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March 31, 2004

Host: Michael Grant
Topics:
· Cesar Chavez Unity Celebration
· Health Care Coverage
In-Studio Guests:
· Roger Hughes, Executive Director, St. Luke's Healthcare Initiatives;
· Dr. Len Kirschner, former director, Arizona Healthcare Cost Containment System;
· Juan Alvarez, former director, Chicanos Por La Causa.

>> Michael Grant:
Tonight on "Horizon," a celebration of his life and legacy. It is Cesar Chavez' birthday, and we look at ways this historic civil rights leader is being remembered.

>>> Michael Grant:
Plus, leading healthcare reform experts look at where Arizonans might focus on healthcare coverage access, costs, quality and choice.

>>> Michael Grant:
Good evening, I'm Michael Grant.

>>> Michael Grant:
First up, in the news, a new report sponsored by St. Luke's health initiatives is titled "Arizona Can: Coverage and Access Now." To create it, some of the country's leading experts on healthcare reform looked at where Arizonans might focus on healthcare coverage in the months and years ahead. Four models were developed to define different approaches to increasing healthcare coverage. The themes are: Universal, single-payer, the development of mandated universal coverage that is primarily funded by one source, for example, the federal government. Employer-based healthcare, expanding and refining America's predominant method of providing healthcare. Expand public programs, such as Medicaid, Medicare and possibly creating new public programs such as high risk pools. And market based, funded by tax credits, vouchers, and medical savings accounts. Joining me now to talk more about the models and the report, Roger Hughes, Executive Director of St. Luke's Healthcare Initiatives. And Dr. Len Kirschner, former director of the Arizona Healthcare Cost Containment System. Gentlemen, good to see you.

>> Len Kirschner:
Good to see you.

>> Len Kirschner:
You need to know that you were my lawyer for a while.

>> Michael Grant:
That was a long time ago, and we can't possibly go there again.

>>> Len Kirschner:
Not another report on healthcare coverage?

>> Len Kirschner:
This report is outstanding, and it lays out many of the issues we've been talking about. And I have to give credit to Roger, the staff and the board of the St. Luke's Health Initiative for taking this on, because it hasn't gone away. You'll be talking about Cesar Chavez. That was one of the issues he was dealing with 40 years ago.

>> Michael Grant:
You were telling me that you had a Whitehouse memo from Califano to LBG and they were talking about a prescription drug benefit in 1967?

>> Len Kirschner:
Administratively confidential, eyes only, from the Whitehouse from the special assistant to the president, Joe Califano, and it says, review the report and make recommendations, relating to the inclusion of prescription drugs in Medicare, 1967. Well, we actually got a piece of legislation passed in December of this past year.

>> Michael Grant:
But Roger, the objective here being or the thrust of the study, we have about a million people uninsured. How best to cover them? I mean, was that what the primary thrust was?

>> Roger Hughes:
It wasn't how best to cover them, but it was looking at alternative models and trying to compare that and the first brush, just looking at what it would cost under each individual model. What it would cost in terms of public dollars to provide that kind of coverage. The models were based upon models that you see floated out on the national debate on healthcare, and you listed them. Universal single payer, employer mandate like they are trying to do in California, all of the free market people with tax credits, medical savings accounts, and the like. And then expanding public programs. If you look at just the cost effectiveness approach, the greatest number of people for the least amount of public dollars, the expansion of public programs comes out the best, the one that actually comes out the worst under these models is the tax credit, because you have to make the tax credit really robust in terms of dollars before that -- you know, before you can entice people to pick it up.

>> Michael Grant:
The premise being here that, okay, if we were going to do it -- if we were going to try to broaden coverage to the uninsured, what will cost us least in terms of these four models?

>> Len Kirschner:
I don't think what costs us least. I think what we have to deal with is the fact that the current system is costing everybody who is in it to pay for this population. They become ill, injured and pregnant, and they come into the system. And these are people who are working, dependents of people who are working. The current system is broken, Michael. I call it chaotic, costly, inefficient, inequitable and superb. It's a paradox. Everybody is paying in, but it's a hidden cost. And it is time, past time, and that's what I really complement Roger and the group there for putting it on the table again. It's time that we did something about fixing this broken system.

>> Michael Grant:
Roger, do we pay for it primarily in two ways, number one, we pay for it in tax dollars, obviously, and then number two, if we have the misfortune of going to the hospital, we have to buy $28 cans of Coke? Are those the two --

>> Roger Hughes:
That's exactly right. We pay for the problem of the uninsured through cost shifting, which has been well, well documented. That's the $20 aspirin, you know, for example.

>> Michael Grant:
Right.

>> Roger Hughes:
But what we've found in the other part of this study, was when you actually talk to Arizonans, as we did, through a number of extensive focus group research and also polling, we find that when you just talk to them about the uninsured, they tend to default to a frame of looking at the uninsured as the poor, and particularly the undeserving poor, and they tend -- Arizonans tend to see the situation as a zero sum game, otherwise, if we have to provide coverage for the uninsured, I'm going to lose something.

>> Michael Grant:
Now, test that premise. Million or so uninsured, how many of them are poor?

>> Roger Hughes:
Well, what we found in terms of the 994,000 that are uninsured, by federal poverty limits standards, roughly one-third of them now are at the 100% federal poverty level or below.

>> Michael Grant:
So where is the other 6 to 700,000 -- who are the other 6 to 700,000?

>> Roger Hughes:
Another third of them are the 100% to 200% of the federal poverty level, and a 200% federal poverty level, remember, for a family of four is about $37,000. If you have to pay a healthcare premium of, let's say, for example, somewhere between $300 and $500 a month, as we do in a small business like St. Luke's Health Initiatives, where our healthcare costs over the past three years have gone up over 120%, that kind of a payment with somebody making $37,000 a year, a family, is like a car payment. The other third are the people making above 200% of poverty, and that is a fast growing group. Many of these people have either been downsized, outsourced, you know, out of various jobs. These are people making somewhere between $40,000 and $80,000. They may be between employment, and increasingly, you are finding large employers, as well as small employers, who are choosing either not to provide coverage or going to cafeteria plans, or they are requiring their employees to pick up more of the costs.

>> Michael Grant:
So the recommendation here -- well, I don't know that it's a recommendation. The conclusion here is the best way to shrink that population would be, for example, to move AHCCCS to 250% of federal poverty level?

>> Len Kirschner:
That's clearly one of the suggestions, but to go back to your first question about who these are, understand, they are multiple different populations. One of the populations we need to look at is the 50 to 64-year-old population in the state. Many of whom who are being outsourced, losing their jobs and can't get back, and with that because of the job situation, they don't have healthcare coverage. That's a population that -- organization that I deal with at AARP is very interested in looking at. When Bill Clinton left office, he had a great line, he said "Next year, I'm going to turn 55, and I'll be unemployed through no fault of my own, and I won't have health insurance." And I think we should have a buy-in program for the 55 to 64-year-old population. It's a multifaceted group.

>> Michael Grant:
So what -- if I pick up this report, and I read it, what does it -- who is the audience and what does it compel me to do?

>> Roger Hughes:
Well, the chief audience that we designed the report for are policy makers, business leaders, media people, people like yourself, to, number one, show them that this issue has been around for the past 30 or 40 years. It's just gotten a whole lot bigger, a lot more expensive.

>> Michael Grant:
A lot more expensive.

>> Roger Hughes:
A lot more expensive.

>> Michael Grant:
You were telling me that --

>> Roger Hughes:
1971 healthcare was 7% of the GDP, total of about $73 billion. Today it's about $1.5, $1.6 trillion, 15% to 16% of the GDP. Now, the report, I think, really focuses on the second half on what Arizonans think about these things. If we had one takehome point that we wanted to stress as a result of this to people like yourselves, people in the legislature, it's that we have to stop focusing on just the problem of people without health insurance. We have to quit demonizing the parts of the health system, be they health plans, providers, pharmaceutical companies, and we need to focus on how the system parts interrelate as a whole, and we need to focus on how better information about healthcare costs, better information about prevention and wellness, better symmetry of information between providers and purchasers, and actually making more of the responsibility upon purchasing healthcare coverage fall back to the consumers so they can drive the revolution that everybody talks about in healthcare.

>> Michael Grant:
Hasn't that been a consistent theme, though, by some that, hold it, we don't -- a lot of these systems do not send consumers the right sorts of price signals in relation to the use or nonuse of the healthcare?

>> Len Kirschner:
Absolutely. The current insurance model takes away from the patient and the provider, knowledge about what the costs are of that system. Much of it is transparent to them. What I think that this report does, it puts it back on the agenda one more time, as we've had this discussion, Michael. We go back, I think, 1987, we met. There was about 180,000 in AHCCCS. If you said cover a million in AHCCCS, would you have anybody uninsured the answer would be probably not. The problem is we still have a million uninsured in the state because the employer-based system is unraveling. The strikes in California in the large supermarket chains was about healthcare coverage. We're seeing that in retiree healthcare. We have a system that needs to be fixed and it takes a hero to do that. Whether it was a John Kitzhaber who was the Governor of Oregon.

>> Michael Grant:
They have had a lot of problems, have they not?

>> Len Kirschner:
The economy went south and the Oregon health plan was a rational approach to an irrational pressure. He said we ration irrationally. Let's go out and talk to the public in ways that they can understand, and they went throughout the state. The Governor of Maine is doing the same thing. We need a hero in Arizona who is going to say, this is a major issue and we need to go out. These are four models that are possible. Not one of them is really going to be the final answer but, they give you a road map to start talking about.

>> Roger Hughes:
One of the things that the public opinion polling showed is number one, Arizonans want to do something about healthcare system reform. They don't necessarily trust government to do the right thing. They don't necessarily trust business health plans and providers to do the right things.

>> Michael Grant:
Do they trust Docs and hospitals?

>> Roger Hughes:
They trust DOCS the most, but --

>> Len Kirschner:
And nurses.

>> Roger Hughes:
And nurses.

>> Roger Hughes:
But they are open to system reform and they clearly are interested in talking about plans for system reform, and greater consumer involvement, and I think the thing that we --

>> Michael Grant:
What does greater consumer involvement, though, mean?

>> Roger Hughes:
Well, I think -- what it means to most Arizonans is greater consumer choice. Really, as against the traditional managed care model, most Arizonans are interested in choosing and keeping and selecting their own providers at a reasonable cost. But I think what they are beginning to realize is that it's very hard to do that in a system where the costs and the indicators of quality are not apparent in and are hidden from them.

>> Michael Grant:
We're never going to back way from HMOs, are we?

>> Len Kirschner:
Yes, we are. The HMO reached its peak 5, 6 years ago. PPOs and other models are coming in to replace that.

>> Michael Grant:
I was using HMO as a broad concept.

>> Len Kirschner:
But they are different, but they are different models, and individuals want that choice. They have to understand, there is a price to pay for that choice. Part of it is that in a 21st century healthcare system, we're going to change the way healthcare is practiced. That means evidenced based care. The genomics project that President Crow is pushing and saying we'll have a whole different model of healthcare in the future than we've had in the past. And much of it is going to be driven by information systems, and Roger's group has been talking about that also with folks here at the School of Business, which is really outstanding.

>> Michael Grant:
Dr. Len Kirschner, thank you very much for being here. We appreciate it. Roger Hughes, good to see you.

>> Roger Hughes:
Thanks for having me.

>> Michael Grant:
It was a salute to a man who not only fought for the rights of farm workers but for the civil rights of all. The Cesar Chavez Unity Celebration took place yesterday. The theme for the event, "Honoring the Legacy of Cesar by Staying in School." The event commemorated the birthday and legacy of Cesar Chavez and brought together students, families, leaders and community organizations. And, as Merry Lucero reports, some people with real connection to Chavez.

>> Let me welcome you to this event today to celebrate the memory of Cesar Chavez.

>> Merry Lucero:
The celebration began with a gathering at Santa Rita hall in Phoenix, the location where Cesar Chavez fasted for 24 days in 1972. He gathered there for the first time together with a group of former farm workers who were Chavez followers in the farm worker movement during the early '70s.

>> Benny Abeyta:
Cesar Chavez meant a lot to me and to my family, and one of the things that I heard him say once was that to be a true human being was to be willing to sacrifice and suffer for others. These are the individuals that did that suffering and that sacrificing. I saw those people here do it.

>> Terrie Cruz:
It was quite an honor to help these people, and it was quite an honor to know Cesar and know his dedication to humanity, and yes, I am very proud that here also, we create the Chicanos por La Causa.

>> Celia Arambula:
Get involved politically. We need to get involved, so go back to to your neighborhoods and do we what we need to do politically.

>> Francisca Montoya:
I still recall being 8 or 10 years old and my mom coming home from work at Arrowhead that Cesar was here and that the farm workers had come out on strike, and it's because of all of these people that are here, that they created a movement that we could then take forward.

>> Merry Lucero:
Also appearing, Mayor Phil Gordon of Phoenix, where for the first time, city workers get a paid holiday for Chavez's birthday.

>> Phil Gordon:
I'm proud of the man we stand to commemorate today and tomorrow on his birthday, a man who finally after some hard struggles and working day in and day out in the fields, was able to graduate from 8th grade, and while his education was limited, his focus in his mind in terms of what really counts, and what we really need to do for our young residents of this community never wavered.

>> Merry Lucero:
City of Tempe employees also have the day off. County Supervisor Mary Rose Wilcox recalled conditions under Governor Jack Williams.

>> Mary Rose Wilcox:
It made us all learn that this humble man was here because we had a Governor at that time who refused to recognize farm workers rights to organize. We had a Governor we needed to get out of office. We eventually got him out, and we elected people who would listen to us. That's what it's about, electing people to offices that will listen, that will pay attention and work for us.

>> Merry Lucero:
The group then marched to Santa Rita park for activities and entertainment.

>> Merry Lucero:
As well as motivational speakers. [Speaking Spanish]

>> Merry Lucero:
In addition to having fun, the celebration had a theme, honoring the legacy of Cesar Chavez by staying in school.

>> Abe Arvizu Jr.:
That's what made them all equal. We have things going on out there in life that things aren't fair, whether it be color, race, religion or creed, but education makes everybody equal, because you have that experience. You have that education that will get you through and maybe get you that job that makes you on the same level as other people.

>> Merry Lucero:
The celebration was sponsored by Chicanos por la Causa to give participants a fun and educational day and to pay tribute to Chavez and other heroes who fought for civil rights and worked to improve life and conditions for farm workers.

>> Michael Grant:
Here now is Juan Alvarez, a former director of Chicanos Por La Causa and former UFW organizer. Juan, how are you?

>> Juan Alvarez:
Fine, thank you. Thank you for inviting me.

>> Michael Grant:
I've heard the name Cesar Chavez for a long time. I'm not sure that I really know a lot about Cesar Chavez. What is his -- what is his legacy, in your opinion?

>> Juan Alvarez:
In my opinion, Cesar obviously was born in the State of Arizona and was raised in California. I met him in late '66, right after six months of first strike in California, and I was very impressed with his commitment of helping and being part of a group that organized farm workers who didn't or had a hard time surviving.

>> Michael Grant:
What pulled him to this movement in his background?

>> Juan Alvarez:
Well, first of all, he was a farm worker himself. He grew up just south of Yuma, and he worked in the fields, and he was, perhaps, a child of a migrant farm worker, so -- as I was, so consequently, he then began to see the injustice, the risk factors within the community. When you work out in the fields back in the '40s, '50s, and '60s, you had no guarantees. You were at risk. An example, my family -- I was born in Texas, and I grew up traveling from Texas to southern Arizona because my family was picking cotton, and all of a sudden, from the '40s to the '60s, automation came in and we were displaced. No guarantees. Meantime, we were subject to the weather. We're subject to illness. We're subject to a number of things that were not part of our society. Well, we were not part of the overall American dream, if you please. Cesar --

>> Michael Grant:
One of the things that I always wondered about, just in terms of the logistics of the movement, with the iron workers or steel workers or, you know, the car makers or whatever, you have fairly centralized industries. You had, you know, a work force, but you also had a fairly select group of employers with whom you could bargain and that kind of thing. Agriculture always seemed to be much more difficult to carry out that sort of union organizing, and for that matter, union negotiating position, because obviously, there is a lot of independent farmers and those kinds of things. Was that logistically as difficult as it would seem?

>> Juan Alvarez:
Well, you have a good point here, however, in the '40s, '50s, '60s, we could see the development of agribusiness. And they were businesses owned by folks -- not necessarily --

>> Michael Grant:
They started getting bigger and bigger.

>> Juan Alvarez:
And consequently, that in itself, and then the demand of different crops would cycle every year, so it was difficult to organize. However, you knew that the crops were coming at a certain point, and consequently, you then knew that you had to go and harvest or work to get harvest or be part of the process. Therefore, it was difficult, nevertheless, it was a bargaining chip, if you please, in the process.

>> Michael Grant:
I take it, initially, probably got thrown out of a lot of doors? I mean, I assume that agribusiness or for that matter, the small farmer didn't exactly embrace the union?

>> Juan Alvarez:
Well, that is correct. They never embraced it. I was involved with the Gallo campaign in California. I was also involved in the organizing here in Arizona, and also involved in the organization in the Coachella Valley and people on the other side of the picket line were not very happy because you were not only asking to be recognized, but also asking in the process of having your rights recognized as a human being.

>> Michael Grant:
And asking for benefits and pay levels and those kinds of things that obviously they weren't providing at that time.

>> Juan Alvarez:
Well, more basic than that. Prior to that, there were no rest room facilities out there. There was no fresh water.

>> Michael Grant:
Job conditions?

>> Juan Alvarez:
Job conditions, the pesticides were on everybody.

>> Michael Grant:
Yeah.

>> Juan Alvarez:
So it was really not a, you know, not a good situation for the farm workers.

>> Michael Grant:
Let's go back to that event at Santa Rita hall. It looked like a good turnout.

>> Juan Alvarez:
It was very good. Santa Rita hall represents a center point of the neighborhood, of the barrio. It's south of the tracks, and it was owned at one point by the Catholic church. It was on loan to the organizing committee of the farm workers, where we had our own meetings, and then from that point, after the boycott, because we were involved with the boycott, within -- we then became the first office of Chicana por la Causa. That's where it started, right there. That started in late '60s and early '70s. Cesar Chavez hat the 24-day fast and that's when this whole thing came about, and obviously a number of challengers were there, but a number of opportunities came about. There was a recall for Governor Jack Williams. There was also a huge petition drive and voter registration, and a number of Hispanic and other community leaders were voted into new offices and a new change came about, and the opportunities came about.

>> Michael Grant:
Almost out of time. Should we have a state paid holiday?

>> Juan Alvarez:
Yes, we should.

>> Michael Grant:
No hesitation?

>> Juan Alvarez:
None, none whatsoever.

>> Michael Grant:
All right. Juan Alvarez, thank you for joining us. We appreciate the input.

>> Juan Alvarez:
Thank you so much.

>> Michael Grant:
For web site links related to tonight's program, as well as transcripts of "Horizon," you can go to our web site. That address is www.kaet.asu.edu click on "Horizon" and follow the links. You can also see what's on upcoming "Horizon" programs. Speaking of which, Governor Napolitano joins me here tomorrow. You can ask her a question via e-mail and we may use it on the program. Send your question to "Horizon" at www.kaet.asu.edu.

>>> Michael Grant:
Here's a look at some of the issues we'll be covering tomorrow with the Governor.

>> Mike Sauceda:
Fire season is upon us with one fire burning near Pine. Governor Janet Napolitano continues her push for all-day kindergarten, asking business leaders to help in her quest. And we'll talk about where the legislature is with the State budget. All topics on first thirst, the Governor on "Horizon." Thursday at 7:00 on "Horizon."

>> Michael Grant:
And Friday, of course, we'll bring you the Journalists' Roundtable edition of "Horizon." Thanks for being here on a Wednesday. I'm Michael Grant. Have a great one, good night.

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