Part 2 of a two-part podcast featuring Jodi Reid, executive director of the California Alliance for Retired Americans, discussing gaps in original Medicare, plus the commission planning California’s healthcare future!
Is California’s healthcare future in the hands of a commission?
—– TRANSCRIPT —–
Welcome to Code WACK!, your podcast on America’s broken healthcare system and how Medicare for all could help. I’m your host, Brenda Gazzar.
How are seniors meeting their needs for late-life long-term care? What are California’s biggest obstacles to winning single payer, Medicare for All, which would include long-term care? To find out, we spoke to Jodi Reid, the executive director of the California Alliance of Retired Americans, a grassroots senior advocacy organization. She has forty years of organizing experience on issues ranging from health care to housing.
Welcome to Code WACK! Jodi!
Q: Many state Medicare-for-All bills, including California’s most recent Medicare-for-All bill, AB 1400, include coverages that currently aren’t covered by Medicare, like long-term care. Can you tell us why long-term care is so important for seniors? And how are their needs for late-life long-term care currently being met?
Reid: Well, I’ll start with the second part which is their long term care needs are not being met very well so it is well known that people do better, (are) happier, healthier and live longer if they can age in a place with the most independence, and in their communities, with their families, with their friends, with their congregations, and with a little bit of assistance can stay independent potentially to the end of life, but that (home) care is really expensive and ranges in California anywhere from $25 to $100 an hour for someone to come out and provide what’s called “assistance with daily living activities,” things like showering and feeding and medicating and stuff like that. Nursing homes and residential care facilities, many of which are paid for with public dollars, are much more expensive.
They cost close to now, the estimates are close to $100,000 per person per year that is on the public dime for the most part. So, just like the idea of guaranteed Health Care for All saving money, keeping people at home with some assistance so that they can do that safely, and preferably, is not only more humane, it’s also more affordable but it’s not covered by Medicare, so you have to be Medi-Cal or Medicaid eligible to receive any kind of those services right now. They’re only publicly supported and so you have to be very, very low income in order to qualify for home care or other kinds of long term supports. You know there’s case management services and other kinds of services including, you know, an incredible model called PACE (Program of All-inclusive Care for the Elderly) where you basically go, well, pre-COVID It’s Medicare and Medicaid combined to provide full-person care, both social services and medical services so there’s all kinds of innovative programs, but they’re really only using public dollars so you have to be income eligible, and that leaves out more than two-thirds of the Medicare population in California. So not only is it really expensive, what winds up happening often is that family members wind up providing that care because they can’t afford it otherwise. And that has all kinds of repercussions, taking some family members out of the workforce, which lowers the income for that family. Often, these folks have younger family members to care for as well as their elderly parents, and it is a huge burden on families, but two-thirds of people who are getting care at home are getting them from a family member without any financial support or training or respite. So it’s a huge strain on our workforce, but also on our families.
Q: Yeah, right, thank you. California Governor Gavin Newsom convened the Healthy California for All Commission, which was established to achieve access to health care for all Californians through a unified financing system, including single payer. What do you think about the commission?
Reid: I’m not a big fan of commissions to do policy in the first place. Sometimes it feels like that’s just a way to push it off and not really deal with the real solutions, and the real issues at hand and to have some other body that comes up with a proposal that often, if it’s not a politically feasible proposal doesn’t go anywhere, and it’s an excuse for doing what we all know is the smartest, best thing to do. On the other hand, there is a huge issue in California and our ability to move a single payer or guaranteed health care plan however you want to define it, forward, and that’s the money.
The biggest argument by the legislature and members of the public and the media is “how are you going to pay for it?” and so the purpose of this commission as stated by the governor is to come up with, as you said, a unified financing plan, and we need that plan because that could answer the question that many legislators have used as their reason not to support it and have hid behind and it is not an unreasonable thing to want to know how you’re going to cover everybody with better benefits at less cost, and still save money, so that’s a question that has to be answered.
The commission is a mixed bag of folks some of whom are single-payer supporters that want to and have been working on this question for a long time and are anxious to provide the proposal that will help us move forward but there are others who have always been skeptical. Some of them come from the insurance industry or are connected to the insurance industry and don’t have a real interest in changing things. And so, I am nervous about or skeptical about whether this very diverse group of commissioners can come up with a proposal that they can all sign on to that will answer the question, and provide the way forward in terms of financing. But having said that, there are some bright lights in that commission and some folks who have really made it clear and have provided studies, looked at other countries and what they have been able to successfully do, and the information is there to make the right decision and part of the job of all of us in the public is to push the commission, and ultimately the governor to taking the road that’s going to get us to single payer, but that road is unclear right now, given the diversity of the commission.
Q: Right. So do you think that it’s more likely that the commission will be central to California winning single payer in the future, or do you think more likely that it will be a footnote?
Reid: Well, I want to say the first that it’ll be the way we get there and that what they come up with what will be useful in moving forward, and I’m hoping, I mean one of the things that we’ve been talking about sort of in the single-payer activist community is, you know like in the Supreme Court, where there is a majority decision, they vote and one of the justices writes up the decision of the majority and why there’s often what’s called a minority report and those who disagreed and voted differently write their rationale, and we’re hoping that at the very least we can get a very clear, secondary report from those who are pushing for this single-payer system of financing, so that we can utilize that to say, yes, the Commission came up with this and I think it will probably be fairly generic and probably not take us where we need to go.
But if we can get some other proposals on the table to say here’s another way that came from your very own commissioners and try and help move that forward that will have a, you know, a plan B, that we can rally around and use and that’s, I am hoping that we can get at least that.
Q: Thank you, Jodi. What do you think absolutely must happen before we win single payer?
Reid: Well, I think that we need to educate the public… It’s easy to say “yes everyone should have access to health care, health care as a human right” but I think we have a huge media challenge, a publicity challenge, a marketing challenge, because the status quo has every interest in keeping things the way they are because they’re making millions and billions of dollars by charging us high prices that are not contained.
And so I think the policy is clear. I don’t think there’s anybody who can disagree that in the countries that have a single-payer program whether it’s national health care or what we’re talking about which is a publicly funded but privately provided system which is what we’re envisioning here in California — that’s what’s in AB 1400 and all the other predecessor bills. We’re not talking about changing who provides care and where they choose to provide their care whether it’s in the Kaiser system or individually as a provider, and they’re paid privately by this government fund that’s a single fund and people send in their invoices and get reimbursed for the care that they provide, but they can do that provision however in whatever kind of networks they want whereas, like in England for example, everybody works for the National Health Program. They are public employees as health providers. That would not be what we’re proposing here.
So, but the policy, there seems to be even amongst the commission agreement that the policy is a good one. The issue is funding for many of the people on that commission. It’s the political will, and so the political will needs to happen by us, the public requiring our elected officials to champion this, to lead on this, to vote for this, because we’re never going to compete with campaign contributions and the money that the industry currently has but our elected officials also have to win a vote by the people and so part of our power is by making sure more and more people understand what this is, why it’s better, how it will work, how it will save them money and provide better care, and then forcing our elected officials to stand up. Otherwise we won’t be in a position ever monetarily to compete with the insurance industry and the pharmaceutical industry so I think that’s our biggest challenge.
Yes, we need to convince the legislators and the governor and others to go for it but we are the people who have to convince them to do it, and so it means we need to be engaged and educated. I think COVID is going to help us. That’s the only good news out of COVID that I can even possibly think of is that now everybody, or many people realize that my health care impacts your health. My health has a direct impact on your health, and that we’re all healthier together. And I think we’ve learned that in a pandemic if we’ve learned nothing else, and that it pays to have us all have access to good health care so that we can keep ourselves and our neighbors and our family safe and healthy too. So I think the message is becoming clearer now because what we’ve been saying as sort of a motto, we’re living.
Q: Right, right. Great point. Thank you so much, Jodi. We really appreciate your time today.
Reid: Sure. Thank you for having me.
Find more Code WACK! episodes on ProgressiveVoices.com and on the PV App. You can also subscribe to Code WACK! wherever you find your podcasts. This podcast is powered by HEAL California, uplifting the voices of those fighting for health care reform around the country. I’m Brenda Gazzar.
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Great Podcast. thanks for posting!