Clinical Professor for the Department of Medicine, Division of Pulmonary and Critical Care Medicine at Duke University Medical Center in Durham, NC. Grounded in his experiences as an undergraduate at Columbia University at the height of the antiwar and civil rights movements of the 1960s, Dr. Kussin brings a lifetime of activism to the cause of universal access to health care. A member of Health Care for All North Carolina, he has been one of the most frequently requested speakers for medical grand rounds on the subject of health care reform, the right to health care, and the benefits of improved Medicare for all. His experiences as an intensive care physician add a personal, human dimension to his reflections on the importance of improved health care legislation.
The forum was attended by 82 community members. The presentation was followed by discussion. Event ratings indicated that on average registrants felt the forum gave them an improved understanding about the forces leading to the current difficult health care reform situation, what we would need to do to bend the cost curve, and how Medicare for All alone is not going to cut it. And everyone thought Dr. Kussin was an excellent, knowledgeable, and impassioned speaker. Many commented on the need to have similar presentations and to continue educating the community about this topic. Hopefully Dr. Margaret Flowers' talk on Friday, October 15, in Durham will bring us all added ideas and information.
Dr. Kussin has been kind enough to give us permission to post his presentation on this website. Dr. Kussin's presentation
HOW HEALTH CARE REFORM WOULD HELP NC. A recent report by Families USA.
Un-insured. In 2007 19.3% of North Carolinians under the age of 65 lacked health insurance for at least one year. An average of 1,500,000 residents had no health insurance. Reference Premiums vs. Paychecks: A Growing Burden for NC Workers by Families USA, Sept. 2008.
A March 2009 report by the North Carolina Institute of Medicine suggests that due to the recent increases in unemployment since 2007, the number of uninsured in North Carolina is estimated to be at approximately 1.8 million.
Under-insured. Rising health care costs and slow wage growth has forced more Americans to join the ranks of the underinsured. For example: your insurer has excluded a pre-existing condition from your policy. Or maybe your deductibles and co-pays will become a financial burden that could lead to personal bankruptcy if you become seriously ill. Or, your lifetime policy benefit is too low and your share of costs will be enormously high if you have a catastrophic illness.
Lack of personal security. You should have the personal security knowing that whatever your employment status, age, income, or medical history or condition, you have health insurance. The United States is the only industrialized country that does not have a national health insurance plan that covers everyone. It is the only country where people go bankrupt trying to cover health care costs. It is the only country where people worry about how they will pay for unexpected health care costs.
Runaway premiums. In North Carolina alone, premiums grew 5.3 times faster than workers earnings between 2000 and 2007, according to Families USA's new report, Premiums vs. Paychecks see above). Annual health care premium cost increases far exceed cost-of-living increases. For family health coverage provided through the workplace in North Carolina, annual health insurance premiums in the 2000-2007 period rose from $6,649 to $11,618--an increase of $4,969, or 74.7 percent.
Between 2000 and 2007, the median earnings of North Carolina's workers increased from $23,080 to $26,316--an increase of $3,236, or 14.0 percent.
Rising deductibles and co-payments. Even as premiums rise dramatically, we are paying more and more out of pocket for the same health care services.
Employer squeeze. Employers are put in a tough position of having to balance profits and employee health care needs. They increasingly face the task of choosing among insurers and millions of policy plans. Most recently employers have found it less expensive to fly workers to foreign countries for medical procedures. North Carolina has experienced an especially large decline in the percent of residents who received health care insurance from their employers.
Emergency room closures. Today, every North Carolinian, insured or not, facing an emergency, has to cope with hours of emergency room wait. This is because emergency rooms have become the last resort for the uninsured. Increasingly emergency rooms are providing so much uncompensated care that they have had to close their doors.
Lack of choice of providers. For many North Carolinians their choice of health care providers increasingly has become severely limited by insurance companies. Often, especially in rural areas, they are unable to find a provider near where they live.
Poorer benefits. Many insurance companies have limited benefits. For example, dental, vision and many parts of mental health care are often non-existent or inadequate.
Inefficiency and confusion. We have thousands of insurance companies and tens of thousands of insurance plans. It is confusing for patients, providers, employers and it is very inefficient. Too many health care dollars + nearly 30% - are spent on tedious administrative costs, marketing, and profit instead of on direct health care services.
Poorer medical outcomes. The United States spends twice as much money for health care per capita than the most advanced industrial countries and has the worst population-based health care outcomes in the industrialized world. For example, our life expectancy is the lowest in the industrialized world. To a large extent, this is because there are no system-wide standards of care or standards for reporting and investigating errors. It is estimated that over 700,000 Americans die each year from preventable medical errors in hospitals. Clinical and administrative waste is a big problem in our health care system.
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