How the Transformation of the Health Care Industry Impacts Single-Payer Organizing

Date and Time:
Sunday, August 24, 10:20AM-11:30AM, ILWU Local 6 Hall, Conference Room 2

Presenters: Martha Kuhl, California Nurses Association, Carolyn Travao, patient advocate, and Ramon Castelblanch, University of California at Berkeley

Description: When Medicare was passed into law in 1965, the term “health care industry” did not exist, small primary care practices were common, and the American Medical Association was the primary opposition to universal healthcare. The healthcare delivery system has changed, and is changing rapidly - change that will be further accelerated in the era of the Affordable Care Act. This workshop explores how the changing healthcare landscape creates new challenges and new opportunities for single-payer organizing.

Notes by Presenters and Conference Participants:

The ACA has restructured the health care industry.
It has enshrined health care as a commodity that you buy and it creates a medical industrial industry. It creates tiers of health care based on bronze, silver, gold, and platinum plans.

Technology is standardizing care, but it does not improve our health care. It is really person-to-person interaction that makes health care better. There is a new specialist whose job is to capture the maximum reimbursement by using the right words in your EMR. Note that they often preface it by saying, “we don’t want to tell you what to say, but if you say … ”. For example, you need to say acute respiratory distress instead of short of breath. It rewards word smithing as opposed to patient care.

Outpatient centers and observation rooms are created to shorten length of stay meaning some patients never get admitted, but can spend days in observation. The level of acuity has risen a lot for those who are admitted putting more strain on nurses. Tiered care determines which specialists you can see and narrow networks of providers limits the care you can get.

We need a single high standard of care that all patients should expect. Unfortunately, outcomes will still differ based on social determinants of health (poor have less access to resources). SP creates a platform that we all need.

Carolyn worked for Aetna call center in California. She says that AETNA went from 80,000 to 30,000 employees and have outsourced their call centers to India. She told her own story after leaving Aetna she was uninsured and she had 17 hours of chest pain that she refused to have treated because of her insurance status. She finally went to the ER where they diagnosed her as having a heart attack. Fortunately, she lived, but she has heart failure and is limited in her activities. The SP movement is very important according to her because there are millions like her who need insurance.

We are seeing indigent and low-income people moving to Medi-Cal (California Medicaid) but they are not able to see a primary care physician because of long waiting lists and limited acceptance. There is a lot of pressure for primary care doctors and physician assistants who have to see lots of patients. Administrators are measuring how many minutes are you staying in each room. Too long and you can get written up. Insurers ultimately are deciding how you practice.

Healthcare Health Care for All, California Nurses Association gro.sesrunlac|eractneitap#gro.sesrunlac|eractneitap, or to moc.liamg|okcisannod#moc.liamg|okcisannod are all taking horror stories post ACA. It is important to document these stories and we can distribute to local groups to use with their legislators. We need videos of patient stories, theater of the oppressed showing sad stories, public education.

One story was relayed about a physician fired for writing a LTE. We need protection for whistle blowers if we are to get stories.

One nurse said they were able to reduce their infection rate to zero. How? No cultures were taken so they could show that they have no infections.

Hospitals are in competition with free standing ERs. The ERs take those with good insurance and send the rest to the hospital. They are a triage method based on insurance.

We are changing the definition of what we mean by health care.

Location of care is moving away from hospitals. Minute clinics, retail clinics are growing.

Depersonalization of care

For profit effects on the health care system. Investment capital is becoming health care.

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