Universal Healthcare

Welcome to Knox Community Well Be!  The show has been running since March 2018, and is a non-partisan show for and about local communities and community health and well-being. Please be sure to give us a like on Facebook and Instagram.

Group Update Nov 29, 2018

Universal Health Care: 

The Affordable Care Act seems to be withstanding limited funding and is growing during open enrollment. January 7 is Legislative Action Day for health action groups—noon in Nashville. Review PowerPoint slide attached and see the petition in the weekly action list for 12/02/18. 

Why Medicare Needs to be part of the Solution

By Andrew F. Bennett III

InsuranceThatFits.com

The Problem of what drives healthcare costs:  The three main drivers of healthcare costs are:  1.  End of life care, 2.  Care of those with Chronic Conditions, 3.  Discreet health events (think a heart attack, accident, or stoke that people survive and do not require ongoing care).

The problem of fragmentation:  The individual market in the US is divided into so many different risk pools that costs cannot be distributed widely enough to drive costs down.  Insurance is regulated at the state level, so you automatically have 50 risk pools.  On top of that there are multiple carriers which split the risk pools even more. Even in the large group market there is still a great deal of fragmentation in the risk pools.  That fragmentation leads to higher premiums.  When risk pools are deeper and more robust risk is spread out further and costs come down.

The insurance card you carry from the large company you work for has an insurance company name on it.  What many don’t know is that many large companies self-insure and the insurance company provides only administration and probably a stop loss for huge claims.  All those companies that self-insure are not in any insurance companies risk pool (except for the catastrophic event).  All this fragmentation of risk pools increases costs.  

The problem of competition:  There is also no competition in the healthcare market outside of Medicare.  Outside of Medicare we have the big 5 companies (Humana, Cigna, United Healthcare, Anthem, and Aetna).  In addition, many states (about 37) also have not-for-profit Blue Cross organizations.  So, in most states there are six major competitors.  However, that doesn’t paint the whole picture as in most states two of those six organizations have well over 50% marketshare.  That is not competition.  You can’t make a sweet sixteen out of six competitors.  In those places where two companies share most of the market you can’t even make a final four.

The Solution

When it comes to those issues that drive the most cost in healthcare we need them dealt with in the most efficient way possible when it comes to paying claims.  The system that takes care of most of those costs now is Medicare and it is one of the most efficient health insurance systems in the world.  Medicare has a Medical Loss Ratio (MLR) of 97%.  That means for every $1 that goes into Medicare, 97 cents is used to pay claims or make people healthier.  No other health insurance payment system we have in the USA comes close to that.

Despite handling most of the costs associated with end of life care, premiums in the Medicare system are very low compared to what is available outside the Medicare world.  When it comes to the cost of those with chronic conditions it costs much more to care for a 72-year-old with diabetes than it did 20 years before when they were diagnosed.  Discreet health events (think a heart attack, accident, or stoke that people survive and do not require ongoing care) happen in and out of the Medicare system.  The point is that Medicare already handles the lion’s share of the major factors that drive healthcare costs and it does so very efficiently.

  The proof, as they say, is in the pudding.  Outside the world of Medicare if a 64-year old wanting a high deductible health insurance plan with a $5500 deductible and a $6700 out of pocket maximum could expect to pay around $600 a month in premium.  A high deductible plan is going to mean substantial out of pocket costs in addition to that premium.  Just one year later when the same person turns 65 and goes into the Medicare system they can get the Cadillac plan for half of that.  That would be Traditional Medicare, a Part D plan, and a F supplement for around $300.  In that case their out of pocket costs will virtually be limited to their prescription co-pays. 

Medicare is the largest risk pool in America.  If we add tens of millions of people to that risk pool who are not facing end of life care, who do not have chronic conditions, who only occasionally have discreet health events then Medicare Premiums should go nowhere but down.

Medicare provides a base of coverage, but there are deductibles and co-insurance to be paid.  There are Part D plans that help cover pharmaceuticals.  There are also Medicare Supplements (also known as Medi-gap).  For the healthcare of anyone patient there could be up to four payers (Medicare, a Part D plan, a supplement, and the patient may have co-insurance to pay).  So be clear, what I am suggesting is not single payer or socialism.  What Medicare does is put most of the risk in one single pool and multiple ancillary risks into competitive risk pools.

Again, the proof is in the pudding.  There are probably 40 or more companies just in TN selling Medicare supplements.  There is a deeper level of competition both for Part D plans as well as Advantage plans.  So, for those that want market driven healthcare where competition drives prices down…look no further than Medicare.

There is some talk about selling across state lines.  Unless, the coverage is vastly different then a policy in Iowa is probably not going to have substantially different premiums than a policy in Kansas.  Some politicians carry on about how each state needs the flexibility to determine its own coverage rules.  The way I see it the human body needs pretty much the same care in Tennessee as it does in California.  Some men get prostate cancer, some people have broken their foot in a snow sledding accident, some people have torn (dissected is the medical term) arteries, others get pregnant, others have gall bladder issues.  All these things require healthcare.  All these things happen in each and every state.  All these things should be covered.  

What I do not support is re-inventing Medicare into a single payer system.  Medicare is not now, nor should it ever be single payer.  It does not fit our economic culture.  Given that Bernie Sanders is out there talking about creating a single payer Medicare for all system this may be news to some.  Medicare is also not socialized medicine.  Socialized Medicine is where the government owns the hospitals, owns the labs, owns the MRI and CT machines, and all the doctors and support staff are on the government payroll.  That’s not what Medicare is, it is not what Medicare should be.    

If you want to see market driven healthcare, if you want to see everyone have coverage, if you want to see deeper risk pools, if you want to see cost effective health insurance…Medicare has to be part of the answer.  It works and it fits the economic culture we have in this country.  After than we can actually start to tackle the cost of healthcare and not just health insurance.

HEALTHCARE FOR ALL

Questions for candidates- Questions which can help identify the candidates’ positions vs. leading/gotcha questions; questions which get to the heart of where a candidate "stands" and what that means for TN.

Leadership

1) Will they take the key leadership role in driving improved healthcare in TN or will they look to the legislative body to make the changes needed?

2) What can Tennessee do, without input from the Federal Government, to improve the system of health insurance and healthcare in TN?

3) What public health initiatives can TN take to improve the quality of people's lives in TN?

4) What are the cost drivers that insurance companies look at to set rates and how can we impact those in TN to help drive rates down?

5) "At a recent legislators breakfast at UT hospital, our state representatives said that the primary goal regarding finances in Tennessee was to ensure a balanced budget, and the second priority was on education.  How would you ensure that all Tennesseans have affordable care and access to healthcare in light of the need to balance the budget 6) How do you plan to ensure that insurance companies re-invest in Tennessee and not pull out of the state or local areas?"

Mental Health

1) Should mental health coverage be an essential service?

2) Is funding mental health coverage for all part of your plan to combat the opioid epidemic? To combat school shootings? 

Rural Health

1) How would you ensure access to quality health coverage in rural areas? Would you consider subsidizing rural health centers and hospitals? 

2) Rural hospitals in non-expansion states are 8 times as likely to close as compared with expansion states. What are your proposals for securing the financial health of rural hospitals? A recent study of 4,500 hospitals across the country compared hospitals in Medicaid expansion states with non-expansion states. The data show that there were significantly fewer hospital closings in Medicaid expansion states as compared with non-expansion states

4) What are your recommendations for improving outcomes for common surgeries for the uninsured in rural Tennessee?

Economy

1) TN leads the nation in bankruptcy filings, many of which are medical. TN also is #1 in minimum wage jobs and 49th in wage growth. What are you doing to improve the economy for workers so they can afford health care?

Opioid Crisis

1) What do they think of Haslam's program to combat opioid addiction?

2) Can you explain why we would take 20 million from the treasury to fund OPIOID Programs when we could expand medicaid and receive 90 - 10 match from our federal tax dollars that we have paid to provide broad health care coverage for 280,000 Tennessean and it would provide funds for and programs for the Opioid epidemic? The Federal Government has never renigged on its share of medicaid match. Can you explain why that would not be a better health and financial plan for Tennessee?

Disabled

1)  Did you know that the Bill passed in Congress and signed by 'the White House' that will drastically cut benefits for our disabled population? What can be done, since this will definitely impact their health and medical care?

Veterans Administration

1) Did you know about the "new" management at our VA Hospitals here in Tennessee? (and around the country as well!) The extra benefits provided in the ACA are gone for Vets, and non-medical employees are making decisions about prescriptions...."cancel them ALL immediately" and are no longer admitting homeless Vets but are putting them on a long wait list? 

Prescription Drug Costs

1) What measures will you propose to combat the high price of prescription drugs?

Medicaid Expansion

1) Will you support an expansion of Medicaid?

2) It has been shown statistically that States that accepted medicaid expansion have been able to offer more insurance providers that those that did not accept medicaid expansion. This simply due to the pool of people to get insurance enlarges. It is also a fact that the electorate has been taking over the medicaid expansion in states like Main, Utah, Florida, Virginia and now West Virginia. Polls show that a majority of democrats and republicans are in favor of expanding mediciad. Would you side with the people and ask for reconsideration of medicaid expansion for Tennessee?

3) Why are we letting so much money that could be coming to our state go to other states? I want to know how they plan on funding healthcare in TN and how they plan on dealing with the gap in coverage.

4) A study recently reported in JAMA compared the most common surgeries in Medicaid expansion states with non-expansion states. The data shows that there were significantly better outcomes in Medicaid expansion states than in non-expansion states. With 32 states expanding and 18 states not expanding, data are demonstrating almost weekly, the advantages for consumers. 

5) What are your thoughts on Governor Haslam's efforts on Insure Tennessee? What are your thoughts on expanding medicaid / medicare / accepting the block grant for expansion in Tennessee? What are the disadvantages of block grants?

Behavioral Health Support Groups – A Support Group is a gathering of people with similar situations who meet regularly to share their concerns and victories with others in the group.

Anonymous Support Groups

Adult Children of Alcoholics in Knoxville – www.adultchildren.org 

Alcoholics Anonymous 865-522-9667 – www.etiaa.org , www.aa.org  

Al-Anon/Alateen Family Group in Maryville – www.knox-al-anon.org  

Overeaters Anonymous – www.oa.org 

Narcotics Anonymous 1-844-409-3762 – www.naknoxville.org  

Anger Management @ Recovery Education Center – TennCare Only - 865-374-7134

BRIDGES – Building Recovery of Individual Dreams and Goals thru Education and Support – 

1st, 3rd, 5th Fridays @ 1:30 @ Peninsula Professional Building – 865-373-8207

Caregiver Support Group for any adult caring for another adult 865-977-5744

Co-Occurring Disorders Group – Wednesdays @ 740 @ First United Methodist, Montvale Station

Divorce Support Group – 865-982-6070 – Spring and Fall Sessions – Meets @ Monte Vista Church

Domestic Violence Class – www.dvclass.com  - On-Line Course that meets court requirements

Domestic Violence Support Group – women only 865-982-1087; www.havenhousetn.org 

Eating Disorders – 

OA in Louisville – Janice @ 301-602-6750 – Wednesdays @ 5:45 pm www.oa.org 

Focus in Knoxville – 865-622-7116 - separate Groups for the person with eating disorders and the family members of that person– male or female groups  www.focustreatmentcenters.com 

Family Support Group thru NAMI – call 865-724-5074 for current meeting day and time

Gamblers Anonymous – Tuesdays at 545 pm @ Cornerstone of Recovery - only for those with a 

gambling problem, or think they have a gambling problem www.gamblersanonymous.org  

Grief Support Group information numbers

For Widows and Widowers

Adult Grief Group at Blount Memorial 865-977-5702 – Call for dates

Care and Share with Lisa 865-983-1000 – first Wednesday every other month

Changing Reins 865-233-3090 www.manesupport.org No Riding - for Widows of all ages

Compassionate Friends - Parents who have lost a child at any age 865-984-4223, 

tcffoothills@bmnet.com, www.compassionatefriends.com 

Families Facing Grief – for children and families - 865-233-3090 – www.manesupport.org

Pet Loss Support Group – UT Veterinary Medicine 865-755-8839, www.vetsocialwork.utk.edu  

Suicide Grievers Support Group – for family and friends 865-671-9631 - Knoxville

Men’s Sexual Abuse and/or Assault Survivors– Sexual Assault Center – 865-558-9040 (led by a male)

Mindfulness Based Stress Reduction (MBSR) – UT - 865-974-5574, www.vetsocialwork.utk.edu 

Parenting Classes – 865-660-3711, LivingWaterLCE@outlook.com 

Peer Support Academy – Mental Health Classes and Activities for Adults. Free Transport 865-373-8207

PFLAG (Parents, Families, Friends of Lesbians and Gays) – 865-268-9665 

www.facebook.com/pflagmaryville - monthly meetings

Recovery – Groups vary by location: Co-dependency; Chemical Dependency: Men Only or Women

 Only; Family Support; Life Hurts, God Heals; Grief and Loss; Teens (age 13-18), etc. 

Recovery @ Maryville 865-982-1273 – (Wed) www.CRMaryvilletn.com  

Recovery of Blount County 865-679-8610 – (Sun and Wed) www.harboursgate.org in Louisville

Recovery Revolution @ RIO in Maryville 865-984-9200 – (Tues) www.RIOrevolution.net 

Recovery @ Cokesbury (Knoxville) 865-246-0449 – (Thu) www.RecoveryatCokesbury.com

Veterans – Reboot Combat Recovery – for Veterans and Spouses – Call Stacy @ 865-582-5330

www.RebootRecovery.com 12 week class on Spiritual Aspects of Combat Recovery  

With Hope in Mind – 16 hour NAMI course for family members/caregivers of adults with mental illness 

Classes are scheduled as needs arise. Call Trish @ 865-556-6635 to register.

Women’s Sexual Abuse and/or Assault Survivors– Sexual Assault Center – 865-558-9040 Info Line

Crisis Hotlines 

1-855-CRISIS-1 (1-855-274-7471) – Mental Health and Substance Use Crisis Services in TN

1-800-273-TALK (1-800-273-8255) – www.suicidepreventionlifleine.org, www.TSPN.org 

Text Crisis Resources, text “TN” to 741-741 - or call 1-800-273-8255

LGBTQ Crisis – 1-866-488-7386 – www.thetrevorproject.org 

Transgender Crisis – 1-877-565-8860 – www.TransLifeLine.org – staffed by transgender people

Adult and Youth Mobile Crisis 865-539-2409 or 1-855-CRISIS-1 or 1-855-274-7471

Adult Protective Services 1-888-277-8366 – www.reportadultabuse.dhs.tn.gov 

Child Abuse and Neglect Reporting Hotline 1-877-237-0004 www.apps.tn.gov/carat 

Contact CareLine of East TN 865-584-4424 (10am – 10pm) www.contactlistens.org 

Domestic Violence – Haven House – Maryville 865-982-1087 www.havenhousetn.org 

Domestic Violence – National 1-800-799-SAFE (1-800-799-7233) – www.thehotline.org

Family Promise – Shelter for Homeless Families 865-233-4737 www.blountfamilypromise.org 

Pregnancy Resource Center 865-977-8378 – www.prcbctn.com

Pregnant Teens 865-602-2956 – ask for Richelle – www.fcaknox.org  

Runaway Hotline 1-800-run-away (1-800-786-2929) – www.1800runaway.org

Sexual Assault Center – Crisis Line 1-865-522-7273 - www.mcnabbcenter.org/sacet

Self Injury – 1-800-DONTCUT (800-366-8288) – www.selfinjury.com 

Trafficking – Natl Human Trafficking Resource Ctr 1-888-3737-888 – www.polarisproject.org 

Veterans Crisis Line – 1-800-273-8255, Press 1 – www.maketheconnection.net

Advocacy Help-lines and Other Resources

Adult Protective Services 1-888-277-8366 www.reportadultabuse.dhs.tn.org 

Autism Society of America in ETN – www.asaetc.org – 865-247-5082

Bipolar - Depression and Bipolar Support Alliance – www.dbsalliance.org – 1-800-826-3632

Blount County Community Enrichment - has a variety of free services: Therapy, Parenting, 

Child Abuse, Substance Abuse, Domestic Violence, etc. - 865-984-2115

Bullying = Cyber, Verbal, Social, or Physical – www.stopbullying.gov 

Child Protective Services 1-877-237-0004 www.apps.tn.gov/carat 

ChildNet – counseling and psychiatric medications for ages 2 to18 - 865-681-6990

Man Therapy – free and interactive mental health website for men – www.mantherapy.org 

Mental Health Association of East Tennessee – provides free screenings, workplace

programs, free speakers, and technical assistance 865-584-9125 – www.mhaet.com

National Alliance on Mental Illness (NAMI) – www.namitn.org

Maryville – 800-771-5491 – nami.maryville@namitn.org 

New Hope – Blount County Children’s Advocacy Center - For victims of sexual and/or physical 

abuse and their non offending family members - 865-981-2000 – www.blountkids.org

Peer Recovery Call Center – 865-584-9125; (M – F from 900 – 430) - www.mhaet.com 

Substance Abuse and Mental Health Treatment Referral Information 1-800-662-4357 

www.findtreatment.samhsa.gov 

Surviving Suicide Loss – Amer Found of Suicide Prevent – 888-333-AFSP (2377) www.afsp.org 

Teen Suicide Prevention – 1-800-273-TALK (1-800-273-8255) – www.JasonFoundation.com

Tennessee Mental Health Consumers Association - Knoxville 865-281-3683 - www.tmhca-tn.org 

TN REDLINE – 1-800-889-9789 – Addiction Treatment Referral Line – www.taadas.org/Redline 

TN Voices for Children – Knoxville Region - 865-523-0701- www.TNvoices.org

True Purpose Ministries – 865-681-4861 – Christian-based Male Residential, learn a trade – 

www.truepurposeministries.com 

Veterans – Homeless – 1-800-VET-HELP (1-800-838-4357) – www.nchv.org 

Youth Topics – www.youth.gov – over 25 topics with information and links