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Last Year's Single Payer Summit Post 35 Years of Reaganomics

[re-post of 5/17/10 from s4d and corrente]

Margaret Mead once said:

Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has.

On Saturday, April 24th, I attended a Single Payer Teach-in at St. Luke’s Hospital on Manhattan’s Upper West Side. It was a thrill for me to get to hang for a day with some of the universal health care champions whose articles and/or civil disobedient adventures I have been following on the PNHP (Physicians for a National Health Program) website over the past year. Leaders such as Dr. Andy Coates, Dr. Margaret Flowers, Katie Robbins.

Had I been a more deeply involved and a longer term single payer activist, I could do justice to many of the other hero-activists that were also there in the huge hospital conference-auditorium. I felt humbled and a bit guilty rubbing elbows with these members of Mead's "small group", the serious walkers of the walk. The marathoners of universal health care. Ready for the next round. At one point someone declared he had been battling "35 years of Reaganomics."

The unofficial theme of the event was labeled by one speaker: "How to keep the energy going." There was to be morale building and strategic planning for the next wave of activism. There was also to be a deserved degree of collective mourning and expression of anger and frustration for the passage of the dysfunctional new health insurance bill.

I went there to learn, as well as give these activists my support. I went -- selfishly -- to use them for my own morale re-building. I also went because lambert had posted the event on correntewire and madamab recommended I go since she couldn't. Sometimes that extra networking is a real kick in the ass -- to get one from the point of "hmmm .... maybe I SHOULD go," and then forgetting all about it, to taking it very seriously because other people are.

Handwritten jottings from this event have been sitting in a small blue spiral notebook at the bottom of my backpack for several weeks. Since I'd turned my work schedule at the last minute upside down to attend, I had gone on very little sleep. I was easily reminded of this from the sloppy and cryptic note-taking. A bit of googling and emotional memory are helping me fill in the blanks to offer a belated and limited summary on the NYC summit of this vital social movement.

I noticed on the back cover of my notebook that I had jotted down during the course of the day catchy, often acerbic references to our health care system I had heard. Let me spill an eclectic few. (Sorry they are out of context.)

Medical apartheid
Cruel health care incrementalism of Obama
Grand experiment of neo-liberalism (from Andy Coates)
DEFORM not Reform
Corporatism is a polite word for fascism (I heard this one a few times)
Public option, wholesale embrace of privatization
Democracy is not a Spectator Sport (on T-shirt)
It's not that we are now against the Dem party, WE ARE ANTI-RULING CLASS
SPINO (single payer in name only)
Obamacare is a Band-Aid
No Long Term Care = Enforced Poverty

There were compelling analyses from so many articulate and passionate spokespeople, but I think by focusing primarily on the early, keynote address of Dr. Margaret Flowers I can convey at least some of the essence and intention of the single payer movement at this point in time. Dr. Flowers is a determined champion of health care reform and a captivating speaker. And, God bless her, she provided a tight outline of straightforward talking points my sleep-deprived mind could wrap around.

She began her talk with the 3 goals of the Single Payer movement (what Single Payer advocates are still VERY determined to achieve), then turned to the 3 main things Single Payer Advocates learned during this most recent health care reform battle. (Dr. Flowers has also written an article entitled: After the Reform: Aiming High for Health Justice for Tikkun Magazine which I will refer to also.)


Dr. Flowers asserted that of the 3 major goals of the Single Payer movement:


... NOT ONE was achieved within the new Congressional reform. (As the auditorium audience collectively released a mournful sigh. Three for zip? Zip for three? How do you say it? (Actually, I say it, "Aggggghhhhhhh!!!!"))

Dr. Flowers acknowledged some of the positives of the new Obamacare legislation:

The inclusion of children up until the age of 26 in their parents' insurance plans.

The gradual closing of the infamous "donut hole".

An emphasis on prevention and public health.

Increased funding for community health centers.

Some incentives for primary care providers.

Okay, deep breath. Here are just some of the serious issues (relating to the lack of universality, equity and accountability) with Obamacare that were discussed by Dr. Flowers (with some expansion from her own article, Dr. Andy Coates' and others' later talks and also an article by Drs. Woolhandler and Himmelstein).

1) The bill will omit at least 23 million Americans from any coverage.

2) The individual mandate (to purchase private insurance with penalties for noncompliance) will force people who can't afford health care to pay a fine for not affording health care as well as having to go without it. At the same time, the mandates guarantee the private insurance companies millions of new customers.

3) The requirement to accept people with pre-existing conditions will increase premiums to unaffordable levels. People will be forced to purchase policies with "skimpier" coverage or do without. This will increase the numbers of under- and uninsured Americans. This will also drive even more Americans into bankruptcy from medical debt.

4) There will be no government cost-saving negotiations for drug purchasing. Drug firms will be paid full price for their products.

5) Employers are still in control of insurance plans for their employees. Many will undoubtedly drop employees from their insurance plans because of costs. It will be cheaper for them to pay the fines for doing so.

6) There will not be enough primary care physicians in place to equitably cover even the insured population.

7) The bill is unfair to women. It offers no subsidies for abortions, setting up an unjust double standard -- accessibility of abortions for wealthier women but not poorer ones.

8) The bill is unfair to immigrants. The law excludes undocumented immigrants from buying insurance in the new exchanges, even if they can pay full price. The bill bars legal immigrants (green-card holders) from receiving publicly subsidized insurance for five years.

9) There is no serious cost oversight. Some providers may charge, say, tobacco-using patients up to 50% more than non-tobacco users for coverage.

10) Co-pays will grow ever larger.

11) In 2018 the taxation on so-called "Cadillac plans" will kick in and will hit millions of working families.

12) Health care plans will become "skimpier" across the board and there will be huge out-of-pocket expenses.

13) There will still be a serious number of HMOs delivering inferior care at inflated prices and overcharging Medicare.

14) The law reduces federal subsidies to public and other "safety-net hospitals." There will be fewer such hospitals and they will be overwhelmed. Since 23 million Americans will remain uninsured, millions will desperately need safety net hospitals since many hospitals reject patients with costly illnesses.

15) The bureaucracy will take on nightmarishly complicated and costly proportions, especially the initial defining of eligibility among the citizenry. One of the advantages of expanding Medicare for All was to save on the bureaucratic and executive pay costs of about 30 cents on the dollar. These already high costs are bound to spike upwards.

Flowers finally stressed that the Obamacare legislation is full of loopholes that will allow private insurers to handily avoid serious regulation.

Before I go on with Dr. Flowers analysis of lessons learned, I would like to acknowledge yet one more very serious often ignored problem not remedied in Obamacare. Long term health care. Pearl Corn blogging on Huffington Post eloquently captured the intense degree of consciousness raising we were all privileged to experience and witness at the Saturday summit from some protesting attendees:

The most compelling and heart-wrenching part of the event was the appearance of six severely disabled men and women in wheelchairs. ... Long-term care only exists with Medicaid, meaning you must prove poverty and have no assets to qualify. These folks have been marginalized and left to a life of poverty.

One man, disabled rights activist Danny Robert [who had once had a successful career in the motion picture industry], is afflicted with MS and spoke from his wheelchair, breathing from an oxygen tank with his companion and fellow activist Nadina LaSpina by his side in her own wheelchair holding his speech for him. He described the challenges this community lives with every day, and she noted that if they had married, he would have been taken off of Medicaid because she had taught at the New School and other universities and had income, so he would no longer qualify for Medicaid. She has polio and in time will go on Medicaid as well. Then they will be able to marry, impoverished but together. This group of activists fight daily to live independent lives in their own apartments with aides they train to fill their needs. No institutional existence for them, a core issue for these feisty activists. They are inspirational.

In her article Ms. Corn asks, "What kind of an America have we become when our laws prevent marriage in order to qualify for a class-defined healthcare program that is Medicaid?" She points out that the Obama health plan has no provision for long-term care. This is a major issue most Americans don't want to address and yet may be forced to one day. Only in the Single Payer Conyers bill H.R. 676 is long term care included, for rich and poor, without the declared poverty stigma and restrictions of Medicaid.


Okay. That was a lot to take in. But allow yourself another deep breath, square your shoulders and let's move on to Dr. Flowers' 3 Lessons Learned from this most recent health care reform fight (with, again, some additional commentary from other speakers and relevant blogs).



Under her first category, "Not To Compromise", I had scribbled down in all caps Dr. Flowers' declaration, “ANYTHING LESS THAN FULL UNIVERSAL HEALTH CARE IS A DISASTER!” Flowers also made use of a quote from Gandhi:

All compromise is based on give and take, but there can be no give and take on fundamentals. Any compromise on mere fundamentals is a surrender. For it is all give and no take.

In her article she applied this quote as a wise argument with which to refute the White House's and Congress' insistence that compromise must happen within the private insurance model framework. According to Flowers and the Single Payer activists, Obamacare abandons the "fundamentals." Denies all citizens a basic human right to health security. Refuses to establish the fundamentals of "universality, equity and accountability." It allows preventable deaths, continued suffering from under- or non-insurance, debilitating bankruptcies from medical debt.

Flowers pointed out that all other industrialized nations have health systems based on the principles of health care as a human right. Our health care system, so inequitable and ranked a lowly 37th by the World Health Organization, is ironically also the costliest among industrial nations.

Dr. Flowers spoke of the incredible pressure to pass ANYTHING within the White House and the Democrats of Congress. To have this "anything" heralded an accomplishment since our Dem president had made health care his "signature issue." She pointed out that Obama surrounded himself with many who had fought for health care reform during Clinton's reign and were undoubtedly "traumatized". "They had an escalated fear of the corporate opposition and squandered an honest national debate on back room deals." (ugh) Not so surprising the many perks extended to industry not citizenry in Obamacare.

As for the public option, a particular sore spot for us single payer advocates, Flowers pointed out it was a useful (though ever nebulous) entity in "splitting the single payer movement and confusing and distracting it with endless discussion about what type of public option would be effective. "

Despite all the brouhaha about the public option and its acknowledgment in the media echo chamber, Flowers declared there was never any chance it would be included in the regulation. She wrote in her article that in March 2009 Baucus admitted it existed as a "bargaining chip only" and that Glenn Greenwald a year later confirmed it had been privately negotiated away, long before Congress ended what Flower labeled its "charade" fight for it.

Most confounding was how pro-corporate the President and Congress were in refusing to acknowledge abundant data that a market driven health care system was unsustainable. This unsustainability is clearly evidenced by the cost-challenged "reform" health care state program of Massachusetts.


According to Dr. Flowers the most frustrating attack on clarity (beside the insane hysteria of "socialism") was the confusion of single payer with the public option. That was both due to diabolical deliberation and obtuseness on the part of the corporate-owned media. It lumped all objectors to Obamacare as "pro-public option." In reality there was a serious moral and philosophical divide between the two groups of advocates.

Dr. Flowers acknowledged there was a certain naivete among us Single Payer advocates that common sense would simply prevail. Access and affordability one would think would be compelling arguments. She claimed that legislators and pro-reform groups liked to speak about principles but were not challenged enough on the commitment for implementation of these principles. She believes the Single Payer advocates were too tentative in what they were asking for.

Indulge me an interruptive rant here. I, too, had assumed long ago that common sense would prevail. Single payer health care. Sane, simple and clear. Humanitarian and fiscally renewing. It would generate between $350 and $400 billion a year to cover all of us. The gouging insurance providers would be out of the equation. What more could we want, America? A cake walk to legislative victory I naively assumed. Logic and EMPATHY (oh dear!!!) would be applied to our national situation. What was I thinking? Where have I been?

This is bizarro-world. Ethical freakshow America. The era of craven and/or obtuse media disinformation and/or total black-outs of all that is wholesomely relevant. Hysterical crazymaking protesters commandeering the airwaves. Matt Taibbi drolly quotes the type: “Keep the Guv’mint off my Medicare.” Tea Party faux-populism, significantly and covertly sponsored by the likes of Dick Armery of FreedomWorks and other right wing/corporate entities. The ferocious and amoral corporate cronyism that flourished under Bush and the fresher hells of cronyism now with Obama.

I, too, waited for Single Payer Expanded Medicare For All to be embraced and celebrated as America's solution to its health care crisis. It was ignored. It was never allowed on that damn "table." I wrote a blog after a frustrating while entitled "Single Payer – Code Name 'Rumpelstiltskin'”. For so long I had been chewing on my fist in exasperation. How could I be watching the media, President and members of Congress totally IGNORE what was clearly best for the country? Even Frontline ... FRONTLINE!!! ... conflated public option with single payer -- adding profound insult to profound national injury by omitting the words and total concept of "single payer."

The ferocity of the disinformation, disenfranchisement campaign of the single payer enemies from both parties, of the corporations, of the media -- that campaign's ultimate effectiveness -- was a very bitter pill for us single payer advocates to swallow.

Dr. Flowers said firmly, clearly and reassuringly that now that the "clamor" of the health care bill has died down, it is time for this country to have a “civilized” discussion. She also pointed out that we obviously cannot count on corporate-driven mainstream media to foster such a discussion. It will have to be a on a more personal, grass roots level and through “independent sources of media.”

In her article she eloquently cited the humane as well as achievable goals of Physicians for a National Health Program, founded in 1987:

We envision a lifelong universal health system-much like traditional Medicare-that is nationwide. We envision a system that allows patients to choose where they receive their care, permits caregivers and patients to determine the best course of treatment with assistance from evidence-based data, controls costs in a rational way through simplified administration and negotiation of fair prices, and is progressively financed. Its publicly funded nature would make it transparent and accountable. Because it would be privately delivered, it would allow caregivers to compete based on quality of care provided. Private health insurers would be relegated to a position of offering supplemental plans and possibly providing administrative support.

Dr. Coates made a most insightful comment at one point as to why clarity was NOT allowed to prevail by desperate right wing conservatives and corporatists. "If single payer had been embraced it would have exploded the Reagan myth that government is evil and incompetent!"


Another all caps quote from Dr. Flowers in my notebook:


Dr. Flowers continued that even by the supposed allies of Single Payer we were sold out: Kucinich, Conyers, Sanders, Wiener. They succumbed to party pressure and group think. The "hold your nose and vote for the lesser of evils" decision-making prevailed.

Dr. Flowers contended that the final mistake was allowing the upcoming elections to impact the context of passing reform. Also for allowing the mainstream media to ignore or dismiss the Single Payer movement as a super-left, super-fringe group when it was acknowledged at all. The Single Payer movement should have remained and insisted on being identified as non-partisan. It should not have relied so much on the support of the Democratic party. Not only were Democrats in our government beholding financially to corporate donors, but also driven by that need to pass ANYTHING and declare it successful so as to ensure success in upcoming elections. They were pressured to support the compromising backroom deal-making of their President.

What easily prevailed was the gamesmanship to settle for the "appearance of historic reform" rather than the statesmanship of fighting honorably for its actuality.

I seem to be turning in my blogs these days to Dr. Martin Luther King as a forever spiritual messenger for the healing of America. In the context of this blog, it is Dr. Flowers who cited him within her own very inspiring declaration:

The Rev. Dr. Martin Luther King Jr. taught us that to witness an injustice and not work to correct it is in itself an act of violence. As a physician and an advocate for nonviolence, I cannot ignore the injustice of the great health inequality that exists in our nation or ignore those in need who cannot afford medical treatment. We have delayed this struggle for too long. Alice Walker said, "We are the ones we have been waiting for." So, let's do it. We have the resources. Now we must create the political will. Together, we can create a health justice movement, educate ourselves, speak with clarity, and organize independently of any political party.

A health justice movement. Count me in, Dr. Flowers!