Universal Health Care: Exploring The Path Ahead
Table of Contents
- On behalf of KPCC and Elias and our partners for the National Center for the...
- Based on profit and it's based the insurance industry the pharmaceutical...
- In a low-income community in underserved community and our biggest issue is...
- Have we were we were able to pass consumer protections in Sacramento but...
- At race we have to look at bias we have to look at the social determinants of...
- Intention in our mindset issue arms and we don't like it's like we don't have...
00:09
on behalf of KPCC and Elias and our
partners for the National Center for the
preservation of democracy thank you so
much for joining us this evening I am
Lynn grosse a producer here at KPCC in
person we produce all kinds of events
like this one tonight tonight's forum is
the third installment of our SoCal
solution series in which we ask you to
help determine the specific focus of the
program by submitting your questions and
suggestions we then put it to a public
00:41
vote for tonight's forum the top
vote-getter was focused on universal
access to health care just a few things
before we get started we are
live-streaming so please no audio or
video recording feel free to take
pictures we just ask that you turn off
your flash if you could please silence
your phone that would be great for those
of you on social we are using the
hashtag Universal health after the forum
we hope that you guys stick around for a
01:13
casual reception in the lobby that about
covers it without further ado your host
healthcare reporter Michelle Faust Robin
[Applause]
my name is Michelle Faust Raghavan I am
a healthcare reporter at KPCC I've been
covering health and health care policy
for a number of years now and I'm very
glad that everyone came out so give
yourselves a round of applause for
01:45
coming so we're here because the United
States spends more money per capita on
health care than any other
industrialized nation but we also have
some of the worst health outcomes of any
industrialized nation so increasingly
Americans want this to change and they
want our government to help bring down
costs by by also at the same time
improving quality and increasing access
to health care this week the Kaiser
02:18
Family Foundation had a poll of
registered voters that found that health
care is one
of the main things that people want the
presidential candidates to address in
this 2020 election as people are getting
ready for that and that's especially
true for Democratic voters the same poll
also showed that many voters
misunderstand the many proposals before
Congress that look to create a national
health plan the best of those that's
known is the Bernie Sanders plan the
Medicare for all
02:47
so people want answers right so that
poll also found that many people are
understand that Medicare for all would
be one thing that would create a
national health care program but what
would also cost more in taxes what they
don't often understand is the way that
those propose to potentially save money
in the health care system meanwhile
people are struggling to afford their
health care a recent Gallup poll showed
that at least a quarter of Americans
chose to skip health care treatments
03:19
because of their fear of the cost that
can't be a surprise at all in a country
where medical bills are still the
leading cause of bankruptcy even with
the gains in the health coverage that
we've gotten under the Affordable Care
Act so it's no wonder that KPCC
listeners all of you
Aleya Streeters are most likely to ask
me questions about health care costs and
proposed reforms to the overall system
so the question we're addressing tonight
is is there a path forward with
03:50
universal health care that would provide
quality care and not break the bank the
question has been posed for many years
Governor Schwarzenegger vetoed two
attempts to create a single-payer system
in California and the 22 thousands a
bill in 2017 that sought to start a
process was passed in the state Senate
but that was pulled before it got to the
assembly that was not the end of the
conversation in the state however the
04:22
state legislature has taken some steps
to design to lower the cost and increase
access to care Governor Newsome's budget
will include more money to help lower
the cost for middle and low income
families and help them buy health
insurance uncovered california's
marketplace it also expands medical
eligibility to include people between
the ages of 19 and 26 regardless of
their immigration status to kick things
off let's look at some of very very
04:53
simplified explanations of three models
of universal health care from other
countries around the world and how they
have achieved it so again very very
simplified if we look at first the
Canadian model upwards of 70% of health
care is covered by the federal and
provincial governments most health care
providers are private and they're paid
on a fee for basis a fee-for-service
basis covering basic services
some people have additional private
05:26
insurance to cover the cost of other
things that are not covered by the
government the annual out-of-pocket
costs per person is less than two-thirds
of what we pay here in the United States
the United Kingdom has socialized
medicine where the doctors work for the
government hospitals belong to the
government and care is mostly free at
the point of service because consumers
pay higher taxes to cover the cost of
the program but still England spends
just over three thousand dollars a
person on health care that's about a
05:57
third of what is spent in the United
States if we look at the model in
Germany everyone in Germany is required
to have health insurance sound familiar
insurance is a hybrid public private
industry most people buy insurance
through highly regulated nonprofit
sickness funds and those are often
funded by income taxes the cost is based
on income and your employers will pay a
06:29
portion of that if you can't afford an
insurance the governor the government
will cover most of those costs Germans
spend about half of what Americans spend
on health care so to discuss this I want
to now invite our panelists to come up
first I'd like to invite Anthony Wright
the executive director of
Health Access California dr. Alaine
Bachelor chief executive officer of the
Martin Luther King jr. Community
07:00
Hospital dr. Geoffrey Joyce director of
health policy at the USC Schaefer Center
and on he'll iike a meatus of the
executive director of the California
physicians alliance so thank you all for
being here I'm glad to have this
conversation I want to start with
basically let's deal with the main
question at hand the whole point of this
conversation is is there a path to
universal health care that will provide
quality care and not break the bank and
07:34
we just went over a handful of models do
any of those look like a model that we
could possibly go we could address that
with so let's go ahead and start with
you Anthony
so the answer to the question is there a
path e the answer is yes every other
country does it well you know why
shouldn't America we need to get to a
place where everybody has access to
affordable health care we need to get to
a place where the health care costs are
not breaking the bank of us whether as
workers and our paychecks whether it's
as employers and our bottom lines
08:05
whether as taxpayers and and aid in
terms of what we're contributing in our
healthcare system as you said we spend
more on health care than anybody else in
the entire world and it's not because
Americans use health care any more than
anybody else in fact we we actually use
health care less we have less incidence
of going to the doctor of going to the
hospital it's because that per unit
price is just so much more in America
than in other countries and part of that
08:36
is because we don't use the power of us
as citizens as the purchasing power as
all of us together to bargain for the
best price and value and so there's
there are ways to do it as you mentioned
there are different ways to do it each
country does it
each industrialized country that does
have universal care does it in a
different way and frankly many of them
many of us here in America do it we're
we have a British type system for our
veterans in the VA we have a
09:09
canadian-style system for our seniors in
Medicare we we have we just instituted
for some who are in the individual
market something close to a a German
type model with the with the exchanges
but we also are unique in having huge
cracks in that system and so we need to
take steps and we have taken some steps
with the Affordable Care Act but there's
many more to go okay dr. Geoffrey Joyce
as Anthony mentioned I think there are
many ways to get there there is not one
09:39
simple solution I do think there are
politics involved as well as just what
is the the best way to cover the
population clearly I think if you go to
a system like in Britain there are flaws
there they have long queues they have
limits on they make societal decisions
that I think would be very unpalatable
to some Americans so from a political
perspective certain systems that work
well in other countries may not be
feasible or as I think accepted here the
10:09
system in Germany I think is more akin
to what some people have been talking
about doing in the United States of
managed competition taking it out of
sort of private hands fully and making
it more regulated by government in
Germany the government negotiates prices
which as Anthony mentioned is really the
outlier in the United States if you look
at spending on health care its price
times quantity in our quantity generally
outside of prescription drugs and high
costs imaging is in line with the rest
of the world it really is pricing and so
the question is how would we price and
10:41
do it in a way that is again there will
be winners and losers no matter what we
do and what type of reform we do is we
have to do it carefully
angeleka I agree with the other
panelists that there definitely is a
path forward but it hasn't been written
down and thought through and distributed
to the public so even though there is a
path forward we have to come to an
agreement and it has to be written down
so that there can be some sort of
evaluation to make sure that we don't
11:14
anyone that is currently reliant on the
current health care system and we also
have to make sure that we continue
moving like Anthony said we had some
great gains under the Affordable Care
Act but that doesn't mean that it's
fixed and that we have universal health
care in terms of the different types of
systems I think that it's perfectly
normal for Americans to want an American
a uniquely American system and I think
that based on the needs of our country
that we have we can take pieces of each
of these systems that work for us it
doesn't have to be one or the other we
11:46
can definitely go ahead and shape it to
meet the needs of our residents dr.
Elaine bachelor yes I agree with all of
our other panelists that yes there is a
path forward and we should find that
path it's well past time for us to
provide universal coverage in our
country health care is a basic human
need just like clean air clean water
education we find a way to provide all
of those for all of those human needs we
have the means to provide health care
12:18
for everyone we currently have a system
that's not working well for many people
we have a three-tiered
insurance system in this country we have
commercial insurance for people who get
insurance through their employers but
many of those people are struggling with
affordability we have Medicaid or what
we call medi-cal in California for
low-income individuals but because
Medicaid plays such very low rates to
providers low income individuals
struggle with access to the care they
12:52
need Medicare for the elderly seems to
be the system that meets the needs of
individuals the best and thus I think a
lot of the calls that we're hearing now
to expand the number of people on
Medicare to more earth not all Americans
so I commend the people that are here
today because I think we're all going to
have to learn more about what those
options are and what those potential
paths are and act from knowledge and not
just from fear of the unknown
13:24
speaking of Medicare for all I'd like to
toss for
a moment now to the director of health
care for all Los Angeles marine crews
who's also a nurse and is a supporter of
Medicare for all yes I would say one of
the things that America is unique in is
that we have people dying in this
country that wouldn't die if they lived
in any of the other countries we have
37,000 people who die every single year
in this country because they don't have
13:55
access to care and many more died
because of the inadequate access to care
and part of that is we don't really have
a health care system we have a medical
industrial complex we have a Wall Street
based system where our health care is a
financial instrument and we are we are
the the profit centers for that system
we have in order to provide a solution
you have to ask what is the problem and
the problem is we have a system that's
14:27
based on profit and it's based the
insurance industry the pharmaceutical
industry and the Hospital Association
Industries are practicing medicine
without a license
we have we have so many people in this
country who are not only rationing care
themselves and these are people with
insurance they can't afford to use their
insurance because of the system that we
have we have a system where if it makes
14:58
money for Wall Street to give you care
you get it and if it makes money to deny
you care your care will be denied so we
have the number one cause of bankruptcy
in this country is medical debt you ask
someone in Canada about medical debt
they don't know what you're talking
about it's unique to America that we
have medical debt and that we have
people dying because they can't not
access care so one of the first things
you have to do when we look at a
solution is say well what are the
15:30
problems number one we have to get rid
of the insurance industry we have to get
rid of for-profit siphoning money out of
the system it's very simple if you want
a medical system
health care system that offers care to
people you cannot extract a trillion
dollars a year out of the system for
for-profit entities and that's what we
have thank you so a lot of the
conversation that we're having so far is
16:01
coming back to cost and people rationing
themselves or people not getting access
because of cost whether or not they have
insurance and it kind of throws it back
to a listener question that we received
ahead of the event
why is health care so expensive here and
why does it continue to increase so much
every year so I'd like to get started
with that question and Geoffrey Joyce if
you could please get started with that
question it we do much more than any
other country do have a for-profit
16:32
throughout in the pharmaceutical
industry we basically set prices what
the market is willing to bear as opposed
to government negotiated or fixed prices
we have for-profit insurers we have
for-profit hospitals even though it's
historically it's been a not-for-profit
sector I do think this bends are the
capitalistic sort of historical legacy
that we have a dynamic capitalistic type
system and when you mention rationing I
think it's important to recognize that
we do ration every country rations of
17:03
health care typically in Europe it's
done on the supply side they restrict
access to expensive therapies that they
don't think are cost-effective they
don't let 85 year-olds get heart
replacements they make societal
decisions of what's cost-effective and
what is not in the US side we typically
ration based on your ability to pay so
if you have generous insurance or you
can afford it you can get access to any
technology so I do think it's a all
countries ration I think we make
decisions and we have it's both
political and philosophical about I
think Americans feel they have a right
17:34
to see any provider and have choice of
providers and have access to treatments
where I think it's much more of a if
this is not socially cost-effective
that's okay we'll forego that in this
country where in the u.s. I don't think
that's part of the nature but it's
getting to you your your broader issue
about coughs we do not negotiate
typically
the government does not negotiate prices
outside of Medicare and Medicaid and
that is one of the reasons why we spend
significantly more than other countries
18:05
having said that it's not just the
healthcare system we can't say we don't
do as well as Britain or we spend more
simply because of our medical care
system it's also the health of our
population the diversity and the sort of
birth to grave type coverage I think
that manifests itself in poor health
outcomes I mean it sounds like you're
speaking towards the social determinants
of health and dr. Lane Bachelor you and
I have had conversations in the past
about how that adds to the cost when
18:35
you've got people who are not getting
good health care before they come to the
hospital they're not doing as well when
they're there can you talk to me a
little bit more about that yes so when
we talk about the social determinants of
health we're talking about things like
access to healthy food access to safe
places to exercise transportation
employment living in safe conditions
environmental toxins all of those things
contribute to health and in other
19:05
countries like in European countries
they spend more as a society on those
social determinants Europeans spend
twice as much on social aspects than
they do on health care in the United
States we spend about 90% as much on
those social determinants as we do on
health care so we we have a ways to go
to address those social determinants
fortunately people are starting to
19:37
realize that it's that it's an important
area that needs investment and we're
talking about it more and we're doing
more so for example I'm a hospital but
we are experimenting with programs to
provide healthy food for individuals who
have conditions like diabetes or heart
failure that require a healthy diet we
provide transportation for people who
need help getting to healthcare and even
better we're starting to take the health
care to where people live and where they
20:08
are comfortable receiving it so I think
we're starting to realize that that's an
area that we need to invest more in so
that we're not spending all of our
resources on healthcare thank you I'd
like to turn now to Louise McCarthy
she's the president and CEO of the
community clinic Association of LA
County and a lot of your patients are in
this same situation where they don't
necessarily have access to all of the
social determinants of health but your
mission is to try to provide more health
care before they end up in the hospital
20:40
absolutely I would say that and I really
appreciate dr. bachelors comments about
the social determinants that patients
are coming into clinics hospitals etc
it's housing and housing affordability
is a real chief concern here in Los
Angeles especially as we're looking at a
$15 minimum wage and the fact that some
of the minimum wage increases will
actually end up making people ineligible
for medical in California so this
challenge does push/pull of trying to
create income equality at the same time
21:11
as just the cost of living in California
and particularly Los Angeles is so high
such that now as the federal government
is looking at chained CPI and rebasing
how we handle our federal poverty level
which would disadvantage us even more
than it does today the fact that if you
make X amount in California and X amount
in Alabama you're at the same place on
the federal poverty level is a real
challenge when it comes to accessing
federal programs so health centers I
think when we look at the question of
21:42
the social determinants and where cost
happens primary care is not the cost
driver and health care upstream
solutions are not the cost driver in
health care but the problem is that we
put the long in longitudinal you will
not realize our savings this year or
next but you will realize them in the
out years when those hospital visits
don't happen and that's the struggle
with reorganizing this system is to say
how do we reorganize it and recognize
out your savings as opposed to current
22:13
year spending well it's interesting that
you mentioned housing I you may have
noticed if you came in they had the
panel with with I make
soliciting questions I'm taking a new
focus looking at the health of older
aging adults most of the questions that
I've gotten in the few weeks that we've
had opened that up with the mission
statements at KPCC have been
specifically about housing and older
adults who are not getting that kind of
a care so it goes back to the questions
that I'm getting what you mentioned
right there so I wanted to kind of turn
22:46
it to you I'm hella guy you can talk
about a little bit about what can
physicians do I I had a conversation
really recently with a physician and he
said you know the goal is as I mentioned
in my intro improving access improving
cost improving the quality of care but
the physician with whom I spoke said you
really can only have two of those three
in a medical system and I wonder if you
agree with that oh no I don't agree with
23:18
that I think it's unfortunate that you
that someone would have the thought that
you can you have to pick and choose I
mean we at CAPA believe that everyone
should have access to high-quality
affordable accessible sustainable
healthcare and I think that it's really
limiting to think that we have to choose
what we want and give up we what we want
really to have as an outcome I think
that it's really important to keep
23:50
pushing for the changes that need to
happen I myself come from an underserved
community so this is deep deeply
personal for me and I was raised on
medical and I know that to individuals
that are reliant on these health
services that it matters whether or not
someone is out there with them asking
for these changes and I don't think that
we can only have two out of the three in
a health care system why do the other
countries have a system that meets all
of the the qualities that we want to see
24:20
in our healthcare system so I think that
that's just a way to deflect and not
want to work on this really it will take
a lot of work to get to universal health
care and I think that we really can do
it so I would disagree with that
statement Anthony
like to turn that question to you I mean
I think I think the the the issue is we
have specific issues in our health care
system with regard to costs I mean I
24:50
think it's absolutely true that we under
invest on the human services side and
that balloons out into our health care
system and I think that there is some
evidence that some of the differential
between us and other countries is
because of that that that because we
don't invest in housing and child care
and education and other things then that
gets reflected in health care system I
think there's another issue which is you
know just about the complexity in the
confusing nature of our health care
system you know with all these different
middle middle men and-and-and problems
25:21
and procedures that are in place that we
could do a lot to streamline though
that's one of the reasons why my
organization for 30 years of support is
a medicare-for-all solution and has
worked year and year out to try to
figure out how to standardize and and
create clear standards and consumer
protections for folks dealing with the
healthcare system but fundamentally
comes down to this question of price and
there are trade-offs in any reform you
do but some of those but but they don't
those are trade-offs between different
25:52
parts of the industry not necessarily
for the patient which at the end of they
should be is not just another
stakeholder it's the point of the
healthcare system so the so in other
words you know if there is a question
about what how do you negotiate for the
for what is the rate that we pay for
certain providers then there is a
question about what is fair how much is
too too much how much is too little
maybe you know maybe medical or even
Medicare pays too little in some circles
26:23
but you know should other providers get
paid three four or five times the
Medicare rate which happens now if they
have a certain market power and that's
actually fundamentally one of the issues
that we want to resolve is that at the
end of the day how much people get paid
for healthcare actually has little
relationship if at anything for the with
the cost of that care the quality of
that care
the outcomes of that care it actually
has much more to do with what is the
relative market power of any one part of
26:55
the healthcare system versus the rest of
it and that's not an incentive for
improved quality or equity or reduce
cost that's just an incentive for for a
hospital system to get bigger for for a
certain group of specialists to have a
bigger payment schedule and we need some
sort of rationality to our health care
system and I think that there is a role
for government to impose that if we're
27:24
going to rely on even market forces
where the market does exist in
healthcare which is not a lot we need to
have we need to set the terms so that
they actually encourage the innovation
we want rather than the innovation that
is just about greater consolidation and
greater consumer confusion doctor lien
Bachelor reimbursement rates are very
important for a hospital to be able to
work so I wonder what your thoughts are
on that well I had a couple of thoughts
one is the complexity that Anthony is
talking about is part of the cost
27:56
problem because a lot of that complexity
is what other people would call
administrative waste and adds to the
cost in addition we have a system where
the payment side is very fragmented with
a lot of different insurance companies
and health plans and they really
struggle to achieve that market power to
be able to demand lower prices and lower
rates from providers so I think both of
those things are problematic now I work
28:26
in a low-income community in underserved
community and our biggest issue is
equity we're on the low end of the
reimbursement scale and because the
reimbursements to providers in our
community are so low we don't have the
physicians there we don't have the
prevention and disease management and as
a result people come into the hospital
with conditions that have gone way out
of control
and we spend more money on the back end
28:58
to treat people who are far gone than we
would spend on the front end
I think Louise was talking about the
need to invest more in primary care in
in disease management and prevention and
that is another way that we're going to
get a handle on health costs right now
we're spending way too much on emergency
care on in stage care and not enough on
the front end okay dr. Joyce just
following up on that I agree with Elaine
29:30
in the sense if you look at differences
between the u.s. and let's say European
countries of Japan or Canada we do spend
proportionately less on basic primary
care and much more on specialty care I
think there's a sense of I should be
able to go and see an ophthalmologist
cardiologist whatever specialist and and
there was some backlash by consumers
when managed-care came in in the 80s and
90s to say you have a gatekeeper a
primary care doctor who's going to sort
of monitor whether you have access to
those specialists so I think we do under
30:01
invest in primary basic primary care
which I think most other European
countries do better and we tend to spend
too much and specialty care okay
I'd like to take a couple of moments to
take a question or two from the audience
so we have a couple of runners here that
are here to take your questions if
anyone have a burning question
so I'm curious it's really interesting
to think about the other countries and
what we have but so I'm a primary care
physician and I was lucky enough to go
to public health school where I got a
30:43
lesson on how we ended up where we are
today and so and then I also happened to
be there when the Affordable Care Act
was passing and it was like this
incredible dramatic story of how is this
gonna pass and how is it actually gonna
happen so just being pragmatic like you
know even if we wanted to be Germany or
a mix of Germany like how are we going
to get there given the political reality
and in particular given all that you've
31:13
mentioned about negotiating costs how do
we you know that just seems like a
no-brainer like why are we not is that
that the first step to say like you know
Medicare gets to negotiate drug costs
yeah well drug costs are a separate
complicated issue part of Medicare Part
D the drug program for seniors in the
legislation was that the it would be an
industry sort of competition among plans
and and and the government would not
negotiate prices it would take an act of
31:45
Congress to change that drugs are a
somewhat separate issue I think the
broader issue you mentioned of how do we
get there and I think that's one of them
more I think somewhat disingenuous parts
of Bernie Sanders proposal is you know
we have about a hundred and sixty
million people who have private
insurance today and most of them are
fairly happy with the quality of care
that they have access to not that
doesn't say there are segments of the
population that don't changing that
system for a hundred just look how Obama
was just crucified for saying you're not
32:17
gonna lose access to you change your
doctor and some small fraction did have
to under the ACA so if you want to try
and transform 160 million people with
private insurance that are fairly well
covered now and said we're gonna put you
in Medicare and Medicare has got many
quirks two very unusual health policy I
don't think that's very realistic so I
think building on sort of a sort of a
more towards moving
towards manage competition more managed
care which we've seen Medicare and
Medicaid to increasingly over the past
20 years where there are private firms
32:48
that are paid something by the
government a fixed per month or per year
fee to manage that that population where
they have incentives to provide more
cost-effective care provided you put
some quality parameters around it so
they don't shirk on on care and don't
provide inadequate care I think that
type of managed competition and moving
towards that away from traditional
fee-for-service Medicare is a place
that's more pragmatic and realistic
kappa has a plan a couple of ideas for
that so I'd like you to take that Hanaka
33:19
yes so thank you for asking that
question
obviously that is the question that
anyone who supports universal health
care Medicare for all or a single payor
that's what they're asking why aren't we
doing this it seems like a no-brainer so
Kappa actually believes that we need a
strategic approachable and realistic way
to get to universal health care and a
unified system of public financing
specifically and we actually came up
with a document we are calling it the
roadmap to golden state care that takes
into account our current health care
33:51
system here in California and it is it
lays out a plan that is strategic
approachable and realistic it the beauty
about our plan is that it is phased in
there are three phases so that we don't
disrupt the care for anyone who is
currently really reliant on our current
health care system and then also so that
any positive changes that are any
changes that we make we want to ensure
that they are positive because sometimes
you think that you are going to change a
small piece of the system and it has a
34:22
negative consequences so we want to
ensure that any changes that happen are
positive and that they are leading us to
the ultimate goal of universal health
care but I think the key point here is
the fact that we we need a plan there
there currently isn't a plan written out
that would actually get us there that
looks at our current system thinks about
where we need to go what type of laws
need to be passed maybe there's systemic
changes or anything like that so that's
why Kappa took the the lead in meeting
with health policy experts here in
34:53
California
individuals that really know the health
care system and wrote this this plan so
it's on our website see a physician's
Alliance on org if you're interested and
also it's just really important to have
champion so individuals asking these
types of questions and really pointing
out that we can get there we definitely
can get there and we we really just need
to be really cognizant of the fact that
there is no plan but anyone that sets a
go knows if you set a goal you make a
plan for it and you work until you get
35:22
there Anthony you were shaking your head
yeah I mean I think you know you you
mentioned the Affordable Care Act and
the fight about that I think you can you
can see it as both good glass half-empty
or glass half-full like just all the
work that went in to pass that and you
know we Health Access led a lot of the
effort to try to pass the Affordable
Care Act here in California and we
remember the very tough fight it took to
get that passed and and and how
improbable it was you know to get
exactly 60 votes in the Senate to get to
35:54
get you know the to vote one or two vote
margin that speaker Pelosi was able to
get in the house to get that through and
then of course the ten-year psychodrama
the discussions been in over the
Affordable Care Act but let's recognize
the progress that we've made that
millions of people now have coverage
that didn't have it before had millions
more of consumer protections and when
that and and when people who campaigned
against that that law finally got into
power and had the moment to undo it
36:25
there was such a backlash from the
American public that at the end of the
day it's that that effort stalled that
it was maybe one thumbs-down away but
there was that that effort stalled and
there was I think a changing in the
expectation of the American public that
people should not be denied for
pre-existing conditions and I think
that's the basis of an American value
that that health care is a right there
is much more to do to fulfill that that
36:57
promise and that premise but I think
that we started to lay that not just in
the passage of the Affordable Care Act
but in the fight to defend it and and so
the question is how do we build upon
that
and you know we're starting to have that
conversation now both at the federal
level with the presidential candidates
but also here in California now we're
gonna talk about that in a second of
what we can do the steps we can take
even here in California to advance that
goal and make progress and I do believe
that part of the progress is not just
passing additional policies as elements
37:29
of trying to get to this goal from not
from just building the policies and the
policy infrastructure but also building
the political momentum success spaghetti
success breeds success and I think that
we can more show people tangible
progress then more folks will come along
for the next step and for the next step
dr. bachelor so I just wanted to add
that as conditions in our country change
the politics change as well as
healthcare prices continue to go up even
38:00
families and individuals that have
commercial insurance employer based
insurance that provides good coverage
are struggling with affordability one of
the ways that employers have maintained
coverage is to increase deductibles and
cost-sharing to the point that many
families now are entering medical
bankruptcy even with insurance coverage
we're also seeing a widening gap income
gap and a gap between the haves and the
have-nots more people are moving on to
38:31
public insurance programs a third of
Californians are on Medicaid half of the
the babies that are born in our state
are on Medicaid so as these conditions
change we're seeing more public support
for universal coverage and even for
single payer during the previous during
the previous presidential election
people who said we should have
single-payer we're told they were you
39:03
know crazy and unrealistic and now
during this election cycle you know many
of the Democratic candidates have a plan
for how we get to single-payer so I
think the politics are changing and
what's possible is now changing thank
you do you
another question in the front oh sorry
thanks I have a question that gets to
your talk about how the market how
market forces influence what we're able
to do we had a question that that speaks
39:35
of it to the politics of the situation
I'm wondering what the thinking is or
what's been done around there's so many
industries that are vested in the
current system and the way that it works
and there they stand to lose a lot if
things change and what people have
people been thinking about how those
industries can be redirected or also not
offer a solution that isn't all win lose
situation because I think that's how you
maybe also help move things forward and
40:05
you help get more people on board when
you don't have when the lobbying that's
so powerful maybe neutralize a little
bit maybe we could redirect them to work
on climate change well I I think that
that's why you need a strategic plan you
need to really be strategic about how
you are approaching this industry and
remind them that they have a
responsibility for the people that are
40:36
buying into their product or whatever it
is that's why part of our roadmap is
talking about responsible practices and
there's some s e-g standards that can
also help with that so there's different
ways that you can really make sure that
the industry is changing because right
now it isn't it doesn't have the
patient's interest at heart and it's
very obvious but no one is out there
regulating them reminding them of the
fact that there is a patient on the
other end of that phone call when you
41:08
are denying the care there is a patient
that is struggling to pay those bills
that you keep sending over and over
again and that they have a
responsibility first and foremost and
doing that or addressing these problems
should be in a strategic way so one of
the reasons that Medicare for America
gets a lot of support is because it
envisions an ease
your transition for the existing
industry so America Medicare for America
41:40
would allow Americans to participate in
the Medicare program if they so choose
but would also allow employers to
continue to provide commercial insurance
would allow insurance companies to
continue to provide policies would allow
for Medicare Advantage plans which are
also run by insurance companies but
would begin to move the market more
toward universal coverage and a unified
42:07
payment system thank you thank you I
think one of I appreciate the question
because I think if we're gonna take
single-payer seriously or any solution
seriously we need to take the obstacles
to that to that solution seriously as
well and there are there are real
obstacles whether it's voters fear of
change sometimes whether it's a
procedural obstacles like the US Senate
or it's a state constitution but but I
42:42
think or ideological opposition or just
party politics that we see you know a
lot of the fight around the Affordable
Care Act at the end of the day ended up
whether you were team blue or team red
and you know given the the way our
politics has strung out but in terms of
the issue of industry opposition it is
very hard I work in the State Capitol
and it's very hard to advance a reform
that takes on the entire industry at
once right you know you know doctors
hospitals drug companies insurers of we
43:14
have we were we were able to pass
consumer protections in Sacramento but
it's it's usually not when we have the
entire industry opposed it's usually
when we can say okay how do we deal with
with the bad with the bad actors with
specific grievous problems in this
industry or in that industry and and
we're and also make the case to other
folks in the industry really do you want
to defend what they're doing and and
make them make that point because you
43:45
know for example you know with regard to
rates there are
certain providers that that are able to
charge a lot of money like again as I
said four or five nine times Medicare
rates but the primary care physician is
not one of those right so you know the
primary care physician might act or
actually King drew might get an increase
in their reimbursement rates under some
of some of the reforms that we're
talking about and so how do you you know
make that case and and and and not to
44:17
say that you're you're gonna get
everybody to be happy but how do you
make the distinctions between either
different industries or within those
industries because there is a positive
case to make to most of the providers
that you know a lot of the providers
don't love the system that they're in
now either and so how do you make that
case and and help make those
distinctions because it's hard to take
on the entire industry all at once so
yes go ahead no sorry just a quick
follow-up because I think that is a
great question that three point three
trillion dollars one out of every six
44:48
dollars in our economy is somebody's
income whether it's a physician and
ensure a drug company a hospital and so
they do lobby and they fight and they
resist and so I think pragmatically we
probably won't get to a vast overhaul on
Medicare for all the single let's say
pay or single insurer until the fiscal
solvency of Medicare and Medicaid is is
terrible which is not that far off in
the future but I think what's more more
pragmatic is to more shift some of the
risk of managing a population which is
45:20
what the Affordable Care Act did is say
here here are five or ten thousand
people manage that population and we'll
pay you a per person and and you have to
meet quality metrics I think that
incremental shifting the risk of high
financial cost of a population on to a
large group a provider group and say
manage that population as efficiently as
you can is probably what we will is more
pragmatic in the short run so one of the
issues that comes up when we talk about
insuring more people or getting access
45:50
to more coverage for more people is do
we have enough providers to address that
and and do we have enough providers who
are getting paid sufficiently to want to
continue to do that
I wonder what your thoughts are on that
doctor bachelor so I can tell you the
answer for the community that I serve is
definitely not and part of the reason
that we don't is that we are a community
that as low income most of our residents
are either insured through Medicaid or
uninsured it simply doesn't pay enough
46:22
to attract the the providers in the
community that we need that's why you
know our emergency department is caring
for you know over a hundred thousand
visits a year because there simply
aren't enough providers in the community
so what we'd like to see is a plan that
both provides universal coverage and
introduces more equity into the system
so that resources are distributed a
little more fairly and people in our
46:53
community can access the primary care
the prevention and the disease
management that will keep them out of
the hospital and ultimately lower our
costs angeleka what does CAPA believe
would be a way to handle some of that
physician shortages if more people are
getting care I definitely think that we
need a multi-faceted approach so it
can't just be investing money into
primary care we need to make sure that
the physicians in these communities that
we're talking about equity that they
look like the community members there
47:25
that they understand what it's like to
live in these communities and that they
have that cultural sensitivity as well
so I think that we need to think about
grants to support primary care but also
look at medical education so we have to
support students of color low-income
students students that belong to
underserved communities and support them
through college and then also into
medical school we we are reliant right
now on loan forgiveness but if you think
about it I'm sure a lot of you in the
47:56
audience know how much having loans
weighs on your psychology you know the
ability to go into work and know that
you have to pay back those loans so why
aren't we thinking outside the box why
are we just relying on loan forgiveness
and making that interest just get bigger
and bigger over the year
so we have to really think about
approaching this topic of having enough
physicians having enough physicians that
look like the population of California
in these communities from multiple
48:28
approaches at the same time I think that
one of the drawbacks from everything
that has been tried so far is that it's
usually investing a lot of money just in
one portion and instead we really do
need to think about preparing the next
generation of healthcare leaders making
sure that we are anticipating the needs
of the California population our current
system isn't set up to meet the
population of California in 2019 it's
actually him set up to meet the
48:58
population of 1996 I remember hearing
this in one of the conferences why are
we always playing catch-up that doesn't
make any sense we really do need to
anticipate the needs of the future
population of California one thing I
must say is that the data suggests that
American physicians are paid 25 to 35
percent more than their comparison
physicians in other countries but the
number of physicians per thousand
population in the US is significantly
lower than our in our comparison
countries so if you think about what we
49:31
spend on doctor services it's not out of
line with our comparison countries so
when you talk about the supply of
physicians we're already at the lower
end
Michell relative to our two European
countries so you I think one option is
physicians are expensive we can be
smarter about it Rick and if more
pharmacists and nurses treating basic
primary care issues write runny noses
the minute clinics and these that the
success of them in these malls are
partly meeting an unmet need and you
know the vast majority of the cases
they're handling can quite easily be
50:02
handled by nurse practitioners or
someone below a physician level so yes
we probably need if we're gonna put more
emphasis on primary care we need more
physicians but we could probably do it
smarter and more efficiently
Anthony yeah and beyond the scope of
practice issues that the professor was
talking about I I mean there was there
is a there was a major Commission that
actually looked at health care workforce
that was released earlier this year me
and major commission would you know the
UC the UC president
and and a number of other luminaries
coming out with these issues and they
50:33
came up with many recommendations many
recommendations some of which have been
mentioned here some of which are in
place now things like loan repayment in
the new budget that was just passed in
the last week there is money from the
tobacco tax that we helped campaign for
a couple years ago that goes to loan
repayments for doctors who are willing
to commit to serving at least 30%
medical patients for example or to or to
work in certain areas for example
because one of the issues is that I
51:04
think that there's a question about
whether it's a shortage there's clearly
a matt'll distribution of doctors
there's no there's no shortage of
doctors in Beverly Hills there is and
there there is there is in the Central
Valley so so I think that there's
something to be done about distribution
there's something to be done about
training and having a pipeline of new
and frankly diverse population and
there's also about how do you actually
even provide the care is it do we need
to is it about doctors or is it about a
51:36
whole range of health professionals and
what can we do in the upstream before we
even get to the the intervention in a
doctor's office so it's a range of
things and and again a more coordinated
universal system would be a better way
to manage and handle and plan and invest
in that in the system we want rather
than letting the market dictate and the
market dictates that oh there's a few
specialists that means specialist get
paid more and so if you're if you're
52:06
adopted if you're training to become a
doctor
it seems very lucrative to go into those
specialties rather than primary care
even though societally we actually need
more primary care doctors right so you
brought up an halika the idea that we
need more culturally appropriate care we
are also living at a time where there
are major disparities not only an income
but also in in race in the kind of
outcomes that people are getting my
colleague Chris connealy you've probably
heard and if you haven't you should look
52:38
it up on Elias comm or go to KPCC
and look at the reporting that she's
done
on the disparities of the number of
black babies that are dying and not
making it past their first year Latino
children are not that far behind them
and black mothers and latina mothers are
dying very quickly in childbirth in ways
that they shouldn't be and that's just
one of the many other disparities that
we see in health care system what are
some of the things that we can do even
as we expand access that we're sure that
53:09
the quality is equitable I'd like to
start with you doctor bachelor well I
think one of the things we could do is
measure quality and report on quality by
ethnic group by income levels so that we
have a more transparent system we're
able to see what's happening and we're
able to hold providers accountable for
their outcomes
you know physicians tend to be very
competitive and when you measure them
and you put it up on the wall they
53:41
figure out how to do it better so part
of it is making our workforce more
diverse and having better alignment
between providers and patients that's
something that we've been able to do in
my health system we've we've done a
great job of recruiting very talented
physicians who are african-american who
are Latino and it makes a huge
difference to patients even when I was
in medical school I realized that
54:13
patients who didn't speak the same
language as their doctors weren't
getting the same quality care so I think
it's a combination of things but I think
part of it is shining a light on what's
happening and holding people accountable
for better results what can we do in
policy for that well I mean I think
there's a lot that we can do first of
all you just have the focus on equity
it's not just costs not just quality
it's about equity we did there are
things we can that if we if we don't
have an equity lens on these things
there's some reforms that happen that
54:44
could have a disproportionate impact on
certain communities if we don't have the
data to really monitor what's going on
in certain communities that have special
needs whether it is
racial categories whether it's an LGBTQ
community whether it's income or other
issues in terms of some specific bills
going to doctor bachelor's point about
the data there one of the bills that
we're sponsoring this year a b99 by
55:14
Assemblymember Luz Rivas would actually
require that the plans in covered
California have to not just report which
they and detail their quality metrics
and their equity metrics about how
they're doing in certain health outcomes
but that that information be public and
published to you as the consumer when
you're when you're selecting your plans
on covered California and that's a we
think an important things that you can
do both price comparisons but also
55:44
quality comparisons plan by plan and so
that I have that plan specific
information I think that's an important
thing I think another piece is not just
to deal with the fact that there are
these disparities but also recognize
that some of the disparities are because
of people's circumstances and social
determinants of health but they're also
due to due to the societal issues we
have including ones of bias and so for
example you mentioned the very
significant issues of black infant
mortality there is a bill by Senator
Holly Mitchell SB four to four that
56:17
would require implicit bias bias
training especially for the issue to
deal with the issue of black infant
mortality and I think that that's a
that's a step to acknowledge that there
are things that we can do that are
universal to improve the system for
everybody but there's some specific
remedies that we need to address
specific problems in specific
communities sue yes go ahead just really
quickly I think that we have to be a
little bit careful about shifting this
56:49
to the providers we are seeing large
numbers of burnout among physicians and
other providers and the reason why they
are feeling burnt out is because of the
need to see this many patients within
their day so this is once again talking
about the system being about profit
being about seeing as many patients as
possible so that
the insurance companies can turn around
and say that they've made large amount
of money for their shareholders so I
although I do think that we have to look
57:19
at race we have to look at bias we have
to look at the social determinants of
health I think that we really have to be
careful to shift this over to the
physicians because there's a high number
burnout suicide rates among physicians
and other health professionals so as we
talk about inequities in health care one
of the things that has changed in in
will change very shortly in California
is that medical is now going to be
shortly covering people up to age 26
57:51
regardless of their immigration status I
wonder if you believe a doctor Bachelor
that that's going to make an impact on
your patients is it going to expand the
number of patients that you'll be seeing
I do think that it will make an impact
on patients it's a good thing it's it's
progress for people to have some
coverage rather than not having coverage
that's hugely important but I don't want
to lose sight of the fact that Medicaid
is still underfunded and people who are
58:23
on Medicaid still struggle to access
quality care but it is definitely the
right thing to do a movement in the
right direction and it will make a
difference in accessing health care dr.
Joyce know and you can just make the
public health argument right not only is
it is it ethical and the right thing to
do but it benefits everybody when you
don't have an indigent population that's
being untreated okay so I want to leave
a little bit of time to have some
questions but I'd like you to tell me
58:54
having heard each other speak tonight
too as we begin to wrap up was there
anything that you heard tonight that it
was new or points to a different path
maybe than what you originally came in
with thinking would be the best path for
healthcare moving forward I'll start
with you Anthony
I mean I first I do want to just
reiterate the exciting progress that we
have made in California with regard to
59:29
expanding medical to all young all
income eligible young adults regardless
of immigration status that is the first
time in any state that we are expanding
medical to to undocumented folks that
are not children or pregnant women to
another adult population and and that's
not the only thing we did in the budget
we also took steps to provide greater
affordability assistance in covering
California with significant new help
especially for those over the 4 times
01:00:01
the poverty level cliff where the
Affordable Care Act runs out there was
other expansions of Medicaid medical to
seniors and improvements like restoring
some key benefits that had been worked
10 years ago like audiology and speech
therapy so you know I want to
acknowledge the progress that that we've
made in California to take steps toward
it but there's so much more to do and I
think what I heard here was the that was
the range of those steps and I think the
thing that you know sometimes this gets
01:00:32
framed as a debate as you know is it you
know go for a full solution or just
build on the Affordable Care Act and I
think the right solution is always both
right that you know people can't wait
for for the help that they need now
anything we can do now would be great
recognizing that there is a but but we
also can't lose sight of that longer
larger Veit and longer vision that will
take out some time that we'll have some
transition efforts both because of the
politics of it but also because of the
01:01:02
policy to get to that vision and we need
to have both and I think what we hear
heard here was I think a fuller
explanation that that I think I've heard
in a lot of the national conversation
about how we actually can marry and
these two complementary efforts together
doctor bachelor so one of the things
that I heard tonight that's heartening
is I heard a pretty complete agreement
among this panel that we ought to have
universal coverage in this country that
it's time for that I also heard a lot of
01:01:33
pragmatic
around the various proposals and issues
that need to be addressed and I think
that if we continue to work together
address the challenges that we have a
good chance of getting where we all want
to go so I'm pretty optimistic that's
our choice same I thought you'd have a
ringer in here that would stir the pot a
little bit but I think we all basically
are of the same mind where we spend way
01:02:04
too much on healthcare we're a very
wealthy country we should not have
twenty eight million uninsured people
another 20 million underinsured people
so I think we're all in agreement and
you guys who are here I assume basically
are here for the same reason what I
think it can mention a little bit and I
think we overlooked is the link between
health insurance and health is not that
strong or as strong as you think well
well everyone should be insured the
Whitehall experiment and Britain Oregon
Health Study the ran health insurance
experiment all found when you gave
01:02:34
people's insurance or more generous
insurance it had modest but fairly small
effects on health over intermediate
timeframes so we shouldn't lose track of
we do want to improve health
I hate health insurance is important but
the ultimate goal is how do we improve
population health and that gets lost in
all of these discussions and Hanaka so I
agree with the other panelists I think
that it's great that we're we agree on
the fact that we do need universal
health care I think that what was
01:03:04
missing was really how do we get there
the the actual plan so I've been saying
the same thing that we need a plan
written down for that and a plan forward
I am optimistic myself I think that it's
great to see a lot of people here too
that support the notion I'm assuming of
universal health care and I'm optimistic
because we have a student branch capsule
and these students will be the future
leaders of the healthcare system they
are pre-med they're pre-nursing any
health professional and along with the
01:03:37
polling that took place this past week
at the American Medical Association to
support single-payer or to take away
their official opposition to signal
single-payer
it lost by just a tiny margin it was 47
in support of taking away that
opposition to 53% but I think that the
key point is that the 47% was led mostly
by medical students so this means that
the future leaders of healthcare want
single-payer they want universal health
care they want Medicare for all so I
01:04:09
think that if we can present a plan to
move forward that there is support and
as soon as these students have the
opportunity to take action which is now
they can go ahead and speak to their
legislators be involved in these
conversations like showing up I see a
lot of young faces out there and I think
that we just need a plan to move forward
ok I like to take a moment to ask a few
more questions we have our mics out
there there's a couple right right here
in the front
01:04:40
oh ok ok I can't see the lights hi
Michelle a couple of comments burn out
I'm a family physician have been for a
long time
burnout is not because we're seeing too
many patients burnout is because we are
doing too much clerical work and
reporting too much and we're reporting
on quality issues that we didn't
determine as doctors they're quality
01:05:15
issues that the bureaucrats decided
would be a good thing to count so we
count a lot in terms of the managed care
system which I am part of at times it
really outrages me when I go downtown
and see a tall building but the managed
care insurance company's name at the top
when I go out to the valley and see tall
buildings with the insurance companies
named on the top when I go down to Long
Beach and see managed care companies
01:05:46
with their names on the top I don't have
a building with my name on the top I'm
just a doctor trying to take care of
patients but I do know that the overhead
for insurance companies is about 30
percent and the insurance and the
overhead for Medicare is about three
percent and somebody said well Medicare
negotiates its fees no Medicare doesn't
negotiate his fees they set their fees
01:06:17
and that's what we take the insurance
companies set their fees and reduce them
on a daily basis so as a primary care
physician I'm getting paid about in real
dollars the same amount of money I did
20 years ago so there's something wrong
with the system it's been chopped up
it's been turned into a medical
industrial complex and patients are
suffering because of this when we ask
01:06:47
the question or when Obama asks the
question do you like your medical care
wrong question it's do you like your
medical insurance and if you answer that
question most people don't have any idea
what the answer is they may like their
doctor though yeah thank you doctor did
you have a comment dr. Joyce well
you said a lot a lot of good things I
agree with one thing there is a bit of a
01:07:18
misnomer of Medicare being much I think
a single-payer obviously we have a very
fragmented system and there are
inefficiencies in it but I think
Medicare sometimes gets put up as this
beacon of efficiency well first all
their administrative costs tend to be
lower because it's a proportion of what
the spend is and they and it's basically
covering seniors who consume a lot of
health care so you have a small
administrative cost over a very big
denominator so it's a little misleading
in that sense in addition there's a lot
of fraud and inappropriate use within
01:07:48
Medicare where there really isn't a
financial incentive to route that out
and so I think we would clearly save
some money administrative Lee and simply
and simplifying our administrative
structure for sure but it's not of the
magnitude that you and others have to
have discussed Anthony I I appreciated
your point about the you know do do
people like their health
and I would I would postulate because
you know in dealing with insurance
01:08:19
companies at the Statehouse at the
department health care you know you know
insurers will typically say well we have
a you know 70% satisfaction rate and
eighty percent satisfaction and you know
and you know part of it as I look I said
well how many of those people actually
use care in a given year like because I
think when people most people who you
ask you know do you do you like your
health plan have not really used that
health plan in the last year because
they're healthy right that they've gone
to the doctor they've they've gone to
01:08:50
doctor once or twice they've had a good
experience and then that's fine it you
know if you really want to find out if
the health plan is good or not ask the
cancer patients as the HEA the people
who are dealing with HIV the asker you
know somebody who is who has a who's
really using it in a real way rather
than just the people who are happy to
have the card in their pocket and what
they're liking is a financial security
that comes with health coverage because
let me be clear people want and need
health coverage and it I agree with the
01:09:21
professors that actually health coverage
doesn't have a big impact on your health
because it's really about after you get
sick right you know it's a health
coverage you know hopefully gives you
the primary preventive care to help you
get healthy but it's really about the
financial security once you get sick it
really is protecting you so you're not
one emergency away from financial ruin
and so I think that as we try to so
number one I do think that there is an
opportunity to take a look and really
evaluate health plans based on the
01:09:52
people who actually use it you know
which is that 20% in any given year not
the 80% but number two I do think that
as we reform we should acknowledge how
much people really value that financial
security because and and there is really
good evidence that even the Affordable
Care Act expansions have made a big
impact on bankruptcies on foreclosures
on and also on people's anxiety about
their financial situation and so what we
need to provide and expand on is how do
we provide that financial security
01:10:23
people I I work in health care but I
think I'm much more in the business of
provide
the giving people economic security in a
broader way we had a question over here
okay so I'm just wanna good you see I
think aspect about it no the single play
we all know it's a calm way and it's
easy if you could like fifth grade and
then just give them a scenario like hey
we have like 350 million people right
now some people have like good health
01:10:58
care others don't have it you see so how
can we bring a plan that everybody can
have a health care about like five year
old or sick
I mean it won't be a but it can try to
draw a plan like everybody can have it
easy when you read the news like the me
right between us of Dallas easy and then
they defecate that the idea that the
single pay it's not gonna work
you see what I'm saying and then we
Americans like we believe in statistics
and expect and all that stuff you see
what I'm saying when they put that
01:11:28
intention in our mindset issue arms and
we don't like it's like we don't have
well nowhere to go because from hava
they say like if single pay the
economy's gonna be boom is what I'm
saying so if we educate people like
that's a hack and we also improve the
whole system you see but look know that
we we can make it work so even if we can
make it work I write and shoot our
leaders or like our despot sit down and
then bring a plan that is wrong say but
most were thing like maybe it's a cost
insurance company but if we actually set
out and then do the single page we can
01:11:59
tell to sometimes around now flood
insurance who don't mean by it
because it's expensive you see but it's
insurance company their right to sell
those insurance to people who lives in
like from a recent stuff is you can say
but they all know that health care it's
like a we treat health care like a
fashion is what I'm saying so it's like
if you have the money you can get word
about system you know but that is like
everybody's needs I will need every me
to survive in this world so I think that
we should actually plan on making the
01:12:31
single page what everybody if if it's
gonna create a problem then we should
actually take education health care in a
single sector so that like we can utter
her
focus on that that aspect with down low
passes on or anything in that case we
can actually have more focus on that
that but within like business everybody
shall I make billions of dollars it's
how to connect track you see an enemy I
don't care if you make trillions of
dollars but if so everybody gets the
same care yes well then that's what
you've made your job but if you make all
01:13:02
this money and are you doing how can you
know so what I'm hearing you say is that
you believe that health care should be a
right and so do you but do you have a
question for the panel yes my question
is like okay so the question is like
what I'm trying to say is like we've
thought we've studied we talked about
hour hour and half and most of you are
agreed on single P yeah but some people
also think nice in the pill no way is
what I'm saying because the happiest
toxicities based on day I mean what
about research they've done you see what
01:13:33
I'm saying but what I'm trying to say is
I wish me advertised like because I had
a see a hole see you on a television
saying oh we can work and work and work
single pay is not gonna work it's what
I'm saying he's a role model and if my
mother told me that the moment he said
that I'll forget about that is what I'm
saying and I think of others but I'm
trying this again I mean you can make
your millions but so people are trying
is Ron say you say Afghan Americans like
even dreaming gets one year you see but
then we are all human beings we are all
01:14:04
the same people the same as this earth
it's not for anybody it's for all of us
how to protect it so how is it that
somebody who is just sitting down
somewhere you just brought a person to
the world he doesn't me know what is
going on
Islam saying and then he has to also
suffer from some ones we can talk about
it over and over again and the issue is
that when we talk about this are we are
also overshadowing some other issues
that is important like transportation
like like like maybe what I'm saying so
what I'm trying to miss you actually sit
01:14:35
down and then have a good plan that it
can alleviate this hot case you so that
we can do away with you cuz we've come a
long way okay thank you I appreciate it
I mean one of the things that folks
should be aware about is that again I
think this good here in California even
clearly
presidential candidates on the
Democratic side are having some of this
discussion right now about what is this
what is the steps what are the paths to
get there I think at the state level
folks should recognize that the both
01:15:07
this legislature and this governor have
I have although in slightly different
ways proposed having a commission to
Council to really plan out what does
what does move in California to such a
universal system look like including a
medicare-for-all type system what does
that look like to cost it out to flesh
that out over them the next year or so
and so that's something that is is gonna
be resolved in the final budget that's
being passed in the next couple of weeks
and so we're gonna have that
conversation here in California I'm
01:15:38
recognizing that there may be obstacles
including the federal government that is
hostile to health care in general in
California and specific so how do you
know how could so what are those steps
that we can take in the meantime like
some of the things that we talked about
but but how do we plan for that feature
so that we can move forward to that
there is Winston Churchill did have a
comment though that Americans always do
the right thing after they've done
everything else so and you just follow
up on that
while there's probably near unanimous
support for some sort of universal
01:16:09
coverage in this room the Republicans
are already messaging this as socialized
medicine right well it's socialism and
Ronald Reagan called Medicare socialism
back then so oh there are segments of
the population that are clearly not in
supportive of this right now so it's so
the transition is not as simple as it
seems but I think that you really
brought up the fact that we do need to
approach this from various different
sectors so one piece is public education
like you were saying if you hear your
role model telling you that single-payer
01:16:40
isn't going to work you as a young adult
that is learning about the healthcare
system that seems so daunting of course
you're going to take the advice of your
role models so what's really missing is
public education so Kappa has created
some videos that are you know
approachable we can't have right today
we were speaking in some policy jargon
right there's a lot of people out there
that don't know anything about the
health care system I didn't know about
the health care system
growing up because I was just trying to
survive and these are the people that
01:17:11
need it the most the people on medical
the people from underserved communities
the people that are suffering because of
the social determinants of health but
using the word social determinants of
health already takes a lot of these
people out of the conversation and
that's what a lot of people don't
realize that you have to make sure that
the messaging is for the audience that
you want and the fact that we are using
words like single-payer universal
healthcare and Medicare for all
interchangeably is also causing
confusion like the kff polls have shown
01:17:42
so simple videos like the ones that CAPA
has created are would be really helpful
but I think that also making sure that
we're approaching this problem or this
goal of reaching universal health care
and single-payer from getting support
from the public getting support from
people that our legislators getting
support from health policy experts
getting support from young adults and
actually valuing their input as the
future leaders so I think that we just
need to really make sure that we
encompass many factors into this
01:18:14
movement do you know I would say more
forums like this where people are being
educated about the issues where we're
talking about the challenges and where
people are getting more engaged and
really learning about the pros and cons
of the different approaches so that we
have an educated public that isn't going
to be fearful of the unknown we have one
01:18:44
with time for just one more question so
on the state level there have been many
organizations that have been keeping
universal health care such as the Nurse
Association and then health access as
well as Kappa has been leading a lot of
the incremental change which we've
highlighted today such as individual
mandate and health for all young adults
and it's been amazing to see all of that
change so I wanted to ask what you all
see as being a priority for next year
01:19:15
what do you see the governor
prioritizing actually
taking a real approach on what does your
organization support for next year and
what what is something that is realistic
that we can support thank you
well we're gonna continue the
conversation afterwards so if we can
hold our comments go ahead so I mean I
think I want to highlight a couple of
things that are happening again you know
01:19:47
in the state budget
we we have taken some important steps to
increase affordability assistance so
that no hundreds of thousands more
Californians don't have to spend more
than the percentage of their income to
get coverage that that the debt to
expand Medicaid to more people who
currently fall through the cracks are
excluded from coverage and I think we
would like to have governor Newsom
continue on that steps to take those
steps down again not as a replacement
for the broader goal of a fully
01:20:18
universal health care system but as a
complementary effort to take those steps
toward we can without federal approval
with before we even get to the question
of you know will we have a new president
a new Congress that we could actually
deal and have that conversation with we
California can take steps now to cut the
uninsured rate in half again we went
from 20 percent uninsured down to 10
percent from 7 million uninsured down to
3 million we can cut it in half again to
the 5% that most industrialized
01:20:48
countries are at if we just here in
California in California can we let the
panel speak I I would I also want to say
that there are there are things that we
can do not just next year but in the
next couple of weeks to confront the
industry the industry with regard to
ways that they are right now taking
advantage of consumers I'll just point
to two bills in the in a limited time we
have one is on prescription drug
companies there's a practice where they
actually pay their generic competitors
01:21:20
not to compete with them so they can
continue to charge inflated rates it's
called pay for delay and there's a bill
ABA to four by assembly member Jim wood
to enforce the the two
vent this practice which now we knit we
now spend three billion dollars a years
as Americans because of inflated prices
because of this practice it's something
that Attorney General Becerra is working
on we're working with him and that bill
will be up in in committee votes in the
next couple of weeks the other bill is
on surprise medical billing ad 1611 by
01:21:53
by Assemblymember David Chiu and this is
the question where if you go to an
emergency room and it happens to be out
of network you get a bill of thousands
if not tens of thousands of dollars and
it's basically because the the hospital
has a monopoly of you at that moment
because you don't get to choose what
emergency room you go to when you're on
the gurney of an ambulance and we want
to make sure that you do not get billed
more than whatever your cost-sharing is
in your insurance plan and that the
hospital doesn't get to charge whatever
the whatever they want that they that
01:22:25
that there is a fair reimbursement but
it's not not one that inflates the cost
of the system and so that bill is
probably the biggest fight in the
legislature right now on the healthcare
industry and there will be a vote by
your state your senator including many
from from Los Angeles in the state
legislature that's a be 16 11 so those
are some actionable items that you can
take to again provide real help to real
people in the next couple of weeks
Elaine please Elaine you had some
thoughts for the move some of the other
01:22:58
things we could do in this state is
improve the Medicaid program that's a
program that's run by the state it's a
partnership between the state and the
federal government we want to protect
the gains that we've made under the
Affordable Care Act so we don't want to
go backwards but we do want to make that
program stronger and improve access to
the patients who are who are already
insured through that program another
thing we can do at the state level is
improve funding for educating healthcare
01:23:30
professionals and starting to correct
some of the mail distribution that we we
talked about earlier so I think those
are some of the incremental things that
we can do you know immediately thank you
Jason just a and I'm you all know more
about state politics than I do I
unfortunately I think the states have
had to become more innovative and
thoughtful because of the vacuum in
Washington but when we do talk about
broader healthcare issues and medicare
for all of that type of universal it
really should be federally sponsored and
supported but states are gonna have to
01:24:03
do as best they can in this vacuum I
think we can do a lot at the state level
as many of you might know that in Canada
their universal health care system
started at their province level right
and their well what they call States so
why can't California that has one of the
largest economies in the world take
action into their hands so I think that
it's important to understand and
remember that California can definitely
do a lot we hold a lot of power and we
01:24:33
can show the nation how to move forward
our ask is that our state legislature
and our governor come up with a
strategic approachable and realistic
plan to get us there
something that isn't disruptive to our
system that gets buy-in from the public
and you know we've talked a lot about
consumers who might be scared about
change that's just human nature on
something that is measurable we are
measuring how we are getting to a
universal healthcare and unified
publicly financed system on something
that clearly lays out that we want a
01:25:04
unified publicly financed system and I
just I just really think that there is a
lot that we can do and we something that
all of you can do is go to our website
see a physicians alliance org we have
our road map up there it's 20 pages you
can sign our petition to really get
support for it and to move our state to
universal health care I would like to
thank our panels our panelists at this
time thank you very much I'm halika
Ramirez dr. Jeffery Joyce dr. Alaine
Bachelor and Anthony Wright and I'd like
01:25:35
to thank all of you our audience for
being here today and participating and
asking great questions we'll be having a
reception afterwards to continue the
conversation so thank you very much I'm
Michele Faust Raghavan and this is the
KP cesium % in production