THE PUBLIC, HEALTH, NURSING, AND UNIVERSAL HEALTH CARE: THE PUBLIC, HEALTH, NURSING, AND UNIVERSAL HEALTH CARE Ellen R. Shaffer, PhD, MPH The Policy Center on Trade and Services ershaffer@earthlink.net Public Health Nurses/California Nurses Association June 9, 2002


Public Health Nursingin the Forefront: Public Health Nursing in the Forefront Crucial population health services Frontlines of community care, prevention Organized!


Globalization and the Public Sector : Globalization and the Public Sector Global economic agenda International trade and services Public health Universal health care


Global Corporate Agenda: Attack on the Public Sector: Global Corporate Agenda: Attack on the Public Sector Cut taxes on corporations and the rich Cut services Privatize Deregulate Free trade agreements Weaken unions and workers' right to organize and have a voice in the political process www.aflcio.org


U.S.: Federal Tax Cuts Decimate Surplus: U.S.: Federal Tax Cuts Decimate Surplus January 2001: Congressional Budget Office (CBO) projected federal budget surpluses: $97 billion in 2001, $104 billion in 2002 $2.7 trillion over ten years. Tax cuts cost more than $1.6 trillion over 10 years, + recession July 30, 2001, Treasury announced that it would borrow $51 billion during the quarter 2002: CBO projects a $1.1 trillion deficit through 2010 Senate Democratic Policy Committee


Shifting Tax Burden From Corporations to Working Families : Shifting Tax Burden From Corporations to Working Families In 1957, corporate income taxes provided 27 cents of every federal revenue dollar. 1977, corporate income taxes provided 15 cents of every federal revenue dollar. In 1997, corporate income taxes provided  less than 12 cents of every federal revenue dollar. Aflcio.org


Reduced Government Investment: Reduced Government Investment The federal government spent about $63 billion less on investment in 1997 than it did during an average year in the '70s: Physical capital (highways, buildings, etc.) Research and development (a long-term investment in high-wage jobs) Education and training Aflcio.org


The Costs of Deregulation1997: The Costs of Deregulation 1997 Telephone Communications Savings & Loans Trucking Aflcio.org Employment down by 144,000 jobs (19%) Employment down by 211,000 jobs (46%) Inflation-adjusted wages down by $3.52 per hour (28%)


Services: Next Business Frontier: Services: Next Business Frontier Shift services from public sector to private sector Users of services = Consumers User Fees Better shoppers for health care Better shoppers for water Decimate public regulation and accountability


Why Services: Why Services Finances Telecommunications Insurance


Trade Negotiations : Trade Negotiations World Trade Organization: agreements set terms (NAFTA, FTAA, GATS) World Bank and International Monetary Fund: loans to “developing” nations Interest on the loans lead to debt Austerity in social programs Results: greater poverty


General Agreement on Trade in Services (GATS): General Agreement on Trade in Services (GATS) Facilitate private foreign corporations trading in the U.S. in: Hospitals, equipment and supplies Nurse registries Insurance Pharmaceuticals Water and sanitation


Governments Lose Ability to Protect Services and Users: Governments Lose Ability to Protect Services and Users Article 1110 of NAFTA: a government may expropriate property if it is done a) for a public purpose; b) on a non-discriminatory basis; c) in accordance with due processes BUT: It still needs to pay compensation. 


How Much Compensation?: How Much Compensation? Methanex case: a Canadian firm brought a nearly $1,000,000,000 claim based on the State of California’s decision to ban the sale of MTBE, a suspected carcinogen, in order to protect the State’s drinking water supplies; Metalclad case: a U.S. firm recovered $16,000,0000 under NAFTA, based on the refusal of a Mexican municipality to grant a permit for the construction of a hazardous waste treatment facility in the community.


Public Safety For Sale: Public Safety For Sale In the SD Meyers case, a U.S. firm brought a successful NAFTA challenge to a Canadian government ban on the export of PCB wastes. Recently, the U.S. Crompton corporation has threatened a NAFTA suit over Canadian restrictions on a dangerous pesticide called lindane, which is a possible human carcinogen banned in Europe for agricultural use, and in California for use in anti-lice shampoo


European GATS Priorities:Water, Postal Service: European GATS Priorities: Water, Postal Service US and CA could be sued in World Trade Tribunals for: Setting trade restrictions on services Giving preferences to public services (DSH, immunization programs, Medicare AHC payments) “Fast Track” Bill HR3005 strips Congressional oversight of Administration trade negotiations


Vital Human Services for Sale : Vital Human Services for Sale “Some kinds of public policy choices should be decided by democratically elected governments, not by unelected trade bureaucrats.” U.S. Senator Jon Corzine (D-NJ)


Market Failure in Water: South Africa : Market Failure in Water: South Africa World Bank proposal to charge “user fees” for water Water cut off for inability to pay $6 connection fee 80,000 infected with cholera in eight months 180 dead Patrick Bond


Water: Ghana : Water: Ghana Average income $1 a day World Bank: privatize urban water system as condition of providing loans User fees Guaranteed rate increases for foreign private transnational coporation


Market Failure in Health Care: Market Failure in Health Care Rising costs Rising uninsured Falling quality Nursing shortage Population health Emphasis on acute vs. prevention


SHIFTING COSTS: SHIFTING COSTS INDIVIDUAL CONSUMERS CANNOT REDUCE HEALTH CARE COSTS THROUGH INDIVIDUAL “PURCHASING” DECISIONS. “USER FEES” AND “CHOICE” PLANS SHIFT HEALTH INSURANCE COSTS FROM EMPLOYERS TO INDIVIDUALS


Uninsured: Dying from a Toothache in the U.S.: Uninsured: Dying from a Toothache in the U.S. A man in his early 20s with a worsening dental infection was unable to afford a dentist. He finally saw a physician who prescribed an antibiotic, but the patient was unable to pay for the prescription. He came to our clinic when the infection had spread to his chest. He died soon after admission. The egregious is commonplace in our non-system. JAMAVol. 286 No. 20, November 28, 2001"Within the System of No-System," Robert L. Ferrer, MD, MPH


Disparities in Insurance: Disparities in Insurance 56% of Latino noncitizen children 23% of African Americans, age 0-64 21% of Asians, age 0-64 14% of non-Latino whites, age 0-64 (source: Current Population Survey 1998, per Brown 8/00; and KFF 4/00)


Disparities in Outcomes: Disparities in Outcomes Infant mortality per 1,000 6.0 White 14.1 Black Maternal mortality per 100,000 5.1 White 17.1 Black (sources: NVSS, CDC, 10/5/99; Healthy People 2010)


Access and Quality: Preventable Hospitalizations Increasing In CA: Access and Quality: Preventable Hospitalizations Increasing In CA Shortages and maldistribution of primary care MDs, nurses, dentists Over 400,000 preventable hospitalizations for Ambulatory Care Sensitive conditions annually Immunizations, diabetes, hypertension $5.7 billion a year in preventable charges


Patient Safety: Everyone At Risk: Patient Safety: Everyone At Risk Underuse, Overuse and Misuse 98,000 people die annually from avoidable errors in the hospital.


Who You Gonna Call?: Who You Gonna Call? Enron?


California Health Care Options Project: California Health Care Options Project Federal funding to study expanding coverage (HRSA) CA Health and Human Services Agency: contracts to 9 proposals 6 Incremental 3 Single Payer www.healthcareoptions.ca.gov


Single Payer: Single Payer Government collects all funds for health care Eliminates 30% spent on administrative waste, profits Basis for universal coverage in every industrialized country Health Care is a Social Responsibility


California Health Service Plan (HR 3080): Reforming Delivery System + Financing Improves Quality, Access +Savings: California Health Service Plan (HR 3080): Reforming Delivery System + Financing Improves Quality, Access +Savings Now: Private Random Inequitable Hierarchical Unpopular Clinicians leaving Access and Quality: Preventable Hospitalizations Increasing In CA Frequent users dissatisfied NEW: Publicly accountable Organized Fair & Rational Teamwork High Quality Responsive


Operating Principles: Operating Principles Government role: Set goals for quality and costs Organize the system Hold system accountable Control costs on the supply side: Use budgets, not co-pays Increase primary care Engage population: Elected patient boards participate in decisions


Public Owns An Organized, Accountable Delivery System: Public Owns An Organized, Accountable Delivery System Public owns health facilities Pays for health care workers’ training Allocates services based on population need Strengthens “safety net” providers Strategic planning using population health data Public Health Dept. charged to improve population health Dynamic. Responsive, Flexible


Reimbursement Goals:Ethical Professionalism, Appropriate Utilization, Cost Control: Reimbursement Goals: Ethical Professionalism, Appropriate Utilization, Cost Control Clinicians paid by salary Health facilities paid by budget, reflecting case mix Can be modified by State HHS to achieve cost and quality objectives Financial and organizational incentives tied to performance


California Health Service Plan (CHSP): California Health Service Plan (CHSP) Saves $7.6 Billion A Year And Covers Everyone


CHSP Savings: CHSP Savings Average household saves $813 /yr Some save over $1,500/year Highest income group pays only 1.5% extra - or less Most employers save $20/worker Total system savings over 10 years: $45 billion


Universal Health Service: Politics: Universal Health Service: Politics End government-bashing Get the government off our backs and on our side! Public Health practices and principles are models for the entire system


Opponents of Reform Recognize The Crisis: Opponents of Reform Recognize The Crisis Rep. Bill Thomas (R-CA), Health Chair, Committee on Ways & Means: Employment-based system of insurance “fatally flawed” Paul Ellwood, architect of managed competition: “Uneven care in the U.S. is a national disgrace. Ultimately, this thing is going to require government intervention.”


Public Believes Federal Government Responsible for Assuring Minorities Equal with Whites in Health Care: Public Believes Federal Government Responsible for Assuring Minorities Equal with Whites in Health Care (source: WA Post/KFF/Harvard survey 10/95)


What Can We Do?: What Can We Do? Build support and co-sponsors for universal single payer health care reform in Congress and the California Legislature Frame the debate: Issue statements and resolutions that a publicly financed and organized universal health service is the most viable route to coverage, quality and equality in health care for all!


Save Global Health : Save Global Health Stop HR 3005: Fast Track on GATS Subscribe to the Globalization and Health Listserve:


Declare Health Care and Water:: Declare Health Care and Water: Vital Human Services Human Rights