The first week of the legislative session provided the opportunity to support a proposal for universal health care in Nevada, and the Nevada Nurses Association was one of several statewide organizations that urged the Assembly Committee on Health and Human Services to take positive action.

In a compelling power point presentation, Joseph Jarvis, MD, showed members of the Assembly Committee why health care in America today is failing and how universal health care could work in Nevada. He contrasted U.S. per capita spending for health compared to other countries; he showed numbers of uninsured in America; the numbers of adult deaths in America annually due to uninsurance; the business costs of trying to provide coverage for employees; high cost of health care bureaucracy; fragmented care; limited choice of provider; and more.

Dr. Jarvis outlined the advantages of a single payer universal health care plan.

It is important to clarify that single payer is NOT socialized medicine. There is no public ownership of facilities and providers are not public employees.

What is single payer?

It is universal health care that will provide medically necessary health care with public financing.

It covers everybody.

It is comprehensive.

The consumer has unlimited choice of provider who charges fee for service. There is cost control but not ilinical management.

It is portable and has built in accountability.

It would be paid for by a statewide, non-profit health insurance plan.

All revenues for health care would be combined into one private, non-profit trust fund, to be known as the Nevada Health Cooperative, while ensuring that health care delivery systems remain in the private sector.

It calls for no increase in revenues.

It effectively addresses access and cost control.

Single payer reduces the bureaucracy that costs Americans more than $300 billion dollars a year, fragments health care, leads many Americans into bankruptcy because of medical costs, and makes it increasingly difficult for small businesses to insure employees.

Dr. Jarvis presented six principles as guides for reform of health policy in Nevada. He asked the Legislature:

a) to endorse those principles and

b) to approve a one year neutral study of methods for reorganizing health care policy and systems in Nevada in relation to those principles.

His second request to the legislature is that they ask the Nevada Congressional delegation to support the States' Rights to Innovate in Health Care Act. This act needs to be re-introduced in this Congress. It allows states to receive direct grants to develop plans for comprehensive health care. The states would then receive direct grants to develop their own plans and, if a plan is approved, they would receive all federal funds that would otherwise flow into the state) including Medicare and Medicaid payments), and receive waivers of federal statutory and administrative barriers.

This is a very simplified summary of a very important '·! presentation; I believe a complete set of documents is ' available at the Legislative Counsel Bureau.

Dr. Jarvis is a volunteer member of the faculty of the Department of Family and Community Medicine at the University of Nevada School of Medicine and receives no salary or other payment from that institution at present. Dr. Jarvis served as Nevada State Health Officer from 1987 to 1989.

Organizations that gave supportive testimony before the Assembly Committee on Health and Human Services on February 9, 2005 were:

Nevada Health Care Reform Project; Nevada Nurses Association; Great Basin Primary Care Association; Progressive Leadership Alliance of Nevada; Religious Alliance of Nevada; National Alliance for the Mentally Ill of Southern Nevada; Nevada Women's Lobby. Nevada State Medical Association was scheduled but speaker was ill.

(Nevada Nurses Association testimony follows):

Testimony before the Assembly Committee on Health and Human Services delivered via video conference, February 9, 2005:

My name is Patricia van Betten. I am a registered nurse and a member of the Board of Directors of the Nevada Nurses Association.

I am here to speak on behalf of the Nevada Nurses Association in support of the proposal for Universal Health Care for Nevadans.

America's nurses have a long history of support for a quality health care system that is accessable and affordable. We call for an essential core of health care services available to everyone. We envision a restructured health care system that will focus on prevention and wellness, delivering care in familiar, convenient, community based settings. We ask for the utilization of the most cost-effective providers in the most appropriate settings.

Nursing's priorities for health care reform are reinforced by the Institute of Medicine of the National Academy of Sciences, in their 2004 report, Insuring America's Health: Principles and Recommendations. I included a summary statement of their principles and recommendations as well as a website for their full report among my references. The ultimate goal of health care reform is to improve health. Expanding and providing coverage is the means.

In an ideal world, we would approach and solve this dilemma nationally. But national health care failed in 1948 and in 1994. While we pursue the National Institute of Medicine goal of universal coverage by 2010, we cannot neglect current responsibilities in Nevada because the needs are too great.

Political barriers will prevent the federal government from enacting any meaningful health care reform in the near future. The only possible hope is that Nevada will again initiate change and serve, in Justice Louis Brandeis' famous phrase, as "a laboratory of democracy."

You showed this to be true when you led the nation and passed the Patient Protection Act in the 1990s, after national health care failed. Nevada also passed legislation to help people with prescription drug costs. Several states are now exploring a variety of ways to provide health care, to demonstrate what can be done, and they are all willing to share with one another, to help find workable solutions. This is necessary, until such time that we can get the principal of universality embodied in federal public policy.

The state Children's Health Insurance Program is an example of a federal-state partnership. In fact, this is the approach that was encouraged by Ken Frisof in May, 2003. Dr. Frisof, a physician, is the national director of UHCAN (Universal Health Care Action Network). In his paper titled: "The Federal-State Partnership Health Care Reform Model," he writes how policy makers are being forced to look at health care reform because managed care did not contain costs and it did not increase access. Disagreement about how to achieve universal coverage opens the door to new opportunity. He states that "the federal-state partnership model provides an opportunity to unify advocates of reform who agree on the goals of universal coverage but disagree on which plan should be adopted to reach that goal.... It permits states to choose how to organize their own medical care arrangements while encouraging them to financially provide universal coverage that includes comprehensive benefits while ensuring fiscal viability, portability and administrative accountability. Federal standards would be established and federal legislation would be passed to offer financial support to those states that meet those standards. Outcomes could then be evaluated of the various state plans, to set the stage for a national system."

I encourage you to agree to study this proposal by Dr. Jarvis and to explore the request of federal waivers, especially on Medicaid. A serious immediate concern is the need to protect Medicaid from caps and cuts which will erode care. Another concern is processing. I understand that federal agencies were quick to review and grant waiver requests in the past, but that there has been a major slowdown in the past few years.

Two strengths will help this plan succeed. One is the high level of skill that several of you have in dealing with legislative health issues; the second is the large and broad based advocacy group, the Health Care Reform Project, ready to help you garner public support for this very important issue. This plan for Nevada could become a demonstration project and a model for the rest of the country.

This health plan is a necessity for Nevadans. In the words of those who work continually for reform, healthcare for all is a medical imperative, an economic imperative, and a moral imperative. Please act on this plan.

REFERENCES:

Health Care Access Campaign http://www.uhcan.org/ HCAR/

Seeking Justice in Health Care: Getting from Here to There April 2004

Universal Health Care Action Network (UHCAN) www.uhcan.org

Frisof, Ken MD & Regan, Carol, MPH. State Leader Perspectives on Efforts to Reform Health Care and Promote Universal Coverage Oct. 2004. UHCAN. www. uhcan.org.