Frequently Asked Questions
1. How does a policy statement, like Proposition 1, actually improve health care coverage?
Policies shape programs. Once proper policies are in place, the types of programs that emerge are better designed, more efficient, and, most importantly, more effective.
2. Will passage of Proposition 1 raise my taxes now or in the future?
No. Proposition 1 directs the City of Tacoma to advocate for a better health care system on the state and federal levels. This type of advocacy will not increase expenses or taxes in any way. Proposition 1 also directs the City to use international health standards and policies on a local level in order to improve exisitng health programs. Again, running existing programs more efficiently and more equitably will not increase expenses. For more detail see the responses to questions 6 and 11 below.
As for the future -- Right now we pay about $7,200 per person per year for health care in the United States. This amount is paid from our state and federal taxes, and from insurance premiums payments, deductibles and co-pays. All of the other industrialized countries in the world have universal health care and pay about $2,500 per person per year. The statistics show that the people in those countries have better health -- lower rates of infant mortality, longer life expectancy, lower rates of cancer, diabetes, asthma and obeisity -- at less than half the cost. Over time, our taxes should decrease and deductibles and co-pays should be greatly reduced or eliminated if we have a more efficient, health-centered (not profit-centered) health care system. And, best of all, our health will improve too!
3. Why are local policy statements, like Proposition 1, necessary or useful?
Change will not come from the top down.
Like all social movements, a fundamental change in health care will require local action and advocacy. Pressure on the state and federal governments from cities is real and powerful. Cities deal directly with the challenges of the uninsured as well as the challenge of paying for employee benefits and the like. Just as in the case of the Kyoto Protocol, cities can move the country forward in a real way. This effort is not unique to Tacoma. The question is, will Tacoma be part of this effort?
4. What can local communities do to improve health care access?
Significant health reform will occur once there is an organized, strong grassroots base of support for protecting and expanding health care access. Health reform requires local community efforts that can:
Analyze complex legal and policy issues in order to develop achievable policy alternatives that will attract broad support; build a strong grassroots base of support; design and implement media and other communications strategies to build timely public and political support for reform and to weaken opposition arguments; build and sustain strong broad-based coalitions and maintain strategic alliances with other stakeholders; develop and implement strategic health policy campaigns; and
generate resources and implement health-reform campaigns.
5. What should health care policy be?
In terms of health care reform, the fundamental policy should be: make everyone as healthy as possible. Seems simple, but that’s not the underlying policy of our current system. Instead, health insurance financing takes first priority – maintaining the viability of the private insurance industry is perceived as either a laudable goal or an unfortunate reality that can’t be challenged. The first step toward refocusing health care reform efforts is to change this current priority. The language of Proposition 1 does this. It states that Tacoma views improving the health of the community as the foundation of health reform, not any other concern.
The language used in the underlying resolution that supports Proposition 1 comes from international law. This language is currently being considered and adopted across the country on the state, county and city levels. Using these international standards makes sense. These standards are the result of years of discussion, debate and consideration among the 192 nations that are members of the UN. They represent the closest thing we have to a global consensus on what it means to protect and encourage community health care. See the answer to question No.11 for a detailed explanation of these standards.
6. How would voter approval of Proposition 1 change Tacoma operations?
Currently, the City contributes to the running and funding of the Pierce County Health Department. Adopting the explicit standards regarding accessibility, availability, quality and appropriateness would mean that all health care programs the City contributes to and/or administers could be subject to evaluation based upon these standards (see answer to question for what these terms mean in practice). These would not significantly change current city policies, but would, perhaps, make them more comprehensive – and thus, better.
7. Are there jurisdictional issues that prevent the City from taking action on health care?
No. The adoption of a policy regarding what the priority of the health care system should be does not interfere with the operations of the Pierce County Health Department.
As noted above in response to question no. 5, to the extent the City adopts the international standards and it contributes to and/or administers health care programs, the City can choose to use the accessibility, availability, quality and appropriateness standards to design, implement and evaluate health programs. It could also ask the County to consider designing and evaluating its programs using these standards (in addition to those already on the books).
The City can delegate the activities described in the resolution to the Pierce County Department of Health. For example, the City can ask the Department to convene an expert panel or to prepare reports and the like. To the extent to which some of these activities are already being done by the County, the City can make a special effort to publicize the findings on its web site, through city publications, and through other means.
8. How would universal health coverage affect people who already have insurance?
The international standards ask governing bodies to make everyone healthier in the most efficient and effective way. To the extent to which the uninsured receive more appropriate, high-quality care, the less expensive it will be for everyone. Right now, many people avoid seeking treatment for chronic conditions or avoid preventive care because of the expense. This lack of care often leads to emergency (and expensive) treatment at hospitals and clinics. There is little follow-up care in these situations. So more money is ultimately spent and it is paid for by either higher premiums or higher taxes. Those who already have insurance coverage would benefit in the form of lower premiums, lower co-pays, lower deductibles and a more rational, straight-forward system (Currently, approximately 30% of every insurance premium dollar is not spent on health care. It is spent on administrative expenses, marketing, and salaries). Also, if the system were less bureaucratic, physicians could spend more time with patients, spend less on administrative expenses and could then pass that savings on to patients.
9. Are these policies in place elsewhere? Are they working?
Yes. Out of the 37 industrialized nations in the world, the US is the only one without universal health coverage. In all other countries the cost of care is less than half of what it is in the US . The US spends about $7,000/yr. per capita on health-related expenses. Other industrialized nations spend about $2,500/yr. per capita. The US ranks 31 in the world in terms of health indicators – behind every other industrialized country. These indicators include: rates of infant mortality, obesity, cancer, diabetes and asthma, and general life expectancy.
10. Do international standards require that the financing mechanism be public or private?
No. International law takes no position on what type of financing mechanism is used. It only requires that the system meet accessibility, availability, quality and appropriateness guidelines in order to make everyone as healthy as possible. (Please note that under international law, health care is considered a right, not a privilege -- like the right to free speech). The other industrialized countries which have all satisfied the right to health care have used a range of financing mechanisms. For example: Canada – public, single payor; England – public single payor plus private insurance option; Germany – private insurance, regulated by the gov’t. – like utilities in the US ; Japan – mixed public and private insurance.
11. What are international human rights health care standards?
There are four basic standards that must be met to respect, protect, and fulfill the right to health and health care. These define what needs to be done; there are also guidelines that define how to carry them out.
What needs to be done
Availability
Functioning facilities, goods and services, and programs have to be available in sufficient quantity frequently a problem for rural areas, but in urban areas, this is an issue of which health problems are most severe and whether there are sufficient personnel and services to address those problems.
Accessibility
This is frequently the big question in the US ; can an individual get to the doctors who are out there? Can they afford it? Can they physically reach it?
Quality
The state must ensure that health facilities, goods, and services are scientifically and medically sound. Quality requires skilled medical personnel who prescribe medicines and medical procedures appropriately.
Also connected to availability and accessibility: if an individual can’t afford to go to a specialist, or if the insurance company won’t allow an individual to get a particular procedure, the quality of care is compromised.
Quality also ties in the doctor-patient relationship: how much time is there to spend with the patient?
Appropriatenes
Health care meets ethical standards and is culturally appropriate. Language and cultural considerations are met. Simplicity of the programs – health care should be simple and straightforward to use. How standards are implemented.
Many of the procedural elements are already done under the current system; international standards make it explicit that these elements are important because of the benefits they provide to overall health.
How to do it
Information – materials available in multiple languages; people should know how to access services.
Non-discrimination – programs not implemented in a discriminatory way.
Remedy – if availability, appropriateness, quality and accessibility are not met, the individuals should be able to seek redress.
Participation – targeted beneficiaries should participate in the design and implementation of health care reform programs.