DelawarePolitics.net

Here is a summary of my notes from the meeting with Senator Carper.  I will try to keep it brief (Epic Fail!) and only bring out the key topics. 

I arrived at Del Tech and saw a handful of 9-12 Delaware Patriots among others waiting outside because it was, as billed a closed-door meeting.  Mike DeStefano was the other member of my group that was given the opportunity to attend the meeting, as he is one of the policy minded members of our group, having read all of 3200 and everything he could find about the Senate bills, including a draft of the Finance Committee’s bill which is still un-numbered but available on-line.  (http://i2.cdn.turner.com/cnn/2009/image … e.bill.pdf )

The meeting began with a welcome and introductory remarks by Senator Carper.  He mentioned some of the public comments that he had heard about the health care reform legislation and all of the misinformation that is floating around.  He wants to clean up the misconceptions and get down to just the facts.  (This is from his website so I assume these are some of the facts he wants us to know.)  One fact being that most people on Medicare like it, including part D, and that administration makes up 3% of the premiums for government provided health care.

He moved to a discussion of the Federal Employee Health Benefit Plan (FEHBP).  Many people have asked, “Why can’t everyone have the same coverage as Congress.”  So he explained a little about what that plan is.  It is an insurance pool that covers approximately 8 million people, to include our federally elected officials, federal employees, their dependents, retired federal employees, and their dependents.  The plans range from what has been termed the Chevy plan to the Cadillac plan.   Senator Carper’s plan costs a total of $12,000 per year, where it would have cost about $13,000 per year in the private sector.  He says that the government pays 72% of the premium (which means the taxpayers) and that the individual being covered pays the remaining 28.

He sees two broad options.  The first is to let everyone participate in FEHBP.  However, he says that his Republican colleagues have stood in the way of that option.  The second option is to create a second, similar pool referred to as “the exchange.”  The exchange could either be nationwide or broken into smaller regional pools.  The states would still be regulated separately and so people still won’t be able to purchase it across state lines.  Therefore, in states where there was little to no competition they would offer a government option to provide that competition.  (I addressed this when I was given a chance to speak.)

After this Senator Carper turned the time over to his staffer, Raquel Russell to explain the course of the rest of the meeting.  Next all the participants would introduce themselves and where they were from.  Then we would all get some time to make statements.  She also reminded us that it was a closed-door meeting so no recordings, video or audio were permitted.  (At that point I turned of the audio recorder that I had sitting on the table.)

Participants included the American Heart Association, the Central Delaware Chamber of Commerce, the National Association of Realtors, the Leukemia and Lymphoma Society, PPG (the paint manufacturers), the Alzheimers Association, the 9-12 Delaware Patriots, a physical therapist with his own practice, Coca-Cola and the Soft Drink Industry, and the Health Care Sharing Ministry.  There were also at least half a dozen of Senator Carper’s staffers present in the room.

As to their comments, I’ll try to keep it concise, but as you can see I am not doing a very good job of that.

The American Heart Association talked about health care costs bankrupting families, that the current system is fragmented, and shared a story of one individual that was bankrupted and lost their home when they were hospitalized and had their insurance lapsed.  They want affordable, simple health care, and they want it as soon as possible.

The Central Delaware Chamber of Commerce focused their remarks on cost drivers not related to the actual health care.  First, they want some form of medical liability reform.  Second they want to stream-line the delivery system of health care by improving IT and communication between doctors.  Additionally they stressed that the process for implementing health reform should be in small steps, it needs to slow down, and the public needs to be educated and kept aware of what is happening.

The National Association of Realtors was concerned about employers being forced to pay for benefits.  The Association wants to support health care reform as long as it is the right kind.  He also asked how many mandates were in the FEHBP.  Neither Senator Carper, nor any of his staffers could provide a clear answer to that question.

The Leukemia and Lymphoma Society wanted to know how clinical trials would be affected.   They urged the government to take it slower on health care because of all the people this will impact.  They stated that America has the best health care in the world, and Senator Carper mentioned that he questioned that.  They went on to talk about how the uninsured still receive care, they may not get to choose their doctor, but they still receive care, in many cases, pro bono.  She also expressed openness to looking at a disaster cap on insurance, where the government would pay for health care rather than the insurance companies after a certain dollar amount.  Finally they said we need to look at the things that will lower the actual cost of health care.  If we did that the cost of insurance would go down.

PPG explained that they provide comprehensive health care for over 85,000 people at a cost of over $200 million per year.  If health care coverage costs continue to rise they will no longer be able to do that.  They had 5 points and I am not sure if I got them all correctly.  1.  They want a level playing field where if one group is taxed they all are.  Unions and other special groups should not be exempted.  2. Keep the ARRISA exemption.  3. They could support an individual mandate.  4. They support the exchange idea over a government option.  5. Catastrophic coverage must be kept on the table if they want to cut costs.  Then he asked how they can help and Senator Carper responded that they can help spread correct information about health care reform.

The Alzheimer’s Association mentioned the need for a long term health care package.  The average Alzheimer’s patient lives for 8-12 years after diagnosis.  Care during that time is very costly to the family.  She encouraged support of the Alzheimer’s break through act.  She also stressed that Delaware’s Insurance Commissioner is one of the few that actually has bite and that we need regulation.  Reform would be easier if some regulations were made nation wide.  (I assume because that would allow for better portability of insurance between states.)

The 9-12 Delaware Patriots were next.  I started out by stating that I am a member of the 9-12 Delaware Patriots but we were not representatives.  We are a citizen’s group with a wide variety of opinions about health care reform, and that our founder Russ Murphy chose to be outside with the rest of the citizens.  I then shared some of my ideas about what I want and don’t want.   Here is my list.

Want-

Bite-sized legislation (Read the bill and understand it)

HSA a must

Medicare Medicaid Reform

IHS reform

Fraud Enforcement (Begun by Bush expanded by Holder)

More People paying into risk pool not people paying more to insurance providers

Non-legislative Solutions

Electronic Medical Records owned/controlled by the patient

Streamlined insurance claims process, filing, and reports.

Tort Reform

Free-Market Competition

Affordable insurance and lower cost of routine medical expenses

Don’t Want-

Government Option

Single Payer

More government or Insurance Company control

Higher Prices, less service, lower quality, less efficiency, more waste, more fraud, longer waits, rationing

Illegal immigrants covered

I also addressed the idea of using a government option for states that don’t have enough competition, by stating that if states are going to pay into a regional pool then they should also be able to take out of that regional pool.  The purchase of insurance across state lines should be made available, at least within the range of the regional insurance pool.

Mike DeStefano then laid out some of what was in the actual bills (HR 3200 and the Senate draft) and why so many citizens opposed them.  One factor being the size.  He stated that if the disposition of Congress was really that the American people should have health care coverage similar to their own (as is stated in the bill) than he could boil the 1000 plus page bills down to about 2 pages.

The physical therapist mentioned that there was a void in the health care system after Hillary Care was proposed and failed.  The insurance companies filled that void with “managed care” which allowed them to set the price for reimbursement.  He mentioned that as a doctor it has come to the point where he is making no profit and he has not been able to increase the pay of his staff for several years.  He also mentioned that there is a lot of waste in the current system.

Coca-Cola and the Soda industry were there primarily in opposition to one of the proposals to pay for the health care reform by taxing soda.  Their point was that no single industry should foot the bill.  They mentioned that they have stepped up to the plate and provide a lot of healthier options among their offerings.

Finally was the Health Care Sharing Ministry.  They have a grass roots system of sharing health care costs.  The cost to members is less than $5,000 a year and it goes beyond typical health care.  When a member is sick they ask other members to pray for them and visit them or write letters of encouragement.  They requested that like the Amish and the Mennonites they be exempted from the penalties of whatever legislation was past.  Senator Carper was interested in some of their ideas and likened it to a co-op.

Senator Carper and his staff then made closing remarks.  He shared the example of two towns in Texas, one where coverage cost $15,000 per patient per year, the other where it cost $6,000 per patient per year.  He blamed the difference in cost of the entrepreneurship of the doctors in one town providing more tests and services than were needed in order to earn more money.  He then talked about the Mayo Clinic, Cleveland Clinic, and other Co-Ops and systems that he things are great examples.  He talked about what works including the FEHBP. 

He mentioned malpractice reform, and suggested using the states as testing grounds.  In some areas suites must be brought before a non-binding panel to assess the viability of the suit before it goes to court.  The plaintiff will still be aloud to move forward no matter what the outcome of the panel.  This method has cut lawsuits in half in some of the areas where tried.  He also mentioned looser pays, safe harbor, health courts, and the clinic paying for malpractice insurance rather than the doctors.

He also mentioned that reform needs to include taking care of those with pre-existing conditions.

Next the health care fellows on his staff spoke.  One shared the concept of rather than comparing US health care to other countries, trying to bring the level of care for everyone in America up to the level of care received at the best clinics in America, such as Mayo or Cleveland.  The other staffer mentioned the speed size and cost of reform.  He said that while it may cost $1 trillion dollars, if we do nothing it will cost America $32 trillion dollars.  (I found this somewhat offensive as no one in the room was suggesting that we do nothing.  This whole cost of doing nothing argument is getting tired and as we have seen it is often distorted.)  He also mentioned that Senator Carper and President Obama both promise not to pass health care reform that will increase the deficit. (I think that once they rebuilt the trust between people and the government that may mean a little more.)

Finally Senator Carper and Raquel talked about keeping HSA’s under the new plan and finding cures for chronic diseases.  He also laid out his four core values.  1. Figure out the right thing and do it.  2. The golden rule.  3. Focus on excellence.  4. Never give up.  He closed with the 80/20 rule which was used by Senator Kennedy and Senator Enzi on the Senate HELP Committee in order to get so much done.  They thought they agreed on about 80% of things and disagreed on 20% so they focused on what they agreed on and left the 20% for another day.  He suggested that we all agreed on 80% of things and asked us to leave the 20% for another day.

With that the meeting closed.  You can see some of the aftermath of the meeting in my earlier post.