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Adult Study Interactive Presentation

This program developed by the Health Care Task Force of St. Noel Catholic Church in Willoughby, Ohio, and made available to UHCAN for use in other settings.  The program contains an overview of the U.S. health care delivery system and four skits that portray just a few of the problems Americans encounter in seeking health care today.
Outline:
Overview: Health Care - The Problem
Scenario #1: Lack of prescription drug coverage for those in Medicare
Scenario #2: Uninsured students, homemakers and early retirees
Scenario #3: Employer-based insurance
Scenario #4: Single working mother with no health care benefits

Introduction:  Thank you for allowing us to share with you the serious concern your Health Care Task Force has about the availability of health care in the United States.  During the next 20 minutes you will see a series of skits designed to illustrate a number of facets of the problem.  We will also provide you with some data and statistics and invite you to support a resolution which is before congress and which urges our legislative leaders to address the need for universal access to health care.  We will begin with a prayer.

Prayer:  Loving and faithful God; you are the source of all that is just and true.  Grant us generous hearts and persistent spirits as we strive to ensure health care for all.  Keep us ever mindful of the reality of your presence in our neighbor, especially those who are sick or suffering.  We pray this in the power of the spirit through Jesus, your son, who is friend and savior and neighbor to all.

Scripture Reading: Luke 10:29-34

“Who is my neighbor?”  That question may have a familiar ring as we find it posed by a lawyer in the Gospel of Luke.  Jesus responds by telling the story of the Good Samaritan.  Currently our health care task force is answering that same question with stories too, stories about the uninsured and the under insured.  They are “taking the show on the road,” so to speak.  In an effort to inform parishioners about the current situation in health care and what we can do about it, the task force, with the full endorsement of the Parish Pastoral Council, has been doing 20 minute presentations for various parish groups at their regularly scheduled gatherings.  The presentation includes several short dramatizations of some of the predicaments people confront as well as the following handouts, which contain more detailed information.

Health Care: The Problem

The United States spends more than twice as much on health care as the average of other developed nations, all of which have universal health care.  Yet in 2000 over 38 million Americans had no health insurance.  It is expected that when the Census Bureau announces the number of uninsured for 2001 the number will have increased to over 40 million. 

Despite the fact that we spend 60% more per capita on health care compared to Germany, which is the second most costly health care system in the world, 18% of our population has no insurance.  Less than 8% of the German population is uninsured.  We spend 50% more per capita on health care than Canada and 0% of Canadians are uninsured.

It would seem natural that out spending our fellow industrial nations in health care should ensure that we have the “best” health care in the world.  Alas, such is not the case.  The World Health Organization, as well as the US DHHS compiles data every year on measurable indicators of health in a nation.  The United States ranked 23rd in infant mortality behind Canada in 15th place and Germany in 6th place.  Life expectancy statistics reveal similar ironic results.  Canadian and German citizens are likely to live longer than Americans (by several years in the case of females) despite the fact that they spend less per capita on their citizens’ health care.

So how did we get here?  Our present system of health care is a manifestation of the shortage of labor force during the post WWII era.  It was easier to draw employees to one’s company by offering benefits such as health care.  In a tight labor market such as existed after WWII, and more recently as existed in the late 1990’s, health care benefits become a carrot in the employer’s armament to draw potential employees into the company.  At such times, jobs that usually did not include health care benefits would have to offer them.  It they did not offer health care benefits, companies would be face with losing potential employees too rival companies that did offer health care benefits.

This use of the labor contract as the source of health care leads to insecurity by merit of the fact that one’s health care has become a commodity in bargaining between labor and business.  If the company decides not to offer the benefit of health care, the individual becomes uninsured.  If the employee loses his job, he loses his health insurance.

But the reality of the uninsured in America is that fully 50% of the uninsured are employed.  They are, however, in low-income jobs, which have never offered health insurance benefits.  The cab driver, landscaper, gas station attendant or house painter all fall into this category.  Fully a third of those people could afford health insurance if it were offered to the individual at the same rate as group policies charge per individual.  This does not happen.  The remaining two thirds of the uninsured could not afford health insurance even if they were able to obtain insurance coverage at group rates.

Not only do the uninsured not have equitable costs for policies compared to the insured, on an individual billing item the uninsured are charged more than the insured patient is charged.  This is a result of the fact that insurance companies are able to bargain for discounts with health care providers based on the volume of patients the insurance company represents.  These discounts can often be as much as 50 % lower than the billed charge.  The uninsured individual has no such volume purchasing power and so pays the full cost of services extended by a provider.

The uninsured are not only lacking in economic leverage, they are also less likely to be active voters, less likely to donate to political parties or lobby groups and overall, have very little political leverage even though they stand to gain the most from a change in the current health care system.

On the other side of the political power spectrum are the drug and insurance companies which stand to gain the most from maintaining the current system.  The pharmaceutical industry is the single largest donor as an industry to political campaigns in the U.S.  The political clout enjoyed by the drug industry is gargantuan.  Insurance companies are similarly well connected in the federal government through highly paid, highly effective lobby groups.

But what does the average American think about providing health care to the uninsured.  Fully 77% of those polled in 1998 were in agreement that all Americans should be insured.  Employers also have a majority viewpoint that all US citizens should be insured and 52% of the legislators in 1998 agreed that universal health care should be the norm.

So if the majority of citizens, employers and legislators agree on this issue, why isn’t everyone insured?  Many people believe that all citizens already have “ACCESS” to health care.  Anyone can go to an emergency room right?  That, to some, means everyone has “ACCESS”.

This would be an acceptable resort if it weren’t so ridiculous from the clinical and economic viewpoint.  The old adage, “You can pay me now, or you can pay me later,” is so very appropriate in this situation.  Do we want to pay for the patient with diabetes and hypertension to have good ongoing care and access to medicines to control these problems or do we want to wait until she walks into the emergency room in kidney failure needing a kidney transplant or lifelong dialysis because of the effect the uncontrolled diabetes and hypertension had on her kidneys?  Some might think this is a farfetched example, but in reality it is all too common: the uninsured individual encounters numerous obstacles to obtain care from chronic medical problems.  Poor control of chronic medical problems can lead to catastrophic and extremely costly consequences.  So ACCESS does not mean the emergency room, it means health insurance.

In reality the government already provides for 64% of health care dollars paid in this country.  Private insurers and individuals pay 26% of health care expenditures.  The step towards a universal health benefit therefore is not so large as many may think.  In an effort to urge our legislators to once again begin a dialogue about health care, please consider supporting the Health Care Access Resolution (House Concurrent Resolution 99) directing congress to enact legislation by December 2005 that provides access to comprehensive health care for ALL Americans.  A few additional facts, the resolution and a petition for your use follow.

SCENARIO #1

THEME: Prescription Drug Coverage for Those in Medicare 

PROPS: Two chairs and newspaper. 

NANCY: (to audience) Good afternoon. I want to introduce you to my neighbor, Mrs. Riley, a sweet elderly woman who has lived next door to me for 15 years. Like many seniors she is on a fixed income and struggles to make ends meet.  I’m going to let you listen in on a conversation we had yesterday morning.  Oh yes, just one thing, Mrs. Riley is as “bright as a dollar” but a little deaf, so I hope you’ll excuse me if I crank up the volume a bit!

(Scene opens with Mrs. Riley walking across room very slowly and with labored breathing.  She picks up newspaper, walks to chair and sits down and begins to read the paper.)

NANCY: (speaking loudly throughout-having trouble getting Mrs. Riley’s attention)  “Mrs. Riley, oh Mrs. Riley…”  (Mrs. Riley finally looks up from reading her paper and gives a weak wave.)  Hi neighbor!  May I sit down?  (Mrs. Riley gestures toward the chair next to her.)  Mrs. Riley, I saw you go out to get your paper just now and noticed you seemed short of breath.  How are you doing this morning?

MRS. RILEY: (speaks very slowly and haltingly)  Oooh… Hi there… Nannn…cy.  You’…re… right…… So… short … of … brrrea..th… (sighs and pats chest)

NANCY:  Maybe you should let me get your paper Mrs. Riley.  I’m worried about you neighbor!

MRS. RILEY: Oh no dear… The doctor…says… I need… some exercise… The problem is… I’m… almost… out… of medicine… Just …taking… one… heart pill a …day… instead of two like I’m suppose to… to make…them… last longer…Cost… too… much!

NANCY: (in dismay) Mrs. Riley, that’s not good, you could be endangering your health!  Doesn’t Medicare pay for your prescription?

MRS. RILEY: Subscription!… to the paper you mean?… Heavens no!… I can’t even get them… to pay for… my pills…

(Nancy, with a look of half amusement and half sympathy, gently pats Mrs. Riley’s arm.)

NANCY: (looking out to audience and shaking head) No prescription coverage?!  That’s no way to treat a neighbor!

Facts following Scenario #1

    1. Did you know that one in four elderly persons say they skip doses or fail to get prescriptions filled due to cost? (Commonwealth Fund Quarterly Volume 8 Issue 2)
    2. Did you know that as an industry, pharmaceutical companies rank number one in Fortune 500 list for profit as percent of revenue?  In the year 2000 drug companies earned 17% profit on revenues.  Most industry groups, including the oil industry ear 4-5% profit revenue.  (Fortune Magazine and web site 4/17/00)
    3. Did you know that drug companies spent 12% of revenue on research and development? (Fortune magazine and web site 4/17/00)
    4. Did you know that taxpayer dollars apportioned by the federal government (National Institute of Health, National Cancer Institute…) account for 36% of all medical research and development done in this country? (http://bernie.house.gov/bustocanada/drugsheet.asp)
    5. Did you know that the Congressional Joint Economic Committee reported that between 1967 and 1992 seven of the top twenty-one revenue generating drugs on the US market were developed with federally funded research including: Tamoxifen, Taxol, Prozac, and Capoten.
    6. Did you know that the US government has no price regulatory rules governing the cost of a drug created with federal dollars once it is brought to market?
    7. Did you know that in Canada, where the government regulates drug prices, the cost of prescription drugs is 50% less than in the US?  Forty-five pills of the usual starting dose of Prozac cost 105 US dollars in the United States and the same number of pills costs 43 US dollars in Canada.  That is a difference of 59% for a drug that your tax dollars allowed to be created.  (http://bernie.house.gov/bustocanada/drugsheet.asp)
    8. Did you know that drug companies spent 22% of revenues on marketing?  In the year 2000, $16 billion was spent on drug marketing.  Eight billion was spent on samples.  Almost 5 billion was spent on promotion to doctors.  Two and a half billion was spent on direct to consumer marketing.  Did you know that Merck spent 161 million advertising Vioxx direct to the consumer in the year 2000.  Sales of the drug quadrupled from the previous year to $1.5 billion for a drug that is no better for controlling arthritis pain than is ibuprofen (Motrin).  (National Institute of HealthCare Management Research and Education Foundation:  Prescription Drugs and Mass Media Advertising in 2000 11/20/01)

 SCENARIO #2

THEME:  Uninsured Students, Homemakers and Early Retirees

PROPS: Steering Wheel

RALPH: (to audience) My friend and neighbor, Joe, is home on break from college.  The other night we were on I-90 on our way to an Indians game and Joe was driving and this is what happened.

(Scene opens with Joe and Ralph (or Josephine and Rachel), two young adults in the car and on the freeway.  Ralph, the passenger, keeps turning his head as cars are whizzing by.)

RALPH:  Is it me or are we going reeeaallly slow Joe?  Everyone is honking and giving us dirty looks as they fly by us.  You usually have a lead foot, something wrong with the car neighbor???

JOE: (glibly) The car is fine.  Just being careful, don’t want to get into an accident.

RALPH:  Yah, Well at this rate we’ll be in time for the seventh inning stretch!  I believe in being careful but don’t you think you could crank this buggy up to at least 40!

JOE:  Well if you must know I don’t have insurance.

RALPH:  (excitedly) No insurance!  It’s illegal to drive in the state of Ohio without insurance.  You could get busted!  I’ve never heard of such a stupid thing!

JOE:  Calm down, calm down.  I’m talking about health insurance, not car insurance!  My parent’s policy doesn’t cover me anymore and I’m only working part time so I have no benefits.  And it was either my college tuition this year or a very expensive individual policy.  Just trying to stay healthy.

RALPH:  I’ve heard there are some inexpensive policies for college students like you.

JOE:  Humph!  I’ve looked into those- not much coverage and no prescription benefit!

RALPH:  (without understanding) Gosh, I’m sorry Joe.  You are young and healthy but even so, a person never knows when they’ll need a doctor or the hospital.  That certainly isn’t a way for the system to treat a neighbor… Ah, would you mind turning on the radio so we don’t miss Thome’s first at bat?

  1. Facts following Scenario #2
    1. Did you know that 20% of uninsured patients are students, homemakers and those in early retirement?  (Himmelstein and Woolhander: Tabulations from Current Population Survey 1999)
    2. Did you know that individual insurance rates for young males and females averages $2800 per year (with no maternity benefits) for a plan that offers benefits typically available in group insurance plans?  For an individual in a minimum wage job this would represent almost 1/5th of his/her income.  Individual insurance rates can be found for much less cost, but come with much higher deductibles and many fewer benefits.  (The Commonwealth Fund Quarterly: Volume 8, Issue I, Spring 2002)
    3. Did you know that the uninsured receive less preventative health care, are diagnosed in more advanced stages of disease and receive fewer medications and therapeutic surgeries? (Kaiser Family Foundation)
    4. Did you know that being uninsured increases mortality by 10-15%?  (Kaiser Family Foundation)
    5. Did you know that better health increases educational attainment and that better health increases earnings by 10-30%?  (Kaiser Family Foundation)
    6. Have you realized that although by law you have to have car insurance, there is no law in this country requiring health insurance?

SCENARIO #3

THEME:  Employer-based insurance

PROPS: Plate of cookies

FRANK: (to audience) Sam and Judy, newlyweds, just moved in next door.  Actually Sam is the son of one of my best friends.  The wife just baked some cookies.  (Takes a bite of a cookie and while chewing says): Think I’ll take them some cookies and welcome them to the neighborhood!  Want to come along?

FRANK: Hi Sam!  Welcome to Dodd’s Landing.  Here are some cookies from Lois.  Where’s Judy?

SAM: Hey Frank, thanks for coming over.  Judy is at her mom’s.  Wow!  Those cookies look great.  (Takes one and takes a bite.)

(Frank and Sam sit down.)

FRANK: Well neighbor, how’s married life treating you?  You and Judy have been married almost a year now, haven’t you?  Don’t mean to pry- but any little ones on the way?  I know your Dad can’t wait to be a grandfather.

SAM: To tell you the truth, Judy and I are very anxious to start a family, especially since we are both in our mid-thirties, but there is one problem.

FRANK: (concerned) What’s that Sam, nothing serious I hope.

SAM: No, not really.  But I just started a new job and the insurance doesn’t kick in fro 6 months.  So we just have to wait.

FRANK: Well Sam, when Lois and I were having our kids, as I remember it took 9 months.  So even if Judy got pregnant tomorrow, I don’t see the problem.

SAM: It’s not that simple Frank.  You have to read the fine print in those policies and ours says, “No pre-existing conditions- and that includes pregnancies.”  Besides what about the pre-natal care Judy would need, to say nothing of the fact that neither of us has insurance should we become ill in the next few months… Judy and I need to be careful… in more ways than one… (Half jokingly) Say Frank, you think Lois would mind if I slept in your guest room until January!

FRANK: What a bummer!  And just when I was looking forward to having another new neighbor, one I could rock to sleep!

Facts following Scenario #3

    1. Did you know that 2/3 of all Americans have employer-sponsored health insurance?  This allows the employer to receive preferential tax treatment, pool employees to balance risk and exercise group purchasing power.  (Gabel: Commonwealth Fund Quarterly, Volume 8, Issue 2)
    2. Did you know that in the year 2000 employers typically paid 75-86% of an average employees premium ($221/month for a single policy and $588/month for a family policy) passing on the remainder to the employee.  (Glied: Commonwealth Fund Quarterly Insurers Shifting Health Care Costs to Workers 12/00)
    3. Did you know in the year 2000, health benefit costs increased by 11% over the previous year?  Employers passed on this increase to the employee by either increasing the amount of the premium paid by the worker or by reducing benefits covered by the plan.  (Gabel: Health Affairs Market Watch Exclusive 4/17/02)
    4. Did you know that 62% of low-income workers do not have coverage through their employer?  (Low-income worker is defined as anyone who makes less than 200% of the federal poverty level; for a family of 3 is $13,290.) (Glied: Commonwealth Fund Quarterly Insurers Shifting Health Care Costs to Workers 12/00)
    5. Did you know that 74% of those who changed insurance plans in the year 2000 did so because they changed jobs or because their employer changed plans?  (Health Affairs 2000: 19(3): 158)
    6. Did you know that the current economic downturn could add 20 million more to the ranks of the uninsured? 

SCENARIO #4

THEME: Single working mother with no health care benefits

PROPS: Telephone & two chairs back to back.

LISA: (to audience) I’m a little worried about my neighbor, Sue.  When I talked with her yesterday she had a terrible cough!  She’s a single Mom and burning the candle at both ends, caring for two children and working FT for $7.50 an hour at the factory and no health care benefits provided.  Think I’ll give her a call and see how she’s doing.

SUE: (coughing, weakly) Hello?

LISA: Oh Sue, you don’t sound any better, in fact you sound worse! (A bit alarmed)

SUE: (coughing periodically) Yeah, I know… I didn’t sleep a wink last night… Just coughed and coughed.

LISA: Have you called your doctor yet?  I would be happy to watch the kids if you can get in this afternoon?  I’m beginning to really worry that you might have pneumonia.  Are you running a fever?

SUE: Yeah, my little Betsy is worried too.  Betsy was so cute this morning… “Mommy, how ’bout you takes come of that yucky pink medicine Dr. Tom gave me last time I coughed.”

LISA: You certainly have a thoughtful daughter but Sue, (pleading) what about the doctor?

SUE: (coughing even more) Can’t go… No insurance… too many bills… Can’t afford the $69 or $80 for the visit to say nothing about the medication… Lisa- I have to go… baby’s crying.

LISA: Sue I’ll be over shortly to give you a hand so you can maybe get a nap before you go to work this evening.  (Hangs up and sadly says) That’s no way for my neighbor to be treated!

Facts following Scenario 4

    1. Did you know that 20 million of the 41 million uninsured are EMPLOYED in low-income jobs like Sue?  (Himmelstein and Woolhander: Tabulations from Current Population Survey 1999
    2. Did you know that 8.5 million of the 41 million uninsured are children?  (Census Bureau Data 2001)
    3. Did you know that 1 in 4 non-elderly women report delaying or going without care in the past year due to the costs of obtaining health care? (Kaiser Family Foundation: Women’s Health Policy 5/7/02
    4. Did you know that 1 in 5 non-elderly women do not fill prescriptions because they cannot afford to?  (Kaiser Family Foundation: Women’s Health Policy 5/7/02)
 

 

Faithful Reform in Health Care ~ P.O. Box 6174 ~ Wilson, NC 27894-6174 ~ 1-888-863-8910