Noting that he was “really excited” to be here today, Schulze said he’d been with the organization for about 19 months, and is working to bring the medical center back to what it had been here. When word spread in his workplace that he was coming to Rotary to speak, many there wanted to come along and talk too – including Emergency Services (Nursing) Director Jacqueline Maturan and Seton Community Board Vice Chair Fred Naranjo who had donated a lot to this community to help with food insecurity (a big challenge here, he said) and Dr. Edmund Toye who is a general surgeon.
Schulze had learned about Rotary a couple months ago at a regional meeting to discuss what the next big project would look like. He learned that Rotary and District 5150 wanted to improve mental health in this country and the world; he had met Rotarians and learned of Rotary’s role in polio eradication. He has family members in Rotary in Taipei (district 3481) who met their significant others through Rotary.
He said he is not here to tell us how to fix health care but to share some facts about it. He noted that this is the only developed country where health care is not a (constitutional) right. But the U.S. is a health insurance marketplace. Here, you buy health insurance, and your health insurance company has a network of doctors, hospitals and ancillary providers they contract with. He invited us all to engage in the discussion too, since he wanted to learn more about passions with health care in San Mateo County.
He listed some numbers: the number of Americans age 65 and up is expected to increase from 58 million in 2022 to 82 million in 2050. When Medicare started in the 1960s, it was only designed to provide coverage for 5 years (i.e. age 65 to 70) and people are now living beyond the average age of 100. There are longevity conferences around the world focusing on how to live to be over 100?
The U.S. population now is older that it has ever been, so we have to have infrastructure in place to support the care that will be needed. We know that the majority of health care in this country – about 80 percent of health care -- is used by people 65 and older. We need to educate the population to use health care more when they are younger versus when they reach 65 and up. Between 1980 and 1922, the median age increased from 30 years of age to 38.9 years of age; we are seeing many states with populations getting older. Maine, for example, has a median age of almost 45; New Hampshire’s median age is 43.3.
We also are seeing obesity increase among Americans, to about 40 percent. And there is also a rising demand for elder care, especially among individuals of lower income and those with dementia; that number is doubling from about 6 million to 13 million.
Schulze said he is bringing this up because, as we start getting older as a population, we have to make sure we have the infrastructure to care for these individuals, make sure they are healthier, visit their doctors when they are younger -- you can’t wait till you are 65 to begin going to your doctor. There are many things we can do to keep our population healthy.
One item he wanted to add, is food insecurity. In 2022, about 9.1 percent of people 65 and older have food insecurity – they may not know where the next meal is coming from, or if they’re going to have dinner.
Stacy asked for clarification: What exactly do you mean by “food insecurity”? Answer: Not being able to afford healthy food, not fast food. We’re talking about a good serving of fruit, vegetables, meat, proteins.
California recently passed a law saying that, for hospitals, if you have excess and unexpired food, you have to work with a local food bank to donate it. Sometimes food in hospitals or cafeterias doesn’t get used; work is ongoing with food banks to donate it. When we’re looking to solve issues with health care, this is something we need to focus on.
Longevity: He mentioned that the number of individuals living past 100 is growing, in the 1950s, 1990s, 2000s. Currently we’re at about 101,000 centenarians, a number expected to grow by 2054 to about 422,000 individuals living past age 100.
Globally, we’re seeing about 722,000 centenarians, a number expected to grow to 4 million. You’re talking about the infrastructure to support the longer time that people are living.
Senior housing is very, very problematic, especially in San Mateo County. There is not enough senior housing available, to support individuals living longer. By 2030, we’re expected to have a shortage of 550,000 senior housing units. What’s needed is about $275 billion invested to improve that shortfall. And it’s not just seniors; we know the shortage of housing in the state, which is why property values are so high. Supply and demand. But especially the senior community; there’s not enough assisted living facilities to support the growing need. Facilities here are at 90-95 percent capacity, with wait lists. There is a shortage of independent living facilities as well. And it’s not cheap; the going rate for a shared room is about $8,000, and for your own room, about $12,000 a month. That’s insane, Schulze said; “We really need to figure out how to improve senior housing, especially in this community.”
We’re also faced with another challenge: there’s a number of seniors who can’t afford to live in these facilities, who need care they can’t afford. The closest assisted living facility that he knows of that accepts insurance is out in the Sacramento area; far away for an individual who may have family here. It may not be convenient to visit family members who live in Sacramento. These are some of the statistics to think about when figuring out how to fix health care. He invited questions.
Kevin O’Brien asked, as a professional in the business, how do you explain the fact that we’re the only first-world country that does not have any kind of national health program, and what is the resistance to that? Answer: it starts with health care literacy, teaching the population about health care. Individuals are coming out of high school or college, never having taken a class in health care or not knowing what a copay is. How do you pick your health insurance? What’s the difference between a PPO, an HMO, an EPO – There’s so many terminologies, differences in a high-deductible health plan. There’s so much we can do to educate our population and it needs to start at a young age, just like in high school when you have to take American government, or economics. There should be a basic health care literacy class as well, that covers fundamentals: What do individuals need to know about health care in order to survive?
Kevin broke in: We have lawmakers, people whose responsibility it is to take care of us, and they resist the idea that we should have some kind of national health program. Where does that resistance come from?
In response, listeners volleyed suggestions of business and economics. Finally Shulze said there are a number of things at stake, reasons we don’t have a national health care program in place. Someone suggested the reason may be money; we have a huge and rich population and a national health care system would be costly to have, like in Australia or Canada. Another listener suggested the population and the cost; we are paying the bill every day, Kevin said, but not getting the care we need. We have a high cost for people who are insured, as insurance companies have negotiated lower prices with medical professionals to provide coverage at below what the market would bear. We’re paying for it, Kevin said, so the argument that we can’t afford to do it is specious, and he doesn’t think that that’s true. He thinks there are highly invested lobbyists who are keeping our congressmen from doing the right thing for us. People who are in the health care business are the ones who are trying to get everyone insured. If you’re 65 and go to a doctor for the first time, they’re going to find something, and if you’re 25, you’re more likely to maintain your health for longer. So there is no good argument to not have a national health plan, though he was sure people in this room would disagree with him.
Seton (Coastside) was mentioned: what is your company doing regarding services in our situation here?
A woman answered that our country was founded around rugged individualism - “only the strong will survive” - as seen in the libertarian movement, and a lot of that runs health care issues. People don’t want to fund it because our country was founded on something very different from other countries: not on driving people out, but if you came as an immigrant, you survived based on how strong you were. That’s something that goes deeply in the core of this country. Barbara Nielsen spoke up: she is a nurse as well, and recalled the early 80s when suddenly hospitals became businesses. There was a change in the way we did healthcare; because it’s all about the money. Money is driving a lot of us, as well as those opposed to getting big business out of healthcare. She said she couldn’t be the kind of nurse she wanted to be anymore, because of big business; she can stay on the phones and do triage but can’t be at the bedside. “And that drives me insane,” she said, and added that, "we as patients and as people don’t get the kind of health care we deserve or fought for." She agrees with Kevin: Maybe it has to come from within, we’re not helping our patients if we’re just in it for the money.
Tim noted that there are hospitals, individuals and insurance programs they are working with, including a charity care program, Medical and Medicare. He recalled someone asking where could they go for their care if they didn’t qualify for insurance; he noted that they have the new Dignity Health Care facility. Urgent Care will take all insurance, and Seton Medical Center has a charity care program as well. Those who don’t qualify for insurance, he would ask to come to this facility to get the care here or at Seton Medical Center Coastside.
When asked what are they doing about health care here, with Seton Medical Center Coastside, the answer is that they’re targeting opening the new facility in spring 2025. There were significant damages from the two atmospheric rivers in the past two years, and there’s been a lot of repair work in that facility, in the skilled nursing facility side and the emergency department side. They’re excited to be able to open very soon. There’s new equipment being brought in too: including radiology and laboratory equipment, a standby emergency department, and other services that are needed. He sits on the Age-Friendly Half Moon Bay advisory committee, and also listed Kaiser, Sutter, Stanford, talking about how to improve health care in this community. He acknowledged the need for more doctors in the county, among the needs that “we all have to work together on.”
You can walk into any emergency department regardless of age, race, background or ability to pay, he said; emergency departments will provide screening and treatment.
RotaCare Half Moon Bay was spoken of as a place to receive medical care with no questions asked, and Tim said that they had worked closely with RotaCare and Clinic by the Bay as well, which had sent patients to their facility for enhanced imaging.
Stacy spoke of the educational aspect; many things were listed she had not known; how can the public know what services are available and how to access them? Tim said there aren’t a lot of programs out there that teach health care; he himself teaches a health care policy course at Dominican University in San Rafael; students understand some aspects of health care but more programs and public forums like this Rotary meeting are needed. Tim said that programs have been put together to teach high school, college students about health care. He added that people have to understand challenges and basic fundamentals of health care and what is needed to fix it. Stacy added that there are younger adults, and their parents, who may think they don’t need such services now – but guess what? In time, they likely will. Or their parents will.
Moving on to the next slide, Tim continued: One thing we all have to do a better job on is educating our population on the basics. He cited the Affordable Care Act, through which annual physicals are “at zero dollars.” These are important: you work with a primary care physician, who can order appropriate tests, like blood tests or metabolic panels, immunizations or cancer screenings, comprehensive exams that cover heart or lungs – “the basics, right?” It’s these preventative visits that help us know if we have something serious developing, that we might not be aware of.
Dr. Toye spoke about prevention. Of course there are socioeconomic factors, but anyone can walk into hospital emergency care, and no questions asked. But, he said, we don’t want you to walk into the emergency room – we want you to have preventive care, because, according to the Kaiser model, good prevention is better than emergency care.
He teaches at the University of California, San Francisco, and does emergency room and trauma care, through which he sees a lot of situations, including with the homeless. He spoke of focusing on well-being before conditions become problems – i.e., cutting down on “too many desserts” before you have to deal with obesity. Doing that is more important before you have to have urgent care.
Warren asked Tim for a clarification – he’d mentioned no cost for clients on the Affordable Care Act – is your 20 percent of adults a subset of who is on claim or subscribing to ACA, or all the adults in the U.S.? He said yes to the latter; only 29 percent are getting physical exams. There are multiple surveys out there as well; and people don’t know that physical exams are free – one physical exam on an annual basis. You need to go to established care; your doctor needs to know your medical history and we need to know if there are things developing, to keep healthier.
Warren spoke of zero cost through ACA versus costs for those of us who pay for health care. He’d like to see an age range; is it younger adults, age 18-30, who are healthy? It’s not free for us, but for those on ACA, he guessed so. Kevin chimed in: things like X-rays aren’t free.
The speaker said it depends on the health plan. You can walk into a public facility and get care, though you have to wait in long lines; they get to people as fast as they can. He pointed out that Medicare is not meant for everything, and MediCal is for the underserved.
You can have a free physical but you have to pay for tests ordered, Kevin said.
Schulze said he was brought up “on the good old days” of medical practice: 20 percent for lab tests and 10 percent for X-rays. Now, everybody asks for CT scans, without which they feel undertreated. “That’s what society wants. But in the good old days of medicine, we actually listened to the patient. We did a physical exam and used the lab to confirm my suspicion. But that’s what the public wants – if I don’t get an MRI you’re not treating me right.”
Another speaker said that an issue with universal healthcare is, now “we want instant. We want medication; we want everything, right now,” which drives costs. They claimed that “in other countries, if you are elderly and need a triple bypass, they tell you ‘you’ve lived a long time, why do you need this?’ and deny care. Americans, we’re not used to being denied care.” That was their perspective, but not necessarily what others have heard about what is happening in other countries.
Kevin said that his doctor tells him that his recommendations for care can’t be influenced by what insurance the patient has, and he likes straight recommendations from his doctor, though he realizes that that isn’t the real world or what other doctors do.
The speaker showed a slide image of Seton Medical Center Daly City, with the emergency department and triage area. Everyone who goes through the emergency department gets triaged by a nurse first. He didn’t have photos of Seton Coastside, but anyone interested in seeing the ongoing work can reach out to him. He said he could give tour. Pres. Irwin asked if we as a group could have a tour. the response was that it would be set up in the next few months.
Tim confirmed his focus on the needs of seniors and patients’ concerns; here, instead of over the hill. Seton Community Board Vice Chair Fred Naranjo noted appreciation for how the Tim is listening to the community. Mention was made of the local doctors who are also doing a good job in listening to the community. Seton Community Board Vice Chair Fred Naranjo noted that in his lifetime, growing up here, “Half Moon Bay has always been neglected,” and this medical center “is going to be a jewel.” Many thanks were the response to that.
Asked what departments will be here in future, Dr. Toye listed gunshot or car accident injuries, but for a small community like this there cannot be a way to take care of a major injury. For that you need a major emergency room like a medi-vac, like in Vietnam (pack and run), but those here should be able to get basic nursing care. There were statements emphasizing the importance of preventive care in a small community, more important than a fancy emergency room. This is where Rotary Clubs come in.
There was some debate about the “low volume” in this emergency room, and Liz strongly pointed out that the low volume is because we haven’t had anyone in the ER to take care of us. She had had experience with the ER from being there with injuries, and suggested asking people who had been treated there in the past and then transported to larger facilities like Seton. (“Stabilize and transport.”) The response was that the ER room would be set up like she was saying: For anyone who walks into the emergency department, there is someone in a medical board-certified position who would stabilize them and transport them to a high level of care – according to the mandatory rule of California law for an urgent-care center. And you can get simple procedures here like blood draws;
The address is 600 Marine Blvd., Moss Beach.
Right now there there is also an urgent care station not operated by Seaton at 499 Main St.
CLUB MEETING - OCTOBER 31, 2024
Hints of Halloween delightfully haunted the room when the Rotary Club of Half Moon Bay gathered on Oct. 31.
Pledge of Allegiance - Pres. Irwin Cohen led the Pledge of Allegiance.
Inspirational Thought - Steve Wilson read as the day’s invocation: Some of us are old enough to remember Harold Stasson, governor of Minnesota but he never got nominated and became kind of a joke in American political lore even if he was a smart man. But he said: “Have the courage and the wisdom and the vision to raise a definite standard that will appeal to the best that is in man, and then strive mightily toward that goal".
Guests - Guests included Rosi Fontana’s partner Hal Novotny and Stacy Trevenon’s husband Doug Mallon.
Global Grant Training -
Kevin O’Brien discussed Rotary Global Grants: The minimum project for a Global Grant is $30,000, which few clubs have. Typically, several clubs go in together, and work on projects with clubs from another country. Rotary International has grant money and District 5150 has grant money, making it possible to put together large projects. The Rotary Club of San Bruno is fortunate to have 15-20 members who work on such projects; they put together a project requiring about $140,000. So it’s possible to do big things; Kevin encouraged us that, is there’s something we really want to do, that we really feel compelled to help out on, we have an example: we’ve done some really good water projects that require money and cooperation from other clubs and Rotary International . We could discuss that with Mitone (who was not there today): One thing she has talked about in her upcoming term as District Governor is to think really big. It takes time to put together one of these projects, but they have a big impact.
Liz acknowledged the breakfast servers who helped that morning: Paul, Warren, Joe, Heather, Susan, Dennis. Once a month the Lutheran Church provides breakfast to the needy, from 6 to 10 in the morning, and our club members pitch in with this. There’s a picture on Facebook.
Mary Rogren had seen Caroline, a 2016-17 exchange student from Belgium, who just graduated from medical school. Mary is going to Auckland, New Zealand in mid-November, where she has been in contact with a Rotary club, and would like to bring something to them. She asked for suggestions. (Someone said, A car? A pumpkin?)
John Evans said that on Pumpkin Festival weekend they had driven their 60-year-old Porsche to Santa Barbara for a antique car rally and had a great time. He commented that over that weekend, there was a blue Porsche parked in their driveway; they wondered who it belonged to. It was suggested that they should make a donation to the club. KEVIN?????