Horizon, Host: Ted Simons

July 10, 2008


Host: Ted Simons

state of Healthcare


  • HORIZON examines the state of healthcare. We interview Donna Smith, who was featured in Michael Moore's Sicko, a documentary about healthcare.
Guests:
  • Ken Strobeck - Executive Director, League of Arizona Cities and Towns
Category: Medical/Health

View Transcript
>>>Ted Simons:
Tonight on Horizon, Arizona cities and counties not too happy about a provision in the state's 2009 budget. A look at how the current state of healthcare may be inadequate for many who believe they're covered and we update a story we first showed you last year about one woman's quest to become be American citizen, next on Horizon.

>>Announcer:
Horizon is made possible by contributions from the friends of eight, members of your Arizona PBS station. Thank you.

>>>Ted Simons:
Good evening, thanks for joining us tonight on Horizon. I'm Ted Simons. Late last month the governor signed a 2009 budget, nearly $10 billion meant to eliminate the deficit and continue to provide funding for state services, as the dust settled though one provision left out of Arizona counties and cities, the provision with require them to send nearly $30 million to the state collectively. At a press conference last week the governor addressed a reporter's idea and the cities felt she was balancing the budget on their backs.

>>Reporter:
The cities and towns have complained that the budget was essentially balanced on their backs and even though tax -- we didn't do tax cuts on the state level and tried to minimize cutbacks in services that on the local level those things are likely to happen in the budget. What's your reaction to those complaints?

>>Janet Napolitano:
Well, I think -- let me give you -- I'm going to step back a moment, because you guys have focused 20 minutes on one little part, which is the photo radar. And now you're talking about one complaint by the cities. Let's step back. What was the legislature dealing with? Legislature was dealing with $1.2 billion deficit in the current fiscal year and close to $2 billion deficit in the '09 fiscal year, that just began. That required cuts. It required sweeps, it required bonding for construction which I've always supported and would even in a non-down turn year. They achieved those goals, for example, they didn't touch urban revenue sharing at all. Not a penny. But yeah, there are some other things that ultimately the cities get ort counties get, whatever, but they were spread out. You know, and that had to happen and everybody knew that was going to happen, and compared to what some other states are doing in the circumstance, the cities of Arizona not only have urban revenue sharing totally protected but cuts are very minimal indeed.

>>Ted Simons:
Joining me now to talk about that provision in the budget, executive director of the league of Arizona cities and towns, Ken Strobeck. Ken, good to have you on horizon. Thanks for joining us.

>>Ken Strobeck:
Thank you.

>>Ted Simons:
Let's get to some numbers and try to figure out what we're talking about, close to 30 million overall, for Phoenix, for Mesa, what are we talking about here?

>>Ken Strobeck:
For Phoenix we're talking somewhere in the $5 million range, Mesa about a million seven, of course this is money that comes out of the city budgets, which are already set by statute. We had to have a budget in place by the beginning of the fiscal year. There's no line item says contribution to state general fund in any city budget.

>>Ted Simons:
Did you see and did the cities and towns and counties and such, did they see this coming?

>>Ken Strobeck:
Well, first of all, we totally understand the predicament that the state budget is in, because it's the same economy we're living in at the cities and towns level, and in fact we have seen dramatic reductions in sales tax proceeds, cities have responded by cutting back programs, you've seen stories of cities cutting back hours of service and laying off people and so forth, so we knew that that were in a very tight budget situation, and we also knew that urban revenue sharing is something we had commitments from all the leadership to protect, and they did that. And we appreciate that, holding it at 15\% of the income tax collection. What we didn't see coming was this sort of out of the blue contribution as defined in statute to the state general fund of almost $30 million. Now in the house budget there was a line item that said 18 million which was the extra money that was appropriated two years ago, would probably have to be taken off the table this year. That was in the speaker's budget. But there was no hints whatsoever that there was going to be this other so-called taking of money from the cities and towns and counties.

>>Ted Simons:
And let's go ahead and try to better define what we're talking about here. This isn't necessarily a cut in revenue sharing, because there's a procedure to go through to get to that point. This is basically what the state's saying we're going to give you x, you're welcome, now give us x plus y.

>>Ken Strobeck:
Yes, there's a very high hurdle to get a change in the urban revenue sharing formula and that would require two thirds vote of the legislature as passed by voters in 1992's proposition 108. So they didn't do that. They didn't take any money from revenue sharing but put this provision in that says that cities, counties, and towns have to deposit this money, almost $30 million, into the state general fund. It doesn't say why or what it is, doesn't say whether it's an assessment, whether it's a tax, what is it? It just says you shall deposit the money in the state general fund. So we have a lot of questions about what is this and was it done legally.

>>Ted Simons:
I was going to ask, what is it, a, and b, is any of it legal?

>>Ken Strobeck:
We don't know. We're in the process now of trying to have experts analyze the provision and say given the definitions in the constitution and requirements for two thirds vote to raise taxes, is this a tax? How can it be defined any other way, and also is it legal to raise revenue in a bill that is specifically an appropriations bill, which has another constitutional provision.

>>Ted Simons:
The original house budget which didn't get much play, but in that budget from the house, revenue sharing cuts were I believe $18 million, and I know that there were some who were saying, well, we didn't go that route, so the cities and towns it could have been worse in some way, shape, or form. Would you have rather just had them come out and say we're cutting revenue sharing this much and we're going to get the votes passed and that's going to be the deal as opposed to this kind of formula?

>>Ken Strobeck:
Our basic principle is never violate the 15\% of income tax collections, that was in the ballot proposition passed over 30 years ago and that's what we depend on and we build our budgets from year to year on that. But to have that one amount of extra money, we knew that that was going to be in play, the speaker had told us that that was something he was considering, but he said if we do have to take it off the table this year, it won't be a permanent cut. It will just be a deferral, we'll put it back on when times are better, and so that probably that -- we knew that was in play all session, but we certainly had no idea about this other giveback.

>>Ted Simons:
Governor, we just saw the sound bite from her weekly press briefing, basically saying that considering other states it could be a whole lot worse.

>>Ken Strobeck:
Well, I think yes and no. In other states they don't have the balanced revenue picture we have in this state which I think has been very successful, and you can see cities and towns produce over 90\% of the income tax proceeds. The economic engine of the state. You know, where do businesses choose to locate? They locate in attractive communities with good infrastructure and nice public services and those kinds of things, so it's been a mutually beneficial investment by the people of the state investing in the success of cities and towns.

>>Ted Simons:
Was there not a provision, maybe I'm thinking house bill here, correct me if I'm wrong, was there not a provision that said counties can go ahead and raise taxes to get this money to get over this threshold?

>>Ken Strobeck:
Yes, there is in the section 47 part of the house bill 20 dish forgot the number. Section 47 does say that counties could raise taxes, sales taxes and other taxes in order to pay this. Cities already have that authority, so we didn't need to have that explicitly added to us in order to do that. But still the idea of a roll down or a pass along to say we're raising taxes at the local level but only because we have to remit it back to the state, I don't think people would see that very favorably.

>>Ted Simons:
What's going to happen? What will cities and counties do?

>>Ken Strobeck:
Very good question, that's not the only thing that hits us. Hurf has been cut by almost a million dollars, a provision in the bill says we have to start paying an extra $7 million for crime lab services, airport grant funds have been cut, so there are a lot of things that are happening in budget while urban revenue sharing itself wasn't touched, there are a lot of things that impact cities and towns and local communities.

>>Ted Simons:
Municipalities are also dealing with a rough economy right now, especially involving housing, without going too deeply into it, how much of a hit is that?

>>Ken Strobeck:
Like I said, the sales tax is way down and the biggest component that's down is construction sales tax. And we've seen some of the fastest growing communities like Queen Creek and some other suburbs that were just in hyper growth mode, have really collapsed in terms of their revenue, particularly from construction sales tax. And they've responded by eliminating positions and laying off folks and cutting hours and really tightening their belts. But sales tax all over the state is really down; I'd say probably 10 to 12\% across the board.

>>Ted Simons:
So more tightening of the belts to come.

>>Ken Strobeck:
Yes.

>>Ted Simons:
All right. Ken, thank you so much for joining us, we appreciate it.

>>Ken Strobeck:
You bet.

>>>Ted Simons:
Many Arizona residents are fortunate to have healthcare in some way, shape, or form. Unfortunately illness and disease can strain anyone to the limit, regardless of coverage. In a moment Larry Lemmons will talk to Donna Smith, she featured in Michael Moore's recent documentary "Sicko" which focused on our ailing healthcare system. But first Paul Atkinson with a story closer to home.

>>Paul Atkinson:
The McKinney family of chandler deals with medical issues on a daily basis. Bessie, the family matriarch, has dementia and needs around-the-clock supervision. Her daughter-in-law provides most but they hire Delores Dell a few days a week to help out. It took six months to find her and they pay out of pocket $20 an hour for her help.

>>Stan McKinney:
My mother's a retired professor from University and has her teacher's benefit package, but really, to get the type of care that's necessary, there does have to be some supplemental funding to really cover her needs.

>>Paul Atkinson:
Stan knows his mother is fortunate to be in a position where supplemental care can be provided and paid for. Many seniors may not be so lucky.

>>Jan Dougherty:
We don't have a workforce of even what I call our front line workers, our CNAs, certified nursing assistants, home health aides, those kinds of folks are informal care givers that go into the home to perhaps become a companion for a confused individual or provide a bath to someone who can no longer safely get in and out of the tub by themself.

>>Paul Atkinson:
Jan is director of family and community services for the Banner's Alzheimer's Institute. While the amount of money spent on home healthcare is expected to skyrocket, right now it makes up the smallest percentage of money spent on health-related expenses. The nonprofit Kaiser Family Foundation shows spending for nursing home care represents 6\% of the health costs while prescription drugs account for 10\%. Miscellaneous personal healthcare costs and other health spending such as on equipment, make up 13 and 16\% of overall costs respectively. Twenty-one percent of the amount of money Americans spend on healthcare goes to physicians and clinical services. While hospital care accounts for the largest sum, more than 30\% of overall healthcare costs.

>>Jan Dougherty:
The bulk of healthcare dollars actually go to hospitals. When in fact the hospitals which are necessary part of our healthcare system, but really provide a very small part of healthcare. They're getting the most dollars, where are we incentivizing, hospitals.

>>Paul Atkinson:
One reason hospitals receive the bulk of the healthcare funding is their role in caring for those who don't have access to preventive medical care.

>>Michael Grossman:
So if you get sick and you don't have access to healthcare, what are you going to do? You're going to go to a drug store and buy something and get sicker, and then when you're really sick you're going to go to the hospital and get your care.

>>Paul Atkinson:
According to the Kaiser family foundation, in 2006 people without health insurance made up about 16\% of the population. An estimated 46 and a half million people. The majority of Americans about 54\% had health insurance paid in part by employers. About 14\% of Americans, those who are retired or disabled, received Medicare, while 12\% had medical coverage provided by the government. About 5\% of Americans paid for medical expenses out of pocket. But it is the uninsured, some 16\% of Americans, that cause doctors such as University of Arizona's Michael Grossman, to worry.

>>Michael Grossman:
We have 40 to 50 million people who do not have access to medical care. That's atrocious. We need to address that. We have many people who have some insurance and consequently have some access to medical care, but they're on the brink. Anything major that comes along and if their insurance company decides they don't want to certain things, could be disastrous.

>>Paul Atkinson:
In 1990, per capita spending on healthcare was $2,800. In 2006 more than 7,000. The Kaiser Family Foundation also found that the premiums employees pay for health insurance increased 87\% from 2000 to 2007, making affordability of healthcare coverage a key issue for many.

>>Endia McKinney:
Today prices are going up but your salaries aren't matching that. And I think that's a big reason that people, you know, you have to decide am I going to pay my mortgage or insurance? So we're fortunate that we've been able to do that so far.

>>Larry Lemmons:
Donna, just to let everyone re-familiarize themselves with you, could you explain who you were in Michael Moore's documentary "Sicko."

>>Donna Smith:
My husband and I were the couple who very early in the film moved in with our daughter into her small storage room or separate office, and then later on in the film I was one of the eight patients that Michael took to Cuba.

>>Larry Lemmons:
That was pretty extraordinary. Things looked really dire for you, and then he took you down to Cuba, yelling at the Guantanamo Bay, pretty funny. Could you talk a little bit about that sort of transition for you that experience doing that?

>>Donna Smith:
It was a pretty interesting time period for us, as you -- if those who saw "Sicko" know, we went through a pretty rough period, being bankrupt and having lost everything that we worked a lifetime to get, even though we had insurance, and I got a call in early December of 2006 asking me if I had a passport, his producers, and I said no. I don't. And they told me that they were thinking of take something of us to another country to contrast medical care and so their original plan was to take Larry and I to Norway and contrast a family there who the husband had heart problems, wife with cancer, and the difference in how those things happen. And then they had this idea apparently to try to take the 9/11 rescue workers to Cuba, and that's how that evolved. So my first reaction when I heard we were going to Cuba was a little bit of fear because honestly my thought, most Americans, we don't know a lot about Cuba. We fall back to the '60s when we saw John Kennedy worried about the Cuban Missile Crisis and all those things, so my husband kind of said Cuba? So we ended up going, I went, my husband did not go. His health problems are serious enough that all the travel was going to be difficult for him, so I was the one who ended up going and what an amazing experience it was going to Cuba and traveling with Michael Moore is an interesting experience.

>>Larry Lemmons:
Currently you work for Cal. nursing.

>>Donna Smith:
I do.

>>Larry Lemmons:
Tell us about that organization.

>>Donna Smith:
California nurses is an organization that's a union of 80,000 nurses, a professional union, across the country, many in California, but certainly not all. We have nurses in all 50 states and I currently am stationed in the Chicago office where the national nurses organizing committee and its regional office in the Midwest, and I do communications work, writing and helping nurses put together information about the things they're working on, and I also get to talk about healthcare reform and write about healthcare reform and that's been an amazing transformation for me, from being in a very difficult situation to having them recognize my value and hire me and bring me into the organization.

>>Larry Lemmons:
Considering all your experiences involved with this, tell me what you think are the primary problems with healthcare today in the United States.

>>Donna Smith:
I from a patient's perspective, I think that the problems generate primarily from the four profit motivation of the healthcare industry in general, whether it's the health insurance industry primarily, pharmaceutical industry, profit is the primary motivation, by law. I mean, that's how they operate. Stockholders have to make money and the only way you can make money in American business is to take in or earn more money than you pay out. There's no other way to do it. And, you know, they take in premiums from each of us every month then pay out for our care, and if there are patients among us who cost a lot of money in terms of care, they're not going to make profit. And that system has gone way out of whack for us in this country, so many Americans, 47 million at least, maybe more now; 50 million perhaps, have no insurance whatsoever. And about another equal number of people are underinsured like my husband and I were. We have the policy available to us as a group policy, but it doesn't have enough coverage, your deductibles and co pays are too high and if you're not sick, that's fine.

>>Larry Lemmons:
Think that is a misconception people have, I'm insured, no problem. But if something catastrophic happens you may discover you are underinsured like you were.

>>Donna Smith:
Absolutly. And I share something not in the film in "Sicko," we also had AFLAC disability insurance, which was wonderful, I love AFLAC, but also I had a healthcare savings account. We were well covered, we thought. But my husband has serious coronary artery disease and peripheral artery disease and he got sick in December of one year, $9,000 worth of maximum out of pocket expenses later, the calendar year tipped over into January, when you're eligible for another round of deductibles and out of pocket expenses, within two months we were $20,000 in debt, even though we were insured and our disability coverage didn't nearly cover that amount of money, nor -- wiped out the healthcare savings account quickly. Most American families you can't do it all, you can't pay the premiums and put enough in a healthcare savings account to keep yourself protected.

>>Larry Lemmons:
When have you seen in terms of remedies?

>>Donna Smith:
I'm a strong advocate of single payer universal healthcare for everyone, makes the most sense fiscally, I think all of us paying into one single pool of publicly financed privately delivered program is the best. I want to still go to the doctors, I want to choose the doctors I see, the hospitals I go to, the clinics I use, and under a single payer system that the public pool of funding is what we change, but we keep all the things we like about the American medical system, which is we go where we want to go, we choose the quality of doctor we want to see and we go with that person. I believe that's the best way. There is a plan right now, John Conyers offered h.r.676 which is in congress, we don't have to reinvent the wheel even. There are 90 congressional cosponsors right now for h.r.676 right now. More than 20\% of your congress already cosponsors that legislation, so I think my push, my, you know, while it's sexy to talk about the presidential race and who's going to be nominated and who wins and so forth, that person doesn't write the law. Congress writes the law. So my effort really is to get more congressional people educated to why I believe single payer is the best way to go and to help those people get elected so we can get a procedure progressive plan.

>>Larry Lemmons:
Very briefly, likely resistance from?

>>Donna Smith:
The health insurance industry of course, because they won't be part of the picture if h.r.676 passes and the pharmaceutical industry, because there will be some negotiation in prices.

>>Larry Lemmons:
Donna, thanks so much for talking to us.

>>Donna Smith:
Thank you very much.

>>Ted Simons:
Diane Brennan is a news anchor at KTAR and happens to produce our own journalists' roundtable on Fridays and until very recently she was a Canadian. That's all changed. We first profiled Diane two years ago when she was trying to become an American citizen. Recently she achieved that goal.

>>Larry Lemmons:
This line snakes through the parking lot of the celebrity theater in Phoenix. Nobody queuing seems to care about the wait. Actually the waiting is almost over. They've waited years to get to this point. A few more minutes won't matter much.

>>KTAR van:
Not just extremist Islamic fundamentalists.

>>Larry Lemmons:
When we first met Diane Brennan a couple years ago, she was anchoring at KTAR. At that time she was classified as a permanent resident, a Canadian at birth. She had a green card and wanted to become an American citizen.

>>Diane Brennan:
My green card's good for 12 years but I would like to become a citizen here. I love the country. I'd like to vote. And like to do a few other things. I want to apply an amazing race and you have to be a citizen to do that. So I'm there.

>>Larry Lemmons:
Her waiting is almost over and perhaps the season of the amazing race is in her future. Brennan had to jump through a lot of hoops to get where she is. She's been trying to become an American for over a decade. The most common misconception we may have about legal immigration is that it's a relatively easy and quick process.

>>Jeanne Kent:
Ok, well, let's try and do it the easy way. First thing someone has to do is immigrate to the united states as a lawful permanent resident. And generally there's two ways to do that. Either through a family based petition or employment based petition. And obviously a family based petition means someone that's already here in the United States either as a lawful permanent resident themselves or US citizen can file a petition to immigrate that person to the United States. And with the employer petition, a similar process in that an employer files a petition looking for someone that has a special work skill that's needed and maybe there aren't enough Americans that have that skill and they'll immigrate the person. Once the person gets here to the United States, generally they have to be a permanent resident and be here for five years before they can qualify to file for citizenship. There are certain exceptions for military personnel and for spouses of US citizens, they only have to wait three years, so once they are ready, they've put their time in and can file an application for citizenship or naturalization, we call it, and to do that they fill out an application. They can submit it to their service center, they go through fingerprinting and security checks, they come to the office for an interview that covers the items that are in their application. They also have to take an English and civics test and assuming everything goes well with that and they pass their interviews and they're scheduled for a ceremony, excuse me, so that's the process in a nutshell. And of course it sounds easier than it really is, depending on the person.

>>Larry Lemmons:
And as this naturalization service indicates, if one is so inclined, eventually citizenship can be obtained.

>>Crowd:
With liberty and justice for all. And I take this freely without any mental reservations or purpose of evasion, so help me god.

>>Speaker:
Congratulations, ladies and gentlemen.

>>Larry Lemmons:
Brennan says even though the process was not easy, it was worth it.

>>Diane Brennan:
A lot of little stumbling blocks and stuff, just kind of in terms of administration and paperwork, things like that, so it's not easy at all. It's a lot of waiting, a lot of paperwork, and, you know, immigration is backlogged a lot of the time too. So but we did it. I did it. We finally got it done. I'm pretty excited.

>>Larry Lemmons:
What's your advice for other prospective people who want to become American citizens?

>>Diane Brennan:
Fill out all your paperwork correctly. It's definitely worth it. It feels like it takes forever, but just be patient and you'll get there. Fill out your paperwork correctly. Correctly.

>>Ted Simons:
And congratulations to Diane. Tomorrow on horizon the east valley tribune has been doing a series on immigration. We'll learn procedure about that and we'll get up to date on any loose ends still out there from the recent legislative session. The Journalists' Roundtable Friday at 7:00 on Horizon. That is it for now, thank you so much for joining us. I'm Ted Simons, you have a great evening.

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