Health Care 2009 - David Wilson, Myra Christopher, Elaine McIntosh

WELCOME TO THE PRACTICAL
PERSONAL ENRICHMENT SERIES.
I'M EMILY FOWLER.
TONIGHT'S PROGRAM IS ENTITLED
HOW HEALTH CARE REFORM AFFECTS
YOU, YOUR PARENTS AND CHILDREN
AND FEATURES 3 SPECIAL GUESTS.
WE HAVE DAVID WILSON, PRESIDENT
OF THE AARP KANSAS ON THIS END
OF THE TABLE.
IN THE CENTER, MYRA CHRISTOPHER,
PRESIDENT FOR PRACTICAL
BIOETHICS AND ON THE END, ELAINE
McIN TOSH, PRESIDENT OF KC
HOSPICE AND PALLIATIVE CARE.
I LIKE TO REQUEST YOU TURN OFF
ANY PAGERS OR PHONES SO WE DON'T
DISTURB PEOPLE AROUND US.
THANK YOU.
THIS SERIES IS UNDER WRITTEN BY
THE NORMAN AND ELAINE SUPPORTING
FOUNDATION WITHIN THE GREATER
KANSAS CITY FOUNDATION IN
PARTNERSHIP WITH JOHNSON COUNTY
COMMUNITY COLLEGE.
TONIGHT'S PROGRAM IS THE SECOND
OF 7 IN 2009 AND THIS IS OUR
5th YEAR.
THESE PROGRAMS ARE NOT BEING
OFFERED ANYWHERE ELSE AND WE
HOPE YOU'LL LEARN SOMETHING
TONIGHT THAT YOU DID NOT KNOW
WHEN YOU GOT HERE.
OUR EVENING WOULD NOT BE
POSSIBLE WITHOUT NORMAN AND
ELAINE FOR WHICH THE THEATRE AND
THE SEMINAR SERIES ARE NAMED.
THEIR GENEROSITY TO OUR COLLEGE
AND ORGANIZATIONS THROUGHOUT
KANSAS CITY AND THE NATION IS
LEDGEIARY AND I'D LIKE TO TAKE
THIS OPPORTUNITY TO THANK NORMAN
WHO IS HERE TONIGHT AND ELAINE
POLSKI.
POLSKI. [APPLAUSE]
NOW I'D LIKE TO QUICKLY TAKE YOU
THROUGH THE THE PACKET WHICH YOU
WERE HANDED WHEN YOU CAME IN
TONIGHT AND WE HOPE THAT YOU'LL
TAKE THIS INFORMATION HOME AND
SHARE IT WITH YOUR FRIENDS AND
FAMILY.
AS YOU KNOW, THESE MATERIALS
WILL HELP YOU REMEMBER WHAT YOU
HEAR TONIGHT.
NORM TELLS ME WE FORGET 75% WHAT
HAVE WE HEAR, SO HAVING IT
WRITTEN DOWN IS WORTH A LOT.
LET'S GO THROUGH THE LEFT SIDE
OF THE PACKET.
ON BRIGHT GREEN, NORMAN'S 10
COMMANDMENTS, VIS OUR HOW TO
LIVE A SUCCESSFUL LIFE AND ON
THE BACK OF THAT, MY LEGACY TO
YOU, PRINCIPLES TO ACHIEVE
FINANCIAL INDEPENDENCE FROM JIM,
THE FOUNDER OF AMERICAN
RECENTURY INVESTMENTS AND
NORMAN'S EN INVESTMENT
STRATEGIES.
BEHIND THAT ON A MELLOWER COLOR
OF GREEN, THE POWER OF KINDNESS
AND THE ON THE BACK OF THAT SOME
KINDNESS QUOTES.
ON LAVENDER, THE BIOGRAPHIES AND
A LIST OF THEIR 48 ENDOWMENTS ON
THE BACK THAT SUPPORT
ORGANIZATIONS IN THE UNITED
STATES AND IN ISRAEL.
ON BRIGHT RED, THE TV SCHEDULE
FOR SPRING 2009 AND NORM WANTED
ME TO SHARE WITH YOU, WE'LL BE
REPEATING THE SALUTE TO A
GREATEST GENERATION PROGRAM
WHICH WE DID LAST NOVEMBER, 12
TIMES THIS SPRING.
SO THAT'S ONE OF OUR CLASSICS.
HE LIKES TO SHARE THAT WITH YOU.
BE SURE AND TUNE IN WHEN YOU CAN
ON CHANNEL 17, TIME-WARNER AND
SHORE WEST, CHANNEL 22 ON
COMCAST.
THEN OUR SCHEDULE OF SEMINARS
FOR THIS YEAR ON THE BACK.
THE NEXT PAGE ON T. TAN AA
LETTER WITH THE RESPONSE TO THE
CURRENT ECONOMIC SITUATION AND
THE ACTIONS HE WILL BE TAKING
UNTIL THE MARKET IMPROVES.
AND HE WANTED ME TO MENTION THAT
HE DOES AN ARTICLE EVERY
QUARTER, WHICH IS ON THE PINK
SHEET RIGHT AFTER THAT, AND IN
THE ARTICLE, HE WROTE IN JULY OF
2007, AND AGAIN IN AUGUST OF
2008, HE WAS ADVISING PEOPLE
EVEN THEN TO GETGO CASH.
GET OUT OF STOCK.
SO, WE HOPE YOU TOOK THAT
ADVICE.
BECAUSE I DIDN'T.
ANY WAY.
MOVING ON TO PINK.
THAT IS NORMAN'S ARTICLE FOR
MARCH 1 OF 2009.
AND ON THE BACK OF THAT, THE BIG
5 MUTUAL FUNDS HE HAS BEEN
HOLDING AND THINGS HE RECENTLY
SOLD.
IF YOU LIKE TO RECEIVE NORMAN'S
ARTICLE, PLEASE SEND HIM 4 SELF
ADDRESSED STAMPED ENVELOPES AND
HIS ADDRESS IS AT THE TOP OF THE
HORIZONTAL SIDE OF THAT PINK
SHEET AND HE WILL BE HAPPY TO DO
DO THAT AS HE DOES FOR AROUND
200 PEOPLE AROUND THE COUNTRY
EACH QUARTER.
ON THE YELLOW SHEET, HOW SAFE IS
OUR STOCK MARKET?
A 50 YEAR ANALYSIS ON THE RATE
OF RETURN ON STOCK INVESTMENTS.
HE WANTED ME TO REMIND YOU OVER
THE LAST 50 YEARS THERE HAVE
ONLY BEEN 12 YEARS WITH NEGATIVE
PERFORMANCE.
OVER TIME THE STOCK MARKET
ALWAYS SEEKS NEW HIGHS.
AND ON THE BACK OF THE YELLY
SHOW IS THE SYSTEM OF WEIGHTED
SCORES HE USES TO RANK HIS
MUTUAL FUNDS AND THESE SCORES
ARE USED ON THE PINK SHEET.
SO THAT IS THE LEFT SIDE OF THE
PACKET.
THEY MIX IT UP A LITTLE ON ME
THIS TIME SO YOU'LL FIND THE
GREEN QUESTION CARDS, THE SURVEY
CARDS, BLUE QUESTION CARDS,
GREEN SURSAY CARDS, IN YOUR
PACKET AS WELL.
ON THE GREEN SURVEY CARD, WE
LIKE YOUR FEEDBACK ON TONIGHT'S
PROGRAM, HOW YOU THINK THINGS
WENT.
HAVE YOU LEARNED ANYTHING?
YOU CAN ALSO SUGGEST FUTURE
TOPICS FOR US FOR FUTURE
SEMINARS, ADD YOURSELF TO THE
MAILING LIST IF YOU'RE NOT
ALREADY ON IT AND GIVE US YOUR
E-MAIL ADDRESS IF YOU LIKE TO
RECEIVE E-MAILS ABOUT THE
SEMINARS COMING UP.
AND THEN THE BLUE QUESTION CARD,
IF YOU HAVE A QUESTION FOR A
PANELIST, WE LIKE TO YOU WRITE
IT ON THIS CARD.
THE USHERS WILL COME AROUND AND
PICK THESE UP OR HAN THEM TO ME
AND WE'LL GET THEM TO OUR FOLKS
AND WE'LL GET THEM TO OUR FOLKS ON STAGE WHEN THE TIME COMES.
ON THE RIGHT SIDE OF YOUR PACKET
IS INFORMATION SPECIFIC TO
TONIGHT'S PROGRAM AND I'M NOT
GOING TO GO INTO DETAIL ABOUT
THAT.
I WOULD LIKE TO TURN IT OVER TO
OUR FIRST SPEAKER OF THE NIGHT,
DAVID WILSON, WITH AARP, KANSAS.
DAVID.
THANK YOU.
I THINK WE'LL GENWITH OUR POWER
POINT SLIDE, IF WE COULD.
THANK YOU.
IT'S BEEN QUITE A DAY TODAY.
I SPENT THE DAY AT THE CAPITOL.
THE BUDGET HEARINGS FOR THE
DEPARTMENT OF AGING WERE TODAY.
I GAVE TESTIMONY TO HOPENY HOME
AND COMMUNITY BASED SERVICES.
IT'S NOT A VERY PLEASANT
SITUATION.
THE BUDGET CUTS ARE ONGOING.
SO TODAY, AFTER ALL THAT, I WANT
TO RELAY TO YOU WHERE I SEE AS
STATE PRESIDENT OF SENIOR
ADVOCACY ORGANIZATION, THE
RAPIDLY CHANGING AND WHAT I TELL
YOU TONIGHT PROBABLY WILL BE
GIVEN TOMORROW.
THE TIGHT OF MY TALK IS THE HIGH
COST OF DOING NOTHING TO FIX
HEALTH CARE.
WE CANNOT AFFORD TO DO NOTHING.
WE ARE GOING TO HAVE TO DO
SOMETHING.
AND IT'S NOT GOING TO BE EASY.
WHAT IS AT STAKE IN WHERE WE'RE
GOING?
WAGES ARE TIGHTENING.
UNEMPLOYMENT RISES, SOARING
MEDICAL COSTS ARE SWEEPING
INDIVIDUALS.
FAMILIES AND BUSINESSES AND THE
NATION AS A WHOLE.
1-2 AMERICANS SAY SOMEONE IN
THEIR FAMILY SKIPPED PILLS,
POSTPONED OR CUT BACK ON NEEDED
MEDICAL CARE DUE TO THE COST OF
CARE.
MEDICAL EXPENSES TRIGGER NEARLY
HALF OF ALL PERSONAL BANKRUPTCY.
THE GOVERNMENT SPENDING ON
HEALTH CARE PROGRAMS IS RISING
RAPIDLY.
SO RAPIDLY THAT IT JEOPARDIZES
OTHER PRIORITIES.
THOSE OF YOU THAT HEARD ME IN MY
LAST PRESENTATION ABOUT A YEAR
AGO, THERE WAS A BUNCH OF OTHER
STATISTICS THAT ARE STILL TRUE.
AND THINGS LIKE THE UNITED
STATES RANKS 42nd IN THE
WORLD IN LIFE EXPECTANCY YET WE
PAY SO MUCH BUT WE ARE 42nd
IN LIFE EXPECTANCY.
BANKRUPTCIES ARE UP 1SCOW% IN
THE PAST 8 YEARS.
IT IS 165%.
IT'S A PHENOMENAL CRIES.
WAGES ARE TIGHTENING, MEDICAL
COSTS ARE SQUEEZING INDIVIDUALS.
THE PRESIDENT, FORTUNATELY, HAS
PROMISED TO DEAL WITH THIS
ISSUE.
WE ARE GOING TO TALK ABOUT WHAT
WE CAN DO AT THIS POINT FROM HIS
PLAN.
THE FINANCIAL BURDEN OF HEALTH
CARE WILL ONLY GET WORSE OVER
TIME WITHOUT ACTION.
AS HEALTH CARE COSTS CONTINUE TO
GROW FASTER THAN WAGES, YOUR
INSURANCE WILL BECOME MORE AND
MORE UNAFFORDABLE.
TAKE A WILL BE AT WHAT IS GOING
ON HERE WITH THE AVERAGE -- WITH
PREMIUMS FOR HEALTH CARE AND
THIS CHART HERE, THE LIGHT BLUE
REPRESENTS SENGEL FAMILY
PREMIUMS, THE DARK BLUE AS A
FAMILY.
SINGLE INDIVIDUALS, FAMILIES.
COMPARE THE YEARS 2,000 TO 2008.
EACH YEAR MORE AND MORE OF YOUR
PAYCHECKS IS BEING STIPEND OFF
TO PAY FOR YOUR HEALTH CARE
PREMIUMS WHICH ARE RISING 4
TIMES AS FAST AS YOUR WAGES.
YOUR FAMILY'S TOTAL PREMIUM,
WHAT YOU AND YOUR EMPLOYER
PARTLY CLOUDY SKIES IF YOU HAVE
AN EMPLOYER PAYING, HAS ALMOST
TRIPLED IN THE LAST 8 YEARS,
RISING TO MORE THAN 12,000
DOLLARS.
WE LOOK AT THE BAR CHART IN
2,000, AND THE AVERAGE
INDIVIDUAL PAID BOTH EMPLOYER
AND INDIVIDUAL, ABOUT 2400
DOLLARS.
FAMILIES PREMIUMS WERE ABOUT
6400.
THAT'S WHAT THE INDIVIDUAL PAYS.
IN 2008 THERE WERE 12,640
DOLLARS FOR FAMILIES.
OUT-OF-POCKET, COSTS ARE
SKYROCKETING.
ON AVERAGE, AMERICANS LIKE YOU
ARE SPENDING MORE THAN 10% OF
THEIR FAMILY INCOME ON
OUT-OF-POCKET HEALTH CARE COSTS.
OUR LEADERS FAIL TO FIX HEALTH
CARE AND RECENT TRENDS CONTINUE
OUT-OF-POCKET COSTS ARE LIKELY
TO GO UP AS WELL.
WITHOUT ACTION ON THE HEALTH
CARE SYSTEM, THE NATIONAL COSTS
WILL BE SET TO DOUBLE IN THE
NEXT 8 YEARS.
ANOTHER INTERESTING THING WE
HIGHLIGHT FOR YOU.
YOU'RE PAYING MORE FOR THE COST
OF UNCOMPENSATED CARE.
WHEN PEOPLE CAN'T AFFORD TO PAY,
THEY GO TO THE HOSPITAL.
THEY MAY GET THOSE SERVICES AND
USUALLY DO FOR FREE.
AND SOMEBODY HAS TO MAKE THAT
CALL.
GUESS WHO THAT IS?
THAT'S YOU.
IF YOU ARE PAYING FOR HEALTH
INSURANCE, IT SHOWS UP IN YOUR
HOSPITAL COSTS AND PARTICULARLY
IN YOUR HOSPITAL COSTS, YOU'RE
PAYING THE UNCOMPENSATED CARE
AND THIS IS ONE OF THE KEY
DISCUSSIONS YOU'LL HEAR ABOUT
HEALTH CARE REFORM, SHOULD WE
MANDATE HEALTH CARE?
IF EVERYBODY HAD IT, THEN TO
GIVE YOU AN IDEA OF HOW HUGE
THIS IS, THE LEFT HAND BAR IS
THE COST OF UNCOMPENSATED CARE
OF 2008.
AND THE COST OF THAT IS 5
BILLION MORE, 56,000 DOLLARS.
THAT'S 5 BILLION DOLLARS MORE
THAN THE TOTAL REVENUE THAT
MICROSOFT CORPORATION SPENT.
SO THE RIGHT HAND BAR IS THE 51
BILLION.
THAT WAS THE TOTAL REVENUE THAT
MICROSOFT HAD IN THE YEAR.
THIS IS WHY EVERYTHING COSTS SO
MUCH.
I DON'T MIND TELLING YOU I WENT
IN THE HOSPITAL FOR A TEST.
AND I'LL TELL YOU WHAT IT WAS.
IT WAS A COLONOSCOPY.
IT WOULD HAVE COST ME ALMOST
11,000 DOLLARS IF HI NO HEALTH
INSURANCE.
THAT'S THE DEAR, THE LAB AND
EVERYTHING ELSE.
THE DOCTOR THE LAB.
FORTUNATELY I PAID MORE LIKE
1,500 DOLLARS FOR THAT PO
SEEDURE.
WHY WAS IT SO MUCH?
I KEPT ASKING THAT.
WHAT I WAS TOLD IS THE
UNCOMPENSATED CARE PEOPLE AT THE
HOSPITAL HAVE TO ASSUME ALL OF
THOSE COSTS THAT THAT IS WHY
IT'S SO EXPENSIVE.
I DON'T KNOW HOW -- I WOULDN'T
HAVE DONE IT.
I WAS ON MY OWN IF I DIDN'T HAVE
HEALTH INSURANCE, I COULDN'T
HAVE AFFORDED TO DO IT.
SO THAT UNCOMPENSATED COSTS, THE
UNCOMPENSATED CARE IS WHAT IS
PUSHING UP THE COST FOR A LOT OF
PEOPLE AND WHY YOU'RE PAYING SO
MUCH AND PARTICULARLY IN
HOSPITAL COSTS.
SO, MONEY SPENT ON EMPLOYEE'S
HEALTH CARE INSURANCE IS MONEY
THAT CAN'T GO IN YOUR PAYCHECK.
IT'S COSTING THE EMPLOYERS MORE
AND MORE AND MORE TO PROVIDE
HEALTH CARE INSURANCE.
AND YOU'RE SEEING MORE AND MORE
COSTS TOO.
YOU'RE HAVING TO PAY A LARGER
SHARE OF THAT TO THE EMPLOYERS
SAYING WE CAN'T DO THIS.
YOU'RE GOING TO HAVE TO PAY MORE
FOR LESS COVERAGE.
FINANCIAL HARD SHIPS AND
MILLIONS TURN TO GOVERNMENT
HEALTH FOR HEALTH CARE.
AND BY THE I WAY, THIS IS A
LITTLE ASIDE.
THOSE WITHOUT HEALTH INSURANCE
HAS GROWN 39% SINCE 1990.
LAST YEAR 12 1/2% OF KANSANS
LACKED HEALTH INSURANCE.
THIS WEAKENING OUR ECONOMY.
IT'S HAVING A BIG IMPACT.
IT'S PRICING BUSINESSES OUT OF
HEALTH CARE.
A LOT OF BUSINESSES ARE CUTTING
THEIR HEALTH CARE ALL TOGETHER.
THEY ARE SAYING TO THEIR
EMPLOYEES, GO FIND YOUR OWN
HEALTH CARE.
OR THEY ARE OFFERING HEALTH
INSURANCE BUT OFFERING VERY
LITTLE ASSISTANCE.
IT'S FORCING BUSINESSES TO CUT
COSTS, TO SHIFT THE COST TO THE
WORKERS AND IT'S CAUSING THEM TO
HAVE TO CUT RAISES BECAUSE
HEALTH INSURANCE IS COSTING MORE
AND MORE.
IT'S ALSO BECAUSE OF THESE COSTS
GOING UP, KEEPING SALARIES AND
WAGES LOWER AND REDUCING YOUR
SPENDING POWER AND LEAVING
MILLIONS OF AMERICANS UNINSURED.
THAT'S WHAT REALLY STRUCK ME WAS
THE FACT THAT A LOT OF PEOPLE
WHO HAVE JOBS DON'T HAVE HEALTH
INSURANCE.
EMPLOYER CAN'T AFFORD IT AND THE
EMPLOYEE CAN'T AFFORD IT EITHER.
THE SHARE OF SMALL EMPLOYERS
OFFERING HEALTH INSURANCE
DECLINED AS THE COST OF COVERAGE
HAS INCREASED.
IT'S REALLY PUTTING THE HEALTH
CARE BUSINESSES AND PUNCHING
HEALTH CARE TO EMPLOYEES, THE
COST HAS INCREASED 140% OVER THE
PAST 10 YEARS.
AND COUNTLESS SMALL BUSINESS
WORKERS ARE GOING WITHOUT
INSURANCE BECAUSE 80% OF THEIR
EMPLOYERS CAN'T FIND HEALTH
INSURANCE CARE FOR THEMSELVES OR
FOR THEIR EMPLOYERS.
IF YOU LOOK BETWEEN THE YEARS
2,000 AND 2008, THE SHARE OF THE
PERCENTAGE OF EMPLOYERS OFFERING
HEALTH INSURANCE DECLINED 68%.
AND IT'S CONTINUING TO DROP.
SO IT'S FORCING THE SHIFT,
HEALTH INSURANCE ISN'T
AVAILABLE.
HEALTH INSURANCE IS VERY
EXPENSIVE AND HEALTH CARE IS
VERY EXPENSIVE.
I HAVEN'T EVEN TALKED ABOUT
PRESCRIPTION DRUGS.
SO, WE HAVE THIS HUGE GAP.
PEOPLE WHO LACK HEALTH INSURANCE
HAVE A HIGHER RISK OF DYING
PREMATURELY THAN THE INSURED
COUNTERPARTS.
THIS IS ANOTHER PRETTY AWESOME
THING.
ACCORDING TO AN INSTITUTE OF
MEDICINE REPORT, ADULTS WITHOUT
HEALTH INSURANCE ARE 25% MORE
LIKELY TO DIE PREMATURELY THAN
THOSE WITH HEALTH INSURANCE.
PREVENTIVE CARE IS CERTAINLY A
BIG KEY.
WORKPLACE IS AFFECTED, THE LACK
OF ACCESS TO QUALITY CARE LEADS
TO AVOIDABLE SICK DELAY AND
BILLIONS OF DOLLARS ARE LOST
ANNUALLY.
SO THIS IS A HUGE HUGE CRISIS.
COSTING LIVES, WORKPLACES ARE
AFFECTED, POOR QUALITY HEALTH
CARE IS COSTING OUR NATION TOO
MANY LIVES AND DOLLARS AND TIME.
NOW LET'S START TALKING ABOUT
WHAT IS GOING ON.
I COULD GO ON AND ON.
THE STATISTICS ARE AWESOME.
IN FACT, I WOULD ASK A QUESTION
I ASKED LAST TIME AND NEVER GOT
AN ANSWER TO AND PROBABLY NEVER
WILL, IS THE QUESTION, WHY IS IT
THAT WE SPEND 6,000 DOLLARS PER
PERSON PER YEAR PER HEALTH CARE
IN THE UNITED STATES AND STILL
HAVE CLOSE TO 47 MILLION PEOPLE
WITH NO COVERAGE WHILE CANADIANS
SPEND HALF THAT WE SPEND YET
HAVE LONGER LIFE EXPECTANCY,
LOWER INFANT MORTALITY RATES AND
ALL THEIR PEOPLE HAVE EQUAL CARE
AVAILABLE FOR THEM?
THAT WAS A QUOTE FROM THE AARP
BULLETIN IN 2007.
THAT IS A VERY, VERY IMPORTANT
QUESTION.
LET'S LOOK AT AARP PRIORITIES.
WHAT ARE AARP'S KEY PRIORITIES
IN HEALTH CARE REFORM?
WE ARE ENTERING A TIME WHEN WE
ARE -- I BELIEVE, WE ARE GOING
TO DEAL WITH HEALTH CARE REFORM.
IT'S A COMPLEX ISSUE.
IT INVOLVES THE STATE BECAUSE
THE STATE HAS A STEAK IN ALL
THIS.
SOME OF YOU HEARD ABOUT SOME OF
THAT GOING ON IN THE SMOKING
BANS AND THE MEDICAID, WHICH IS
PARTIALLY COVERED BY STATE
FUNDING.
THOSE ISSUES.
AND IT'S A FEDERAL ISSUE.
THIS IS KIND OF WHAT WE ARE
STANDING FOR RIGHT NOW.
THE PRIORITIES ARE MAKING
AFFORDABLE HEALTH CARE COVERAGE
OPTIONS AVAILABLE TO EVERYONE,
ESPECIALLY PEOPLE AGES 15-64,
AMONG THE FASTEST GROUP OF
GROWING GROUP OF IN INSURED.
INTERESTING THING, THE PEOPLE IS
64 GROUP GET LAID OFF.
YOU THINK A HEALTH INSURANCE
COMPANY WILL INSURE THEM?
PROBABLY NOT.
IT WOULD BE PROBABLY HARD TO GET
OR VERY, VERY EXPENSIVE TO GET.
THIS IS A HUGE GAP AND IT'S
GROWING WORSE BECAUSE OF THE
ECONOMY.
SO WE WANT TO MAKE AFFORDABLE
HEALTH CARE COVERAGE AVAILABLE
TO EVERYONE BUT WE WANT TO PAY
ATTENTION TO THE HOLES OPENING
UP AND THE DANGERS THAT IT
MAKES.
NUMBER 2, WE WANT TO KEEP
MEDICARE AFFORDABLE BY REWARDING
DOCTORS AND HOSPITALS FOR
QUALITY RATHER THAN QUANTITY OF
CARE.
AND WE WANT TO PROMOTE
PREVENTION IN HEALTHY BEHAVIORS.
ONE WAY TO CONTROL HEALTH COSTS
IS TO PREVENT FROM GETTING ILL.
AND THAT MIGHT BE MEANING
EXERCISING, MIGHT BE SEEING YOUR
DOCTOR REGULARLY OR ESTABLISHING
A REGULAR RELATIONSHIP WITH A
DOCTOR OR OTHER PROVIDER AND
THEY BECOME -- YOU'LL HEAR THIS
TERM A LOT -- YOUR MEDICAL HOME
THAT.
PERSON OR ORGANIZATION THAT
KNOWS YOU VERY WELL AND CAN HELP
GUIDE YOU THROUGH THE SYSTEM.
WE WANT TO CERTAINLY ELIMINATE
BROAD WASTE AND ABUSE.
NOTHING MAKES ME MADDER THAN TO
SEE THE WASTE AND ABUSE THAT
OCCURS IN OUR HEALTH CARE SYSTEM
IN PROGRAMS LIKE MEDICARE AND
MEDICAID.
FINALLY WE WANT TO IMPROVE CARE
COORDINATION FOR PEOPLE WITH
CHRONIC CONDITIONS AND HELP THEM
STAY IN THEIR HOMES AND OUT OF
INSTITUTIONS.
WHETHER IT'S LONG-TERM CARE,
WHETHER IT'S SHORT-TERM CARE OR
HOSPITALS, PEOPLE DO FAR BETTER
IN THEIR HOMES AND THEY TRY
BETTER IN THEIR HOMES.
NOW LET'S TALK ABOUT HEALTH CARE
REFORM FOR THE OBAMA
ADMINISTRATION.
THIS IS GOING DO GIVE US SOME
CLUES, ALTHOUGH NOT ABSOLUTE.
THIS IS A CHANGING PICTURE ON
HEALTH CARE REFORM.
IT'S RAPIDLY CHANGING BUT THERE
ARE SOME THINGS THAT OCCURRED
THAT ARE IMPORTANT FOR YOU TO
KEEP IN YOUR MIND AND IT MAY
VERY WELL GIVE YOU AN IDEA ABOUT
WHAT TO EXPECT IN THE NEXT 6-9
MONTHS, PERHAPS.
FIRST OF ALL, THE ECONOMIC
STIMULUS BILL, THE AMERICAN
RECOVERY AND REINVESTMENT ACT OF
2009, AND DEALT WITH HEALTH CARE
REFORM AND ECONOMIC RECOVERY.
NOW THESE ARE VERY CLOSELY
RELATED.
I HEARD A LOT OF PEOPLE, DEAL
WITH THE ECONOMIC RECOVERY AND
FORGET ABOUT HEALTH CARE REFORM.
YOU CAN'T DO IT.
THEY ARE SO TIED TOGETHER IT'S
UNBELIEVABLE.
THE HEALTH OF BUSINESSES SO TIED
TO THE HIGHER COST OF HEALTH
CARE AND INSURANCE THAT THEY ARE
STRAPPED.
INDIVIDUALS WHO EITHER HAVE JOBS
CAN'T AFFORD INSURANCE OR CAN'T
AFFORD TO PAY THE COPAYS OR
DEDUCTIBLES.
IT'S ALL TIED TOGETHER.
AND THEN OF COURSE WHEN PEOPLE
LOSE THEIR JOBS, THERE IS THAT
ISSUE OF HEALTH CARE.
SO, AND WHAT IS SURROUNDING
THIS, HEALTH CARE IS GETTING
MORE EXPENSIVE.
SO IT IS A REAL SPIRAL AND
HEALTH CARE HAS TO BE DEALT
WITH.
NOW THIS IN THIS ECONOMIC
STIMULUS BILL IS CONTROVERSIAL.
I'LL GRANT YOU THAT.
IT'S A COMPLEX PLAN OF
EXPENDITURES AND TAX CUTS WITH
THE HELP OF REVIVING A
STRUGGLING NATIONAL ECONOMY.
CONGRESS APPROVED AND THE
PRESIDENT OBAMA SIGNED, THE $789
BILLION MEASURE THAT INCLUDES
NEARLY $3BILLION IN TAX CUTS AND
MORE THAN $450 BILLION IN NEW
SPENDING, MOST ALLOCATED OVER
THE NEXT FEW YEARS.
NOW LET'S LOOK FOR MORE DETAILS
ABOUT THIS.
AND IT WILL GIVE US AN INSIGHT
AS TO HOW THE HEALTH CARE SYSTEM
IS HURTING AND SOME OF THE
THINGS THAT ARE BEING DONE
IMMEDIATELY IF NOT ON A
LONG-TERM BASE.
THIS BILL, THE ECONOMIC RECOVER
BILL OF THE AMERICAN RECOVERY
REINVESTMENT ACT OF 2009
PROVIDES A SIGNIFICANT INCREASE
IN MEDICAID SPENDING THAT WILL
HELP STIMULATE THE ECONOMY AS A
CURRENT ECONOMIC DOWNTURN CAUSES
CASE LOADS TO RISE WHILE STATE
REVENUES PLUMMET.
LET ME EXPLAIN.
MEDICAID IS A PROGRAM FOR PEOPLE
OF LOW-INCOMEES TO PROVIDE A
WIDE RANGE OF MEDICAL SERVICES
AND EVEN LONGER CARE.
THE COST FOR IT ARE SHARED
BETWEEN THE STATES.
AND THE FEDERAL GOVERNMENT.
IT IS AN ENTITLEMENT PROGRAM,
THE STATE HAS TO DO THIS.
AND THE STATE DOES HAVE CONTROL
OVER THE PROGRAM IN THE SENSE
THAT IT HAS THE ABILITY TO SET
THE RULES AS TO THE
QUALIFICATIONSFUL HOW MUCH IT
PAYS, THAT IS ALL SET BY THE
STATE.
AND THE STATE OF COURSE CAN
MATCH IT UP TO THE LIMITS THAT
IT WAS ABLE TO ESTABLISH.
NOW IN THIS PARTICULAR PROGRAM,
AS THE ECONOMY SOURS AND GOES
DOWNHILL, THE NUMBER OF CASE
LOADS, IN OTHER WORDS, THE
NUMBER OF PEOPLE WHO DON'T HAVE
ENOUGH FUNDS HAVE TO TURN TO
MEDICAID, ARE INCREASING.
AND YET, THE STATE WHO
ULTIMATELY GETS THE BILL, THEIR
REVENUES ARE DROPPING
PRECIPITOUSLY AND YOU ALL HEARD
ABOUT THE REVENUES DROPPING IN
BOTH KANSAS AND MISSOURI.
SO, WHAT THE STIMULUS BILL DOES
IS PROVIDE A SHORING UP OF
FEDERAL DOLLARS OF THE MEDICAID
PROGRAM TO CONTINUE THOSE
SERVICES.
THIS ACT ALSO PROVIDES ESSENTIAL
BUILDING BLOCKS FOR HEALTH CARE
REFORM SETTING THE STAGE,
INCLUDING SUPPORT FOR HEALTH
INFORMATION TECHNOLOGY THAT
INCLUDES CRITICAL PRIVACY
PROTECTIONS, HEALTH CARE
COMPARATIVE REACH EFFECTIVENESS
RESEARCH, NURSE AND PRIMARY
CARE.
ONE OF THE KEY PROBLEMS AND
ISSUES WE DEALT WITH IN HEALTH
CARE REFORM IS HOW WE EXCEED
THESE INFORMATION.
BELIEVE ME, IT'S AMAZING HOW
MUCH IS BUILT OL THE PACKETS OF
PAPER, YOU'RE RECORDS GO FROM
THE DOCTOR TO THE NURSING HOME
TO THE HOSPITAL AND BACK AGAIN.
AND IT'S A BIG PILE OF PAPER AND
WE HAVEN'T FIGURE ID OUT WAYS OF
DOING OR GETTING RID OF THE
PAPER.
WHEN I PERSONALLY HAVE GONE IN
FOR HEALTH CARE, HI HAD TO GIVE
MY COMPLETE RECORD 2-3-4 TIMES
OVER AND OVER AND OVER AGAIN.
A LOT OF WASTE THERE.
WE ARE TALKING ABOUT WANTING TO
PROTECT PEOPLE.
WE ARE ALSO TALKING ABOUT
COMPARATIVE EFFECTIVENESS
RESEARCH.
RESEARCH THAT DOCTORS CAN USE ON
WHAT WORKS AND WHAT DOESN'T
WORK.
AND ALSO ALLOWING YOU AS THE
PUBLIC TO SEE THIS INFORMATION
SO YOU CAN ASK INTELLIGENT
QUESTIONS.
THAT'S PART OF THOSE BUILDING
BLOCKS.
MORE ELEMENT, AFFORDABLE HEALTH
CARE INSURANCE, BY A SUBSIDIZED
COBRA.
THE COMPREHENSIVE OMNIBUS BUDGET
RECONCILIATION ACT IS BASICALLY
ALLOWING YOU TO CONTINUE YOUR
HEALTH INSURANCE THAT YOU HAVE
WITH YOUR EMPLOYER AFTER YOU
LEFT THE EMPLOYMENT.
AND THE PROBLEM IS HUGELY
EXPENSIVE.
DOUBLE, TRIPLE THE PREMIUMS IN
MANY CASES.
AND SO WHEN PEOPLE LOST THEIR
JOBS IN THE DOWNTURN, THEY HAVE
NOT BEEN ABLE TO TAKE ADVANTAGE
OF THE COBRA LEGISLATION AND SO,
THE RECOVERY AND ECONOMIC
STIMULUS BILL WOULD HELP
SUBSIDIZE THOSE COBRA PAYMENTS
SO PEOPLE CAN AFFORD THEM AND
STAY INSURED.
INCREASE FOOD STAMPS AND
NUTRITION SUPPORT.
IF YOU'RE NOTE EATING WELL,
YOU'RE NOT GOING TO BE HEALTHY.
AND TRANSPORTATION
INFRASTRUCTURE PROJECTS,
MOBILITY OPERATIONS.
WHAT HAS THAT GOT TO DO WITH IT?
YOU LIVE IN WESTERN KANSAS, MOW
BUILT SEA HUGE ISSUE AND IT'S
TRUE IN KANSAS CITY.
HOW DO YOU GET TO THE DOCTOR?
HOW DO YOU GET TO THE
PHARMACIST?
HOW DO YOU GET TO THE THERAPY
YOU MIGHT NEED?
ALL OF THIS IS ALL INNER PLAYING
IN THAT.
NOW THE LATEST MOVES OF COURSE
INVOLVES THE FACT THAT THE
PRESIDENT HAS BEGUN HEALTH CARE
REFORM WITH HIS LATEST BUDGET
RECOMMENDATIONS FOR 2010.
IT IS AN OUTLINE.
IT IS A BUDGET FOR THE
DEPARTMENT OF HEALTH AND HUMAN
SERVICES, HHS, AND I'LL TALK
ABOUT THAT IN A MINUTE.
76.8 BILLION, DOWN SLIGHTY FROM
78.4 BILLION IN FY209 BUT THE
STIMULUS PACKAGE INCLUDES
ANOTHER 22.4 BILLION IN RELATED
SPENDING.
IN THE BUDGET PROJECTIONS THAT
PASSPORT OBAMA IS PROVIDING, HE
PUT IN A PLACE HOLDER.
WE STILL DON'T KNOW ALL THE
DETAILS.
634 BILLION IN HEALTH CARE
RESERVED FUNDS DESIGNED TO BEGIN
TO HELP COVER THE COST OF
OVERHAULING THE HEALTH CARE.
WHY CAN'T HE SAY SPECIFICALLY?
HE CAN'T.
JUST SO MANY MOVING PARTS IN ALL
THIS.
NOW, THIS RESERVE FUND HAS
CAUGHT A LOT OF STATIC.
AND IT IS REFERRED TO AS THE
DOWN PAYMENT ON THE HEALTH CARE
REFORM SYSTEM.
IT'S FINANCED IN PART BY
SQUEEZING 316 BILLION IN
EFFICIENCIES OUT OF THE CURRENT
HEALTH CARE SYSTEM BY ALIGNING
INCENTIVES TOWARDS QUALITY,
PROMOTING EFFICIENCY AND
ACCOUNTABILITIY AND ENCOURAGING
SHARED RESPONSIBILITY.
THE RESERVE FUND IS ALSO
FINANCED IN PART BY REBALANCING
THE TAX CODE.
THE WEALTHIEST WILL PAY MORE.
THE BUDGET WILL REQUIRE HIGHER
INCOME SENIOR CITIZENS IN THE
MEDICARE DRUG PROGRAM TO PAY
HIGHER DRUG PREMIUMS.
THAT'S HIGHER INCOME FOR
SENIORS.
SO THERE ARE VERY CONTROVERSIAL
PARTS TO ALL THIS.
NOW, ONE GOOD THEN AS WE ALL
KNOW, IS THAT THE GOVERNOR HAS
BEEN APPOINTED SECRETARY OF THIS
HUGE AGENCIES, HHS.
I SAY I THINK THAT'S A GOOD
IDEA.
I THINK SHE WILL BE VERY GOOD AT
IT.
IT'S PROBABLY GOING TO BE THE
MOST DIFFICULT JOB SHE WILL EVER
HAVE THAT A LOT OF PEOPLE HAD
EVER HAVE IN REFORMING THE
HEALTH CARE SYSTEM, BUT IT HAS
TO BE DONE.
THE LAST ATTEMPT AT MAJOR HEALTH
CARE REFORM IS 16 YEARS AGO.
WITH PRESIDENT CLINTON.
HIS APPROACH WAS VERY DIFFERENT
FROM WHAT PRESIDENT OBAMA HAS
DONE.
PRESIDENT CLINTON KIND OF PULLED
TOGETHER A PLAN A LITTLE BIT OF
SECRECY AND THEN SAID, HERE IT
IS.
PRESIDENT OBAMA HAS TAKEN A VERY
DIFFERENT APPROACH APPROACHING
IN A VERY OPEN WAY.
YOU MY HAVE READ ABOUT THE
HEALTH CARE SUMMIT HE JUST HAD.
AND THAT IS A GOOD SIGN.
YOU'RE GOING TO KNOW WHAT THE
PLAN IS BUT IT'S NOT GOING TO BE
AN EASY THING BECAUSE THERE WILL
BE PARTS IN THIS SOME PEOPLE
WILL LIKE AND SOME PEOPLE WON'T.
IT'S PART OF POLITICS.
THE REPUBLICANS DON'T LIKE THIS.
THE DEMOCRATS DON'T LIKE THIS.
AND WE GET GRIDLOCKED.
WE HAVE TO BREAK THAT GRIDLOCK.
FINALLY, PRESIDENT OBAMA SAID,
HEALTH CARE REFORM IS NO LONGER
JUST A MORAL IMPERATIVE.
IT'S A FIGS CALL COMPARATIVE.
NOW MY FINAL COMMENTS
ARE -- THAT'S NOT MY FINAL
COMMENT.
SOME INITIAL COMMENTS THAT I
JUST QUICKLY WANT TO GO THROUGH.
DON'T LISTEN TO RUMORS.
I'M AMAZED AT THE NUMBER OF
PEOPLE WHO SAY, I HEARD THAT WE
ARE ALL GOING TO HAVE TO PAY
DOUBLE THE TAXES.
AND THIS IS FROM AN INDIVIDUAL
THAT PROBABLY IS AT OR BELOW ANY
POVERTY LEVEL THAT YOU COULD
POSSIBLY IMAGINE.
THERE ARESOME RUMOR AMONGERRING
GOING ON.
PLEASE BE CAREFUL.
THERE IS SO MUCH RUMORS GOING
ON.
SECOND THING IN TERMS OF
SURVIVING IS VERY, VERY
DIFFICULT TIMES.
TAKE CARE OF YOURSELF.
YOU WANT TO AVOID HEALTH CARE
COSTS, TAKE CAKE OF YOURSELF.
I WENT OUT AND I NOW EXERCISE
EVERY DAY AND I'M DIETING DOING
WEIGHT WONNERS.
I HATE IT.
I LOVE TO EAT.
BUT I GOT TO DO THAT.
AND IT DOES REALLY DOES MAKE A
BIG DIFFERENCE.
NUMBER 3, CHECK OUT YOUR
CHANGING BENEFITS.
RESOURCES UNDER THE STIMULUS
BILL.
THE COBRA, CHANGES MEDICAID AND
SOCIAL SECURITY STIMULUS
PAYMENTS.
A NUMBER OF THINGS IN THERE THAT
MAY BENEFIT YOU DEPENDING UPON
YOUR SITUATION.
DON'T BE AFRAID TO CALL AND ASK
FOR HELP.
AREA AGENCIES ON AGING IF YOU'RE
A SENIOR.
THE KANSAS DEPARTMENT ON AGE,
THE SHIFT PROGRAM, A PROGRAM
THAT HELPS YOU FIND AFFORDABLE
QUALITY HEALTH INSURANCE TO
ANSWER YOUR QUESTIONS.
OR OTHER STATE AND COUNTY
PROGRAMS.
AND WHY YOU SHOULDN'T BE AFRAID,
YOU PAID FOR THEM.
THESE ARE YOUR AGENCIES.
YOU PAID FOR THEM THROUGH YOUR
TAXES.
MAKE GOOD USE OF THEM.
NOW MY WIFE SAY SOCIAL WORKER
AND SAYS THAT'S FINE, BUT WHERE
DO YOU FIND OWL THOSE?
THERE ARE SEVERAL DIFFERENT
WAYS.
THE EASEDDIEST IS TO GET ON THE
INTERNET.
GO TO THE STATE OF KANSAS,
GOOGLE THE STATE OF KANSAS AND
LOOK THERE, THE KANSAS
DEPARTMENT ON AGING.
YOU WILL FIND OUT ABOUT THIS
RELATIONSHIP PROGRAM AND IT WILL
HELP YOU SORT OUT MEDICARE,
MEDICAID, PART D PRESCRIPTION
DRUGS.
THAT'S WHAT THEY ARE THERE FOR.
IT WILL SHOW YOU WHERE THE AREA
AGENCIES ON AGING IS.
AND YOU CAN PICK UP YOUR
TELEPHONE BOOK ON THE AREA
AGENCIES ON AGING.
THESE ARE WONDERFUL RESOURCES.
THEY ARE GREAT.
THEY WORK REALLY HARD AND THEY
ARE THERE FOR YOU BECAUSE YOU
PAID FOR THEM.
DON'T BE AFRAID TO USE THEM.
NUMBER 2, CHECK OUT AARP.
I'M PROUD OF IT.
AARP HAS LOTS OF INFORMATION.
IF YOU HAVEN'T BEEN TO THE
WEBSITE, YOU NEED TO BE.
THERE IS LOTS OF GOOD
INFORMATION THERE.
AND FINALLY, BE INFORMED AND
SPEAK OUT.
I THINK THIS LAST ELECTION WAS A
GREAT EXAMPLE OF THAT.
BUT THE BEST THING, YOU HAVE TO
BE INFORMED.
TAKE THE TIME TO READ.
VISIT THE AARP WEBSITE.
THERE IS LOTS OF INFORMATION
THERE ABOUT HEALTH CARE REFORM
AND HEALTH CARE.
AND BE INVOLVED.
THAT'S WHAT I HAVE TO SAY.
NOW I CAN SAY THANK YOU VERY
MUCH AND I GUESS WE'LL BE
AVAILABLE FOR QUESTIONS TOWARDS
THE END.
I THINK DAVE HAS GIVEN A
REALLY GOOD OVERVIEW WHAT HAVE
WE KNOW ABOUT HEALTH CARE REFORM
AT THIS POINT.
BUT THERE IS MORE UNKNOWN ABOUT
HEALTH CARE REFORM AT THIS POINT
THAN THERE IS KNOWN.
WHAT I WOULD SUGGEST TO YOU IS
THAT YOU MIGHT WANT TO LOOK AT
THE COMMONWEALTH FUND WEBSITE.
MANY PEOPLE BELIEVE THAT OBAMA
BIDEN PLAN IS FUNDAMENTALLY
BASED ON A REPORT THAT A
COMMISSION IS A COMMONWEALTH
FUND DEVELOPED THIS TITLE, THE
PATH TO A HIGH PERFORMANCE U.S.
HEALTH SYSTEMS, A 2020 VISION
AND THE POLICIES TO 55 THE WAY.
IT'S AVAILABLE ON YOUR WEBSITE
AND IT'S FREE TO YOU.
AND IT'S BASICALLY IS AN OUTLINE
OF WHAT DAVE JUST ARTICULATED.
THE HEALTH CARE AND
INSURANCE -- NATIONAL INSURANCE
EXCHANGE WHERE THERE WAS A
PUBLIC PRIVATE INSURANCE POOL.
IT WOULD BE REQUIRED THAT ALL
PEOPLE WOULD HAVE INSURANCE.
MOST FELT PRIMARY CARE AND IN
PARTICULAR A PRIMARY HOME.
MORE EVIDENCE BASED
DETERMINATIONS ABOUT
REIMBURSEMENT AND BUNDLED
PAYMENT MECHANISMS, INCREASED
USE OF HEALTH NEVERTHELESS
TECHNOLOGY AND POPULATION
APPELLATE POLICY TO ROW MOAT
HEALTH AND WELNESS.
SOME OF YOU WILL KNOW HIM,
DR. JIM, THE FORMER CEO OF
TRUEMAN MEDICAL CENTER WAS
CHAIRMAN OF THE COMMONWEALTH
FUND COMMISSION.
IT'S A VERY WELL THOUGHT OUT
DOCUMENT ABOUT 25 PASSAGES.
BUT THERE IS AN EXECUTIVE
SUMMARY.
I ENCOURAGE YOU TO READ IT.
I WANT TO TALK ABOUT HEALTH CARE
REFORM IN A MORE NARROW WAY
TONIGHT.
I WANT TO TALK ABOUT A NARROW
BUT A VERY ESSENTIAL PIECE TO
REFORM.
LAST WEEK, JIM WAS SPEAKING
BEFORE THE GREATER BOSTON
CHAMBER OF COMMERCE AND I'M
GOING TO READ A SMALL QUOTE FROM
HIS REMARKS TO YOU.
JIM SAID, AS THE ECONOMY WORSENS
AND UNEMPLOYMENT AND GOVERNMENT
BUDGET DEFICITS FLOW, EXPLODING
HEALTH CARE COSTS ARE BECOMING A
HOTTER ISSUE THAN EVER.
ONE OF THE VERY BIGGEST
CHALLENGES TODAY ISN'T MEDICAL
OR FISCAL.
IT'S THE ETHICAL CHALLENGE OF
LETTING LIFE IN.
END OF LIFE ISSUES WILL BECOME
EVEN MORE SIGNIFICANT AS
MEDICINE ADVANCES AND SOCIETY
AGENCIES.
I THINK YOU NAILED IT.
MEDICAL CARE AT THE END OF LIFE
CURRENTLY CONSUMES 10-12% OF OUR
ENTIRE HEALTH CARE BUDGET.
OUR ENTIRE EXPENDITURE ON HEALTH
CARE.
IF YOU LOOK AT JUST MEDICARE
BUDGETS, JUST THE MEDICARE
BUDGET, IT'S IT INCLUDES 27%,
ALMOST A THIRD OF THE ENTIRE
MEDICARE BUDGET.
NOW CONFOUNDING THIS IS THAT MY
GENERATION, THE BABYBOOMER
GENERATION, I'M ONE OF THE
OLDEST BABYBOOMERS ALIVE, HAVE
JUST BEGUN THE LAST CHAPTER OF
OUR LIVES.
THE CENTERS FOR DISEASE CONTROL
WITH WHOM MY ORGANIZATION, THE
CENTER FOR PRACTICAL EYE ETHICS
HAS BEEN WORKING THE LAST 5
YEARS, ESTIMATES BY 2030, THE
NUMBER OF PEOPLE WHO ARE 65 OR
OLDER, THAT IS ELIGIBLE FOR
MEDICARE, AND THE POPULATION
MOST LIKELY TO DIE, WILL DOUBLE
TO NEARLY 72 MILLION PEOPLE.
NOW YOU DO THE MATH.
AND IMAGINE THE COST
IMPLICATIONS TO THE HEALTH CARE
BUDGET.
THEY ARE STAGGERING.
IF WE CAN GET OR TYPESET TO
PROVIDE END OF LIFE CARE, WHICH
IS NOW, FOR MORE THAN TWO
DECADES, MY ORGANIZATION AGAIN,
THE CENTER FOR PRACTICAL
BIOETHICS HAS WORKED DILIGENTLY
TO INCREASE CARE OFA SERIOUSLY
ILL AND DYING FAMILY.
WE WORKED ON IT FROM VIRTUALLY
EVERY ASPECT, NATIONAL HEALTH
POLICY REFORM.
WE HAD THE PRIVILEGE OF WORKING
WITH AARP, WE WORKED ON IT AT
THE STATE LEVEL.
WE HAVE SPENT A LOT OF ENERGY ON
IT AND WORKED ON IT FROM AN
INDIVIDUAL PERSPECTIVE.
EDUCATION AND ADVOCACY.
IT'S MY OPINION, NOW THIS IS MY
OPINION, NOT THE CENTERS
OPINION, THAT WE ABSOLUTELY MUST
HAVE NATIONAL HEALTH CARE
REFORM.
16 YEARS OR 20 YEARS AGO, I WAS
COCHAIR OF A COMMISSION IN
KANSAS WHERE WE TRIED TO DO
HEALTH CARE REFORM AT THE STATE
LEVEL.
WITH FORMER CONGRESSMAN BILL
ROY, FROM WATCH TA.
WE WORKED ON THAT TOGETHER FOR 3
YEARS.
WHEN PRESIDENT CLINTON WAS
ELECTED, ALL THE STATES FELL
LIKE A HOW LONG OF CARDS BECAUSE
THE STATE LEGISLATORS DIDN'T
HAVE THE -- MAYBE IT WAS THE
MORAL WILL, TO FOLLOW-THROUGH
WITH THE WORK THAT HAD BEEN
DONE.
THEY WANTED TO GIVE THAT TO THE
FEDERAL GOVERNMENT AND WE KNOW
WHAT HAPPENED WITH THAT EFFORT.
BUT JUST AS MUCH AS WE NEED
NATIONAL HEALTH CARE REFORM, WE
MUST HAVE EDUCATED CONSUMERS AND
THAT IS SOMETHING THAT AARP HAS
DONE A WONDERFUL JOB OF IS
TRYING TO EMPOWER PEOPLE WITH
INFORMATION TO ACCEPT
RESPONSIBILITY FOR MAKING
INFORMED CHOICES ABOUT HEALTH
CARE.
I THINK CHOICES ABOUT END OF
LIFE CARE ARE PARTICULARLY
IMPORTANT AND NOT JUST FROM AN
ECONOMIC PERSPECTIVE.
I THINK THEY ARE SO IMPORTANT
BECAUSE OF THE EXPERIENCES OF
INDIVIDUALS AND THEIR FAMILIES.
BUT WE ARE NOT THERE.
OVER AND OVER AGAIN FOR ALL THE
RIGHT REASONS, AND BY THAT, I
MEAN PEOPLE WHO ARE TRYING TO
MAKE GOOD DECISIONS FOR THOSE
THEY LOVE, I SEE FAMILIES MAKING
CHOICES THAT END UP IN
NIGHTMARISH SCENARIOS FOR THEIR
LOVED ONES AND RESULT IN
PERMANENT DAMAGE TO THE FAMILIES
UNIT BECAUSE OF THE CONFLICT
THAT EMERGING IN THAT PHASE OF
LIFE.
THE ORIENTATION OR BIAS OF THE
AMERICAN PUBLIC IS THAT MORE
HEALTH CARE IS BETTER HEALTH
CARE.
AND THAT THE MORE EXPENSIVE CARE
IS, THE MORE EXCELLENT THE CARE
IS.
AND AT THE END OF LIFE, THE DATA
JUST DOES NOT SUBSTANCE 8 THOSE
BELIEFS.
IT IS NOT THE TRUTH.
AND IN FACT, THE REVERSE IS MOST
OFTEN THE CASE.
WE KNOW WHAT AMERICANS WANT IN
LIFE.
THERE ARE MOUNTAINS OF DATA.
THERE ARE DOZENS OF STUDIES.
STUDIES ABOUT THIS ISSUE AND THE
GOOD NEWS IS THAT THE DATA HOLD
TRUE ACROSS SOCIAL, CULTURAL,
ETHNIC AND ECONOMIC LINES.
AT THE END OF LIFE, PEOPLE WANT
TO BE AT HOME IF THEY CAN BE.
THEY WANT THEIR PAIN CONTROLLED.
THEY WANT THEIR SYMPTOMS
MANAGED.
THEY WANT TO BE TREATED AS WHOLE
PERSONS, NO, SIR AS THE CANCER
IN ROOM 433.
THEY WANT TO BE TREATED WITH
DIGNITY AND WANT TO KNOW THEIR
FAMILY WILL BE CARED FOR, THAT
THEY ARE NOT AN UNDUE BURD OWN
THEIR FAMILY AND THEIR WISHES
ARE HONORED WHEN THEY ARE KNOWN.
SOUNDS A LOT LIKE HOSPICE TO ME.
YET, BECAUSE OUR PHYSICIANS HAVE
HAD POOR TRAINING IN THIS AREA,
AND HAVE A VERY, VERY DIFFICULT
TIME DELIVERY BAD NEWS, AND
BECAUSE OUR REIMBURSEMENT
MECHANISMS ARE SO SCREWED UP,
THEY ARE ALL ABOUT PERVERSE
AROUND THIS AREA.
AND BECAUSE WE DESPERATELY WANT
TO HOLD TO MORE IS BETTER AND
EXPENSIVE MEANS EXCELLENCE, MOST
PEOPLE IN OUR COUNTRY STILL GET
THE OPPOSITE OF WHAT THE VAST
MAJORITY OF PEOPLE SAY THEY
WANT.
THE MAJORITY OF PEOPLE IN THIS
COUNTRY STILL DIE IN INTENSIVE
CARE UNITS, ISOLATED FOR LONG
PERIODS OF TIME, SEPARATE FRIDAY
THEIR FAMILIES, FROM THEIR PETS,
FROM THEIR TREASURED BELONGINGS.
MANY, MANY ARE UNCONSCIOUS AT
THE TIME OF DEATH AND FOR LONG
PERIODS OF TIME.
OF THOSE WHO ARE CONSCIOUS, MOST
OF THEM WERE TOLD WE CAN MANAGE
59.
OF THOSE WHO ARE CONSCIOUS, MOST
OF THEM ARE IN PAIN AT THE TIME
OF THEIR DEATH.
WE HAVE GOT TO DO A BETTER JOB
THAN THIS.
I BELIEVE, AND THIS AGAIN THERE
IS A SUBSTANCE OF DATA TO
SUPPORT THIS BELIEF, THAT THE
KEY TO REVERSING THIS SITUATION
IS EMPOWERING THE CONSUMER.
IT IS GETTING FAMILIES TO TALK
DIRECTLY ABOUT THESE ISSUES AND
GETTING INDIVIDUALS TO NAME
DURABLE POWERS OF ATTORNEY FOR
HEALTH CARE DECISIONS.
IN YOUR PACKET TONIGHT, WE
PROVIDED TO YOU A DOCUMENT
CALLED CARING CONVERSATIONS.
THIS IS A DOCUMENT THAT AARP
HELPED US IN 15 STATES.
IT'S A DOCUMENT FOR THE CENTER
OF PRACTICAL VIOLENCE.
I'M NOT HERE TO SELL THAT YOU
DOCUMENT.
THERE ARE MANY, MANY GOOD TOOLS.
IT IS ON HOUR WEBSITE AND IT IS
FREE.
SO IF WERE SELLING IT TO YOU I
WOULDN'T MAKE MUCH PROFIT NOW
WOULD YOU I?
BUT IT IS A TOOL TO HELP
FAMILIES HAVE A TYPICAL
CONVERSATION.
WE THAN SOMETIMES THE MOST
IMPORTANT CONVERSATIONS ARE
DIFFICULT CONVERSATIONS TO HAVE.
SO WE CREATED THIS TOOL TO
HOPEFULLY HELP FAMILIES AND WHEN
I SAY FAMILIES, I MEAN ENT MAT
RELATIONSHIPS.
I DON'T MEAN NECESSARILY BLOOD
KIN, TO HAVE THESE CONVERSATIO
CONVERSATIONS.
I THAN WHEN FAMILIES HAD
CONVERSATIONS AND WHEN DIFFICULT
DECISIONS HAVE TO BE MADE, THAT
FAMILIES AREN'T OUT IN THE
HALLWAY OF THE ICU UNIT FIGHTING
OVER THAT MOM LOVED ME MOST OR
YOU MOST.
THEY AREN'T FIGHTING OVER WHAT
MOM SAID SHE WANTED.
THEY KNOW WHAT MOM SAID SHE
WANTED.
AND I HEAR OVER AND OVER AND
OVER AGAIN, WHAT A GIFT MY MOM
GAVE ME OR WHAT A GIFT MY DAD
GAVE ME BY HEARING IT.
AND WE HAD THE PEACE OF MIND OF
KNOWING THAT WE WERE DOING WHAT
HE OR SHE WANTED.
CONFLICT ARISES WHEN THESE
CONVERSATIONS HAVE NOT HAPPENED.
BUT WHEN THEY HAVE, AND THE
CONFLICT HAS OCCURRED, AND
CONFLICT ARISES, PEOPLE CAN GO
BACK TO THOSE CONVERSATIONS AND
KIND OF RECALIBRATE AND SAY, NOW
LET'S GET REFOCUSED HERE ON WHAT
DAD SAID HE WANTED OR WHAT MOM
SAID OR WHAT UNCLE JOHN SAID.
AND LET'S TRY TO FOCUS ON WHAT
WE DO TO RESPECT THEIR WISHES
AND TO HONOR THE LIVES THEY
LIVED.
NOW, ELAINE AND I RENTLY HAD A
GLASS OF WINE AND TALKED ABOUT
OUR SHARED WORK.
AND JUST ONE.
[LAUGHTER]
I SAID TO HER, THERE ARE MANY,
MANY DAYS THAT I FEEL LIKE I
HAVE BEEN LOOKING ON THIS STUFF
FUR 30 YEARS.
THERE ARE MANY, MANY DAYS THEY
FEEL LIKE WE HAVE MADE VIRTUALLY
NO PROGRESS.
BECAUSE MOST OF THE CALLS I GET
ARE ABOUT THE BAD CASES.
FOLLOWING THE TERRI SCHIAVO
CASE.
DOES EVERYBODY REMEMBER
TERRI SCHIAVO?
THE PEER FOUNDATION DID A STUDY
AND EVEN AFTER ALL OF THAT, ONLY
30% OF THE ADULTS IN THE UNITED
STATES HAVE ACTUALLY DONE OR
MADE AN ADVANCED DIRECTIVE AND
NAMED A DURABLE POWER OF
ATTORNEY AND HAD A CONVERSATION.
85% OF ADULTS IN THIS COUNTRY
SAY, THEY BELIEVE IT'S A
VALUABLE RIGHT AND SOMETHING
THEY OUGHT TO DO.
SO, WE HAVE A BIG GAP BETWEEN
WHAT WE SAY AND WHAT WHAT WE DO.
AND WE HAVE TO FIGURE OUT HOW TO
BRIDGE THAT.
THE ECONOMICS OF THIS MAY BE THE
DRIVER HERE.
BUT I WOULD HOPE THAT THAT'S NOT
THE REASON TO DO THIS.
LAST NIGHT I GOT A CALL AS I WAS
GETTING READY TO LEAVE THE
OFFICE FROM A FRIEND.
A PERSON THAT MANY OF YOU IN
THIS AUDIENCE MAY KNOW AND SHE
CALLED TO TELL ME HER FATHER HAD
DIED.
I KNEW HE HAD BEEN ILL.
AND SHE CALLED TO THANK ME FOR
THE CENTER AND TO THANK ME THAT
WE HAD SHARED THIS DOCUMENT WITH
HER AND HER FAMILY.
AND THAT THEY HAD HAD THE CARING
CONVERSATION.
AND THAT WHEN THEY HAD GOTTEN
THE CALL A FEW DAYS AGO, HER DAD
LIVES IN CALIFORNIA, HE HAD BEEN
SICK FOR QUITE SOMETIME.
WHEN THEY GOT THE CALL FROM A
YOUNG PHYSICIAN TELLING THEM
THAT HER FATHER WAS ON A
VENTILATOR, THAT HE BELIEVED IT
WAS NOT APPROPRIATE THAT HER DAD
WAS DIEING AND HE THOUGHT THE
RIGHT THING TO DO WAS TO ALLOW
HIM TO DIE.
SHE TOLD HIM THAT SHE WAS HER
FATHER'S DURABLE POWER OF
ATTORNEY AND SHE AGREED WITH HIM
BECAUSE HER FATHER HAD TOLD HER
WHAT HE WANTED.
BUT SHE ASKED THE YOUNG
PALLIATIVE CARE PHYSICIAN, WHICH
SAY BIG WORD, SHE ASKED HIM,
WHAT WOULD BE ACCEPTABLE FOR HER
DAD IT STAY ON THE VENTILATOR
FOR 24 HOURS BECAUSE SHE HAS 3
SIBLINGS UNTIL THEY COULD ALL
GET THERE?
HE SAID HE THOUGHT IT WOULD BE
ENTIRELY APPROPRIATE.
SO IN LESS THAN 24 HOURS, THEY
ALL GOT THERE.
THEY FOUND THEIR FATHER
CONSCIOUS, PAIN WAS BEING
MANAGED.
HE WAS ON THE VENTILATOR.
HE COULDN'T TALK.
AWE 4 OF THEM, THEY CAME FROM
NEW YORK, WISCONSINCE, KANSAS
CITY AND CALIFORNIA TO BE WITH
THEIR DAD.
HAD TIME WITH HIM TOGETHER.
EACH ONE OF THEM HAD TIME WITH
HIM SEPARATELY.
THEN THEY AS A TEAM, THE TEAM
ASKED HIM TO LEAVE THE ROOM.
HE WAS EXCAVATED.
HE WAS KEPT COMPLETELY
COMFORTABLE.
THEY ALL CAME BACK AND HELD HIS
HAND UNTIL HE DIED ABOUT 15
MINUTES LAYER ARE LATER.
AND MY FRIEND SAID, WHAT A GIFT
HE GAVE TO US.
BECAUSE WE HAD NO QUESTION THAT
WE WERE DOING THAT TO HONOR HIM
AND WE WERE SHOWING HIM HOW MUCH
WE LOVED HIM.
THE LAST THING SHE SAID TO ME IS
HOW LUCKY THEY FELT THAT THEY
HAD DONE THIS.
AND I SAID TO HER, THIS SHOULD
NOT BE THE LUCK OF THE DRAW.
THIS SUB THE -- SHOULD BE THE
STANDARD IN OUR SOCIETY.
THIS SHOULD BE THE WAY THAT ALL
OF OF US LIVE THE LAST PART OF
OUR LIFE.
NOW, AS I SAID IN YOUR PACKET
YOU HAVE THIS WORK BOOK.
IF YOU HAVE NOT HAD THIS
CONVERSATION WITH YOUR FAMILY I
REALLY WANT YOU TO ENCOURAGE YOU
TO DO IT:
I HOPE YOU WILL.
ON THE BACK THERE IS A DURABLE
POWER OF ATTORNEY FOR HEALTH
CARE FORM.
WHEN YOU CAME IN THIS EVENING, I
ASKED PEOPLE TO INVITE YOU TO
PUT ON ONE OF THESE PAPER
HOSPITAL BRACELETSES.
THE REASON THAT WE ASKED THAT IS
WITH THE RESEARCH WE FOUND, IT'S
LIKE TIEING A STRING AROUND
PEOPLE'S FINGER.
WE KNOW THAT IF WE ASK PEOPLE TO
WEAR THIS PAPER BRACELETS, UNTIL
THEY HAD THE CONVERSATION, THESE
ARE REALLY DURABLE.
YOU CAN SHOWER IN THESE THINGS
FOR 3-4 WEEKS.
THAT PEOPLE WILL REPORT TO US
THEY WILL WEAR THEM UNTIL THEY
HAD THE CONVERSATION.
NOW I WISH I HAD BEEN SMART
ENOUGH TO MAKE THESE OUT OF
RUBBER AND SELL THEM FOR A
DOLLAR.
I WOULDN'T BE DOING ALL THE
FUND-RAISING I DO DAY AFTER DAY.
I ENCOURAGE YOU TO THINK ABOUT
HOW IMPORTANT IT IS AND WHAT A
GIFT IT WOULD BE TO YOUR FAMILY
TO HAVE THIS CONSERVEIVATION.
I HOPE ELAINE WILL TALK MORE
ABOUT THE ONLY THING I COULD
HAVE WISHED FOR MY FRIENDY
FATHER, INSTEAD OF BEING AT THE
HOSPITAL, THAT HOSPICE HAD BEEN
INVOLVED AND HE COULD HAVE BEEN
INVOLVED AND HE COULD HAVE BEEN AT HOME.
WHAT I WANT TOW COMMENT ABOUT
TONIGHT INVOLVES END-OF LIFE
CARE.
MY ROLE -- I HAVE BEEN INVOLVED
IN HOSPICE SINCE 1977 WHEN IT
WAS VERY, VERY EARLY AND IN SOME
RESPECTS, PART OF THIS IS
CONSIDERED TO BE CHALLENGING IN
THE CURRENT DELIVERY SYSTEM AND
SURFACING THE QUESTION OF
WHETHER WE WERE DOING THE JOB WE
WERE SUPPOSED TO DO.
AND I THINK WHEN WE SHARED OUR
GLASS OF WINE --
[LAUGHTER]
-- I SAID, TAKE HEART.
HAVING DONE THIS FOR 30 YEARS, I
HAVE SEEN SOME DRAMATIC IMPROV
IMPROVEMENT.
-- HE WAS IN A GOOD HOSPITAL.
HE HAD GOOD AND CARING DOCTORS.
HE HAD TO THE WORST POSSIBLE
PAIN MANAGEMENT REGIMEN WHICH IS
STILL UNFORTUNATELY DIFFUSE BUT
IT WAS NOT WELL CONTROLLED.
MY MOTHER HAD NO SUPPORT.
SHE CARED FOR HIM AT HOME BY
HERSELF.
SHE HAD 3 DAUGHTERS IN THEIR
20's ALL WHO KNEW EVERYTHING
THERE WAS TO BEEN THIS AND WERE
CONTINUALLY ADVISING HER AND HE
DIED AFTER A FEW DAYS IN THE
HOSPITAL REALLY WITH NONE OF US
HAVING SUPPORT, THE OPPORTUNITY
TO TALK ABOUT THIS, OR FRANKLY,
A DIRECT CONVERSATION.
IT WASN'T A GOOD THING BUT IT
WAS THE STANDARD OF CARE AT THE
TIME.
IN EARLY 2008, I MET A GUY AT
THE AGE OF 91, WITH GREAT
HOSPICE CARE, WITH AT HOME IN
HER OWN BED AND.
HE HAD HAD TWO MONTHS WORTH OF
WONDERFUL NURSING SUPPORT.
WE HAD HAD THE PHYSICIAN HOME
VISITS WHEN SHE WAS UNABLE TO
LEAVE HOME AND SEE HER OWN
PHYSICIAN AND SHE HAD A VERY
CONTROLLED ENDING, WHICH ALL OF
US FELT VERY SATISFIED WITH.
SORROWFUL, OF COURSE BUT IT WAS
OKAY.
IT WAS SATISFACTORY AND IT WAS
HOW SHE WOULD HAVE WRITTEN HER
OWN SCRIPT.
SO, I SEE, ALTHOUGH WE HAVE OUR
DISCOURAGING DAYS -- ENGWE HAVE
GOTTEN MUCH BETTER AT THIS THAN
WE WERE 30 YEARS AGO.
I WANT TO MAKE JUST A FEW
COMMENTS ABOUT THE ISSUE OF
HEALTH CARE OR HEALTH SERVICES
BEFORE US.
AND IT'S FROM THE ADVANTAGE
POINT OF WHAT WE SEE EVERY DAY.
WE SEE HUNDREDS OF PATIENTS
EVERY YEAR.
AND A FIRSTHAND STORY AFTER
STORY AFTER STORY OF THE
SUFFERYING, PREMATURE DEATH, WE
SEE WITH IT PEOPLE WHO HAVE
NAMES.
WHAT WE REALLY CARE ABOUT IS THE
DEDICATION THAT PEOPLE
EXPERIENCE.
IT HAPPENS EVERY SINGLE DAY IN A
MYRIAD OF WAYS.
PEOPLE WHO ARE BECOMING ILL AND
ARE NO LONGER ABLE TO WORK.
THEY BUY THEIR OWN INSURANCE,
THEY HAVE A COBRA PROGRAM.
THEY LIVE LONGER THAN THEINE
MONTH COBRAS.
THEY RUN OUT -- [INAUDIBLE]
THERE ARE PEOPLE WHO BELIEVE
THEY ARE WELL CARED FOR AND WELL
INSURED AND SO LONG AS THEY
AREN'T SICK, THEY ARE.
BUT WHEN THEY DO GET ILLNESS,
THEY LEARN WHAT THEY DON'T HAVE
COVERAGE FOR.
ONE THING THEY LEARN
UNFORTUNATELY ALL TOO OFTEN SAY
LIFETIME MAX.
PEOPLE GET THEIR LIFETIME
MAXIMUM ALL THE TIME.
IT HAPPENS EVERY YEAR:
THEY ALSO LEARN THE HUGE SABRE
VARIATION IN INSURANCE COVERAGE.
AND I WOULD VENTURE TO GUESS
THAT THE TWO OF YOU PROBABLY
DON'T HAVE THE SAME INSURANCE
AND THE TWO OF YOU HAVE
DRAMATICALLY DENT COVERAGE.
IT'S CRAZY HOW PEOPLE WILL
RATION THE NUMBER OF NURSING
VISITS THEY ALLOW US TO MAKE
BECAUSE THEY ONLY HAVE A SET
NUMBER IN THEIR POLICY.
IELED GUESS THAT ONE OF YOU
PROBABLY HAVE COVERAGE FOR
PERSONAL CARE OR A NURSE AID TO
HELP YOU WITH PERSONAL CARE AND
THE OTHER ONE DOESN'T.
I WOULD BET THAT ONE OF YOU HAS
A PRETTY GOOD PRESCRIPTION
COVERAGE PLAN AND I'LL BET
ANOTHER ONE OF YOU DOES NOT.
WE SEE PEOPLE ALL THE TIME WHO
HAVE NO PRESCRIPTION PLANS AND
YOU ARE SICK, THAT'S HUGE.
THE COST OF MEDICATIONS IS
ENORMOUS.
THE WHOLE SUBJECT OF BANKRUPTCY,
WHEN PEOPLE HAVE MAJOR ILLNESS,
IT'S SO REAL.
IT IS SO REAL.
AND I OFTENTIMES THINK, THESE
ARE NOT PEOPLE WHO ARE NOT
ORGANIZED.
I THINK THAT IF A WHOLE COUNTRY
KNEW THE STORY OF THIS WOMAN ASK
WHAT SHE EXPERIENCED, THE OUTCRY
FOR THE NATIONAL HEALTH
INSURANCE PROGRAM OR SOMETHING
TO ENSURE THAT NOBODY HAS TO GO
THROUGH THIS AGAIN, IT WOULD BE
DEF18ING BECAUSE THAT IS
REAL -- DEAFENING.
IF ALL OF US WALKED IN ABOUT -A
BUT THIS COULD HAPPEN TO ANY OF
US.
I ALSO WANT TO SPEAK FOR A
MOMENT ABOUT THE IDEA OF THE
UNINSURED GETTING CARE.
TO SOME EXTENT I THINK THIS IS
IT.
I DON'T THINK THAT THE UNINSURED
GET CARE.
WHAT TYPICALLY HAPPENS OR OFTEN
HAPPENS IS THAT PEOPLE WHO HAVE
HEALTH INSURANCE IGNORE THEIR
SYMPTOMS, DELAY, DELAY, THEY MAY
BE ABLE TO AFFORD A PHYSICIAN
VISIT BUT THE DIAGNOSTICS AND
SUBSEQUENT TREATMENT IS OUT OF
REAP FOR MOST PEOPLE.
SO WHAT HAPPENS TO PEOPLE IS
THEY WAIT FOR THE -- THEY END UP
IN THE EMERGENCY ROOM.
THEY GET A BIG WORK UP, A
TERRIBLE DIAGNOSE.
THEY MAY OR MAY NOT GET
TREATMENT.
IT DEPENDS ON WHETHER OR NOT
THIS IS A BENEVOLENT PROVIDER
AROUND.
YOU WILL GET CARED FOR IN THE
THE EMERGENCY ROOM BECAUSE THERE
ARE LAWS REQUIRING YOU GET CARED
FOR IN THE EMERGENCY ROOM BUT NO
LAWS REQUIRING YOU GET
CHEMOTHERAPY, THAT YOU GET
RADIATION THERAPY, THAT YOU GET
ANY OTHER KIND OF MEDICINE.
NONE OF THAT IS MANDATED.
SO YOU SELF PAYOR --
SO YOU SELF PAYOR -- [LOW AUDIO]
MAWS APPLAUSE
[APPLAUSE]
IS THIS WORKING?
SO, I KNOW A HUGE THING HERE IS
REAL.
THE OTHER THING I WANT TO
COMMENT ON IS, I DON'T CARE WHAT
ANYONE SAYS, MEDICARE IS BY FAR
THE BEST COVERAGE THERE IS.
MEDICARE HAS MORE CHOICE THAN
ANYONE ELSE.
THEY HAVE MORE CLEARLY WHAT
THEIR BENEFITS ARE.
SOMETIMES JUST FINDING OUT WHAT
YOUR INSURANCE COVERAGES IS A
HUGE TASK.
SO THE IDEA OF THAT -- MEDICARE
WILL CHANGE.
BUT MEDICARE IS THE BEST HEALTH
INSURANCE THERE IS.
AND WE'LL PROBABLY NEVER SEE IT,
US BABYBOOMERS.
WE'LL PROBABLY NEVER HAVE THAT
GOOD COVERAGE AND I DON'T THINK
I EVER HAD THAT GOOD OF
COVERAGE.
IN ANY WAY, IT'S A PROGRAM THAT
SOMETIMES CROSSES THE LINE BUT
SHOULDN'T BE.
WE DON'T OFTEN ACKNOWLEDGE ABOUT
MEDICARE IS MEDICARE IS, IT HAS
A TERRIBLE SELECTION PROBLEM T
TAKES CARE OF EVERYBODY WHO IS
OVER 60.
ALL THE YOUNG PEOPLE WHO ARE NOT
USING HEALTH SERVICES ARE
COVERED BY PRIVATE COMMERCIAL
INSURANCE PLANS.
SO MY OBSERVATION IS, IN SOME
RESPECTS, UNTIL WE COMBINE THE
PREMIUM DOLLARS THAT GO INTO THE
POT FOR OLDER PEOPLE WHO ARE
USING ALL THE HEALTH CARE
SERVICES, WITH THE PREMIUM
DOLLARS FOR ALL THE YOUNGER
PEOPLE WHO ARE NOT USING HEALTH
SEVERANCES, WE ARE NEVER GOING
TO MANAGE THIS ECONOMICALLY.
I KNOW FOR ALL OF US, WHOEVER
OUR INSURANCE COMPANY WAS WHEN
WE WERE IN OUR 20's AND
30's, THEY MADE OFF LIKE
BANDITS WITH US.
SO YOU HAVE TO GET THIS MONNEONE
BUCKET IN ORDER FOR THIS TO
BEGIN TO MAKE SOME KIND OF
ECONOMIC SENSE.
I COUPLE OF THINGS I WANT TO
MENTION.
ONE IS THAT TREATMENT IS NOT
BENIGN AND I SOMETIMES WONDER IF
THAT EXTRAORDINARILY IMPORTANT
CONVERSATION BETWEEN THE
PHYSICIAN AND THE PATIENT ABOUT
THE BENEFITS AND THE BURDEN OF
TREATMENT EVER TOOK PLACE.
BECAUSE TREATMENT, CERTAIN TYPES
OF TREATMENT FOR CERTAIN TYPES
OF DISEASES, CAN KILL YOU.
IT CAN KILL YOU PREMATURE
MATERIALLY BUT THE OTHER THING
IS IT AFFECTS THE QUALITY OF
LIFE.
IT, AFFECT THE LENGTH OF LIFE
AND THE QUALITY OF LIFE.
IT CAN AFFECT THE QUALITY OF
YOUR DIET, IF YOU WILL.
AND THOSE THINGS, THIS SAY WHOLE
ANOTHER CONVERSATION BUT THAT
CONVERSATION ABOUT BURDEN
BENEFIT WITH TREATMENT IS
SOMETHING THAT I JUST DON'T
THINK HAPPENS AS OFTEN AS IT
NEEDS TO.
THE OTHER COMMENT I'LL MAKE TO
SOME EXTENT RELATED TO THAT IS
THE MEDICAL COMPLEXITY OF
PATIENTS WE SEE CONTINUES TO GET
MORE AND MORE ACUTE.
AND I CAN'T BELIEVE I'M SAYING
THIS BECAUSE I HAVE BEEN SAYING
THIS FOR YEARS.
AND YET IT CONTINUES TO BE TRUE.
AND THESE PATIENTS THAT ARE SENT
HOME FROM THE HOSPITAL WITH AN
EXPECTATION THEY ARE GOING TO BE
ABLE TO MANAGE THIS AND THEIR
SPOUSE OR ADULT CHILD OR SOMEONE
ELSE WILL BE ABLE TO HANDLE
THIS, IT IS MIRACULOUS IF
SOMEONE CAN BUT THE EXPECTATION
THAT WE PLACE ON LAY PEOPLE
SOMETIMES IS JUST OVER THE TOP.
AND I'LL GIVE YOU A QUICK
EXAMPLE.
YONKERS DEVASTATING DIAGNOSIS
SEND SMALL CHILDREN HOME WITH A
COLOSTOMY, A TUBE RUNNING
THROUGH THE SKIN TO THE KIDNEY,
A PCA PUMP, PAIN PUMP, A FEEDING
TUBE, THIS IS MORE.
THAT'S ENOUGH.
THAT GIVES YOU A PICTURE.
AND NOW CHILDREN AT HOME.
SENT HOME FROM THE HOSPITAL WITH
PUMP CARE SUPPORT.
THIS ISN'T SOMETHING THAT
ORDINARY MORTALS SHOULD BE ABLE
TO HANDLE.
BUT AS SYSTEM OF SUPPORT FOR
PEOPLE AT HOME IS EPITHETIC.
MEDICARE, EXCEPT IN LIMITED
INSTANCES SUPPORTS SOMEONE BEING
IN THEIR HOME 24-HOURS A DAY.
IT'S MOSTLY INTERMITTENT SUPPORT
PROGRAM.
AND THERE ARE CERTAIN KINDS OF
THINGS THAT ARE JUST TOO
OVERWHELMING TO BE CARED FOR AT
HOME BUT WE SEE THIS EVERY DAY,
PATIENTS COMING OUT OF HOSPITALS
WITH THESE COMPLEX SITUATIONS.
SO THAT'S ALL THE COMMENTS I
HAVE TO MAKE.
THE LAST PART OF MY REMARKS, I
WANT TO FOCUS ON THIS AT A MORE
PERSONAL LEVEL AND A MORE
PERSONAL PREPARETORY LEVEL.
I WANT TO ADDRESS THE VITAL
IMPORTANCE OF HAVING A DURABLE
POWER OF ATTORNEY.
I DON'T THINK PEOPLE REALIZED
HOW MUCH THEY GIVE UP BY NOT
HAVING IT.
YOU GIVE UP YOUR RIGHT TO DECIDE
FOR YOURSELF BY NOT HAVING THAT
DOCUMENT.
AND AS FAR AS MEDICARE AND
HOSPICE IS CONCERNED, YOU CAN
NOT -- YOU CAN'T HAVE HOSPICE
CARE.
IF YOU'RE UNA. UNABLE TO SPEAK
ON YOUR OWN BEHALF, YOU CAN NOT
HAVE HOSPICE CARE BECAUSE IT'S A
CHOICE AND YOU HAVE TO HAVE
SOMEONE WHO IS LEGALLY
AUTHORIZED TO MAKE THAT CHOICE
ON YOUR BEHALF.
SO, IF YOU WANT TO GET INTO
HOSPICE CARE AND YOU THINK YOU
MIGHT BE ABLE TO SEE FOR
YOURSELF, YOU BETTER GET THE
DURABLE POWER OF ATTORNEY.
THE THING I THINK EVERYBODY
NEEDS TO SPEND A BIT OF TIME
THINKING ABOUT IS WHAT WE KNOW,
MOST OF US WILL NOT HAVE A QUICK
EXIST.
MOST OF US WILL HAVE A PERIOD OF
DEPENDENCY OF CERTAIN LENGTH,
HOPEFULLY SHORT.
BUT WE ARE REALLY NOT GOING TO
BE ABLE TO TAKE CARE OF
OURSELVES.
WE WILL HAVE TO RELY UPON, IN AN
OURY OR DAILY BASE TO TAKE CARE
OF US.
AND HOW LONG THAT IS, WHAT IT IS
LIKE, DEPENDS UPON THE MEDICAL
CONDITIONS.
BUT THERE ARE 3 THINGS I THINK
PEOPLE NEED TO PONDER AS WE ALL
BEEN THIS.
THE FIRST ONE IS THE PRACTICAL.
HOW MUCH MONEY DO I HAVE?
DO VILONG TERM CARE INSURANCE?
DO I UNDERSTAND WHAT THE LONG
TERM CARE INSURANCE COVERS?
HAVE I TALKED MY FAMILY ABOUT
THIS?
SO THE PRACTICAL IS AN ELEMENT
HERE.
AND THE SECOND ELEMENT IS THE
UNIVERSE OF THE MEDICAL.
WHAT DO I WANT?
HOW MUCH TREATMENT DO I WANT?
HOW AGGRESSIVE DO A WANT THINGS
TO BE?
AND HOW DO I WANT TO DESCRIBE TO
WHOEVER MY DURABLE POWER OF
ATTORNEY IS, WHAT I REALLY
AMLOOKING FOR?
BECAUSE IT'S REALLY HARD TO
CONTEMPLATE WHAT THE INSTANCE
WILL BE.
YOU CAN DECIDE IF THIS HAPPENS,
THEN I WANT THIS.
IF THAT HAPPENS, NONE OF THOSE
THINGS -- SOMETHING ELSE WILL
HAPPEN.
BUT THE THING THAT HAS ALWAYS
BEEN MEANINGFUL TO ME IS A
DESCRIPTION OF THIS, WHICH IS, I
WANT THE THINGS THAT ARE A
BRIDGE TO RECOVERY.
AND IF THE TREATMENT ISN'T A
BRIDGE TO RECOVERY, BUT WILL
PROLONG MY DYING, DON'T DO IT
FOR ME.
SO, SO IT'S IMPORTANT TO THINK
IN THAT TYPE OF LANGUAGE,
BECAUSE YOU WON'T BE ABLE TO
ANTICIPATE THE EXACT SET OF
CIRCUMSTANCES WHICH MAY BE FALL
YOU WHERE YOU NEED SOMEONE TO
MAKE I DECISION ON YOUR BEHALF.
SO THE PRACTICAL, MEDICAL, THE
LAST IS THE EMOTIONAL.
NOBODY EVER THINGS ABOUT THIS.
BUT IT IS A IMPORTANT COMPONENT.
SO SAY I'M IN THIS DEPENDENT
STATE.
AND I HAVE GOT ALL MY MARBLINGS.
HOW AM I GOING GOING TO COPE
WITH THIS IF WHAT AM I GOING TO
DO WITH MYSELF?
AND THIS IS SOMETHING I LEARNED
IN HEARING STORIES MAKE IT
MEANINGFUL.
DO YOU WANT TO WRITE A MEMOIR
FOR YOUR FAMILY?
ONE WOMAN SAID TO ME, I'LL NEVER
FEEL USELESS WHILE I CAN STILL
PRAY.
AND SHE FOUND THAT WAS WHAT
ALLOWED HER TO BE GRACEFULLY IN
THE BED AND GREATFULLY IN THE
BED WITHOUT BECOMING MIDSTERABLE
AND DEPRESSED.
A COUPLE OTHER COMMENTS I WANT
TO MAKE IN REGARD TO HOW TO BE
HELPFUL IT YOUR FAMILY WHEN YOU
ARE THE ONE IN THE BED.
ONE OF THEM -- TELL PEOPLE WHAT
YOU WANT.
NOT ONLY IN THE MEDICAL
TREATMENT AND OTHER THINGS WE
TALKED ABOUT, BUT IF THERE IS
SOMETHING THAT IS IMPORTANT TO
YOU, IF YOU WANT TO GO FISHING
ONE LAST TIME, PEOPLE CAN MAKE
THINGS HAPPEN.
BUT IF YOU WANT OR MAKE AN
IMPORTANT MEMORY WITH YOUR
FAMILY.
I SEEN OVER AND OVER AND OVER
AGAIN, FAMILIES DO THE CRAZY
THINGS TOGETHER ONE LAST TIME.
AND SOMETIMES IT'S A HUGE
EFFORT.
BUT FAMILIES TAKE THOSE MEMORIES
WITH THIS FOREVER AND TO TRY TO
SERVE SOMETHING MEANINGFUL AND
RICH FOR YOU AND THE PEOPLE YOU
LOVE, IT'S VERY IMPORTANT TO
THEM IN THE LONG RUN.
WE ALSO OBSERVE EVERY DAY SOME
PEOPLE ACCEPT CARE MORE
GRATEFULLY AND MORE GRACEFULLY
THAN OTHERS.
IT'S EASY TO GET SQUIRRELY IN
THE BED BUT IT'S SOMETHING TO
TRY TO REMEMBER.
THE PEOPLE WHO ARE CARING -- I
HOPE I'M NOT SULLY.
I KNOW I WILL BE SOME DAY IN THE
NURSING HOME AND I HOPE I CAN
REMEMBER HOW IMPORTANT IT IS TO
SAY THANK YOU TO PEOPLE WHO ARE
TAKING CARE OF ME.
TO BE GRATEFUL AND TO BE
GRATEFUL IT MAKES A HUGE
DIFFERENCE TO THE PATIENT AS
WELL AS TO THE PEOPLE WHO ARE
AROUND THEM.
LASTLY, I WANT TO SAY A COUPLE
OF THINGS ABOUT THE MYSTERIOUS,
IF YOU WILL.
AND THIS MAY BE A LITTLE MORE
OUT THERE ON THE EDGE THAN MAYBE
COMFORTABLE FOR EVERYONE, BUT
THE OTHER THING WE OBSERVE OVER
AND OVER AND OVER AGAIN IS SOME
OF THE AMAZING THINGSING THAT
HAPPEN AS PEOPLE ARE DYING.
AND IT'S THIS MAGNIFICENT
MYSTERY.
AND I DON'T PRETEND ANY SPECIAL
UNDERSTANDING OF THIS.
BUT I WILL OBSERVE TO YOU SOME
OF THE THINGS THAT HAPPEN
FREQUENTLY.
PEOPLE OFTENTIMES APPEAR VERY
CONFUSED.
USING LANGUAGE THAT DOESN'T SEEM
TO MAKE SENSE.
BUT WE HAVE LEARNED IF YOU TUNE
INTO THIS LANGUAGE, SOMETIMES IT
IS VERY SYMBOLIC.
PEOPLE WILL TALK ABOUT -- HAVE
DREAMS, TALK SEEMINGLY FROM A
CONFUSED STATE, AND IF YOU
LISTEN CLOSE LYRICS YOU HEAR
SOME REMARKABLE THINGS.
YOU HEAR OVER AND OVER AGAIN,
TRAVEL METAPHORS.
YOU HEAR ENDING METAPHORS.
HOME RUNS, CLOSING THE DEAL.
MAKING THE SALE.
AND THIS IS OFTENTIMES
ACCOMPANIED BY TIME.
THIS WEEK.
AND WILL WE FIND MANY TIMES THAT
THIS IS THE DYING PERSON TELLING
US SOMETHING ABOUT TIME.
AND I WILL TELL YOU MY OWN
MOTHER HAD A PRO FETTIC DREAM.
AT 7:00 ONE MORNING, A SUNDAY
MORNING, SHE WOKE AND TOLL
MEDE -- TOLD ME SHE HAD A DREAM
ABOUT BEING IN A CAR TRAVELING
AND IT HAD A TIMEFRAME AND IT
HAD AN ENDING AND I KNEW BECAUSE
I HAVE A TRAINED EAR, I KNEW SHE
WOULD DIE THAT WEEK AND SHE DIED
ON WEDNESDAY.
SO, IT'S REMARKABLE THESE
THINGS.
BUT THEY ARE REAL AND PEOPLE WHO
WORK IN THIS WORK, WILL OBSERVE
THIS OVER AND OVER AGAIN.
I ALSO WANT TO SAY THAT
OFTENTIMES WHEN PEOPLE ARE -- OR
SOMEONE IS DYING, EVERYBODY IS
GATHERED AT THE BEDSIDE AND THEY
SIT THERE FOR HOURS AND DAYS AND
AS SOON AS THEY LEAVE THE
PATIENT DIES.
THIS HAPPENS CONSTANTLY.
THERE MUST BE A POINT TO IT.
AND I REALLY HAVE COME TO
BELIEVE THAT SOMETIMES THAT'S
JUST WHAT NEEDS TO HAPPEN IN
ORDER FOR THE PERSON TO LET GO.
PEOPLE HAVE HORRIBLE GUILT
EXPERIENCES BUZZ THEY LEFT THE
BEDSIDE RIGHT AT THAT MOMENT.
SO, ANY WAY, THE BAD NEWS I
GUESS IS THAT WE ARE ALL GOING
TO DIE.
BUT WE ARE BETTER AT THIS.
AND I JUST WANTED TO MENTION A
FEW PROGRAMS OFFERED BY HOSPICE
THAT MANY HAVE USED.
FIRST, WE OFFER A PROGRAM CALLED
PALLIATIVE HOME CARE.
THE WORD, PALLIATIVE, MEANS
COMFORT.
AND IT IS A VERY SIMILAR PROGRAM
TO HOSPICE EXCEPT WITHOUT A
PROGNOSIS REQUIREMENT.
WE REALIZED MANY YEARS AGO YOU
SHOULDN'T HAVE TO BE DYING IN
ORDER TO GET GOOD PAIN
MANAGEMENT, GOOD SUPPORT FOR
YOUR FAMILY, GOOD KNOWLEDGE,ET
SET A AND SO PALLIATIVE CARE IS
THE SISTER OF HOSPICE PROGRAM
AND IT IS PROVIDED FOR PEOPLE
WHO HAVE A CERTAIN DIAGNOSIS BUT
IT DOESN'T HAVE THE PROGNOSIS
EXPECT ATTENTION.
PEOPLE WHO ARE RECEIVING
PALLIATIVE HOME CARE MAY BE ON A
TRANSPLANT LIST, MAYBE GROWTH
ACTIVE TREATMENT.
IT IS A BROADER ELIGIBILITY.
HOSPICE CARE IS PROVIDED IN
PEOPLE'S OWN HOMES AND NURSING
HOMES AS IT PROBABLY WELL-KNOWN.
BUT THE THING THAT IS THE
GREATEST DILEMMA FOR HOSPICE IS
HOW LATE PEOPLE COME TO IT.
EARLY IS SO IMPORTANT.
PROBABLY 40% OF THE PATIENTS WE
TAKE CARE OF ARE ON SERVICE WITH
US FOR 12 DAYS OR LESS.
THAT'S CRAZY.
OURS IS A SERVICE THAT HOSPICE
PROVIDES.
IT'S JUST DENIED.
WHAT COULD HAVE BEEN THERE FOR
3-5-6 MONTHS, WORTH OF SUPPORT,
THE FAMILIES WENT WITHOUT IT.
AND THE SUPPORT IS WONDERFUL.
YOU'RE MEDICINE ARE DELIVERED TO
YOUR HOME YOU HAVE A NURSE ON
CALL 24-HOURS A DAY.
YOUR OWN NURSE TALKS TO YOUR
PHYSICIAN FOR YOUET SET A
HOSPICE HOUSE IS A SHORT-TERM
CARE FACILITY FOR PEOPLE FOR
WHOM HOME IS JUST NOT THE RIGHT
PLACE.
IT'S SHORT-TERM.
IT'S GENERALLY WHERE PEOPLE ARE
HAVING PROBLEMS OR DOSE TO THE
END OF LIFE.
PEDIATRIC HOSPICE AND PALLIATIVE
HOSPICE IS FOR KIDS FROM
NEWBORNS UP TO 18.
PALLIATIVE MEDICINE IS OUR
PHYSICIAN PRACTICE.
WE HAVE 5 PHYSICIANS ON THE
STAFF.
THIS IS ALL THEY DO.
THEY MAKE HOME VISITS AND MANAGE
AT THE HOSPICE HOUSE AND ALL
KINDS OF THINGS.
A COUNSELING PROGRAM AND WE
ADDED SOLICE HOUSE TO THE FAMILY
OF SERVICES WE PROVIDE.
SOLICE HOUSE PROVIDES FREE
SUPPORT TO CHILDREN AND THIS
FAMILIES.
I THINK I'M BELL 5 MINUTES OVER.
SO I'LL END BY THANKING NORMAN
AND ELAINE FOR THIS SERIES AND
ALL YOU HAVE DONE FOR US AND I
GUESS WE HAVE QUESTIONS NOW.
I THINK OUR SPEAKERS HAVE
DEALT WITH SOME PRETTY
COMPLICATED AND DIFFICULT TOPICS
TONIGHT.
LET'S GIVE THEM A ROUND OF
APPLAUSE.
[APPLAUSE]
AND WE HAVE QUESTIONS HERE.
SO I'M JUST GOING TO DIVE INTO
THIS IN NO PARTICULAR ORDER.
ELAINE, YOU MENTIONED THAT
MEDICARE IS PROBABLY THE BEST
HEALTH CARE THAT IS OUT THERE.
IT GIVES PEOPLE LOTS OF CHOICES.
BUT WE HAVE A QUESTIONER HERE
WHO SAYS MEDICARE PART D, DRUG
COVERAGE, IS A MESS!
IS IT ON THE REFORM
CONSIDERATION?
MEDICINES ARE COVERED OR NOT
COVERED DEPENDING ON YOUR
INSURANCE COVERAGE AND ARE THERE
PLANS TO MAKE CHANGES IN THAT?
I AM PROBABLY THE LEAST
EXPERT ON REFORM ISSUES.
SO I WOULD DEFER TO MY
COLLEAGUES ON THAT.
--EL GIBELTY
REQUIREMENTS -- IT IS A MESS.
IT'S MORE EXPENSIVE THAN WHAT
PEOPLE IMAGINED.
SO THAT IS ONE CONSIDERATION,
ELIGIBILITY.
YES, I'VE NOT HEARD THAT BUT
THE COMPLEXITY ISSUE -- LET ME
GO BACK TO THE COMMENT ABOUT
BEING GOOD.
IT'S BETTER THAN NOT HAVING T
YOU HAVE PART A, PART B, PART D
PREDICTION DRUG.
YOU HAVE ADVANTAGE PLANS AND
THEN THE MED I GAP PLANS.
IT'S HUGELY COMPLEX.
WITH KANSAS, MANY HAD 20-30
CHOICES ON YOUR PART D
PRESCRIPTION DRUG.
WE WOULD LIKE TO SEE IT SIMPLIFY
BUT I DON'T THINK THAT WILL
HAPPEN AS LONG AS A PUSH FOR
PRIVATIZATION AND THESE TYPES OF
THINGS IS THERE.
WHAT WE WOULD RATHER SEE, HOW
FAR, IS GOOD COVERAGE.
AND YOU CAN GET COVERAGE FOR
YOUR PARTICULAR PREPARATION
DRUG.
THAT IS FEST AND FOREMOST.
YES, ITS WAY TOO COMPLEX AND IT
HAS ALL THESE DIFFERENT MOVING
PARTS.
AND HOPEFULLY, WE J. COULD
SIMPLIFY THAT BUT AS LONG AS THE
PRIVATE SECTOR HAS A SAY IN ALL
THIS, THERE IS GOING TO HAVE TO
BE MULTIPLE CHOICES.
THE PRIVATE SECTOR SAYS UP TO.
WE WANT TO HAVE OR BE ABLE TO BE
A PLAYER IN THAT AND YES, WE
LIKE TO SIMPLIFY IT.
WE LIKE TO MAKE IT EASIER.
IT'S VERY COM BER SOMTO GO
ON-LINE.
WE SPENT UNTOLD HOURS ON PART D
WORKSHOPS TRYING TO HELP PEOPLE
SORT OUT WHAT THEIR CHOICES ARE.
WE FINALLY GOT SOMEDAY
PHARMACIES WORKING WITH SENIORS.
BUT, YES, I'D LIKE TO THINK WE
CAN MAKE IT SIMPLER.
BUT I'M NOT SURE IT IS.
AT LEAST IN THE SHORT-TERM.
FIRST I WANT TO SEE SOMETHING
BETTER.
WE HAVE 5 OR 6 CARDS HERE
DEALING WITH QUESTIONS OR
COMMENTS ON SOCIALIZES MS. AND
EVERYTHING FROM EXAMPLES OF
FRIENDS WHO LIVE IN CANADA WHO
STILL AREN'T HAPPEN, TO FOLKS
THAT WANT TO MOVE THERE.
SO, --
[LAUGHTER]
SO WHAT ARE THE ADVANTAGES OR
DISADVANTAGES.
I'M SURE WE COULD HAVE A WHOLE
PROGRAM ON THAT TOP SNEAK I
THINK IT IS REALLY NOT GOING TO
HAPPEN IN THIS COUNTRY.
THE OTHER DAY WHEN THERE WAS THE
HEALTH SUMMIT, YOU MAY HAVE THE
FIRST HEALTH SUMMIT, WE HAD TWO
NOW.
YOU MAY HAVE HEARD THAT PEOPLE
IN CONGRESS WHO ARE FOR
UNIVERSAL PAYMENT, TALKING ABOUT
A SINGLE PAY OR SYSTEM,
SOCIALIZED MEDICINE, HOWEVER YOU
WANT TO CHARACTERIZE THAT, AND
SOME PEOPLE, THE PHYSICIANS
GROUP FOR UNIVERSAL HEALTH CARE
WEREN'T INVITED TO THE FIRST
SUMMIT.
AND THEY THREATENED TO PICKET
THE SUMMIT AND THE THEY QUICKLY
GOT AN INVITATION.
I AM A MEMBER OF A HEALTH POLICY
GROUP THAT THE AMA CONVENED
ABOUT 10 YEARS AGO TO TALK ABOUT
ACCESS ISSUES.
AND IT'S BEEN A PRETTY STEADY
GROUP.
BUT EVERY YEAR WE HAVE ONE OR
TWO NEW PEOPLE WHO WILL JOIN US
AND SOMEONE EVERY YEAR WILL SAY,
WHY AREN'T WE TALKING ABOUT
UNIVERSAL HEALTH CARE?
AND EVERYBODY KIND OF LAUGHS AND
SAYS, TAKE JOE OVER THERE AND
TELL THEM WHY WE AREN'T GOING TO
TALK ABOUT THAT.
BUT THE SPECIAL INTEREST GROUPS
IN THIS COUNTRY ARE QUITE
FRANKLY SIMPLY IN MY OPINION,
TOO POWERFUL TO ALLOW THIS TO
HAPPEN.
PLUS, I DON'T KNOW THAT THE
AMERICAN PUBLIC WANTS IT.
I DISAGREE WITH THAT A LITTLE
BIT BECAUSE I THINK IT MAY NOT
HAPPEN AND AARP WILL TAKE A
NEUTRAL POSITION.
IT HAS TO AT THIS POINT.
BUT IT MAY CHANGE.
THE PROBLEM WITH DRIVING A LOT
OF THIS IS THAT THE PARTISAN
POLITICS AND THE BICKERING THAT
GOES ON AND THEY SAY WILL WE
EVER HAVE THIS SINGLE PAY OR
SYSTEM?
THE INTERESTING THING THAT IS
NOW HAPPENING IS THAT BUSINESS
AND INDUSTRY IS SAYING TO THE
GOVERNMENT, WE DON'T WANT THIS
ANYMORE.
WE CAN'T AFFORD IT ANYMORE.
AND I HAD A LOT OF BUSINESSES
SAY, YOU KNOW, MAYBE A SINGLE
PAY OR SYSTEM ISN'T SO BAD.
IF YOU LOOK AT THE COST OF
RUNNING THINGS LIKE MEDICARE,
FAR MORE EFFICIENT THAN THE
PRIVATE SYSTEMS WE SEE TODAY.
FAR MORE EFFICIENT.
NOW, I'M NOT TRYING TO SAY THAT
THIS WILL HAPPEN OR THAT I'M AN
ADVOCATE FOR IT, BUT YOU KNOW, I
THINK IT HAS TO BE LOOKED AT
WITH THE OTHER PLANS.
THERE IS MUSS AND MINUSES.
I KNOW PEOPLE WILL SAY CANADA,
IT DOESN'T WORK.
REMEMBER THAT QUOTE I SAID?
THEIR INFANT MORTALITY RATES ARE
LOWER.
LONGER LIFE EXPECTANCY.
SOME OF THESE ARE MEASURES ABOUT
THE QUALITY OF HEALTH CARE.
IS IT PERFECT?
IT'S NOT.
BUT YOU KNOW, I'M NOT
REALLY -- I MAY ATTEND TO AGREE
TAT PARTISAN BICKERING IS SO
STRONG IT MAY NOT HAPPEN.
BUT KNOW, THERE ARE PEOPLE
PUSHING TOWARDS THIS DIRECTION
WHO NEVER PUSHED AND ONE OF THE
BIGGEST PEOPLE IS THE PRIVATE
INDUSTRY IN THE UNITED STATES.
THE CARMAKERS, THE OTHER BIG
INDUSTRIES SAYING, WE DON'T WANT
TO SEE THIS RUN PRIVATELY
ANYMORE.
WE DON'T WANT TO HAVE TO DEAL
WITH IT.
PLEASE, HELP US.
WHAT IT WOULD LOOK LIKE I DON'T
HAVE A CLUE BECAUSE THERE IS
GOOD AND BAD IN EVERYTHING.
BUT THERE IS MORE AWARENESS NOW
THAT, IT WILL JUST BE SO BAD.
DO WE NEED TO LOOK AT IT?
I THINK THERE WILL BE A LOT MORE
DISCUSSION ABOUT IT.
WHETHER IT WILL HAPPEN IT'S
STILL PRETTY MUCH UP IN THE AIR.
THIS CONVERSATION HAS
SHIFTED.
WE ARE NOT EACH TALKING ABOUT
UNIVERSAL ACCESS TO HEALTH CARE.
WE ARE TALKING ABOUT UNIVERSAL
ACCESS TO HEALTH CARE INSURANCE.
AND SO, I THINK WE OBVIOUSLY
DISAGREE ABOUT THIS.
I PERSONALLY WOULD LIKE TO SEE
US HAVE A SENGEL HEALTH CARE
DELIVERY SYSTEM WHERE IT WAS A
LOT MORE SIMPLE FOR PEOPLE TO
GET IN AND OUT OF AND SO FORTH.
I JUST DON'T BELIEVE THAT IT'S
GOING TO HAPPEN IN THIS COUNTRY.
I THINK TWO WORDS, IF THE
PRIVATE SYSTEMS CAN COME
TOGETHER AND OFFER AFFORDABLE
OPTIONS, AND GOOD CHOICES,
CHOICES ARE ALWAYS GOOD.
THE PROBLEM IS IT CAN GO SOZv R
THE OTHER WAY AND WE HAVE SEEN
IN PART D, WHERE IT'S SO COMPLEX
AND COM BER SOMAND REALLY HASN'T
LOWERED COSTS ALL THAT MUCH.
CHOICE CAN BE FINE IF IT CAN BE
MADE TO WORK.
I'M NOT SURE IT WORKS TODAY.
WE HAVE A QUICK COMMENT FROM
THIS.
ONE THING, I WISH I WOULD LIVE
ANOTHER 50 YEARS BECAUSE I THINK
IN 50 YEARS WE WILL HAVE A
SINGLE PLAN.
BECAUSE I THINK IT'S JUST
INEVITABLE.
AUTO GOING TO LIMP ALONG UNTIL
IT GETS ORGANIZING PRINCIPLE
AROUND THE FINANCING OF HEALTH
CARE.
BUT, WHAT MAKES SENSE TO ME IS
THAT THERE BE AT LEAST A PUBLIC
OPTION AS WELL AS PRIVATE
OPTION.
AND THE REASON I I THINK WE HAVE
TO HAVE A PUBLIC OPTION FRANKLY
IS BECAUSE WHEN YOU GET TO
MY -- NO PRIVATE INSURERS WANT
ME.
THE PRIVATE INSURANCE MARKET IS
NOT INTERESTED IN COVERING
PEOPLE WHO ARE OVER A CERTAIN
AGE OR HAVE ANY KIND OF LITTLE
HEALTH HISTORY AND BY THE TIME
YOU GET A CERTAIN AGE, YOU HAVE
HEALTH HISTORY.
AND IT'S ALMOST IMPOSSIBLE TO
GET A REASONABLE POLICY IF
YOU'RE LOOKING FOR ONE
INDIVIDUALLY.
SO HOW CAN WE DO THIS AND NOT
HAVE A PUBLIC OPTION?
THAT OPPORTUNITY FOR INDIVIDUALS
TO BUY INTO MEDICARE EARLY AND
THERE IS A SIDE BENEFIT TO THAT
FRANKLY, WHICH IS, THERE ARE
TONS OF PEOPLE IN THE EARLY
BABYBOOMER GROUP WHO ARE REALLY
READY TO RETIRE AND THEY CAN
AFFORD TO RETIRE.
BUT THEY ARE HELD HOSTAGE TO
THEIR JOB BY HEALTH INSURANCE F
ALL THOSE PEOPLE -- THERE A HUGE
NUMBER OF VERY HIGH QUALITY,
HIGH PAYING JOBS WILL OPEN UP
AND SO, MY HOPE IS THAT SOME
KIND OF PUBLIC OPTION DOES
BECOME AVAILABLE FOR PEOPLE TO
BUY INTO BECAUSE IT'S IMPOSSIBLE
TO RETIRE AND BUY A REASONABLE
HEALTH INSURANCE POLICY
[LOW AUDIO]
THAT'S WHAT WE HAVE NOW.
YOU HAVE MEDICARE.
YOU HAVE A PUBLIC OPTION.
YOU HAVE THE ADVANTAGE PLANS,
WHICH ARE PRIVATE OPTIONS, IF
YOU ARE OF RETIREMENT AGE IN 65.
AND THERE IS ADVANTAGE PLANS.
YOU CAN GET TRADITIONAL MEDICARE
WITH WRAP AROUND.
HAVE YOU THAT NOW AND THEN THE
QUESTION IS, IS THAT WORKING?
THE OTHER THING IS, YOU ENGED
ABOUT PEOPLE RETIRING.
YES, IT'S NICE TO HAVE THEM
RETIRE AND HAVE JOBS, BUT THEN
WE RUN INTO ANOTHER PROBLEM AND
THAT IS THE SOCIAL SECURITY
ISSUES, THE RETIREMENT FUND
ISSUE.
I AM GOING TO BE 65 IN DECEMBER.
NO WAY AM I GOING TO BE ABLE TO
RETIRE.
I CAN'T AFFORD IT.
I'LL BE LUCKY TO BE ABLE TO
RETIRE AT AGE 70.
I THINK IT ISN'T JUST HEALTH
CARE.
IT'S ALSO THE RETIREMENT ISSUES
AND THE THE SOCIAL SECURITY
ISSUES THAT ARE ALSO GOING TO
DRIVE SOME OF THIS.
SOME OF IT MAY NOT BE BAD IF
PEOPLE WORK LONGER, SOCIAL
SECURITY WILL BE MORE SOLVENT
LATER ON.
SO IT'S SUCH AN INTERWON ISSUE.
A RETIREMENT AND SECURITY ISSUES
AND HEALTH CARE ISSUES.
THRU GO.
I DO WANT TO MENTION, I'LL G.
I'M GOING TO GET TO A QUESTION
THAT MIRA CAN TALK ABOUT WITH
THE CARING CONVERSATION.
I WANT TO MENTION, I BELIEVE
2009 IS THE 25th ANNIVERSARY
FOR THE CERTAIN FOR PRACTICAL
BIOETHICS.
YOU HAVE SPECIAL EVENTS COMING
UP AND I THINK THAT'S IN YOUR
PACKET SO BE SURE TO TAKE A LOOK
AT THAT BEFORE YOU LEAVE.
HERE IS A TWO-PART QUESTION FOR
YOU.
FIRST OF ALL, WHEN DO YOU
SUGGEST HAVING THE CARING
CONVERSATIONS DYE DIALOGUE,
BEFORE PEOPLE GET SICK OR WHEN
THEY ARE SICK?
AND HOW TO BRING UP THE SUBJECT
WHEN SOMEONE THINKS HE OR SHE
MAY LIVE MANY MORE YEARS THAN
REALISTIC.
IF YOU BEEN THE SCHIAVO CASE,
OR THE NANCY ANNE CASE HERE SOME
YEARS AGO.
TERRI SCHIAVO WAS IN HER 20's
WHEN HER ACCIDENT OCCURRED.
AS WAS THE OTHER WOMAN.
WHEN YOU HAVE THE CONVERSATION,
OR WHEN YOU TURN 18.
BECAUSE IN FACT MAYBE A LITTLE
BIT EARLIER.
WE HAVE A PROGRAM AT THE CENTER
FOR YOUNG ADULTS THAT TARGET
KIDS 16-24 BECAUSE KIDS ARE SO
ACCIDENT-PRONE AT THAT TIME IN
THEIR LIVES.
I THINK A LOT OF PEOPLE ARE
SURPRISED THAT WHEN KIDS GO OFF
TO COLLEGE, THEY CAN'T GET
PARENT'S INFORMATION ABOUT THEIR
CHILD UNLESS THEIR CHILD HAS A
DURABLE POWER OF ATTORNEY AND
HAS NAMED THEIR PARENT.
SO I THINK THERE ARE A LOT OF
REASONS TO DO THIS.
AND I THINK IT IS REALLY SINCE
THE PERSON IS TRUE ENOUGH TO
HAVE THE CONVERSATION, I THINK
IT MAKES A LOT OF SENSE TO DO
THIS AND CERTAINLY BEFORE YOU
GET SICK.
I CANNOT TELL YOU HOW MANY TIMES
I HAD CALLS OF SOMEONE WHO SAID,
WE ARE AT THE HOSPITAL.
MY MOM IS GOING ON HAVE SURGERY
TOMORROW MORNING.
NOW WHEN YOU ENTER THE HOSPITAL,
YOU'RE USUALLY PRETTY ANXIOUS
ABOUT THE SITUATION.
AND THAT'S NOT REALLY THE TIME
THAT YOU WANT TO HAVE THIS
CONVERSATION.
I THINK YOU WANT TO HAVE IT IN A
SETTLED WAY.
IF YOU LOOK AT THE DOCUMENT, YOU
WILL NOTICE THAT IT SAYS, IT
DOESN'T START OUT BY SAYING, DO
YOU WANT TO BE ON A VENTILATOR?
WHO WOULD SAY YES, SIGN ME UP
FOR THAT?
IT STARTS OUT BY ASKING YOU
ABOUT WHAT RELATIONSHIPS ARE
IMPORTANT?
AND WHAT HAS GIVEN YOUR LIFE
MEANING AND JOY IS AND SO FORTH.
SO ABSOLUTELY, WE THINK YOU
SHOULD HAVE THE CONVERSATION
NOW.
IF YOU HAVEN'T HAD IT, HAVE IT
NOW.
HOW YOU GET PEOPLE TO TALK ABOUT
THIS, WHAT I OFTEN HERE IS WHEN
PEOPLE MY AGE, THEY SAY, MY KIDS
DON'T WANT TO TALK ABOUT IT.
SOME PEOPLE MY KIDS AGE SAY MY
PARENTS DON'T WANT TO TALK ABOUT
IT.
SO YOU CAN GO HOME TONIGHT AND
SAY CALL YOUR KIDS OR E-MAIL
THEM AND SAY, I HEARD THIS CRAZY
LADY TALKING ABOUT THIS STUFF
TONIGHT AND SHE SAID E-MAIL YOU.
BUT THERE ARE CASES WHERE YOU
CAN JUST SAY, YOU KNOW, I HAVE
BEEN THINKING ABOUT THIS.
AND I REALLY WOULD LIKE HAVE A
CONVERSATION WITH YOU AND IT
WOULD BE VERY HELPFUL IF WE
COULD FIND SOME TIME TO DO THIS.
APRIL 16 WILL BE NATIONAL HEALTH
CARE DECISIONS DAY.
THIS IS THE SECOND YEAR OF
NATIONAL HEALTH CARE DECISIONS
DAY.
AND YOU GOT IT.
THE CONNECTION FOR THE DATE
APRIL 15, TAXES.
THE 16, THE ONLY TRUE
INEVITABLES IN LIFE.
SO ORGANIZATIONS AROUND THE
COUNTRY HAVE AGREED THAT ON THIS
DAY, WE WILL TRY TO GET PEOPLE
AND HAVE A CALM THOUGHTFUL WAY
TO CATCH THEIR BREATH AND HAVE
CONVERSATIONS WITH THEIR
FAMILIES.
ON OUR WEBSITE, THERE ARE ALL
KINDS OF TOOLS.
YOU CAN FIND BUTTONS THAT SAY WE
HAVE TO TALK.
YOU CAN GET THESE BRACE LETS.
BUT I THINK THE HARDEST PART IS
RAISING THE ISSUE.
IF YOU SAY TO SOMEONE YOU CARE
B-I'VE BEEN THINKING ABOUT THIS,
IT WOULD BE HELPFUL TO ME AND
MEAN A LOT TO ME IF WE COULD
FIND THE TIME TO SIT DOWN AND
TALK ABOUT THIS.
EVEN WHEN PEOPLE SAY, MOM,
YOU'RE GOING TO LIVE TO BE 100.
YOU SAY YES, I HOPE SO.
BUT YOU KNOW WHAT?
NONE OF US KNOWS WHEN OUR NEXT
DAY WILL BE.
SO LET'S FIND THE TIME TO TALK
ABOUT IT.
THANK YOU VERY MUCH.
SOMEBODY ASKED IF YOU COULD
REPEAT THE WEBSITE FOR THE
COMMONWEALTH FUND.
I DON'T KNOW THE ADDRESS.
JUST GOOGLE OR SEARCH ENGINE AND
PLUG IN COMMONWEALTH FUND.
IT'S A NONPROFIT.
IT WILL POP RIGHT UP.
AND IT'S EASY TO FIND THE
DOCUMENT.
I SHOULD HAVE BROUGHT IT BUT I
DIDN'T.
THEY THINK WE ARE ABOUT OUT
OF TIME FOR THIS EVENING.
OUR PANELISTS WOULD BE HAPPY TO
STAY AND TALK WITH YOU-ALL AND I
THINK I WOULD LIKE TO THANK THEM
ALL ONE MORE TIME FOR DEALING
WITH INTERESTING TOPICS FOR US.
[APPLAUSE]
WE HOPE YOU WILL COME BACK APRIL
1.
PLEASE GO OUT TO THE LOBBY AND
HAVE A COOKY AND COFFEE OR PUNCH
BEFORE YOU LEAVE AND STAY WARM.
I'LL SEE YOU NEXT TIME.
I'LL SEE YOU NEXT TIME. THANK YOU FOR COMING.