- Hi, I'm Brad Meyer. I'm running for the US House of Representatives. I'd like. Thank you. So I'd love to take a lot of time talking about me and my campaign, but that's not why you're here today. So I will avoid that temptation as much as possible. I'll sneak a little bit in, but I'll try to keep it to a minimum. I'd like to welcome you to this forum on universal health care. I'm a strong believer in universal health care because the current system is
- really troubled and has been letting us down for a long time. And it's been going on for so long we don't even recognize the failure anymore. It's just kind of normalized. My background is an engineer. I am data driven. And before we dig into facts, I'd like to have us remember that every statistic has people behind it, real lives, families,
- So one of the things that I've run across a lot in the last couple of months talking to people, for example, is older parents that have adult children with disabilities. And they're really concerned that with all of these cuts and the continuing restrictions of healthcare, that after they pass, their children will not be able to negotiate this, like, labyrinthine-constrained system.
- I know that a lot of people will have questions, so the back portion of this meeting we will have a question and answer, so don't feel like you, so try to keep them in mind. So let's start with the facts of the current system. Given comparing us to peer countries, we have the worst infant mortality, we have the worst maternal mortality,
- And we have the highest percentage of preventable death in our system, in our medical system. So on average, Americans die four years earlier than people in universal healthcare systems in other places. And in Indiana, it's worse than four years. We are 39th in life expectancy compared to other states.
- in rural Indiana, it's even worse yet. So it's not four years or even five years in rural Indiana, it's significantly more. So with those poor outcomes, we are still having to pay more than any other country for our health insurance. It's very expensive. 40 million people are having trouble paying their medical expenses right now, even with insurance.
- We have the highest prescription drug costs, and two-thirds of bankruptcies reference medical debt as one of the primary drivers that put them into bankruptcy. And in Indiana, it's worse than that. We are 11th in the country for holding medical debt in our citizens. And it is a travesty that in the United States, you can go bankrupt just trying to stay alive.
- So let's talk about the feasibility. So obviously I'm advocating for universal healthcare and the first question is, is it feasible? Does it make sense? So 30 nations that are similar to the United States have implemented their own healthcare policies and it covers 600 million people. This is not, this is very achievable, right?
- Those systems have better outcomes, lower cost, and better patient satisfaction rates. So it is achievable and it is doable. In the United States, we have 100 million people that are covered under government-run, non-profit,
- medical systems. That's Medicare, Medicaid, CHIP, and then I think a lady was talking to me about the Indian program and then the VA. So we have experience in the United States doing it and there's some problems with that and we'll talk about that in a minute. Medicare administration is 1.3 percent of the charges for
- Private insurance, it's 12 to 18%, and that's money that's going into profits, not going into healthcare. That's $450 billion a year that is spent, and according to a Lancet article, 68,000 premature deaths are caused by the current system that we have. So, we're told that
- that I'm a dreamer, and I am an optimist. You have to be an optimist to run as a Democrat in southern Indiana. Let's be clear about that. But they say it's just a dream. But 600 million people are already living that dream. They're living longer, and they're living healthier lives. It's not a dream. There are concerns. There are mechanics of what needs to be done to transfer from our current system to a different system.
- Every one of those problems have been solved. Every single one of them have been solved. They're not insurmountable. It has happened at least 30 times around the world. We don't have to reinvent the wheel, and we can leverage what we've done with Medicare, Medicaid, and the other programs. This is really a doable thing. Countries like Australia, Canada, Ireland,
- England and 28 other countries in Europe have already made these transitions. It is doable. So the question is, why are we stuck in a system that is more expensive and less effective? And it really comes down to politics and obstruction and greed. The ACA, the Affordable Care Act, was an attempt
- to try to bridge the gap between dreamers like me that would like universal healthcare and people that were in the for-profit system and was trying to bridge those differences and meet them halfway. And when that was put in place, tens of millions of people got new insurance, it eliminated pre-existing conditions, it fixed a lot of problems. And in response to the attempt to bridge that gap, opponents
- have tried 100 times in the House of Representatives to eliminate the Affordable Care Act. And when they weren't able to do that, they started weaseling and turning and obfuscating and making it more difficult. And they used duplicity to convert this from a system that was working better to something that's working about as well as the current system. And it was intentional.
- So, and I'm frustrated by this, frankly. I'm frustrated that you hear a lot of people, both Democrats and Republicans, that say that they're in favor of more affordable healthcare, less expensive healthcare, and really what they're doing is they're slow rolling us to prevent us from getting what we really need.
- we need to get people, and I think there's a guy from the fourth, where's the guy from the fourth? Right here that is also in favor of Medicare for All. So if both of us got in, that's two more votes for Medicare for All. We're going to have to fix this at the ballot box.
- They're also talking about new systems to distract us. One of them is called health sharing. And there's various methods for this. But basically, they are saying, well, here's a new way that some of us can get covered and some of us can do this. And the problem is, when you make health care systems that include some people and exclude others,
- Those others will suffer and die prematurely. This has to be about all of us. It is based on community, and it is actually in our own self-interest to think about this as a communal problem instead of an individual problem. So let's talk about the human impact of this. There was a spike in AIDS in Scott County,
- I don't know, maybe 20 years ago. And political dogma interfered with the ability to make good healthcare decisions. And it required the federal government to quietly step in and push hard on the state government to take action. Now with the new budget cuts coming in, there's all kinds of threats. I know a lot of people are concerned about hospitals. I don't know if anybody knows that there's a hospital
- tour where they're driving from hospital to hospital that are at risk. Has anybody heard of that for today? Yeah, that just popped up in like the last 48 hours. So with the new budget cuts, there's other things coming in. While they're keeping us focused on the hospitals are going to close, my guess is they'll probably under pressure figure a way if we apply pressure.
- to save the hospitals. But there's a lot of other things that are happening over here that we're not focused on. And one of them is the parents I was talking about earlier that have children with disabilities. A lot of those are being cut. They're making it harder to get to apply. They're making it harder to stay applied. It is a real problem. And even worse,
- or at least as bad. They're also looking at developmental care, and they're removing developmental care. And that's happening across the board, not just in our health care, but also in the education. There are things that young children need that have developmental
- issues that if we can reach them in time and if we can give them the help they need, they can get on a better trajectory for their life. But if we miss the window for effective care, they're going to have to live with the results of that for their entire life. Failings that we're going to have in the next four years are going to affect people for 40 years, and that is criminal. It's a pattern of obstruction to try to keep us
- in the for-profit system and to drag any other ideas down so that they're not as workable so that people will go to the only system that's left. So I'm passionate about this, but I am not the expert. So we've asked a panel to join us, and we're going to talk to them in a second. Before we go to the panel, I would like to make a disclaimer on their behalf. These people are not
- here as part of my candidacy. We've got some people in shirts that they're part of my team. They're not wearing my shirts. They are not, their being here is not an endorsement of me. It's not an endorsement of the organizations they're with. So I just wanted to make sure that that was clear. So let's begin with Dr. Stone, who's a nationally known advocate for Medicare for All, an IU Assistant Professor of Medicine, and the Director and Founder of Medicare for All.
- Dr. Stowe? Thank you, Brad. Thank you. So, get my notes up here. I'm like a young person, I'm using my phone to keep notes on when I talk. I'm trying to be hip, I'm 73, but how many of you here have actually heard me talk about healthcare before?
- I figured I saw a lot of familiar faces in the room. I've been practicing medicine in Bloomington for over 40 years and I've been talking about healthcare, healthcare reform, Medicare for all, single payer healthcare for over 30 years. So I've been doing this a while and a lot of it goes back to my roots working in the ER where I worked for 30 years mostly in Bloomington Hospital but I also worked at other places
- in southern Indiana, including Martinsville and Bedford and Paoli and Seymour, a bunch of places around. And so my, the stories, ER doctors can always tell stories, but there are just so many stories of, you know, the guy comes in, he's a carpenter, so you know,
- without me saying anymore that he's uninsured, okay? He's a self-employed carpenter. He's uninsured. And he's limping on this big swollen ankle. And he says, Doc, is it broke? And I say, man, that's really swollen. We got to get an x-ray. He says, no, I can't afford an x-ray. If I could afford an x-ray, I would have come in sooner. And I said, well, I don't.
- I gotta have an x-ray because this looks really bad. It could be broken, but if it is broken, we gotta know just, you know, we gotta know more so we can figure out how to take care of this. And his ankle was broken and you could just tell from the way it looked that if he had come in,
- right after it happened the bones would have still been all fitting together tight but now the bones have shifted out because he's been limping around on it for a couple days so now it needs surgery it needs some screws and a plate and we're looking at a hospital bill of at least twenty thousand dollars and so this guy is totally messed up or another way to think about it is
- Mom brings in a little girl who fell off the swing set. And she landed on her head. And it really rung her bell, and she's concussed. And the little girl's kind of repeating things, but she's got a normal neurologic exam. She's got a little tiny bump on the back of her head. She looks pretty good. Her balance is good. Her speech is clear. I'm doing all these things as I assess her. But what about a CAT scan? I've peeked. I've looked. They don't have any insurance on her.
- She's not even covered by CHIP. So I think she's going to be fine. But if I order a CAT scan on her, it's going to increase her bill by $1,500 to $2,000. What do I do? So I got to make some judgment. And hopefully, I make the right judgment. And I don't get the CAT scan unless I really need to. But this whole system we're in right now is just
- It's such a crazy, complicated, painful, ugly, it's a mess. Brad, I've got no complaints about all the facts that Brad just laid out for us because it is this crazy thing. We got the most expensive healthcare in the world. We don't have the best healthcare in the world. In fact, we're far from it. And the worst thing going on now
- in the last two months is we've got this big ugly bill that's come through and healthcare is facing much more cutbacks and disaster and pain and death and suffering. I mean, it's so much worse than it was when I gave the same talk back in February. It was a little scary then, but now it's laid out for us. And people, you'll hear people say,
- oh, the Republicans were so clever when they, and I'm gonna talk about Republicans and Democrats, and I appreciate the fact, I'll digress for a second, that Brad came to me, he didn't ask me to convince him to be an advocate for universal healthcare, he asked me to help him understand how to make the points and help grow his understanding of it, but he had made this decision, and so I said,
- Brett, I will talk with you and I'll even, you know, do a forum with you. I haven't endorsed you. I haven't given you any money. And I'm going to endorse and give money to whoever wins the primary. That's, you know, that's pretty clear to me. Okay. So that's me talking as an individual. Now I'm back to talking as, you know,
- you know, my 501C, our 501C3 organization, Medicare for All Indiana, Physicians for a National Health Program, the larger group that I'm an advisor to their board of directors and so on. So things are just so much worse now and getting worse, so back to the Republicans, right, that's where I was. So the word is that
- to get the bill through, they postponed almost all of the actual impact until after the midterms. That's not true, it turns out. That's what they say. But actually, all sorts of impacts are happening right now. That's the thing. Some of the impacts won't happen until after the midterms.
- But a lot of the impacts are gonna happen in just a few months as people come to open enrollment this fall and then start new programs, start new insurance coverage in January. So everybody's healthcare costs are gonna go up and some people are gonna lose coverage. The ACA subsidies are gonna be, have been cut way back. That's happening in a few months, okay?
- The number of people dropped from Medicaid is happening. Maybe they're not going to actually get dropped, but hospitals are looking at this, and we've got to budget out a couple years in advance. And the rural hospitals, I was going to mention the Medicaid motorcade today. It's actually Simon Higgs' wife, Michelle, who's one of the organizers of that.
- Indiana hospitals around all rural have all been identified as hospitals that may well go out of business, go bankrupt as a result of these Medicaid cuts, and they're making the changes right now. Now, those 12 hospitals include several that are here in the 9th District, Corden, Salem, North Vernon,
- I'm not sure if there's others in the ninth district, but also in Davies County, Washington, up in Brazil, and up in northern Indiana too. But some of you may have seen that a couple days ago, a big billboard came up, put up in Columbus, Indiana, saying under Trump's watch, this hospital is laying off people and may have to close down. So Columbus is now,
- The Democratic National Committee actually put up this billboard, has focused on, because Columbus announced a couple weeks ago that they're laying off 50 positions and they're not gonna be replaced. They're cutting down whole programs. So Columbus was not one of the 12 that was identified. But they're on the front line now because they announced this and there's a big billboard up. But this is happening right now.
- And it's not all gonna be delayed until after the midterm. And I think people in rural areas are beginning to be aware of all this. Okay, so another couple things. So Elon Musk and his gang cut through government and cut all this stuff, including medical research, cancer research, and so on.
- And then the big, beautiful bill cut all this money out of Medicaid. Now, it's really important to understand, I don't think this has been made clear enough, that when we talk about the United States having the most expensive healthcare in the world and we need to make our system more efficient because we spend too much money that goes to waste, these cuts to Medicaid, especially,
- will have no effect on overall United States healthcare spending. It's a completely, completely different thing. These cuts are just saying the government's not gonna guarantee healthcare that it used to guarantee healthcare support to. These cuts are just gonna drive people out of healthcare, but it's not gonna save money. They're gonna end up going to the ER if they lose their coverage.
- No money in the overall cost of healthcare in the United States is gonna be saved by all these cuts. So that's another important thing to remember. So I could go on and on, but I'm gonna try to narrow it down here a little bit. Healthcare today is an extractive industry. Anybody heard that term before?
- Coal mining is an extractive industry. Drilling for oil and harvesting timber. Those are extractive industries. It turns out that our healthcare system is an extractive industry too. It extracts profits. The system creates profits. It is designed to create, to maximize profit. It is not designed to provide quality healthcare for the largest number of people.
- That's just the reality of where we are. So the other thing that's kind of timely is that we're coming right up to July 30th, which is the 60th birthday of the passage of Medicare and Medicaid in 1965. So Medicare's 60th birthday, Medicaid's 60th, 30th day is coming up. And interestingly enough, both those two programs that were
- created and passed by Congress under Lyndon Johnson as president in 1965 were implemented in one year, in one year without computers. They did it with three by five index cards and Manila folders, you know. So I'm not saying we can make this switch that I want us to make in a year, but we've already taken this big step and originally the idea was
- Medicare taking care of elders, Medicaid taking care of poor people. The most vulnerable people were brought into our system and the plan was then we're going to expand this to cover everybody. The Democrats got themselves messed up between
- Jimmy Carter on the one hand, who did not want to expand Medicare to cover everybody, and Teddy Kennedy on the other hand, and it went on and on. Then Reagan came in and just put everything in the back seat. Clinton's tried to reform healthcare, and they were gonna do it through a way that was basically still keeping the private insurance companies right in the middle of things.
- So let me pick for a moment before you fall asleep from this talk on a hot Sunday afternoon, Saturday afternoon. And we're talking about extractive. So how do insurance companies make money? When they sell policies, their income are the premiums. So that's their income. And to be profitable, then they have to have less expense than they have income. So how do they have less expense
- They deny care. They delay care. They make it more complicated and difficult. They put in prior authorizations. So insurance companies make their money by denying care and by avoiding taking care of really sick people. And I went to medical school to take care of sick people and to care for people. So I'm on the complete other side.
- And I'm not saying that insurance companies are evil. I mean, they're companies that have to make a profit, and even the non-profit ones, like IU Health is a non-profit, but they've gotta make a margin, particularly because they're in this marketplace that is full of profit-seeking, money-extracting entities. Okay, so, but the point is, Medicare and Medicaid, 60 years old, and the initial plan was that they would be stepping stones
- toward a complete universal system. So back to the present, first week of July, The Economist magazine, which is not a left-wing journal, with a polling company called YouGov, which is very reputable polling, asked people, a representative sample across the United States,
- Would you be in favor of having Medicare for all or opposed? And so this is the first week of July, just weeks ago. 59% of people were in favor, 59% in favor, 27 opposed, about two to one, and 14% undecided.
- when you look at the people who made up that 27% opposed, what do you think was the demographic that voted the strongest against Medicare for All? White males over 65. That was the demographic that voted
- the most, and already have Medicare. Shut the door behind me. So, that's where we are. So, Democrats need to have the courage to learn the numbers, understand the issues, and ignore the lobbyists
- and the dark money that wanna keep privatizing our healthcare system. The evidence is overwhelming, the moral case is clear and obvious, and the political benefits are potentially enormous. Medicare for all, the time has finally come
- This is the way to fix the problems. Democrats will have to have the backbone to fight for it, or they can keep on tinkering with our profit-driven system while people continue to die and go bankrupt. That's the choice we're facing. So I really hope whoever gets the Democratic nomination
- agrees with what I'm saying today, and that we can all get out and back them and elect them to Congress and replace Aaron Houchin, who voted for the big bill, beautiful bill, of course. I think we went a few minutes over, sorry. Right or right? I ran a little long myself. Okay, so I'd like to introduce Dr. Ivy Lee,
- if you would come up. She is a beloved Bloomington palliative care physician and current fellow in addictive medicine and will be discussing issues around addiction and recovery. Now there are many things that are not covered under Medicare and one of the semantic arguments that he and I have privately is Medicare for all. I think that it should be universal health care which is more expansive and more inclusive. You know better
- for mental illness and for addiction and for other things. So that's one of the reasons I've brought in a broader panel that's not just talking about, as my grandma would say, the NARA aspects of Medicare for All. Dr. Lee? I don't like podiums because they don't fill them short enough. I can't hear myself. I can't hear you. Just go like that and I'll speak louder. And also, this is my version of PowerPoint.
- I don't know if I'm the best representative to talk about addiction medicine. I'm doing a fellowship, which is training right now. And my background is palliative care. And I got involved with addiction medicine because we had patients on the palliative care team who had pain issues and addiction issues. They were very complicated. And I didn't feel like I had the bandwidth to know how to treat them properly. So I decided to do this fellowship.
- One of the things, there's a few things that the fellowship has opened my eyes to in terms of addiction. And one is that addiction is a medical position. And I think for a long, and even now, it has a stigma that it takes willpower and strength, and you're a poor person because you can't get off the addiction.
- Do you know what the definition of addiction is? And I think we all have a little bit of addiction on us. Addiction is a compulsive behavior of either taking a substance or some sort of behavior that you can't help. And one part of your brain knows this is not good for me. It's continued behavior despite the harms that it's doing to you. And it no longer provides any benefit.
- And it's almost like you're two brains when you have a substance use disorder. One part says, why do I keep on doing this? I'm destroying relationships. I'm losing my job. This is not helping. It's not giving me the pain relief or the high that I used to have. And the other part of the brain goes, just keep on doing this. And you can't control that. That is an addiction. And again, it's not for lack of willpower. Now, a person has to be engaged in their treatment.
- But there are other reasons, and there are social reasons. There are reasons, perhaps, generational trauma or trauma experienced early on in life or trauma experienced in the womb that predisposes a person to addiction. So the next thing that I learned is that I saw a lot of people in our clinics who were at the bottom, who were involved, who were jailed because of it, who were hospitalized because of it.
- and they got on treatment, they got on medication, and they were able to slowly bring their lives back to something of happiness, of productivity, of reestablishing of relationships. So there is a way of helping with addiction. Addiction also is a chronic issue. It's not one solution. You take the medication and you're fine. It is a chronic issue that needs to be dealt with over a lifetime that requires
- continued medical support. I think one of the questions you might want to ask yourself is, so should I care if you don't have, like if you don't have an addiction? And so one of the things I think that's helpful to understand is that it's a ripple effect. The statistics right now are that producers, probably one in 10 producers are identified to have a substance use disorder.
- that varies depending on which substances you're improving. So that's one intent. So I just counted, there's about 50 people here. Five of you might have are being treated or have substance use disorder. Then that ripple expands because definitely families, friends, coworkers, employers get affected. The ripple continues expanding to companies and medical providers. We see that.
- There's a lot of stress, moral distress, and burnout from medical providers trying to take care of people with substance use disorder. And then it goes on where it affects communities, affects the country. I think the tragedy is that it takes away potential. And then I said that there's a global moral distress. This is your fellow man who is suffering. There's ways to help that person.
- We're not using that way. So I'm trying to think of at what level. I think the question was, what would addiction look like in a just world? It's complicated. It's multi-layered. And so this is my other old-fashioned PowerPoint. And it's hard to show you why it is complicated, because it's built on several different levels. And I've listed the levels from the top as things that are a little harder for us to reach.
- And on the top of this would be legislative changes. A big thing is housing. In the cities where housing has been established and housing insecurity is addressed, the addiction issues have come down. But housing is really difficult. There is a Monroe County Recovery Summit where there were people from all levels of involvement with addiction there.
- And they all agreed in Bloomington, I think the numbers were tens of thousands. There are tens of thousands of housing people who needed to be housed and cannot find housing because of the expense and the difficulty of requiring it. So housing is a big one. The other thing is employment. Employment is very important because we know one of the things that fuels addiction is boredom and not having anything to do. So that's on the top here.
- The middle is institutions, not governmental, but institutions. And the things that I've listed here, I don't know if you can read it. That's why I keep a ball to PowerPoint. One of the things is we health care providers have gotten ourselves into this mess. And that was with the opioid crisis. And there have been some turnarounds with that. There's more restrictions.
- And we are more thoughtful about prescribing ovoids. But that also bit us in the butt, because then we were very strict about not prescribing ovoids. And people were suffering for that when their ovoids were quickly cut off. And we now know that that cannot be done. We know that with chronic pain, that people, that ovoids probably don't benefit people that much, but they can't be cut off quickly.
- They have to be slowly coming out. And the other thing is not starting people right away on high risk avoidance. So we've kind of gotten ourselves into this mess. I think we're making corrections for it. Increasing of mental health services, I think that's very important. And we have someone to talk about that. The other thing is, I can't read upside down here.
- Broaden and improve care in the prison system. There needs to be more consistency. In Indiana, about 50% of people who go into the carceral system have some sort of substance use disorder. This one is something that I'm passionate about, this decrease in stigmatization by people who are providing care, because we are seeing that in the hospitals. And I also want to defend those people who have stigmatization. It comes with reason.
- it is very difficult to take care of a patient who has substance use disorder. And it goes both ways. It starts vortexing down where the patient wants more pain medication, the provider's struggling with not wanting to feed into the addiction, and it becomes a worse and worse problem. So I think with education and with working with the staff, we can help decrease stigmatization, expand access to treatment,
- And that's been done in Indiana. And I want to say the good thing in Indiana is since COVID, the overdose rate from opioids has decreased by 20%. So the government has been doing some things right. And then educate, increase public awareness, and practice harm reduction, which is extremely important. Harm reduction is kind of a different type of mindset in terms of giving syringes.
- because we'd rather have people to be able to do safely than to have an overdose and die. So it's a whole new way of thinking and a different way of thinking. And I know some people have a hard time accepting it, but a lot of lives have been saved with syringe programs. So on the bottom here, this is the foundation. This is you. This is what you can do to help with drug addiction. And again, why?
- Why should we care if we don't have a relative or if we don't have an addiction? I think we need to care because this is helping each other. If someone else is hurt in some way, it will come back and hurt us in some way. So it's also just helping the next person. So these are different ways of
- And I think the biggest thing is just learn and understand. And being clear is really helpful. I would suggest that you look at www.in.gov.
- and look under addiction, they have a really wonderful website there that talks about the things that I just talked about in terms of addiction being a disease and how to help it and getting educated on that. So if you're interested, the first thing I would do is look up in.gov. They have a really nice website on that. Listen, and I drew this picture. I don't know if you can see it. It's a face. It's got a smile and ears. And I always tell the medical students,
- We have two ears and one mouth. Use them in that proportion. So the same is listen to what people have to say. Listen to their stories. In terms of stories, I understand if someone is wanting to change something in the legislature, that is one thing that legislative people are most interested in, and sometimes are most moved by, are the personal stories.
- And I'm not gonna go through all of this, but I'm also gonna, except for this one, talk to the kids. Talk to your kids, go to the school of kids. When you look at the statistics as to substance use disorder, they, and they'll say one out of 10 users, they include people 12 years old and up. And a lot of the heavy usage, especially with marijuana and tobacco, are ages 12 through 21.
- And during that time, up to the age 24, the frontal brain lobe is developing, and that's when it's most susceptible to any type of mind-altering drugs, so especially marijuana and alcohol. That's when there's plasticity there, and that can change. I am glad for right now that Indiana has not yet legalized marijuana.
- But if they do, if it comes to that, because there's a lot of money in it, and surrounding states that are using it, if it comes to that, I'm hoping that they will be careful and thoughtful about it and do something to restrict underage kids, probably even 24 and under, from purchasing. Because the marijuana can play a high influence on that age group more than any other age group.
- I'm going to leave it here, and we'll be open for questions, I guess, later on. Yes, ma'am. Thank you. So they're doing play by play. I'm going to do color commentary before I introduce the next. She brought up a couple of points that we need to consider. I mentioned the AIDS problem in Scott County. And one of the reasons that it was so bad is that people did not want
- to set up a needle exchange program because they thought that it would be encouraging. And they had to put that in place. And it was actually forced to be put in place. And the AIDS epidemic in that county went down. There's a lot of moral judgments rather than medical expertise being applied to these decisions. And it doesn't profit us in the long run.
- introduce Erin Jeffries, an assistant clinical professor for obstetrics and gynecology practice, a passionate advocate for women's reproductive healthcare, and she's originally from Mitchell and now practicing in Bloomington. Thank you. So I, unlike Dr. Stone,
- rather new to this space. And so I wanna start by telling you a little bit about myself and why I chose to enter into this space. As Brad mentioned, I am from Mitchell, Indiana. I grew up conservative, faith-based person. I would say my household was rather apolitical. My dad was a Democrat, my mom was a Republican.
- And we never really talked about it. And I honestly entered training with certain ideas of what I thought healthcare looked like, what I thought right and wrong looked like. And then I finished my training. I did my training in Indianapolis at what was Methodist is now Riley and then at Eskenazi Health. And I met women and served women and learned that
- they actually knew more than I did. And I think that's a hard reality for some people to understand. So as passionate as I am about universal healthcare, I'm even more passionate about a healthcare system that cares about women. And I think one of the components that it's hardest for people to wrap their minds around is that abortion is healthcare. That
- that even though, so if we look at post-Dobbs decision, you know, abortion rates are higher than they were before, that it hasn't changed rates, that we're now having more unsafe abortions. But if you look at women's health, obviously the United States, we already talked about infant mortality rates are just terrible compared to the rest of comparable nations. But if we look at Indiana specifically, our rates are even worse.
- women are dying at astonishing rates. Black women especially are dying at two times the rate of white women. And we know that access to care worsens inequity, worsens disparities. And so these rates are likely to worsen. In reviewing statistics in preparation for today, I looked at
- 10% of pregnant women are already uninsured. That's what the current system's in place. That rate is going to get worse with the big ugly bill, as we call it. And I just think it's important. I think that Brad made a important point that we are trying to place our own morality on decisions that need to be made from a medical perspective.
- I may have my own feelings and my own moralities, but I should not put those on other people. If you are not in support of abortion, then don't get an abortion. But there are women that need abortion for their healthcare. I alluded to personal stories being the most powerful. I cannot shake moments that I sat in a clinic as a part of my training where I watched women make decisions that they never dreamed they would have to make. I watched a woman
- who clung to her rosary and just flipped through her beads that she had to make a decision that she didn't want to make. And I just don't understand how people can't wrap their minds around the fact that that needs to be her decision. And so I just hope that this conversation and our dialogue here can help open people's minds because I know that
- My mind has been open and I know that fear, that change is hard, right? That it's scary, that it's uncertain. But I think there are a lot of changes that need to be made so that we all live better lives. I think a statistic just came out that Indiana is the third worst in quality of life. The only two states that are worse than Indiana are Texas and Tennessee.
- and that should tell you something in and of itself. But I just think we need to look long and hard at these moral decisions that we're trying to make for people and determine that it's actually more important for us to care for people. And I was just having a conversation where I don't feel like I have to make those decisions because even as a faith-based person, I believe in an all-knowing, all-powerful,
- God that is bigger than those decisions, that I don't have to make them for other people. And so I hope that we can have a conversation. I think this is one of the most controversial and difficult topics in the universal health care, women's health care space, but I'm happy to have those conversations.
- I know that we're going to talk more about substance use disorder treatment, but I think it's even more difficult when you look at treating substance use disorder in pregnancy and in women, because we have a system that just doesn't reimburse for women's services compared to any other service. A male procedure, like a vasectomy, reverses two to three times more than a tubal for a woman. And so we see even higher shortages in care and in staff because of that.
- I'll leave that and I'm happy to answer questions later. So I think she raised a lot of important points that need to be considered. I would also like to mention that I went in recently and was talking to Planned Parenthood and they're going through a whole bunch of cuts and setting the abortion issue aside because she's addressed it well,
- Planned Parenthood provides a lot of services. My wife and I married very young. We used Planned Parenthood as part of our family planning, okay? And now, as I understand it, they're cutting funding for IUDs, they're cutting funding for testing, and they're cutting and they're cutting and they're cutting, and they're squeezing it down and they're trying to squeeze it out. And this isn't just a,
- this moralistic approach is affecting families. And I know that women have decisions to make, but these are also about families and family decisions. How many children we wanna have? When we wanna have them? Family planning is not just a woman or a man's issue. It's not Republican or Democrat. We all do it. And people that have less money need Planned Parenthood. So, okay.
- There's my little plug. Simon Higgs is an award-winning internet pioneer, founder of Who's Your Action, and grew up with the British National Healthcare System, helped create the Department of Defense's electronic medical record system, and now lives in Monroe County. Thank you.
- As you can tell, I'm not originally from around here. But I do speak Martin Tucky. I have learned that. Where are we? Okay, so I want to share with you a brief overview of how the British National Health Service was established, but I need to place it in the context of what was happening in the U.S. at the time. So January the 6th, 1941.
- U.S. President Franklin D. Roosevelt described the four freedoms in his State of the Union address. He proposed four fundamental freedoms that people everywhere in the world, not just the United States, should enjoy. That was the freedom of speech and expression, the freedom of worship, the freedom from want, and the freedom from fear. Later in Britain, on June 10th, 1941, a committee was announced
- which would survey Britain's existing national schemes for social insurance and their allied services. And we're talking about things like workers' comp and things like that. The U.S. joined World War II the day after the Japanese bombed Pearl Harbor on December the 7th, 1941. So back in England, Sir William Beveridge was commissioned to write a report of the survey findings.
- And that was published as a document called Social Insurance and Allied Services. But we call it the Beverage Report for short. And that was published on December the 2nd, 1942. The Beverage Report's mandate was to envision what post-World War II reconstruction would look like. And it was based on three guiding principles. The first was that proposals for the future should not be limited by sectional interests.
- It was basically paraphrased as a revolutionary moment in the world's history is a time for revolutions, not for patching and not for incrementalism. And I'm gonna come back to that in a minute. And then the third point was the policies of social security must be achieved by cooperation between the state and the individual.
- With the state securing the service and contributions, the state should not stifle incentive, opportunity, responsibility in establishing a national minimum. It should leave room for and encourage for voluntary action by each individual to provide more than that minimum for himself and his family. So basically it's a baseline and based on whatever that person's circumstances and ethics they can build on top of that.
- So that is the social safety net. The Beverage Report was disseminated across the Atlantic and it was studied by both the US and the UK governments. In fact, the US Social Security Board under FDR provided input resulting in FDR including the right to healthcare in his second Bill of Rights in 1944. Now some believe that had FDR not died in 1945, it's possible that universal healthcare
- may have been successful in the U.S. along with Social Security and Medicare at a much earlier time because there was a will for it and other nations were doing it at the time. After FDR died, Eleanor Roosevelt attended the United Nations and helped establish the right to healthcare by having it included in the Universal Declaration of Human Rights of the United Nations.
- So that's 1944, over. The British Labour Party won the 1945 general election on a platform that promised to address Beveridge's five giant evils. The report's recommendations were implemented by the Minister of Health, Ni Bevan, through a series of acts, namely the National Insurance Act of 1946, the National Assistance Act of 1948, and the National Health Services Act of 1946.
- Despite the resistance from our opposition parties and the British Medical Association, the National Health Service Act of 1946 came into effect on July the 5th, 1948, establishing the National Health Service which provided free medical care at the point of need across the UK, regardless of an individual's wealth, and it nationalized more than 2,500 hospitals within the United Kingdom.
- I just realized I missed something, I'm sorry. I mentioned the five evils, I didn't explain what they were. The five major social evils were referred to as the five giants that needed to be addressed. And the giants were identified as want or poverty, disease, ignorance, squalor, and idleness. They all sort of have
- branching definitions based on semantics from there. So, National Health Service was established, so we know it can be done. Yes, it can be done. Now we're gonna skip ahead a bit. After the invasion of Iraq and the fall of Saddam Hussein, the Republicans under George Bush wrote the new Iraqi constitution
- in 2005, they provided universal healthcare to all Iraqis in accordance with the Universal Declaration of Human Rights. But you still can't have it. Neither the Democrats nor the Republicans have actually got any intention of giving you universal healthcare. That's a reality that after being a US citizen for 25 years,
- Still trying to wrap my head around, but it comes back to money and votes and politics. Citizens United doesn't help at all. Okay, so just sorry, I'm not gonna be partisan here.
- To get elected in 2020, Joe Biden promised hedge fund managers that nothing would change, the rich would get richer and the poor would get poorer. And that healthcare would stay exactly the same, extracting premiums as much as $36,000 per family per year before anybody ever went to see a doctor. And of course, those hedge fund managers would handsomely profit from their investments in private healthcare facilities
- and private healthcare insurers. To give you an idea of the lack of political will here, Hillary Clinton's former staff has started a lobbyist firm in Washington DC called the Partnership for America's Healthcare Future. Their mission statement is to settle you with expensive, private, employer-based insurance and emphatically prevent you from receiving any kind of universal healthcare.
- And of course, the insurance companies also have their own trade organization called America's Health Insurance Plans, which lobbies for the right to deny every single one of your medical claims and is behind some of the worst and most unconscionable aspects of Medicare Advantage. Currently, the US healthcare industry costs 17% of GDP. It's actually a little bit higher than that. And it provides partial coverage, under insures everyone.
- And not everybody that has insurance, but those that have insurance are still underinsured. The true cost of universal healthcare is estimated to be between seven and nine percent of GDP. Difference reflects the wealth that's currently being extracted from your doctor-patient relationship. The insurance industry
- is unlikely to lose any money by shutting down healthcare insurance. Now, that's one of the main arguments is what are people going to do? They're actually going to make more money and I'm going to tell you how. There will be some restructuring, but the industry will ultimately profit from it. Once healthcare premiums are eliminated and health insurance is no longer linked to employers,
- People have more financial flexibility to afford life insurance premiums. Since life insurance premiums typically do not pay out for decades, this would generate immediate profits for the insurance industry over and above that of the healthcare industry. Now, back to where we are in this point in history. I don't really need to elaborate on that.
- From the time the Beverage Report was published to the establishment of the National Health Service was six years. But it didn't take six years to build the NHS. It only took three. The first three years were spent defeating Hitler and fascism. We already know what to do.
- A revolutionary moment in history calls for revolutions, not just small adjustments or incremental changes. It is our responsibility to envision what once seemed impossible and turn those visions into reality. We should make bold plans for universal healthcare with no cost at the point of delivery and remove any obstacles that stand in the way. Thank you.
- So when I was growing up, I heard horror stories about the healthcare system in Europe and that socialized medicine evil. And I think many of us will remember the horror stories of the long waits. But let's be clear, the longest wait in the American system is waiting for healthcare that people can't afford, okay? So I'd like to introduce
- Lindsay Potts, yes. She'll be addressing community mental health and sharing her 18 years of experience in behavioral health, including state government and health systems, higher education. Found the next page. Mental health and private practice. And I think that this may be one of the areas that is most overlooked. And it's tied back to our cultural biases
- And you hear this when you're talking to people.
- She's smart enough she didn't get up until I stopped talking. Thank you. We don't even know each other, but she's already figured me out. So a lot of the problems that we have in trying to push things forward is a cultural bias against people that we consider lazy, crazy, or homeless. And because of our biases against that, it prevents us from making good decisions, and it makes us stubborn in not doing things that are in everybody's best interest, because
- maybe some people we disrespect may get something that we have earned. And that's something that we're going to have to address honestly, and we're going to have to get past. So thank you. Hi, everyone. I'm so glad you're still here. Great job. It's been an hour. Move around maybe a little bit.
- So as Brighton did a wonderful introduction, I've had the privilege of serving in community mental health in some capacity, either from a community mental health center to our IU Health System, and also most recently have been able to work with the Division of Mental Health and Addiction for the state of Indiana. And so in all of those roles, I've had the privilege of solving really complex problems. And so hopefully we'll leave here with a little bit of some examples that give us a nugget of hope
- So I know we've been talking a lot about some of the most critical issues, so I'm gonna kind of pivot a little bit. We're also gonna do a thought exercise, so there will be some engagement from you all here in a moment. But we're gonna pivot a little bit to just kind of envisioning what is the ideal behavioral health system. So as many have been talking about, that behavioral health, mental health, substance use disorders, and healthcare is a complex
- problem with complex solutions and that there isn't a single solution that solves it all. So I'm just gonna kind of go over kind of those key tenets of what I would say an ideal system looks like. It is flexible, it's community and family focused, it is evidence driven and
- It is where people are. And so mental health care delivery expands beyond what we would envision within clinics. And so that's where community mental health came to be. I'm loving the history lesson. I've learned a ton from everyone. So just a tiny bit of history on where community mental health started was actually in 1963.
- with deinstitutionalization, so the stories of how we treated those with mental health conditions is pretty horrific in America's history and throughout the world for that matter, but in the United States, the solution was institutionalization until the 60s. We still have several stories of institutionalization today, so I wanna make sure that giant caveat still exists, just in a much smaller scale.
- And so when the Community Mental Health Centers Act in 1963 was passed, it was to go back to the community and identify how individuals with mental illnesses could be integrated. And so that system still exists today. Believe it or not, it's an infrastructure in Indiana. It's an infrastructure throughout our country. And so there's a lot of success cases with it. And so the community mental health system
- is just ripe for solving some of these complex problems because there's a flexibility to it. And so I'm gonna give, this is where we're gonna do our thought exercise. So I'm gonna give kind of a story about how this looks. Okay, so what I want you all to picture, and Dr. Lee kind of had the circle, which I loved, about the center there is the individual who's struggling and then it,
- cascades out. So we don't need to do a show of hands. I'm going to make a broad assumption that everyone in this room has a family member or someone they know that has struggled with either a mental illness or substance use disorder. Awesome. Okay. I see a lot of nodding heads. Great. So what I want you to do is to conjure up that individual, that loved one, that person you care about right now.
- In that, I'm gonna walk you through a story of a general individual and how they would interact with an ideal behavioral health system. So we're gonna wave a magic wand, right? And we're gonna envision that. I want you to do that with your loved one as well. So imagine that we had this system and that this individual is able to interact with our system in the way that I'm going to describe. Okay, so we live, so the example I'm gonna use is because we live in Bloomington.
- And so because we live in Bloomington, we have this wonderful campus and population of students. So if you don't know this, little fact, most mental health conditions, a lot of the ones that are schizophrenia, bipolar disorder, even depression and anxiety, a lot of the majority of those develop during the young adult years, which can extend between
- and we're from like 16 to 17, all the way up to 25, even into the later 20s. And so we have this prime population in Bloomington. So I'm gonna pick a 21-year-old college student. And so this individual is here from, their family lives in South Bend, they're here at IU, and they're studying, and he has had a really great first couple years, has done really well in his classes, has attended, and has roommates and friends.
- It's his junior year and his roommates start to notice that he stops going to class and his grades start to fall. And then they start to notice just that he's struggling a lot more than usual. Not able to get out of bed, not able to interact and just be isolating, even having some odd interactive behavior.
- One time they noticed that this individual, he's really not doing well and they get really worried about him and so they call the local crisis center. And Bloomington's called the Stride Center. If you don't know about it, great resource. And they call the Stride Center and ask for help. And there's a mobile team that comes out and one of those individuals that comes out to see this student is someone who also is in recovery.
- So this is an individual who has already been through the system and is right there to help this individual understand what's going on and to deescalate. They deescalate the situation and identify that this individual needs a lot more care. And so what they do is they help connect them to a therapist the next day. And so that individual, the student comes in to receive care the next day from a therapist.
- therapist realizes as they're talking with them, wow, this individual's family lives far away, let's get in contact with them, gets ahold of the family, of course with the student consenting, and engages them in the care, and creates a treatment plan. That person also gets them connected to a psychiatrist within a week, and that individual's identity, the student is getting access to medication if they need it.
- Also, this individual has assigned a care coordinator. So they're identifying, are there other needs this student has? They've been in Bloomington for three years and hasn't seen a primary care doctor, hasn't had any other needs met. Maybe they also do an evaluation for her, how they're using substances and identify maybe some high risk behavior. And then that care coordinator makes sure that they get access to all of those additional supports and also keeps the family updated.
- And then the care coordinator also makes sure that all of their housing needs and such are taken care of. So this individual then gets appropriate care and gets back to class. The therapist writes a letter to their instructors, make sure that their instructors know that this was a mental health crisis and the individual is receiving treatment and to provide the additional accommodations so that they can continue on their way. So this is the ideal system.
- when we think about, and I want you to go back to the loved one that you had conjured up, and think about if that was their experience. And my guess is no. So, hell no, an emphatic.
- Hell no. And I would say yes, I would say I've been in this field for a very long time working within systems, doing work within our jail system, doing work, our Monroe County jail system and our safety net systems in the hospital, the emergency department and whatnot. And right, most people fall through the cracks. And however, I will say, and this is where the glimmer of hope comes in, there is some bit of hope.
- And so this is where I want to infuse the power of policy. So we've been talking a lot about
- that a lot of the problems and then a lot of some, what are those solutions? And I have had the privilege of bearing witness to some of the solutions and what can happen when people focus on the individuals, on their communities instead of focusing on how they are different politically. And so one of the benefits that mental health, mental health care and mental illness and substance use disorders has had over the last decade
- is it's been pretty bipartisan when you look at.
- from the federal level and at the state level. Not completely, so I'm not gonna be Pollyanna about it, but there's been some pretty big major changes that have happened both at the federal and state level that have been major progresses in this space of treating of this ideal system. And so what I can say definitively is we've built a crisis response system. So here today in this county, we have a stride center. There is a place for people to go. There is a mobile crisis team
- that where people are responding 24 seven. And it's becoming more than anecdotal, which always makes me really excited when I just hear like these stories around from people I didn't like ask about it. And that's starting to happen. And so we're seeing that in this county. And I will say for Indiana, it's over 90% of the counties have that access to that right now today. And that was not the case two years ago. So huge amount of growth.
- There's also certified community behavioral health clinics, which is a federal model. It's in 20 states, and Indiana's one of them, super exciting. So there is that model that actually covers the cost of everything I just described. And so when we start to look at this, there is movement in that direction. What I will say, though, is these are all Medicaid programs, right?
- And so I think that is such a critical aspect of when we talk about this, that we have a solution, but it's still not a solution that serves everyone. And this is one of those scenarios, and I know we've talked a lot about individuals with a full host of potential disabilities that have Medicaid as a part of their healthcare. There's a lot of services within Medicaid that are not covered by commercial insurance at all, at all.
- And so when we talk about mental health parity and all of these needs around this space is that for a transformation to have this ideal system, it cannot be just the Medicaid population that benefits. Yes, ideally, I mean, of course, I am a huge advocate for our most vulnerable and those who need those services the most. And let's do that well, and then let's prove that it works. And then you have the case that this is the better way to provide care.
- And we've already talked about when I could walk you out about how it's really, really expensive to provide bad care. So we know that it's really expensive. So it's not like we're saving money here by providing bad care. We're just providing bad care that actually costs a whole lot more. And so I think with when we look at these Medicaid programs that are promising, I'm very hopeful that these will be the wave of the future if we're able to implement them across the board. So thank you everyone for the time and sticking with me
- and for the thought exercise. She's a lot taller than me, so I'll move the mic down. So I'd like to move on to the question and answer period here quickly, but I do want to get a closing. The bottom line from my perspective is the for-profit system is not profiting us, and universal health care
- works better, costs less, and saves lives. And I don't believe that compromise is possible with those that are trying to undermine health care. And we have to stop fighting over the scraps that they're stripping off. And we need to start fighting for what we really need and go for the big picture, because they are going to make us fight either way. So let's get in the fight that ends with what we need.
- The urgency of the crisis of the debt and the death and the pain that's associated with this far outweighs the difficulties and perceived concerns about implementation, because 33 countries
- have implemented it already, and it's actually more than that, but 33 that are comparable to the United States. So it doesn't seem insurmountable, especially because we are one of the 33 countries that have already implemented a not-for-profit system. We've got the answer. We just need to move forward with it. And the times, they're going to strip it as much as they can every turn they get, so we need to move forward. This is what I believe, and this is what I'll fight for in Congress.
- So he said that, you know, I respectfully disagree with Mr. Stone. I think it really does matter who wins the primary. I feel very strongly that it matters who wins the primary, right? Yeah. So anyway, so I'd like to transition to the question and answer. I would ask, since we don't
- obviously are not wearing watches because I'm running long. If you could, raise your hand and you'll get one minute to ask a question. If you've got like four questions, ask one question so that everybody can get their first question answered and then if we have time, we'll go back and you can ask a second question. All right, so let's, yes sir. Hi, I'm Miles Eddie. I'm here as Miles Eddie but I'm also one of
- speaking personally, I see this framed as the Democrats are going to solve this and we're fighting the Republicans. And I see that a part of the problem is big money and big politics is so detached from the people that we put the people who vote Republican into the same, you know, idea that it's the Republicans. So my question is how do we get
- thinking about this as a community issue, not a political issue, and working together and getting together and especially talking about this so that we, the people, can hire the representatives that are going to represent the people, not the big money and the big politics as it stands right now. So that's a good question.
- And I think, and one of the reasons that I put the references to the Affordable Care Act in there is I think that it is a good example. So as somebody that's running for office, I do have a partisan position and perspective. But the fact is that as Dr. Stone and others mentioned,
- there is a majority of people that wants universal health care and would support universal health care. And that is Democrats and Republicans on both sides. But the Republican Party, the elected officials that are now in the majority and have been in the majority, every time they get in the majority,
- They start trying to kill the Affordable Care Act, and they start trying to kill other things that would benefit us. And they're driving through the Big Bad Beautiful bill. So I think that there is a disconnect between what the base wants and what some party leaders and elders want. There's also broad
- I think that they're on responsible gun ownership, but that will never get passed through in Congress with the people that we have in power now. So I wish it wasn't partisan, but it is very partisan, right?
- And I think that the Braver Angels, I am hopeful that the approach you guys are using from what I've read about the organization is very good. I'll get you one second. You can save your arm. In one second. So a short plug for Braver Angels. Although I have not been associated with them, I did look them up. They'd reached out to me earlier. And I found that
- people on the right were complaining they were too left-wing, and people on the left were complaining they were too right-wing, and I find that a very interesting organization and worth looking into, okay? Because that's the sign of a good compromise. Yes, sir? And also, I have always been impressed by Braver Angels and
- I would love to see Braver Angels sponsor some kind of a healthcare talk. And I know that you're. I think they're working on that. Right, right, yeah. And I've talked to Don Byrd about that a number of times over the years, and he's not with us anymore. But I think part of, you know, the thing is, the public opinion polls
- show that Medicare for all, universal healthcare, whatever you want to name it, is bipartisanly supported and yet both major political parties, their positions are against it. So in some ways, yeah, this is an issue, that's why I addressed the Democrats today, but
- You know, if Houchin comes out for universal health care and whoever's running against her is not, I might have to vote for her. I get that. So it's going to be him and then you. One second. So, sir, tell me your name again. Joe Mackey. Joe Mackey. And I think you're running into the fourth, right? In the fourth. So before we started, Joe and I were talking. And he was talking about what? All right.
- Yeah, yeah, sorry. A friend of mine, a woman named Kathy Gross, was the mayor of Monticello, Indiana, rural white county. Joe, can you maybe stand up? Sure. I don't need to stand here, Joe. Just a minute. Just take a minute. Sure. But Kathy was the mayor of Monticello. And it had happened in the transition that Monticello had an outdated ambulance. And the prior administration bought a brand new one.
- So they were talking about, let's get rid of this ambulance. How are we going to do it? She said, why don't we hold on to it? We'll start a mobile health care for rural White County. So she went to the county commissioners, all Republican. She said, we have this ambulance. I want to start a mobile health care program for rural White County. Will you help me fund it? And they did. And they fell in love with it. It was very well received. The same Republican.
- County Commissioners came down to the State House and said, will you help us fund this for the next five years or whatever that period was. And they actually were on the process of getting the funding. And Kathy lost her race by 50 votes or 75 votes. And the Trump are coming in killed the program, got rid of the ambulance. But health care works and when it works both sides like it.
- rural Indiana is predominantly Republican, so the people who were on the receiving end of this were typically politically not aligned with the people who were organizing and providing it. Just thought. So, sir, was your turn next? Okay. I'm Rob Deppert. I'm not anybody's enemy, but I've been a health insurance broker for 20 years now, basically, in the community.
- A lot of people know me, but I'm the odd man out in that I was a Bernie supporter and have always supported universal health care, Medicare for all. And I think what people don't understand is the insurance industry understands. I went to a trade group here in Bloomington called Life Underwriters, where insurance agents all get meat and have lunch once a month. And they brought in a representative to speak to us.
- And they told us they had a meeting on the public option. What would happen if we had a public option? Because it was discussed with the Affordable Care Act. And basically, public option in their eyes is setting reimbursement rates at Medicare set rates. Because Medicare actually sets the rates and costs to see a doctor and a specialist and to go in the hospital and all of that. And that's why.
- Health care is cheaper for people over 65 because the government sets the cost of everything. But long story short, they said if we had a public option, that private health insurance would cease to exist in three years. And that was the health insurance industry saying that. So I think what we need to understand, maybe not is that, is it a better thing? They even know.
- that they wouldn't exist if they had to have a system where basically people had another choice that kind of took the profit out of it. But that I think we need a strategy that moves us in that direction. And that when I look at it in my years of experience, the government's gone back and forth on whether they favor the kind of health insurance that provides free primary care. Because at one point,
- In 2020, they made it so that Medicare can't have Medicare supplement plans and offer free primary care without you paying your Part B deductible because people were overusing primary care. So as soon as they did that, the other part of the Medicare industry, the Advantage plans, all made their primary care free. So they did it for the supplements. They took it away.
- for anybody that got a supplement after 2020, but anybody that on the advantage plans, the private industry came in and said, oh, we'll make primary care. So my thought is that we need two things, really. We need to make primary care universally free for everybody, regardless of where we're at. And the other thing that we probably need to do to move in the right direction is we need to make Medicare allowable reimbursement rates to standards for every type of insurer.
- Once you do that, moving towards how to finance it and eliminating the waste becomes a lot easier. So I don't know if anybody has an opinion on that, but as I look at it, that's the conclusions I've come to over the last four years. So one of the things that I thought was interesting in that is, how does one overuse primary care? And I understand what you were saying,
- But the phrase is kind of interesting to me. It's like overusing oxygen. I mean, right? They're now saying that in the advantage planes, it's being overused. And that's why the cost of the advantage planes. They've come to the same conclusion the second time. Which is really frustrating if people are just using the care they need, right? I'm sorry. Go ahead. And that's sarcasm, by the way. Sometimes it doesn't translate well. Go ahead. I'm Christina Person.
- And I know Robert from the Bernie Days as well. I'm chair of the Franklin County Democratic Party. I wanted to come down and kind of see what this was all about. I am a proponent of universal national health care standards. It has been preached in it for years that we need a system. I kind of wanted to touch on the topic about the Democratic Party and how we do have folks within the party
- people that are public servants right now who are not for national healthcare for their various reasons. But I am here to tell you now that as a leader in my local party, we are more focused on national healthcare. And we don't care, we don't consider it a Republican or Democrat thing. It is a human right thing. And we need to do something about it. And my understanding of it is the same. They're not all standing on the same platforms.
- So we need to have debates and we need to call our fellow Democrats out and Republicans need to do the same thing. The people need to stand up and start saying we're done with this. Enough is enough. We want this system. It's gone on too long. Do something about it public servants or we're not going to vote for you.
- So the question is how are the changes that are coming both at the federal and state level going to impact those substance use disorder programs that have been building kind of around the state?
- I think in the Indiana statute, there is an exception for staying on HIP if you're in a substance use disorder program. So how that will operationalize, I'm no longer kind of at that level to understand, but it is in that bill that got passed as an exception category. So again, though, this is administrative burden, so anything that adds administrative burden to staying on healthcare will have people fall off
- no matter what, however, there was the intention and spirit of carving that group of folks out. So I think the hope is that that will allow those programs to still sustain. And so that way, as Dr. Lee mentioned, our 20% reduction in, which is continuing to hopefully gain momentum of deaths by overdose, continues to reduce over time. I don't know if others have any other insights. Yes, ma'am. I had a quick question for the physicians on the panel about health
- sharing accounts or these religious-based accounts that have been created. Just from my experience, some of the clients that I have had picked up that I don't, actually I don't deal with health share accounts, did not get wellness visits. They did not get a lot of the things that our plans do offer them now that Medicare and that the federal government has encouraged. Wellness visits, vaccinations, and those types of things. So the physicians on,
- the panel, have you had experience with these types of insurance policies that are religious based that are not actual from an actual insurance company? How do they pay? Do they pay differently? Do they have adjusted rates like marketplace rates or Medicare allowable rates? I was just curious. Before the doctor's answer, I'd like to jump in. And I will allow the doctors to answer.
- Some time ago, I had, my father had died of throat cancer some time before. And a couple, some years after that, I had this big knot in my throat. And I went to a doctor and I said, hey doc, can you take a look at this? And he looked at it and said, yeah, you need to get that looked at. And it's like, no crap, that's why I'm here, right? And he said, no, you don't understand. You need to get that looked at.
- And over the next two years, I had to interface with 10 different medical organizations to get that cancer cured, right? And some of them were small, like I'm counting the phlebotomists that I got our first name based with when they were doing testing, all the way up to multiple surgeries and radioactive iodine treatment to kill my cancer. There were at least 10, right?
- In these health sharing accounts and in other, you know, other systems that people are trying to put in, you don't know how many of those 10 are covered and how many are not. And you're going to find it out after you've signed up and you've severed your protection from regular insurance and God help you if it's the surgeon that you need because the
- These alternatives frustrate me, frankly, because instead of saying, hey, as a community, if 360 million people are on a shared health system, that is universal healthcare, right? So they're trying to just, and the ACA set minimum standards.
- for what is covered and what is not covered. So if you get insurance through them, you've got a good chance of knowing, and they forced that these 10 types of entities would be covered in there. So every time
- you see an organization that says, we found a way around the restrictions of the ACA. Those restrictions are there to protect you and your interests. What they're saying is we found a way around the protections that have been put in place for you. It is like sharks telling swimmers that they need to take down the shark barriers so you can swim free. It is evil. Now, so you ask the doctors to say it, and I just
- I couldn't avoid venting my spleen on this issue, so I will turn to the doctors and say if you've got anything to add. I think my experience with plans have been that they don't cover contraception, and they don't often cover mental health conditions or substance use disorder conditions. They're usually on the exclusions list from my personal experience. I obviously probably haven't dealt with every single plan. And I wanted to mention,
- What I forgot to mention when I was speaking is that I actually wouldn't be alive today if it weren't for the Affordable Care Act. I also had cancer when I was a student in my early 20s. And without the extended coverage from my parents until I was 26, I would not be alive surviving not only a cancer but a recurrence of a cancer. And so I just am passionate about people having care. And there are tons of people who are working their tails off who don't have coverage for different reasons.
- Yes, sir. Ms. Kachwami will be next. Earlier in my career, I was involved in helping set up an employee assistance program. Is there still support? How do you intervene with people, right where their work is, and to get them to help as quickly as possible for a variety of conditions? Initially, they were focused on addiction, but yeah. I'm sorry. Hold on a second, sir. Camera, do you have a live mic there that he could use?
- It would be true. It'll probably feedback. Well, early in my career, I was hired at Fort Benjamin Harrison to help set up some of the very first
- of federal employee assistance programs at a military base, but we also covered the civilians. So it occurred to me that that was one of the easiest ways to get access is at the workplace, where people there, it's easy to identify problems. How do you make it easy? How do you set up prevention systems? And we also created an early kind of family-based
- to make it easier for soldiers and civilians to get help with social services, all kinds of things. So it was kind of a laboratory, but I just wondered is there support for work-based services going on?
- You mentioned that EAP from the substance use disorders programs, and I would say EAP is most pervasive with mental health services still today. I think it is a strong, very quick, easy access point into services. There's some really interesting stuff in the startup space right now in this, not to be very tangential.
- But I do think that those EAP programs are really interesting and a great access point. And I think the EAP model for mental health delivery has been very successful as both I've been a provider of EAP services with individuals who have really benefited from those programs. And so I think it nestles within this well back to kind of the complex solution to complex problems. There's no wrong door.
- for many years to think of this, we need to change our messaging on healthcare. It's not a right that we have to earn or can be taken away. It's not a privilege. It's a basic human need. And why aren't we providing it for everybody? Everyone needs, at some point in their lives, need healthcare. You come into this world needing healthcare, and most of us go out of this world needing healthcare.
- every day in between. So it's a basic human need. And also, one more quick thing. I'd like to touch on something that Rob mentioned that rural spaces, rural hospitals are already feeling the pinch. My husband is a telemedicine neurologist. And I'm not going to say which health care system he works for, but they cover all of Kentucky and southern Indiana. They are already
- overworking the physicians. He is working 11 extra shifts just this month. A shift is 12 hours, okay? And so he is, today he is covering, he's rounding and he's covering urgent care, which Rob, you know as a physician, medical healthcare professionals in here understand, so while he's rounding out patients,
- Hospitals are calling him to take care of strokes. How long do you think he can sustain that and our health care providers can sustain that? They are already feeling that pinch and they're already fulfilling the providers. People are gonna start quitting. My husband works right now because he went into medicine to take care of people. I mean, he doesn't have to work anymore. But if he quit, then they would be even more people
- It's health care. So I'm sorry. My thing is health care providers are being overworked, and they're stressed out. And it's not sustainable. It's true. OK, so you raise an interesting point. And if you go to my website, gradmeier.org, there's a health care section.
- think that the phrase, health care is a right, does not exist in any of that documentation. Because in the polarized discussions, it causes, to use a medical term, an immune response in some people when you use that term. So I just have sidestepped and said, I'm not going to fall into a trap of the semantics of this argument. It is something that we need.
- It is community. One of the things that I was talking to some people about immigration, and I was talking to a lady that was, I think, from Mexico. And she said she moved into rural Indiana, and she said she felt like she was considered weird or odd or off or different. She said, but those people that viewed me as different were the nicest people
- They're compassionate people. They're loving people. They're caring people. They would give you the shirt off their back. And if we can avoid that immune response where they get the backup and get angry and just talk about this isn't the best interest of all of us, they care about the communities deeply. And we are the community. So anyway, so I agree with your point. Yes, that's your second, right?
- This is my second part. All right, hold until I have anybody who hasn't. Yes, sir. Along with Nancy's question, and this is kind of an implementation thing. Does part of your approach or plan involve increasing the supply of primary care providers, so something like expanding med school programs and expanding residencies, or possibly decoupling the AMA from deciding who can become a doctor?
- So the question is, does part of the program that we're asking for include ways to incentivize more people to go into primary care? Do I have that right? Right. And so it turns out there are a lot of ways to incentivize people to go into primary care. The Canadians went through some restructuring of their healthcare system about six years ago.
- So that's the kind of question, the kind of problem that is so important and it's, but just the fact that you can ask the question and you can just, I think, and then you think about a universal system like Medicare for all, then you say, oh yeah, that would actually be easy to do.
- if you had a system that took care of everybody, because for instance,
- We mentioned Medicare sets the prices for all Medicare things right now. They set the prices. Now they get all changed when it goes out into the private insurance industry. Medicare pays for most of secondary, of advanced medical education, like residency programs. Medicare pays for medical education in a huge amount right now. So it would actually be fairly easy to incentivize more primary care. They've done it.
- Now, the big advantage they have in Canada is that medical school tuition in Canada is free. Now, you still need money to go to medical school, because you need living expenses and books, et cetera. But tuition for medical schools in Canada is free. And therefore, the average US medical student at a state
- based school like IU, I think is to graduate with $300,000 of debt from a state school. And so that is a huge, that builds into you an incentive to want to go into a specialty that is the most highly reimbursed because you're coming out of medical school with an average debt of $300,000, not counting your undergraduate debt.
- There are a lot of questions that could be, that we could begin to address actually fairly easily if we had a universal system. One of my heroes remains in all of medicine is a woman named Marcia Angel. And she was the first woman and the only woman to ever be the editor of the New England Journal of Medicine.
- And she was a scorching critic of the pharmaceutical industry, and I recommend you look up Marsha Angel. But she used to say at meetings that I was president at, a single-payer Medicare-for-all system is necessary but not sufficient to
- take care of all the problems in healthcare. You gotta get this part covered, and then we can, and then we've got the leverage to fix a whole bunch of, there are gonna be all sorts of other problems that'll come up, but primary care is one of them that could be fairly easily addressed in this larger system. So I'll see if the board has anything else to add, but I wanted to take a brief left-hand turn. The point about $300,000 for education,
- Years ago, in the 50s, the 60s, the 70s, and fading out a little bit into the 80s, education was viewed as a public good. It was an investment by the community and the children so that when they grew up, they would be able to have a good life and pay taxes and pay for our social security. And we have changed over the years from it is a public good and we're investing in the next generation
- to it as a private good, and they have to invest their dang selves in their own value, and then they are going to be burdened with it. And it's not just a burden for getting new doctors. It is a serious problem in the United States. We have what's called the social mobility. Social mobility is the rating. If you're born into this socioeconomic group, what's the probability you're going to either move up, down, or stay the same?
- And our social mobility is less in the United States. You are less likely to be able to move up than you are in other countries. And a lot of it has to do with our failure to deal with education. So let's go back to health care. I have two notes. I think it's important to note that our shortage is not only in primary care, but it is across the board. And that gap is widening daily by the number of physicians that are burning out because they're overworked.
- I would also like to note that it's not just physicians, it's all of healthcare, so nurses, ancillary staff, et cetera. The second thing that I think most people didn't note in the big ugly bill is that it cut graduate funding, so they limit the amount of grad loans that you can take out. There are a majority of medical students that cannot afford medical education with those limits.
- When I went to medical school, it was $50,000 a semester, and it's now $75,000 for in-state tuition. And so I can't remember the cap is, but I think it's a third of that. And so they would have to privately loan out the rest of the money to cover their medical education. So. I think the bill limits it to 200,000. Yeah, which obviously, compared to the 300 that I mentioned before, yeah.
- I just want to say a word for advanced practice nurses, nurse midwives, physician assistants. That is going to help any doctor with their practice and help everybody in primary and secondary care.
- with increasing midwife care. Indiana, unfortunately, is lacking in that area. Bloomington, actually, is an exception, and I think has been a beautiful space to work in. But midwife care is essential to the care of women across the nation, in this state, across the world. Anybody else have a first question they'd like to ask? Yes, ma'am. We mostly, or probably, are clients of, what's it called, IU Health?
- And we're not exactly ecstatic supporters and appreciators of this organization, nor are the people who work for it. And we haven't had a class action suit or anything yet, but I've heard doctors who've managed to avoid being in this organization say that's what's needed. So I don't know if that's going to do any good or not, but here we are.
- with the big bad bill making things even uglier and worse than they were before it was passed. And so this seems like a great stimulus for action. We have so many things now to complain about. There's one other comment I wanted to make. I have a niece who's under 40 who lives in Eugene, Oregon. And she's only practiced in a bigger practice, four, five, 10 years. I don't even know what it is, but not real long.
- So she is now establishing her own private practice, where it's a subscription kind of thing, where she charges everybody $150 a month, which is lower, I guess, by far than many insurance premiums per month. And so she's going out on a limb. She's recruiting online. And because she has practice.
- Previously with mostly Medicare users, so older patients who have the Medicare insurance to supplement what they pay out privately. With Medicare, they should be able to afford and help sustain her practice. So this is like an intermediary step of not health care for everybody, but an alternative.
- that by somebody who, like Nancy's husband, just in her young years, was exhausted by having so little time with her patients and seeing so many patients in a big hurry. So to avoid burnout, she's trying to do this. Very good. Thank you. Any other questions? Yes, sir. Hi. My name's Mike Hollis. I serve as chief of staff of the Progressive Democrats of America.
- And we have a vision to get 218 votes for Medicare for all, hopefully in the near future. But a progressive populist has never won against a Republican in the US congressional seat. And I know in our Indiana districts, our super gerrymandered and super red. So to both you and to our guests, what will it take to flip
- a lot of these voters. And in Tennessee right now, there is a race for Congress in a very gerrymandered district, District 4 in Tennessee, where a progressive populist will be taking on a Republican for a special election seat. So how do we flip these deep red seats into something that hasn't been done before? People before party. Oh, before party.
- People before party. So I'm trying to temper my thoughts. And she said it for me. So here's the thing. In the last election, we got beat in the ninth two to one. For every one vote we got, the Republicans got two. It is the worst beating that we have gotten
- in decades. And don't nominate the same guy. Well, so part of the problem is that we have, we try to move closer, we try to sound smoother, we try to sound more like maybe what we think the other people are going to vote for us. And my opinion is,
- that we need to screw our courage to the sticking place and say, we're Democrats. This is what we stand for. We believe in universal health care. We believe in social security. We believe in the protections of our community and attract people to us. And we have a better economic message. I talked to a young man that said, hey, I voted for Trump. And the only reason I voted for him, because he agreed with everything I was saying. He said, I voted for Trump.
- Because he said that he wasn't going to tax my overtime and tips, and I need to eat. There are economic policies that we need to address. And we need to have a better message. And I think universal health care is one of them. I think immigration is another one. But this is not about my candidacy, so I'm going to get off my soapbox here. I thank you for the question, other question related to health care.
- I want to make sure that everybody's had at least one. Is there anybody that's still waiting for their first opportunity to speak? Can I just jump in just to kind of answer the gentleman's question? What we need to remember is that in the 2016 primary, Bernie beat Hillary in Indiana. Whether Republicans came out for Bernie
- We don't know, but we know what the voters said in that primary. And the problem that we're facing is what the DNC, National Party, and even the State Party is pushing down doesn't reflect what the voters want. So just to throw this out there, some of us are in the process of burning down the Democrat Party,
- the bad bits and trying to build up the good bits. So we have the Indiana Rural Summit, which is the ground that the state party doesn't touch. So that's basically your county candidates, your city candidates, and even your House and Senate candidates at the state level. The state party doesn't touch any of that. Oh. Indiana.
- IndianaRuralSummit, indianaruralsummit.org, and then we've just created this year Organize in Indiana, which is the goal of cat herding and aligning all the various organizations that are aligned with us, like Mad Voters and people like that. So, yeah.
- Nancy, you two got your hands up. Any last call for first questions? OK. So we're on time now. So I'm going to, unfortunately, ask the last question. And we can hang around a little bit after. I have a question. He'll ask the second to last question. Go ahead, sir. So basically, we haven't had a white male mansplain abortion yet. And I think that's good. The last question.
- So basically my question, actually it was a few months ago, was what is the difference between women's healthcare in the United Kingdom and over here? Something I found is that England actually has pretty much a blanket ban on abortion in the sense that it's called destruction of a child. But what they've done
- is they have a universal healthcare system that carves out all the exceptions. And so basically most of those exceptions are invisible. You wouldn't know they're there, but you wouldn't have the same issues that you have over here from them. And so you're holding essentially two laws in tension that actually work and provide comprehensive healthcare to women.
- is, what can we do? And the answer is, number one, challenge every candidate and ask them explicitly, what is your position on universal health care? And you can't let them use weasel words. And they're going to use weasel words like, I would like more affordable health care. Well, what the? What does that mean?
- And they'll say, well, you know, I feel for these people. And we don't need compassion, we need things fixed, right? I mean, compassion is nice, but we need these things fixed. So make sure that you get a straight yes or no answer. Do you support universal healthcare? And then tell them that that's the way you're gonna vote. Apply pressure to them. And then, for heaven's sakes, vote.
- because that is going to, so in the last election, the Democrats got beat, we got third place in a two-person race, right? And what I mean by that, and she's looking at me strange, like I'm a party chair and she's gonna throw the bull crap flag, more people stayed home than voted, right, for the candidates. So we need to get out the vote and we need
- As you have said, with Braver Angels, we need to start building alliances and take the party partisan-ness out of this and be able to have real discussions. And Republicans are going to need to apply pressure to their people. So, yes ma'am? How about progressive postcards? I've been writing them for years. I don't know if they've been doing any good. But the last hundred I wrote,
- went to Virginia, and they were informative. I am scared Medicare is going to take away this and that and the other. The ones I'm writing now are to Pennsylvania. And there, please remind your friends and family to vote for the three Supreme Court
- So justices, they're Democrats. I mean, specific. You could go online and find this progressive postcard thing. I think it's going to require direct action. I think you're going to have to put it in. So we are at time. We can continue for another couple minutes, but she is going to- Can I announce the debate? We're going to have a debate in November. Please do. November 8 at the Liberty Park Pavilion in Batesville, Indiana.
- Congressional candidates will be gathering to have a debate. Part of this debate, it's a fundraiser. The first part is we're gonna have like a soup, chili, whatever something folks can eat. You pay a fee for the food. That fee, part of that after expenses is gonna go to help someone who is struggling with medical debt in the community, is needing help just to survive or some sort of help.
- We haven't determined how we're going to choose that individual or family or whatever, but we'll figure that out. And then the second part will be a silent auction that is more party-driven to help us. We're doing a billboard campaign to get messages out there about problems that we're all facing because of the big, beautiful bill. But the primary thing that I want you guys to know is that the candidates are going to be gathering.
- Time. All candidates? All Democrat or progressive candidates. Yes. Batesville, Indiana, November 8th at 11. I believe we're going to have it at 11 o'clock. From all over Indiana? For District 9. OK. District 9. So we have information to it on my website. Yes. Four candidates we have right now, correct? Yes, ma'am. Four. OK. I thank you all. We are holy. Woo!