PNHP ACTIVISM 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 October 2009

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.

CHAPTER ORGANIZING April 2008Philadelphia June 2008New Haven Sept 2008New Mexico Nov 2008Atlanta

CHAPTER ORGANIZING March 2009Seattle April 2009Toledo/Ohio SPAN May 2009Miami June 2009Minneapolis Sept 2009Indianapolis Oct 2009Houston

CHAPTER ORGANIZER Contact person for local leaders Assess organizing opportunities Local media and communications Leadership visits to chapters Thanks to Joanne Landy and Ali Thebert

MINNEAPOLIS – June 2009 Hosts: Elizabeth Frost, Susan Hasti, Ann Settgast Wednesday 7 PMForum: Equality and Health Access Thursday 10 amER Conference: Regions Hospital NoonIM Grand Rounds: Univ of Minnesota 1 pmStudent discussion 3 pmPioneer Press: Editorial Board 5 pm Cocktail fund raiser 7 pm Minnesota Universal HC Coalition

MINNEAPOLIS - continued Friday 9 amStar Tribune: Editorial Board 10 amRadio Interview 11 amPress Conference NoonIM Grand Rounds: Hennepin Country 3 pmNPR: Studio Interview 7 pmReception at Susan Hasti’s home Saturday 8 amOrganizers’ breakfast and planning

OPINIONS ABOUT SINGLE PAYER Obama: “If we started from scratch, I would favor single-payer” Baucus: “Single payer is off the table” Progressive Caucus: “...the entire 77-member CPC prefers a single payer approach to HC reform” Republicans: “...single payer is socialism”

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 March 5th – White House Health Care Summit

THE WHITE HOUSE HC SUMMIT March 5, 2009 Friday, February 27th No single-payer advocates invited Monday, March 2nd Press release and call for demo

WHITE HOUSE SUMMIT

THE WHITE HOUSE HC SUMMIT March 5, 2009 Tuesday, March 3rd John Conyers invited Wednesday, March 4th 4 PM: Oliver Fein, PNHP President, called by White House

WHITE HOUSE HEALTH CARE SUMMIT PARTICIPANTS (150) Congress Community/Consumers Stakeholders

WHITE HOUSE HEALTH CARE SUMMIT FORMAT 1:00 – 1:45 PMPlenary 2:00 – 3:15 PMBreakout Groups 3:30 – 4:45 PMTheater in the Round

THE HAND SHAKE “Glad you are here.” “Give my best to Dr. Quentin Young.”

SUMMIT GOALS Bipartisanship Transparency  Congressional responsibility

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 COMMITTEE Dr. Margaret Flowers, Pediatrician from Baltimore Dr. Judy Dasocvich, internist from St. Louis

THE NURSES COME TO TOWN

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 - Quentin 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 29 th - 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 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 th - Health Care Justice week Sept 30th - “Mad as Hell Doctors” arrive in Washington

MAD AS HELL DOCTORS TOUR 26 STOPS IN 22 DAYS WHITE RIBBON RALLY AT THE WHITE HOUSE

Memorial to Dead, 9/21-27/2009

WHY CONTINUE TO ADVOCATE FOR SINGLE PAYER? The economic crisis calls for government stimulus of the economy Everyone benefits: the uninsured, the underinsured, and everyone else who is insecurely insured Employers will be relieved of the burden of rising health care costs/retiree benefits and unfair competition from employers who don’t offer HI Every other industrialized country has done it It is morally the right thing to do!

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 by expanding private insurance

Progress(?) of US Health Reform 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” Medicare ??

THE MANDATE MODEL 1.Everyone required to have health insurance 2.Employers must offer insurance or contribute 3.Rely on private insurance, but offer a public option 4.“You can keep what you have” 5.No regulation of insurance company premiums, deductibles, co-pays, or payment and denial practices Result: System costs increase by billions

THE EMERGING CONGRESSIONAL PLAN 1. New requirements for “qualified plans” -- no pre-existing condition exclusions -- no co-pays for preventive care -- $5,000/$10,000 annual limits on cost-sharing -- no limits on lifetime coverage Result: higher premiums 2. Employment-based insurance otherwise unchanged -- Employers can change coverage and plan -- Insurers can change provider networks -- Employees are still locked into their jobs 3. Employees must accept employer plan, if they can afford the premium (< % of income)

THE EMERGING CONGRESSIONAL PLAN 4.Starting in 2013, the uninsured and small employers can access an “insurance exchange” 5.Subsidies (“affordability credits”) in the exchange up to 300% or 400% of the federal poverty level 6.Public option only available in the exchange 7.“Hardship waiver” for those who can’t afford premiums: they can remain uninsured 8.Expand Medicaid eligibility to all below 133% FPL

WHAT HAPPENED TO THE PUBLIC OPTION? The original “robust” Plan Open enrollment Medicare-like: backed by the Fed govt 119 million members (Lewin) The Congressional Plan Restricted enrollment (only the uninsured) 10 million members (only 5% of population) Self-sustaining: follow same rules as private insurers

BOTTOM LINE ON THE CONGRESSIONAL PLAN If it does pass in some form, it will: Make the world’s most expensive health care system even more costly Not achieve universal coverage Not make affordable insurance available Leave millions underinsured Not control the continuing growth in costs Why? Because it doesn’t really change the way we pay for health care

PRIVATE INSURANCE BAILOUT Employer based health insurance enrollment is declining: million over 10 years Mandates increase private insurance enrollment Significant percent are young and healthy Government subsidies to assist low/moderate income families will further increase private insurance enrollment

CONCLUSIONS A system based in private insurance plans -- will not lead to universal coverage -- will not create affordable insurance A Medicare for All System -- can provide comprehensive services while costing no more than present -- can provide tools to control costs in the future If a mandate plan is passed, the problems of the health care system will not go away. Real health care reform will continue to be essential

We Can’t Wait Another 16 Years! We Need Real Health Care Reform Before the Premium Takes All our Income! Source: American Family Physician, November 14, 2005 Today

WHY CONTINUE TO ADVOCATE FOR SINGLE PAYER? The economic crisis calls for government stimulus of the economy Everyone benefits: the uninsured, the underinsured, and everyone else who is insecurely insured Employers will be relieved of the burden of rising health care costs/retiree benefits and unfair competition from employers who don’t offer HI Every other industrialized country has done it It is morally the right thing to do!

CONTACTS AND REFERENCES PNHP-NY Metro: PNHP National: 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: 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

FUNDAMENTAL FLAW WITH THE PUBLIC OPTION It retains multiple private insurance companies It assumes market competition will work Private HI will dump the sick on the Public Option Public Option cost/beneficiary will rise Private HI will pressure to underfund Public Option Only one-seventh of administrative cost savings

COMPARE THE PUBLIC-OPTION AND SINGLE PAYER Public-Option Single-payer Coverage Millions un-insuredUniversal and under-insuredAutomatic enrollment Cost $1.5 trillion overNo additional cost 10 years How to pay Increase taxes;Redirect $400 billion Cuts to providersadministrative waste Sustainability Use HIT, preventGlobal budgeting; disease managementcapital planning