Why I am an activist and you should be too You are an Activist: White Coat is automatically, whether you acknowledge or accept it is in fact power and privilege. Choice is not whether you use it, but HOW you use it. Doing nothing, saying nothing is being an activist… for the status quo. Big picture… what drives me… Fight back against the deliberate political choices since mid-1970s to enrich few, and to stagnate or impoverish many... Economic: Wages, Pensions, Taxes, Deregulation, Jobs, Benefits, Unions, Privatizing public good… Increasing disparity by income, wealth, decrease in intergenerational mobility Loss of democracy: Big money control, Voter suppression, gerrymandering, Corporations as people (money, speech, regulation). Racism, Sexism, Religious zealotry, anti-intellectualism, anti-reality Choose where I can be most effective: As a physician my voice can be heard best on health issues... Single Payer Mortality & Morbidity due to un-insurance, underinsurance, other lack of access to care, lack of access to healthy living Only developed country without universal coverage. Why put my activity where not going to happen tomorrow... Precisely because that is where I can make difference Dad Medicare from age 0; Med school letter to NYT and hate mail received; Blogging on DailyKos; PNHP; Occupy Be present. Take a public stance… but Organized Find a niche and a group that works for you… and then be ACTIVE with your group Supportive of coalition... Balance of not compromising values or goals, but don't be a splitter. www.pnhp.org/slideshow/2017AM/YourRoleMargaretFlowers.pptx

Change in Share of After Tax Income, 1979-2007

% of National Income Captured, 1917-2012, U.S.

Widening Gap in Life Expectancy Between High and Low Earners Remaining Life Expectancy for Men Turning 60 Morbidity and Mortality and Healthcare Costs are regressive hitting lower-income higher. Current Premium structure is Flat and effective Regressive tax: Pay same premium for same plan (same copay, deductible, other out of pocket regardless of income). Poor can’t afford as good plan, so more underinsured. But have higher needs & costs. Source: Waldron. ORES, Social Security Admin, #108, 2007

www.PNHP.org & www.PNHPNYMetro.org & www.nyhcampaign.org Founded in 1987, Physicians for a National Health Program (PNHP) is a single issue organization advocating a universal, comprehensive single-payer national health program. PNHP has 25,000 members and 40 chapters across the United States. PNHP is the only national physician organization in the United States dedicated exclusively to implementing a single-payer national health program. Our members and physician activists work toward a single-payer national health program in their communities. PNHP performs ground breaking research on the health crisis and the need for fundamental reform, coordinates speakers and forums, participates in town hall meetings and debates, contributes scholarly articles to peer-reviewed medical journals, and appears regularly on national television and news programs advocating for a single-payer system.

Growth of Physicians and Administrators Growth since 1970 Still have ~30 million Americans were uninsured Underinsured rising since ACA with 39 million adults age 19-64 were underinsured in 2014 (21 percent), up from 10 percent in 2003. Underinsurance is defined as having insurance all year but having out-of-pocket medical costs (excluding premiums) of >10% income or having an insurance deductible of 5 percent of income or more. Fragmented pools; competing to not cover the sick; Profitable market is skimmed off the top and privatized (healthy, working, well off); Not profitable (sick, poor, unemployed, disabled) dumped to public or nothing. Only is the only way (necessary; not sufficient), to universal comprehensive quality coverage (& access), and control both total system & individual costs. Bureau of Labor Statistics; NCHS; Himmelstein/Woolhandler analysis of CPS Managers shown as moving average of current year and two previous years

The Human Face of Obamacare: where we still are today Table of Contents Dr. John Geyman’s The Human Face of Obamacare: Promises vs. Reality and What Comes Next Sums up the problems of where we still are today

Still have ~30 million Americans were uninsured Underinsured rising before ACA and rising faster since ACA with 40 million adults age 19-64 Underinsurance is defined as having insurance all year but having out-of-pocket medical costs (excluding premiums) of >10% income or having an insurance deductible of 5 percent of income or more. Its too damn complicated and aggravating for both patients and physicians

Fragmented pools; competing to not cover the sick; Profitable market is skimmed off the top and privatized (healthy, working, well off); Not profitable (sick, poor, unemployed, disabled) dumped to public or nothing. Only is the only way (necessary; not sufficient), to universal comprehensive quality coverage (& access), and control both total system & individual costs.

National Public Health Insurance Universal – covers everyone (Everybody-in, Nobody-out) Comprehensive – all needed care, no co-pays, no deductibles Single, public payer – simplified reimbursement; no fragmented pools or adverse selection Funding is Progressive (tax) not Regressive (rich and poor pay “same” premium) Private delivery of care: private/public non-profit hospitals, HMOs and clinics, private physicians. But no investor-owned (for profit) HMOs, hospitals, etc. Improved health planning Public accountability for quality and cost, but minimal bureaucracy

Single Payer Movement Swells… What is Your Role in the Movement Single Payer Movement Swells… What is Your Role in the Movement? Margaret Flowers, MD & PopularResistance.org http://www.pnhp.org/slideshow/2017AM/YourRoleMargaretFlowers.pptx

8 Stages of Successful Social Movements Bill Moyer’s Movement Action Plan Stages 1 – 3 – Percolation Stage 4 – Take off Stage 5 – Let down Stage 6 – Building consensus Stage 7 – SUCCESS Stage 8 – Defending gains and moving on

Basic Conflict Powerholders vs People Power Powerholders – The elites, through their dominant control of the state, institutions, laws, myths, traditions, and social norms, serve the interests of the elites, often to the disadvantage of the whole society. Power flows from the top to bottom.  People Power - The powerholders' power is dependent on the cooperation, acquiescence, or support of the mass public. This model is represented by an inverse triangle, with the people at the top and the power elite at the bottom. 

What the powerholders do Task: Maintain the status quo Keep the issue out of sight and off the table Control information Deny the issue exists Create myths and threats Discredit the opposition Appear to take action Make minor reforms Co-opt the opposition

What the social movement needs to do Task: Show that the social movement upholds values and the powerholders violate them Keep the issue in the spotlight Counter the myths Eliminate the threats Organize and mobilize people Refuse to compromise too soon Support grassroots action Avoid focus on electoral, partisan politics Reject co-option

How we win Build a diverse movement of movements – solidarity Become a mass (not a fringe movement) Achieve national consensus Mobilize at least 3.5% of the population Maintain flexibility (not a POO) Hold position of principled dissent

Stage 6: Building consensus Public must understand: There is a problem. The current system can’t fix the problem. There is an alternative solution that will fix the problem.

12 Phases of stage 6 Keep the issues on the political and social agenda; Win majority support against current conditions and policies; Cause powerholders to change strategy although they do not solve problems; Counter each change in strategy by showing it is a gimmick, not a solution; Push powerholders to new strategies that take riskier positions and make it harder to hold old positions; Create strategic campaigns that erode support for the powerholders; Expand policy goals as the movement realizes the problems are greater than was evident; Develop stronger and deeper opposition to current conditions and policies; Promote solutions and a paradigm shift; Win majority support for the movement’s solutions; Put the issues on the political and legal agendas; Finally, the powerholders change positions to appear to get in line with public opinion while attacking the movement and its solutions.

Crisis point Opposition to current policies grows quickly. Support for alternative policy rises (movement helps this process) Everyone wants the issue resolved, but government is unable to take action. At the end of Stage 6, many powerholders begin to join the calls for change. As elites defect to support majority opinion, the political price paid by those who want to maintain unpopular policies exceeds their benefits and creates a political crisis that leads to resolution.

Stage 7: Success Dramatic showdown – something triggers another “take off” moment and the public mobilizes in mass numbers. Victorious retreat - the people in power realize they can no longer continue the status quo and launch a face-saving endgame, changing their policies and taking credit. Attrition - where the social, economic and political machinery slowly evolve to new policies and conditions.

Where do you fit in? Bill Moyer identifies 4 roles of social change. All are necessary. A person can play multiple roles but often one role is suited for our personality and strengths. Which role is best for you? Think back to a time in your childhood when you faced a problem – how did you handle it? Did you turn to authority, take personal initiative, turn to others to work collectively or raise a ruckus?

The Advocate (Reformer) Childhood – sought out authorities to solve problems. Transmits movement analyses and goals to authorities. Performs legal efforts – lobbying, courts, etc. Works to create and expand new laws and policies. Acts as a watchdog to ensure the new laws and policies are funded and carried out.

The Helper (Citizen) Childhood – works to solve the problem through personal efforts. Upholds a widely-held vision of the democratic, good society. Demonstrates ordinary people support social change. Gives the movement legitimacy. Makes it harder for authorities to discredit the movement. Reduces the potential for violent attitudes and actions.

The Organizer (Change Agent) Childhood – works to solve the problem collectively. Supports the involvement of large numbers of people in the process of addressing social problems. Promotes a new social and political majority consensus favouring positive solutions. Promotes democratic principles and human values. Supports the development of coalitions. Counters the actions of authorities. Moves society from reform to social change by promoting a paradigm shift.

The Rebel Childhood – raises a commotion to pressure powerholders to act. Puts issues on the social and political agenda through dramatic. Nonviolent actions. Dramatically illustrates social issues. Shows how institutions and official authorities violate public trust by causing and perpetuating critical social problems. Forces society to face its problems. Promotes democracy.

Positive and negative roles

A few words about conflict Conflict can take a stagnant group and move it to a stronger level. Three phases of groups: Honeymoon – superficial polite efforts to get the job done. Chaos – fighting. Community – creates a high-performance team, which happens when members accept on a deeper level the diversity of who they are From George Lakey: https://wagingnonviolence.org/feature/building- our-muscles-for-conflict/

Now that you understand movements, what will you do? Citizen Reformer Rebel Change Agent

Steve Auerbach’s Suggested Bibliography Inequality, Corporate Control etc: Hacker & Pierson (Winner-Take-All Politics, American Amnesia) Economic Policy Institute (EPI): www.epi.org & http://stateofworkingamerica.org/ Center for Economic and Policy Research (CEPR): http://cepr.net/ Saez (& Piketty & Zucman): http://ceg.berkeley.edu/ & World Inequality Report: http://wir2018.wid.world/ Robert Reich (Saving Capitalism), Dean Baker (Rigged), Thomas Frank (Listen Liberal), Kim Phillips-Fein (Invisible Hands) Single Payer: www.pnhp.org Resources: http://www.pnhp.org/facts/single-payer-resources Slides: http://www.pnhp.org/ATL & http://www.pnhp.org/2017-snahp-summit-materials Big Slideset: http://www.pnhp.org/slideshow/2017AM/HealthPolicyUpdateLong2017_Weisbart.pptx Business Case for Single Payer: http://www.pnhp.org/slideshow/2017AM/BusinessCase.pptx Your role as an activist: http://www.pnhp.org/slideshow/2017AM/YourRoleMargaretFlowers.pptx The Human Face of Obamacare: Promises vs. Reality and What Comes Next, by John Geyman, M.D. Talking About Single Payer: Health Care Equality for America Paperback, James F. Burdick M.D. New York: www.PNHPNYMetro.org & www.nyhcampaign.org