Universal Healthcare and the Democratic Legislature

As a true-believer in the Democratic Party, I hate it when I am let down by the party. One of the things that I believe will make us a greater country is universal healthcare. When Americans are healthier they are better workers, better parents, and better citizens. Just as with education, healthcare is a right that all North Carolinians have inherent to their being – it is not a privilege bestowed upon those with the most money. Yet, in our society we too often kill off our poorer citizens by denying them healthcare. Make no mistake, the inability to have preventive care leads to lethal illnesses that could be stopped earlier in the disease progression. Look no farther than curable childhood diseases, which under a universal healthcare plan could be screened for in every newborn. Instead, many of our children suffer through their whole lives with physical and mental retardation all for the lack of a blood test at birth.

So, what have we as Democrats in North Carolina done for better healthcare? Well, not much. Certainly not as much as the Republican governor of Massachusetts. More below the fold.

I received an email alert to this post at the NCDP party headquarters.

Democrats in the General Assembly End Session That Will Benefit All North Carolinians
Early this morning, the North Carolina General Assembly adjourned for the year.

Democratic-controlled General Assembly passed legislation this year:The (I took out all but the healthcare related issues for this post, follow the link to see everything – RP.)
• Providing tax credits to small businesses that provide health insurance to their employees
• Making health care a part of the job
• Protecting the health and safety of children
• Funding and implementing mental health reform
• Preparing for health-related emergencies and natural disasters

This sounds like we did a lot and in some ways we made significant gains. For instance, the money for mental health reform. The legislature put $95 million into mental health (mental illness, developmental disabilities, and substance addiction) for those who can’t pay in some other way. Of course, I am told by a psychiatrist friend that mental health funding had been cut by 40% in the previous years, so I’m not sure where this funding lies with regard to the long-term trend.

One red herring that I have discussed with sources is that two of these bullet points seem to refer to the same legislation; those would be the ones starting with “Providing tax credits” and “Making health care”. The legislature passed a bill giving a tax credit of $250 per employee per year to small business owners who provide health insurance for employees who make less than $40,000/year. If small business owners take advantage of it, it will cover an additional 20,000 North Carolinians.

Do you know how many North Carolinians under the age of 65 are uninsured?

Twenty percent. That equals 1.42 Million individuals under the age of 65 (over the age of 65 all but 1% are insured).

This raises a point I would like to make. Who is uninsured? Not the elderly as this just shows. Not the wealthy, they have insurance. The really poor? Nope, they qualify for Medicaid. It’s the working class, with those age 20-29 who have the greatest chance of being uninsured. Of the uninsured 47% work a FULL-TIME JOB. Another 16% work a part-time job (think second spouse jobs here). What about the rest? Well, 9.3% of those are unemployed, which sounds about right for all the mill workers that lost their jobs and can’t find another one. So, by not providing healthcare for all, we aren’t punishing those who are lazy, we’re punishing those who work.

So, while other states are implementing universal healthcare, North Carolina is once again happy being mediocre. Being at the back of the pack by giving $100,000 to the Health Care Access Study to develop a plan to expand health care access for the million plus uninsured in North Carolina. Remember that the legislature gave $400,000 to the Sparta Teapot Museum. That should give you some idea of how strongly or not the legislature feels about universal healthcare.

I will leave you all with these thoughts on the expense of universal healthcare.
1. You pay for your own healthcare through premiums, copays, deductibles and coinsurance.
2. State employees have a small percentage of their coverage paid by the employer (49th in the country BTW). Their employer is the state, which means you cover a large number of North Carolinians healthcare costs.
3. You pay for Medicaid through your taxes, which means you cover a large number of North Carolinians healthcare costs.
4. You pay for Medicare through your taxes, which means you cover a large number of North Carolinians healthcare costs.
5. Your premiums are about $922 higher per year to cover your provider’s expenses in dealing with the uninsured, which means you cover a large number of North Carolinians healthcare costs.

The only entity that loses in universal healthcare coverage is the private corporations that offer crappy healthcare. Even then, most people accept that universal healthcare should be a public/private enterprise where a baseline coverage is provided publicly (think liability insurance on your car, everyone is required to have it), but then extra perks are offered through private insurance companies (think collision and all those other things you have added onto your policy to protect you just in case).

North Carolina can do better that mediocre when it comes to healthcare.

If you want to join the fight for Universal Healthcare in North Carolina, please contact the NC Committee to Defend Healthcare. or email the Executive Director, Charlie Kafoure.

Comments

Stand up for UHC in NC.

Thanks to any that might choose to read the whole thing.

Jesus Swept ticked me off. Too short. I loved the characters and then POOF it was over.
-me

UHC

In an earlier discussion about our plan for the next legislative session, I asked what the top agenda items should be. You said Universal Health Care was your top priority. I was already sold, but this blog entry provides a lot of the background to nail the case.

Now we have to turn the idea into a bill. That's right, a bill ... one that a like-minded legislator can introduce and use to rally support.

I personally don't know how to do that, having only written a few resolutions with lots of whereas's and now therefore's. But after seeing how the legislature operates up close and personal this year, a bill is the thing that will push this ahead.

You mean...

like this?

SECTION 1. Article I of the North Carolina Constitution is amended by adding a new section to read:

"Sec. 38. Health care.

Health care is an essential safeguard of human life and dignity, and there is an obligation for the State to ensure that every resident is able to realize this fundamental right. Not later than July 1, 2007, the General Assembly shall provide by law a plan to ensure that by July 1, 2011, every resident of North Carolina has access to appropriate health care on a regular basis."

SECTION 2. The amendment set out in Section 1 of this act shall be submitted to the qualified voters of the State at the general election in November 2006, which election shall be conducted under the laws then governing elections in the State. Ballots, voting systems, or both may be used in accordance with Chapter 163 of the General Statutes. The question to be used in the voting systems and ballots shall be:

"[ ] FOR [ ] AGAINST

Constitutional amendment providing that health care is a fundamental right."

SECTION 3. If a majority of the votes cast on the question are in favor of the amendment set out in Section 1 of this act, the State Board of Elections shall certify the amendment to the Secretary of State. The Secretary of State shall enroll the amendment so certified among the permanent records of that office.

SECTION 4. This act is effective when it becomes law.

Jesus Swept ticked me off. Too short. I loved the characters and then POOF it was over.
-me

I don't think so

This is a bill for a Constitutional amendment. While that may be ultimately desirable, is it the shortest path to the goal? I think not. I'd much rather see

the General Assembly provide by law a plan to ensure that by July 1, 2011, every resident of North Carolina has access to appropriate health care on a regular basis."

We resolve plenty of public policy issues without amending the Constitution. Why not just go ahead and create the plan?

I'm hoping to see something like this.

I spoke with Rep. Insko and she said a second bill might be desireable. The Constitutional Amendment was the way education became a right for North Carolinians, back at the turn of the last century. If you put it before the people as to whether it is a right or not, the majority will support it. Yet, at the same time you are now saying how it has to be accomplished.

The problem with passing a specific plan is exemplified by the Clinton plan. Remember the old couple at the dinner table talking about the 12,000 pages of regulations?

Jesus Swept ticked me off. Too short. I loved the characters and then POOF it was over.
-me

I see your point

but

Sec. 1. Convention of the People.
No Convention of the People of this State shall ever be called unless by the concurrence of two-thirds of all the members of each house of the General Assembly, and unless the proposition "Convention or No
Convention" is first submitted to the qualified voters of the State at the time and in the manner prescribed by the General Assembly. If a majority of the votes cast upon the proposition are in favor of a Convention, it shall assemble on the day prescribed by the General Assembly. The General Assembly shall, in the act submitting the convention proposition, propose limitations upon the authority of the Convention; and if a majority of the votes cast upon the proposition are in favor of a Convention, those limitations shall become binding upon the Convention. Delegates to the Convention shall be elected by the qualified voters at the time and in the manner prescribed in the act of submission. The Convention shall consist of a number of delegates equal to the membership of the House of Representatives of the General Assembly that submits the convention proposition and the delegates shall be apportioned as is the House of Representatives. A Convention shall adopt no ordinance not necessary to the purpose for which the Convention has been called.

Sec. 2. Power to revise or amend Constitution reserved to people.
The people of this State reserve the power to amend this Constitution and to adopt a new or revised Constitution. This power may be exercised by either of the methods set out hereinafter in this Article, but in no other way.

Sec. 3. Revision or amendment by Convention of the People.
A Convention of the People of this State may be called pursuant to
Section 1 of this Article to propose a new or revised Constitution or to propose amendments to this Constitution. Every new or revised
Constitution and every constitutional amendment adopted by a Convention shall be submitted to the qualified voters of the State at the time and in the manner prescribed by the Convention. If a majority of the votes cast thereon are in favor of ratification of the new or revised Constitution or the constitutional amendment or amendments, it or they shall become effective January first next after ratification by the qualified voters unless a different effective date is prescribed by the Convention.

Sec. 4. Revision or amendment by legislative initiation.
A proposal of a new or revised Constitution or an amendment or
amendments to this Constitution may be initiated by the General
Assembly, but only if three-fifths of all the members of each house shall adopt an act submitting the proposal to the qualified voters of the State for their ratification or rejection. The proposal shall be submitted at the time and in the manner prescribed by the General Assembly. If a majority of the votes cast thereon are in favor of the proposed new or revised Constitution or constitutional amendment or amendments, it or they shall become effective January first next after ratification by the voters unless a different effective date is prescribed in the act submitting the proposal or proposals to the qualified voters.

At kos

Jesus Swept ticked me off. Too short. I loved the characters and then POOF it was over.
-me

In a waiting room

in Ann Arbor, MI I was sitting with my grandfather while my grandmother was receiving tests to see how cancer treatments were progressing.

What was interesting was that we were the only US Citizens waiting - the rest were Canadian. So, tell me, in this Socialzed Medicine scheme where will I go when I'm really sick?

Talking Point.

I'm sure there are instances of what you are talking about, although you must be a really outgoing person to have asked everyone in the waiting room their nationality.

This lie is debunked (pdf).

Jesus Swept ticked me off. Too short. I loved the characters and then POOF it was over.
-me

I was there

Three other families were in there - so it wasn't a lie.

One of them started by complaining about traffic on the Ambassdor Bridge and assumed we were aware of it, too. We told them the commute from Downriver didn't involve the bridge. The other two chimed in complaining about getting timely, adequate treatment where they were.

Justin, were you awake?

n/t

This is what I'm talking about

It's funny to watch how the folks here complain how they can't talk to "right-wingers" and when someone challenges an assertion with a rather limited and anecodtoal case what do I get:

1) A rebuttal based on the fact that mine was a very limited experience and there's a body of evidence for his proposal
2) A comparison to what Robert was talking about to the Canadian system

No, I get what's behind Door 3) "Oh, well you have to be lying...all Republicans are liars...what are you doing here anyways - troll"

The irony is that the article to which we're commenting is about how the Dems didn't institute a program like that in MA. Part of the reason is a large contingent of Republicans are diametrically opposed to Socialized or Single-Payer Healthcare and would make political hay out of it.

A moderate comprehensive-health care proposal would speak to a large segment of Republicans (myself included) who feel as though major health care issues are being ignored by both parties. Engagement and understanding would lead many of us to be able to propose alternatives that aren't 100% "market driven" if we felt comfortable enough with the facts.

I wonder if I should continue my search for a reasoned Progressive site or should I just conclude that they are all "Amen" Corners.

Justin.

There are waits in Canada for some things. No doubt. However, if you do some research you will find that waiting periods do not exist for emergency procedures, only for elective procedures. I understand you were there for a cancer test/treatment with your parent, but the Canadians might not have been.

Then again, maybe they were. It isn't unusual for people to travel to foriegn countries to get better, more specialized care.

Carl Garrett of Leicester, N.C., will fly to a state-of-the-art New Delhi hospital in September for surgeries to remove gallstones and to fix an overworn rotator cuff. His employer, Blue Ridge Paper Products Inc. of Canton, N.C., will pay for it all, including airfare for Garrett and his fiancee. The company also will give Garrett a share of the expected savings, up to $10,000, when he returns.

Garrett chose to go abroad rather than have the operations locally, where he would have paid thousands of dollars in deductibles and co-pays.

"I think it is a great thing," the 60-year-old technician said. "Maybe it will drive down prices [of surgeries] here in the U.S."

Blue Ridge, which employs 2,000 and funds its own health plan, began studying the idea out of frustration with rising rates at local hospitals, company officials said. Blue Ridge's healthcare costs have doubled in the last five years, to about $9,500 a year per employee.

"The hospitals have a monopoly. They don't care, because where else are patients going to go?" said benefits director Bonnie Blackley. "Well, we are going to go to India."

Elective surgeries in Canada are put onto a waiting list. Elective. How long are those waiting lists? Well, it ends up that no one knows because Canada has kept lousy records on waiting (meaning different standards, not missing or incomplete). A Canadian study reported:

Commonly 20-30% of those on wait lists are found in the international literature to be inappropriately placed, because they have already received the procedure, have died, never knew they were on a list, were placed on the list in the first place for reasons unrelated to medical necessity, or were no longer awaiting the procedure for some other reason."

You could imagine easily enough that 25% of people who never get a procedure because they are dead, don't know about it, or ... well, actually already had the procedure would ruin your statistics. Take those people out of the equation and the wait for ELECTIVE procedures drops rapidly. Finally, several points about comparing Canada and the US.

On average, U.S. citizens experience some of the shortest wait times for non-emergency surgeries among industrialized countries, although the waiting times vary considerably by procedure [11]. Furthermore, the short waiting times apply mainly to those who have insurance; for those who do not, the waiting line is arguably infinite. Finally, the short waiting lists in the U.S. should be tempered with the realization that the lack of universal healthcare in the U.S. means less demand for the system. If there were universal healthcare without an expansion of capacity, one might see how waiting lines in the U.S. could increase [12].

Jesus Swept ticked me off. Too short. I loved the characters and then POOF it was over.
-me

Waiting more?

So, my waiting time is going to increase?

Yes.

IF we pass universal healthcare, and
IF you want an elective procedure, then
because more people will be have their lives saved,
your wait for ELECTIVE knee surgery, NOT EMERGENCY (blown ACL) will go up, unless
we increase our capacity.

Do you know anyone who has been turned down to medical school, then gotten in years later, and is now a great doctor? I know four such people in my limited circle. We could have much greater capacity for doctors in a better system and the waits would not go up.

And, if you haven't been in the medical system lately, you probably have no idea that these waits are already going up. Waits on many tests are weeks long now, if it is non-emergency. Want to see a GP and aren't already a patient, weeks long.

Jesus Swept ticked me off. Too short. I loved the characters and then POOF it was over.
-me

Oh, tell me about it.

I had just dropped out of grad school and was getting ready to move to NC from NY. I didn't have a doctor, because I'd always just used student health. Then I woke up with a UTI one morning. The first doctor's office I called said they could see me in October, because I'd require a full physical. It was the end of July. They then suggested I go to the ER. Eventually, my then-fiance found an office that would see me without a full physical *that day*. (This was prior to the advent of the urgent care centers.) Now I tell everyone I know to establish themselves with a provider just in case.

Regarding the access issue, I think NC has a remarkably progressive stance on physician extenders (NPs, PAs, and CPPs). In NC, patients can be referred to clinical pharmacist practitioners for maintenance therapy of chronic conditions (diabetes, asthma, pain, etc.) Pharmacists can adjust therapy within certain boundaries -- and write prescriptions for them. There are 2 pharmacists in NC who have DEA numbers -- the DEA recognizes their prescriptive authority for controlled substances.

Using extenders for management of chronic conditions is a benefit on multiple levels. First, patients receive more regular checkups and have been shown to have improved outcomes (fewer hospitalizations, fewer complications, etc) over patients who are managed by their primary docs. This leads to the second: reduced utilization of higher-cost services, such as hospitals and ERs, as well as reducing (or increasing the time to initiation of) the additional medications to treat complications. Third, by taking the onus of chronic care off of physicians, the physicians can see more acute patients, as well as get in the annual physicals, etc. Which is, essentially, increasing capacity.

The state of North Carolina now has 4 schools of pharmacy. (Technically, the joint ECU-UNC program may not be another actual school, since they earn their degrees from UNC; however, it increases capacity for students.) Only 3 other states have 4 schools: CA, NY, and OH. Texas has 5. I know that the UNC program encourages students to become CPPs/other clinical pharmacists. Problem is, it can be discouraging to try to find such a position.

Look Justin,

I thought I was being funny at your expense...

I apologize - you are right, we should be debating and not accusing.

I feel that although countries like Canada and England have Universal Health Care and sometimes you hear stories about long waits and mediocre care, we Americans have a chance to make it better.

Instead of duplicating their programs, we will be able to take all the good and come up with better plans for the bad portions of their plans.

Instead of enriching the Insurance companies further, what is so wrong with looking into another way?

Another Way

I agree that there should be another way; but I think the debate should be expanded beyond voices for a single-payers system and those who think that everything will be better with Tort Reform.

From the original post

Even then, most people accept that universal healthcare should be a public/private enterprise where a baseline coverage is provided publicly (think liability insurance on your car, everyone is required to have it), but then extra perks are offered through private insurance companies (think collision and all those other things you have added onto your policy to protect you just in case).

Jesus Swept ticked me off. Too short. I loved the characters and then POOF it was over.
-me

Universal Health Care Polls Badly

info courtesy of a friend with access to such things

When asked if they support Universal Health Care, over 70% of respondents in NC-11 say no.

When asked if they support Health Care for all Americans, over 70% say yes.

The term Universal Health Care was killed by the Clintons in the 90's, so let's start talking about it differently. Some say single-payer, but it sounds wonky.

I prefer Health Security.

The battle against insurance companies has just begun, and if we want to win, we'll need to use language that hasn't already been laden with so much corporate spin.

Scrutiny Hooligans - http://www.scrutinyhooligans.us

Health security...

sounds too much like social security, which the right wing has been trying to dismantle and discredit this whole administration.

National health care/insurance dredges up people like Justin who conflate it with socialized medicine a la Canada and Britain.

Something that combines the concept of basic health care for all Americans with a public/private partnership. Where are the marketing types when you need them?

They tried, but failed

Social Security is perhaps the most popular government program there is. I don't see any danger at all in rhetorically tying health care to Social Security.

Scrutiny Hooligans - http://www.scrutinyhooligans.us

I'm telling ya' what.

Universal healthcare is going to sound a lot better to people these days. Healthcare for all is the official title of the Insko bill and that is an alright name as well.

What it comes down to is people like my Dad, a Republican, paying $1000 a month for health insurance. They celebrated, seriously celebrated, the day my mom turned 65 and was able to get Medicare. She loves it, as do most people who are on Medicare.

Jesus Swept ticked me off. Too short. I loved the characters and then POOF it was over.
-me

Universal cross-post

If registered at OAC go vote for the crosspost by Robert P. (aka chuckles)

Robert, if the blog doesn't catch a wave, crosspost as a diary.

Chris Fitzsimon

Chris Fitzsimon just posted at NCPolicyWatch

Fitzsimon File 8/10/2006
News from the health care crisis

A study by pediatricians in Denver put some new numbers to the costs of ignoring the plight of the uninsured, in this case children. The report found that if children who have no insurance or are on Medicaid and have trouble finding primary care were able to see a doctor regularly, the state would save $46 million a year, largely through fewer serious illnesses and hospitalizations. Nationally, $5 billion would be saved.

The study was published in the journal Pediatrics and found that the death rate of children with limited or no access to care was nearly double that of children who were privately insured.

Health Care

When will they learn? It's like everybody in the administration has lost their minds. It's like people telling me in my business, "Oh, we don't care about the schools, because we don't have children." Huh! In other words, you only care about you and yours? Do you know how hard it is sometimes not to say, "Get out of my car"?

Lovex7

Dredged up from the ooze

National health care/insurance dredges up people like Justin who conflate it with socialized medicine a la Canada and Britain.

I conflate for good reason. Not that I'm evil or that I have made some Faustian deal that has required me to register the way that I do. Far from it.

I do not know of one publically-discussed health care policy initiative with the aim of providing health care to everyone besides "single-payer healthcare". When people talk about "single-payer healthcare", they use Canada as an example. Watch Bowling for Columbine where Michael Moore does just that.

This country is on a spiral that Richard partly described. The insured pay for the uninsured that makes the cost of insurance go up that makes insurance harder for people to afford that causes people to be dropped from their coverage that causes more people to have their health-care costs passed along to the insured that makes the cost of insurance go up even more...

Stopping the spiral is something that needs to be addressed and done so quickly. I agree that there is a solution and I will concede that the party I'm registered to has done a rather poor job of doing much about it.

The reason that I am even commenting is because y'all have seem to given it more thought than those on another site.

The general perception is that if this new "right" is granted - I'm going to be paying more in taxes to assure this right. I have a hard time accepting that I have to subsidize the health-care of 300 lbs. chain-smoker who has a frequent-shopper card at the ABC store and a reinforced La-Z-Boy (even though Richard made a good case that I do in some cases); but I have an easier time accepting that I should do so for a 6-year-old with asthma.

The point is that you're hoping by simply electing Democrats that you'll be able to get everything you want and a Universal Heathcare solution ("single-payer" or not) will appear by doing so. This isn't the case.

However, if you make it a priority on the formation of your platform that health-care and insurance costs are reduced - your ideas will get broader appeal.

On a side note:

did you notice I am no longer banned and now "never was".

Right, must have been something I did.

phtt.

Justin, I'm glad you are here discussing it, because if nothing else it goes to the notion that all types of people in this country are concerned about healthcare. What I fear is some half-assed fix like the Medicare D plan, when we could go for something great. Why is the United States so afraid to lead, why must North Carolina strive for mediocrity?

Jesus Swept ticked me off. Too short. I loved the characters and then POOF it was over.
-me

I think the reason people

I think the reason people choose Canada as an example is because they're our neighbors and they're Same enough to be understandable. The situations in Germany, Taiwan, and Sweden are much better than in Canada, though the German system has flaws that are growing more evident.

While I was living in Oregon, I went to several discussion/lectures on UHC. One of the people who spoke was one of the main architects of the Taiwanese plan. Now, none of them were perfectly translatable to an American situation (since most other countries are a lot smaller, and many countries with national health care have a greater societal commitment to caring for everyone as a Public Good than the US, which has a societal commitment to caring for me and mine, screw all y'all.)

I'm interested in public health. Improving access to health care for all will save money in the end. Vaccinations, dental cleanings, annual physicals and age-appropriate health screenings... these are basic health care. Every American should have access to them. People should also be able to get emergency care when they're sick or have an accident. Chronic disease state management can be more efficiently handled in the method I discussed above (turfing it to extenders who a) bill lower and b) have more time than MDs, which c) lets MDs see more patients), and utilizing pharmacists' clinical skills to streamline prescriptions (which Medicare pays for now as part of Part D, for patients who meet certain spending criteria) can reduce costs.

One of the analogies a speaker in Oregon made was this: The current system has a small percentage of people with Porsches, a higher percentage of people with Hondas, another fraction with jalopies, and far too many with no car at all. UHC would give all people a low-end Honda, and those who can afford it can still upgrade to a better model.