ON THE ROAD FOR SINGLE PAYER: ADVENTURES OF PNHP’S NATIONAL PRESIDENT Oliver Fein, M.D. President Physicians for a National Health Program Professor of Clinical Medicine and Public Health Associate Dean Office of Affiliations and Global Health Education Weill Cornell Medical College February 2010
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ON THE ROAD FOR SINGLE PAYER: ADVENTURES OF PNHP’S NATIONAL PRESIDENT Oliver Fein, M.D. President Physicians for a National Health Program Professor of.
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ON THE ROAD FOR SINGLE PAYER: ADVENTURES OF PNHP’S
NATIONAL PRESIDENT
Oliver Fein, M.D.
PresidentPhysicians for a National Health Program
Professor of Clinical Medicine and Public HealthAssociate Dean
Office of Affiliations and Global Health EducationWeill Cornell Medical College
February 2010
DISCLOSURES
Dr. Oliver Fein has no relevant financial relationships with commercial interests.
Dr. Oliver Fein would like to acknowledge
the assistance of Dr. Margaret Flowers in the
preparation of slides for this talk.
WHAT ROAD? • Toronto • Philadelphia• Phoenix, Arizona• Pittsburgh • San Francisco • New Haven • Boston• San Diego• Atlanta• Chicago• Toledo• Columbus• Miami• Minneapolis• Indianapolis • Houston, Texas• Portland, Oregon• Birmingham, Alabama • Louisville, Kentucky
WITH WHOM:?
• Joanne Landy
former Executive Director
PNHP NYMetro Chapter
• Ali Thebert
Chapter Organizer
National PNHP
WHAT ADVENTURES?Portland, Oregon
Friday, January 29th
10:00 – 10:15 AM Live radio interview on KPOJ
Sunday, January 31st
7:30 – 12:50 PM Fly from NYC to Seattle to Portland
2:00 – 3:00 PM Meet with the Ecumenical Ministries of Oregon
3:30 – 5:00 PM Radio Taping with Bill Resnick – WBOO
5:15 – 6:00 PM Dinner with PNHP Organizers: Peter Mahr, Paul Gorman, Mike Huntington and Paul Hochfeld
6:00 – 7:00 PM TV Taping with Lisa Stiller, Community Media
7:00- 10:00 PM Single Payer Soiree with music by Bob Wicklineand The Nurses Band; the “Mad As Hell Doctors”Tour review; Key note – Oliver Fein
WHAT ADVENTURES?Portland, Oregon
Monday, February 1st
8:00 – 8:45 AM Morning Report at Providence Medical Center
9:00 – 10:00 AMMeeting with Labor Leaders: AFL-CIO, AFSCME, CWA, ONA, IBEW, Jobs with Justice
10:45 – 11:45 AM Editorial Board of the Oregonian newspaper: MaryKitch and David Sarasohn
Noon – 1:30 PM OHSU: Student-Faculty Forum
2:30 – 3:30 PM Portland State University: undergrads
4:00 – 5:00 PM Senator Merkley’s Office: Marybeth Healey
5:00 – 6:30 PM Core Activist Dinner
7:00 – 9:00 PM City Club Forum on Health Reform with RobertDannenhoffer, former President of OMA; Eric Fruits, Cascade Policy Institute, Rajiv Sharma,Professor Economics, Portland State.
WHAT ADVENTURES?
Portland, Oregon
Tuesday, February 2nd
9:00 – 9:15 AM Live radio interview, Aurora, Oregon
10:30 – 9:00 PM Fly from Portland to Denver to NYC
WHAT VALUE?• Chapter building event
• PNHP connects to other activistorganizations: religious, labor, student
• Contacts with local newspaper: OpEds,letters to the editor, expert resource
• Political contacts: PNHP as resource
• Fund raising
• Personal: never stay in a hotel
WASHINGTON ADVENTURES
• At the White House
• In Congress
• Working in coalitions
• PNHP Washington staff
PNHP IN WASHINGTON • Robert Zarr, M.D., Chapter Chair
• Danielle Alexander, intern (July 2008 – June 2009)
• Nick Skala, judiciary intern (June – August 2009)
• Margaret Flowers, M.D., Congressional Fellow (July 2009 – present)
LEADERSHIP CONFERENCE FOR GUARANTEEDHEALTH CARE (LCGHC)
November 2008
• Physicians for a National Health Program
• California Nurses Association
• Healthcare-Now
• Progressive Democrats of America
WASHINGTON ACTIVITY
Working to get “a seat at the table” at every opportunity
• January 20th – Health Care for All Inaugural Ball
• January 28th – Congressional briefing Health Care Economics
• February 25th – Congressional Briefing State-based Reform
PRE - WHITE HOUSE HC SUMMIT
• Thursday, February 26th
No single-payer advocates invited
• Friday, February 27th Phonathon to the White House
• Monday, March 2ndPress release and call for demo
WHITE HOUSE SUMMITWHITE HOUSE SUMMIT
PRE - WHITE HOUSE HC SUMMIT
• Tuesday, March 3rd John Conyers invited
• Wednesday, March 4th 4 PM: Oliver Fein, PNHP President, called by White House
WHITE HOUSE HEALTH CARE SUMMIT
March 5, 2009
PARTICIPANTS (150)
• Congress
• Community/Consumers
• Stakeholders
SUMMIT GOALS
• Transparency
• Bipartisanship
Congressional responsibility
WHITE HOUSE HEALTH CARE SUMMIT
March 5, 2009
FORMAT
1:00 – 1:45 PM Plenary (C-Span)
2:00 – 3:15 PM Breakout Groups(Bi-Partisan)
3:30 – 4:45 PM Theater in the Round(Congress Responsibility)
THE HAND SHAKE
“Glad you are here.”
“Give my best to Dr. Quentin Young.”
WASHINGTON ACTIVITY
• March 5th – Sanders announces S. 703
• March 14th – Senate HELP: stakeholders Dr. Quentin Young
• March 25th – White House Doctors: Dr. David Himmelstein
• April 1st – Congressional Briefing: Private Health Insurance in the U.S.
BAUCUS-13 ARRESTS
• May 5th – Senate Finance Roundtable
8 Arrests
• May 12th – Senate Finance Roundtable
5 Arrests
SENATE FINANCE SENATE FINANCE COMMITTEECOMMITTEE
Dr. Margaret Flowers, Pediatrician from Baltimore
Dr. Judy Dasocvich, internist from St. Louis
THE NURSES COME TO THE NURSES COME TO TOWNTOWN
OUTCOMES OF CIVIL DISOBEDIENCE
• Mainstream Media begins to cover Single Payer – Ed Schultz: MS-NBC– Bill Moyers: PBS
• June 3rd – Meeting with Senator Baucus
• June 9th – Hearing at House Education and Labor Conyers, Angel, Tsou and Jenkins testify
• June 11th – Margaret Flowers at Senate HELP
SINGLE PAYER VOICES
• June 24th - Dr. Young testifies at House Ways and Means
• July 16th - Anthony Weiner announces an Amendment to HR 3200 which would substitute HR 676
• July 21st - Dr. Aaron Carroll appears on the Colbert Report
• July 29th - Dr. Woolhandler testifies on medical bankruptcy
• July 30th - Single Payer Rally at the Capitol: Dr. David Scheiner
• July 31st - Nancy Pelosi agrees to allow Weiner’s Amendment to be introduced in the House
SUMMER LOBBYINGSUMMER LOBBYING
•Doctors, Nurses and Advocates from around the country came to D.C . throughout June and July.
•PNHP opens Washington office!
AUGUST ACTIVITY
• Rep. Anthony Weiner meets with PNHP and decides to request a CBO analysis of his Amendment
• Bullies take over many Town Hall meetings• Single payer is heard at many Town Hall and
congressional representative meetings• David Scheiner takes to the air waves • Ted Kennedy dies
SEPTEMBER ACTIVITY
• Sept 8th - Congress returns to Washington
“Mad as Hell Doctors” leave Portland
• Sept 9th - Obama addresses Congress and the nation
• Sept 21 -25th - Health Care Justice week
• Sept 30th - “Mad as Hell Doctors” arrive in Washington
MAD AS HELL DOCTORS MAD AS HELL DOCTORS TOURTOUR
26 STOPS IN 22 DAYS
WHITE RIBBON RALLY AT THE WHITE HOUSE
Memorial to Dead, 9/21-27/2009
OCTOBER - NOVEMBER(Mobilization for Health Care for All)
• Single payer movement shifts focus from Congress to private health insurance
• 115 arrests in 18 cities
• International Human Rights Day: demos in 34 States
HOUSE PASSES HR 3962November 7th
•220 for vs. 215 against
•Positives- Medicaid expansion to 150% fpl- Public option (although puny) - Surtax on the wealthy- Curb on Medicare Advantage
•Negatives - Uses Mandate Model- Leaves 18 million uninsured- No State Single Payer option- No real cost controls - Implementation date: 2013- No Weiner Amendment- Stupak Abortion Restrictions
PNHP WRITES THE SENATEDecember 22, 2009
“It is with great sadness that we urge you to vote against the health care reform legislation now before you. As physicians, we are acutely aware of the unnecessary suffering that our nation’s broken healthcare financing system inflicts on our patients. We make no common cause with the Republicans’ obstructionist tactics or alarmist rhetoric. However, we have concluded that the Senate bill’s passage would bring more harm than good.”
SENATE LETTERcontinued
....“Some paint the Senate bill as a flawed first step to reform that will be improved over time, citing historical examples such as Social Security. But where Social Security established the nidus of a public institution that grew over time, the Senate bill proscribes any such new public institution. Instead, it channels vast new resources - including funds diverted from Medicare - into the very private insurers who caused today’s health care crisis. Social Security’s first step was not a mandate that payroll taxes which fund pensions be turned over to Goldman Sachs!”
PNHP’s CONCERNS• Fortification of private insurers
• Anti-abortion provisions
• 40% tax on high cost health plans
• Reduction of Medicare payments ($43 billion) to safety net hospitals
• Millions left with inadequate insurance with an “actuarial value” as low as 60%
SENATE PASSES HR 3590December 24th
•60 for vs 39 against
•Positives- Medicaid expansion to 133% fpl
•Negatives- Uses Mandate Model - Leaves 23 million uninsured- No State Single Payer option - No public option - Excise tax on health insurance- No real cost controls - Implementation date: 2014- Undocumented immigrants - No Sanders Amendment- Nelson Abortion Restrictions
THE MEANING OF THEBROWN ELECTION
It was about health reform: Surge afterhe declared himself the 41st vote
• Rejection of mandate to buy privatehealth insurance – a defective product
• Opposition to taxing health benefits
• Fear of Medicare cutbacks
RESPONSE TOSTATE OF THE UNION
If you have a better idea for health carereform, let me know!
• PNHP says its single payer -improved Medicare for All
• Dr. Margaret Flowers was arrested trying to present ouralternative to the President
• February 22nd: The President presents his plan. It looks most like the Senate’s.
OBAMA PLAN• Individual mandate: subsidies up to 400% FLP
(premiums 2 to 9.5% of income)• Penalties: 2014 - $95 or 1% income; 2016 - $695 or
2.5% income• Hardship waiver: income < $18,700 for couple; or
premiums > 8% of income; American Indian• No employer mandate: penalty of $2,000/worker
for businesses with more than 50 employees• HI exchanges state-based in 2014; no public option• Medicaid expansion to 133% FPL; feds cover entire
costs 2014 to 2017; 95% 2018-2019; 90% in 2020• Donut hole in Medicare Part D closed by 2020• Illegal immigrants prohibited from exchanges• Abortions: if subsidized, two separate checks• Insurance Regulations: no pre-existing condition
exclusions or annual/lifetime limits by 2014• Excise tax on employer-sponsored plans with
premiums over $10,200/$27,500 starts 2018• Medicare payroll tax increase from 1.45% to 2.35%
for those with incomes over $200,000/$250,000
HOW WAS 2009 DIFFERENT? (different from 1993-1994)
• Deals were negotiated with privatehealth insurers and Big Pharma
• President delegated bill writing to Congress
• Senate and House passed bills
But the real difference was that the singlepayer alternative-Medicare for All- was heard!
WHAT’S NEXT?• Educate, Educate, Educate• Outreach to other groups: Labor, Religious, Political• Peer organizing within our professional organizations• Grassroots organizing in our communities• Movement building: Connect the dots• Expand media outreach to community newspapers• State single-payer organizing• Encourage single-payer candidates
Reframe our message“Improved Medicare for All”
• What do we mean by improved Medicare?• How do we describe delivery system reform?
WHAT’S NEXT?Practical projects
• A City Council resolution• Impact on college undergraduates
of not having single payer• Teaching single payer in high schools• Workforce implications of moving
from multi-payer to single-payer• Contacts with business community
CONTACTS AND REFERENCES
• PNHP-NY Metro: www.pnhpnymetro.org
• PNHP National: www.pnhp.org
• Bodenheimer TS, Grumbach K, Understanding Health Policy: A Clinical Approach. McGraw-Hill, 2005
• Fein O, Birn AE. (editors), Comparative Health Systems. Am Jour Public Health 2003; 93: 1-176
• O’Brien ME, Livingston M (editors), 10 Excellent Reasons for National Health Care. New Press, 2008
• Geyman J, Do Not Resuscitate: Why the Health Insurance Industry is Dying and How We Must Replace It. Common Courage Press, 2008
PHYSICIANS FOR ANATIONAL HEALTH PROGRAM
(PNHP)
29 East Madison Street
Suite 602
Chicago, Illinois 60602
312-782-6006
www.pnhp.org
OBAMA’S FATEFUL CHOICE
• He did not want to “start from scratch”
• He had two fundamental choices: 1) to build on the public sector (Medicare) or
2) to build on the private sector
• He chose to try to reach universal coverage byexpanding private insurance
Employer mandate
Public option**
Individual mandate*
* “each eligible individual must enroll in an applicable health plan for the individual and must pay any premium required with respect to such enrollment.” (S.1775)
** “you can choose to enroll in the new public plan”