Chapter Meeting July 10, 2010

1. Chapter MeetingJuly 10, 2010 June 12, 2010

2. Agenda • 1. Review of PNHP National Conference Call • 2. State Strategy Group Conference Call • 3. PNHP California Report • 4. Summer Conference- Final Preparations

3. PNHP National • Vermont's Health Care Reform Commission has just chosen Dr. William Hsiao, the architect of Taiwan's successful single-payer program, to do an economic impact study of three prospective models of health reform- $300,000 • The consultant’s task: Give lawmakers three roadmaps the state could follow to achieve a more efficient and accessible but less-expensive health-care system. One must be a government-financed system, and another must include a public option for health coverage along with private insurance. • William S. Hsiao, professor of economics at the Harvard School of Public Health and his associates, Jonathan Gruber, an economics professor at Massachusetts Institute of Technology, and Steven Kappel, a health policy analyst who previously worked for the state and for the Legislature.

4. National Report • Medicare turns 45 on July 30. • PNHP members are urged to speak out at meetings and in letters to the editor and op-eds against any efforts to undermine the program, as limited and flawed as it presently is, and to offer an improved Medicare for all - single-payer national health insurance - as the alternative. • .

5. National Report- Doc Fix • 2 problems with Medicare physician payment model • 1) arbitrary formula for total payments to physicians - the sustainable growth rate (SGR). • will reduce Medicare's physician payments, which already trail those from private insurers, as far into the future as the eye can see. • 2) the relative fees in the current system are a significant cause of the growing imbalance in supply and utilization between primary care and specialty services in the U.S. • That imbalance, in turn, is widely perceived as a major cause of both excessive costs and inadequate quality care. This is not just a Medicare problem: the Medicare Resource-Based Relative Value Scale is used by most private insurers to set relative prices for physicians.

6. National Report- Doc Fix • 1997- Congress refined the formula by which the annual change in Medicare physician fees was determined • Total physician payments per beneficiary should grow no faster than the economy as a whole, as measured by the gross domestic product (GDP). • Policymakers were concerned about increases in the volume of services that beneficiaries received; since total spending equals price times volume, under an aggregate cap, if volume grew more quickly, fees would grow more slowly or be reduced.

7. National Report- Doc Fix • Medicare Physician Fee Schedule was supposed to change physician payment to increase rewards for primary care services at the expense of procedural and interventional services • Appears to have gone totally off track. • For various reasons, the fee schedule, which originally did increase the prices of evaluation and management services relative to those of surgery or invasive procedures, turned in the other direction through the process of annual updating of relative value units. 3 • Surgeons, radiologists, and some medical specialists are now paid two to three times as much per hour as providers of cognitive services, which is about where we began 20 years ago; this was the situation that the fee schedule was supposed to fix. • 3. Ginsburg PB, Berenson RA. Revising Medicare's physician fee schedule - much activity, little change. N Engl J Med 2007;356:1201-1203.

8. National Report- Doc Fix • The way to redress the imbalance between primary care and specialty compensation while shrinking the disparity between Medicare and private insurance is to add more money to primary care while leaving specialists' fees unchanged, on average. • But doing so worsens the federal deficit, providing fodder for those who pose, at least, as opponents of deficit spending. And then the pundits argue that fixing the current system isn't really worth the bother - that fee-for-service payments are so intrinsically counterproductive that we should just scrap them in favor of something better.Except that no one knows what that something is.

9. National Report- Membership • Membership Task Force • First meeting is July 22 at 5p PST (conference call) • Second meeting at the November retreat

10. National Report- Membership • Ideas • Webinars • Ask the expert conference calls • Newsletters that include physician specific issues • Malpractice, Burnout, Reimbursement, ACOs • Outreach to certain physician groups/targets/training

11. State Report • Healthy Majority (the big picture for SB810) • SB810 needs a simple majority to pass without the financing • SB810 needs a 2/3 majority to pass with financing • Then we must prepare for a ballot initiative from the insurance industry. • How do we frame SB810 in light of PPACA • SB810 has moved to the Assembly Health Committee • Member Task Force • Fiscal study for single payer • New Hampshire Ad on Single Payer for Small Business - Tom Clairmont • PNHP Fall Meeting- November 5-6, Downtown Sheraton

12. State Report • Assembly • AD 5: Dr. Richard Pan • Cities: Carmichael, Citrus Heights, Fair Oaks, Folsom, Granite Bay, North Highlands, Sacramento • https://panforassembly.com/ • http://panforassembly.com/get-involved/ • AD 10: Alyson Huber • Cities: Lodi, North Woodbridge, Woodbridge • http://www.alysonhuber.com/ • http://www.alysonhuber.com/volunteer • http://www.joanbuchanan.com/ • http://www.joanbuchanan.com/volunteer • AD 30: Fran Florez • Counties: Fresno, Kern, Kings, and Tulare • http://www.franflorez.com/ • http://www.franflorez.com/join • AD 33: Hilda Zacarais • Cities: Atascadero, Moro Bay, Paso Robles, San Luis Obispo, Santa Maria • http://www.hildazacarias.com/ • AD 65: Carl Wood • Counties: Riverside and San Bernardino • http://wood4assembly.org/ • http://wood4assembly.org/volunteer • AD 68: Phu Nguyen • Cities: Grove, Costa Mesa, Fountain Valley, Westminster • http://www.votephu.com/phu/welcome.aspx • http://www.votephu.com/phu/join-our-team.aspx • Senate • SD 12: Anna Caballero • Cities: Hollister, Merced, Modesto, Salinas, Turlock • http://www.annacaballero.org/ • http://www.annacaballero.org/actionMember Task Force • Fiscal study for single payer • New Hampshire Ad on Single Payer for Small Business - Tom Clairmont • PNHP Fall Meeting- November 5-6, Downtown Sheraton

13. State Report • AD 15: Joan Buchanan • Cities: Alamo, Danville, Livermore, San Ramon, Walnut Creek • http://www.joanbuchanan.com/ • http://www.joanbuchanan.com/volunteer • AD 30: Fran Florez • Counties: Fresno, Kern, Kings, and Tulare • http://www.franflorez.com/ • http://www.franflorez.com/join • AD 33: Hilda Zacarais • Cities: Atascadero, Moro Bay, Paso Robles, San Luis Obispo, Santa Maria • http://www.hildazacarias.com/ • AD 65: Carl Wood • Counties: Riverside and San Bernardino • http://wood4assembly.org/ • http://wood4assembly.org/volunteer • AD 68: Phu Nguyen • Cities: Grove, Costa Mesa, Fountain Valley, Westminster • http://www.votephu.com/phu/welcome.aspx • http://www.votephu.com/phu/join-our-team.aspx • Senate • SD 12: Anna Caballero • Cities: Hollister, Merced, Modesto, Salinas, Turlock • http://www.annacaballero.org/ • http://www.annacaballero.org/actionMember Task Force • Fiscal study for single payer • New Hampshire Ad on Single Payer for Small Business - Tom Clairmont • PNHP Fall Meeting- November 5-6, Downtown Sheraton

14. State Report • AD 65: Carl Wood • Counties: Riverside and San Bernardino • http://wood4assembly.org/ • http://wood4assembly.org/volunteer • AD 68: Phu Nguyen • Cities: Grove, Costa Mesa, Fountain Valley, Westminster • http://www.votephu.com/phu/welcome.aspx • http://www.votephu.com/phu/join-our-team.aspx • Senate • SD 12: Anna Caballero • Cities: Hollister, Merced, Modesto, Salinas, Turlock • http://www.annacaballero.org/ • http://www.annacaballero.org/action

15. State Report • Operation Single Payer

16. State Report- Regional Task Force • Regional Strategy Groups • Bay Area, North Valley, Central Valley, Los Angeles, San Diego • Start by creating a list of regional representatives from each org. • Build regional expert councils

17. State Report- Regional Task Force • Three categories of collaborative programs • Education- • monthly educational forum, media task force • Advocacy • district leader network, healthy majority • Growth • tabling, rallies, endorsements, shared resources/calendar

18. PNHP California • SB810 Technical Advisory Group • Kahn, Abrons, Cwayna, Hendrickson, Skeen, Sullivan • Can we improve the HMO language

19. PNHP California • The single-payer model precludes private insurance that duplicates the public coverage – a measure required both to control costs and to avoid the emergence of two-class care. The question of how to treat nonprofit, staff- and group-model HMOs is complex because they combine a nonprofit provider of care (clearly acceptable in a single- payer model) with a private insurance plan (which is not acceptable).

20. PNHP California • Because the term "HMO" has been used to cover a wide variety of insurers, it is important that legislation clearly define the parameters for HMOs that could participate in a single-payer system, and spell out the restrictions on participating HMOs. Failing this, private insurers would surely exploit any exemption for HMOs to maintain their stranglehold on the health care system.

21. PNHP California • Both PNHP's proposals and H.R. 676 (the single-payer legislation sponsored by Rep. John Conyers; you can find the legislation on the PNHP website at: http://www.pnhp.org) have spelled out the key features that distinguish HMOs allowed to continue under a single- payer system from those that would be proscribed. Specifically, participating plans must:

22. PNHP California • (1) be nonprofit; • (2) "actually deliver care in their own facilities" through salaried physicians who are employees (not contractors) of the HMO; • (3) not use their capitation or budget payments to cover hospital services (hospital services would be paid for through a global budget paid directly to the hospital); • (4) not offer financial incentives based on utilization.

23. The Summer ConferenceJuly 17, 2010| Los Angeles

24. The Summer ConferenceJuly 17, 2010 | Los Angeles • Welcome • Morning Session • Lunch Buffet • Afternoon Workshops • Wine and Fruit Reception • Evening Session with Seafood Buffet

25. The Summer ConferenceJuly 17, 2010 | Los Angeles • Workshops • Education (1:00-2:30p) • Advocacy (2:45-3:15p) • Growth (3:15-4:30p) • Regional Coalitions (4:45p-5:45p)

26. The Summer ConferenceJuly 17, 2010 | Los Angeles • Education Workshops • Press • Speaking to Physicians • Speaking to Labor • Speaking to the Insured/Women • Framing

27. The Summer ConferenceJuly 17, 2010 | Los Angeles • Workshops • Education (1:00-2:30p) • Advocacy (2:45-3:15p) • Growth (3:15-4:30p) • Regional Coalitions (4:45p-5:45p)

28. The Summer ConferenceJuly 17, 2010 | Los Angeles • Growth • Rallies • Outreach to youth, African-americans, Latinos • Video development for the grassroots • Websites and social networking • Tabling

29. The Summer ConferenceJuly 17, 2010 | Los Angeles • Regional Coalitions • Bay Area • North Valley • Central Valley • Los Angeles • San Diego

30. The Summer ConferenceJuly 17, 2010 | Los Angeles • Help • 5 Transitions between full assembly and workshops • 1:30p- Education full assembly to workshops • 2:30-2:45- Education workshops to Advocacy full assembly • 3:45- Growth full assembly to workshops • 4:30- Growth workshops to Regional Coalition full assembly • 5:00- Regional Coalition full assembly to workshops