philly

The Hoagiemeister was in town on Friday to talk about his healthcare plan for PA which he calls Cover All PA [CAP]. He came to town with Rosemarie Greco, Director of Health Care Reform for PA. They were in town for a WHYY TV town hall discussion which will air on November 4th at 6p on channel 12 in Philly. For about an hour or so, host Ed Cunningham lead the discussion after some opening statements from Gov. Rendell and Greco.

Rendell got right into his stump speech. He said there are currently 450,000 fewer Pennsylvanians insured by their employers than in 2000. That's crazy! I was fortunate to have had some decent coverage by 2 of my 3 employers during my time in Philly, but I haven't seen a doctor since being here. Rendell said his plan was three pronged. First, the issue of cost control. Hospital acquired infections can and should be prevented. They are a huge drain on funds and resources. PA was the first state to issue a report on hospital acquired infections in 2005 [.pdf]. That report found:

In 2005, hospitals reported 19,154 cases in which patients contracted an infection while in the hospital, a rate of 12.2 per 1,000 cases. The hospitalizations in which these infections occurred amounted to 394,129 hospital days and $3.5 billion in hospital charges.

During the Q&A period, Rendell went into more detail about the preventative measures and what the Pittsburgh VA is currently doing to help prevent the spread of infection. They're swabbing every incoming ER patient for infections. If a person comes up positive for certain easily spreadable infections, they are placed in a pseudo-quarantine. Their hospital bed is outlined with red tape and nobody is to go inside that red tape box without a full set of gloves, scrubs, mask and other protections. The cost is approximately $175 for each person quarantined. The cost of the spread of infection, $114,000 per person.

The cost of covering the ER expenses of the uninsured: $1.4 billion a year. Rendell would like to implement a non-emergency section of the ER (yes, yes oxymoronic) where people who have non-emergency issues can be triaged to the non-emergency section. Patients would receive treatment from nurses, nurse practitioners and the like at a 60% cost-savings to the hospital when compared to ER visits which require a doctor's input. These mandatory non-emergency sections would be open until at least 9p and would also benefit those with insurance who can't see their PCP outside of normal business hours.

The second prong of his plan is to handle the insurance companies with some reform. How he's really going to do this I don't know, considering that some of his top donors are insurance people. He said that the insurance commissioner currently does not have the power to set health insurance rates. The commish sets rates for other things like car insurance (which Rendell says has been saving tons of dough for PA, but I believe Philly has the highest rates in the country for a major city). He'd give power to the commish to do so and would mandate an initial 7% reduction. He'd also require that 85% of the insurance premiums be paid back into the healthcare system. How that happens, I don't know. He said that he'd also mandate that insurers accept those with pre-existing conditions for coverage.

The final prong would be to cover all the adults (he's already got the kids covered with CHIP). Some 800k - 900k adults currently don't have insurance [counting me]. Under CAP, employers would pay in $130/employee per month with the employee kicking in another $10-$70/mo depending on how much they make. If one is self employed or wants to buy into CAP on their own, they would pay $10 - $280 depending on how much they were able to pay.

How does his $1.4B plan get funded? He says the Federal government would pay about 33% of the cost, employers/employees would pay in about 37% and the state would pay, about 24% through an increased cigarette tax, a new smokeless tobacco tax (apparently PA is the only state without a tax on smokeless tobacco and that does include Virginia) and a 3% payroll tax for businesses not paying directly into their employee's healthcare [that leaves 6%, maybe I misheard his numbers].

Q&A time. And who had question #3? Why none other than yours truly (catch my mug on WHYY12 on 11.4 probably around 6.15p) I asked who would be the one picking the doctors under the CAP plan and for their opinions on two pieces of legislation in the PA Congress, HB 1660 and SB 300. Rendell said that he's all for single-payer healthcare, but it has to be done on a national level and that it couldn't be done at the state level as individual states would be at a competitive disadvantage with such a healthcare plan. He also said that it would cost $5B - $6B to do it. Greco answered part one by saying that Pennsylvanians would be able to pick their own physicians. Her wording makes me think that the free choice is limited to PCPs and not specialists. Rendell added that out of all the presidential candidates, only Dennis Kucinich (D-OH) has a single-payer healthcare plan and he said the reason was because the costs are too high. Maybe the reason is that Hillary was shot down in 1994 for her original plan from both sides of the aisle and people are too chickenshit to take on the issue that a majority of Americans are for (another thing the vast majority of Americans are for? Getting the fuck out of Iraq.).

One lady asked about those who can't afford the payments for healthcare whether it be supplementing what an employer would pay or if it was all on their own. Rendell and Greco just restated the pricing options available with no answer concerning those who couldn't afford anything. Greco did note some interesting legislation in PA - under the plan, parents would be able to keep their children, under the age of 29, under their coverage [couldn't find the bill].

Lots of maternity wards have been closing in PA and across the US with the growing concern of profitability for hospitals. Maternity wards are apparently not big moneymakers, so, in our "culture of life" this administration is fostering, maternity wards are being shut down left and right. One questioner, a nurse practitioner and midwife, asked what could be done to stop the rampant closures. Rendell's answer was bleak: nothing could be done. He said that it was up to the hospitals to decide what goes on in behind their doors. He did point out some changes in PA law allowing nurses, nurse practitioners and midwives to write prescriptions for medicines within their field of practice allowing for more latitude without requiring a doctor's visit.

Another nurse practitioner [rock on for getting to this forum in numbers] asked about nurse practitioner reimbursement - many insurance companies will not cover the costs of nurses and nurse practitioners opting to only pay the expenses of doctors, anesthesiologists, surgeons and the "more important" people to keep costs down in this age of for-profit healthcare. Rendell said that he'd like to reshape how insurance companies pay out to include nurses and nurse practitioners. He added that insurance companies currently also won't cover things like chronic care which is a large donut hole in coverage. Greco added that during Rendell's administration, he authorized/required HMOs in PA to pay for nurse and nurse practitioners.

The next question was on wellness, the preventative steps and improving one's own health like quitting smoking for adults and breast feeding as that is a form of wellness for newborns. Rendell noted his signing of a bill legalizing public breast feeding [that this is illegal or people are so troubled by this as to complain about it, boggles my mind]. He spat out some anecdotal evidence of the State's current wellness program rewarding good behavior like quitting smoking. Incentivizing getting better is a way of getting people to take care of themselves.

During his opening remarks, Rendell talked about "The Invincibles" - males between 21 and 30 who do not have coverage because they don't think they'll get sick [hey, that's me]. An audience member asked how to get those people to sign up for insurance. Rendell said that the low costs of his plan were the best incentive and really, the only way, outside of mandating coverage, to get them signed up. He pointed out the Massachusetts plan where everyone is required to have coverage [requiring everyone to have coverage is a far cry from providing single-payer universal healthcare], and that it is a controversial step. He noted the 80% public support in favor of a higher cigarette tax to fund healthcare, but that many legislators had stupidly taken a "no new tax" pledge and are a roadblock for the plan.

I wasn't happy with the answers during the town hall, but I was glad I had gone and especially glad to have gotten the topic of single-payer universal healthcare coverage on tape for viewers to hear later on [WHYY12, 11.4, 6p]. There's a group of Pennsylvanians [I'm one of them] working on making single-payer universal healthcare a reality here in PA. For more info on it, check out the HealthCare4AllPA website. The CityPaper wrote a couple articles in the last 3 months on Rendell's plan and alternatives.

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