2. 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.

3. Change in Share of After Tax Income, 1979-2007

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

12. 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

13. 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.

14. Growth of Physicians and Administrators
Growth since 1970
Still have ~30 million Americans were uninsured
Underinsured rising since ACA with 39 million adults age were underinsured in 2014 (21 percent), up from 10 percent in 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

16. 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

17. 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

18. 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.

19. 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

20. 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

21. 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

22. 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. 

23. 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

24. 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

25. 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

26. 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.

27. 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.

28. 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.

29. 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.

30. 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?

31. 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.

32. 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.

33. 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.

34. 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.

35. Positive and negative roles

36. 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: our-muscles-for-conflict/

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

38. Steve Auerbach’s Suggested Bibliography
Inequality, Corporate Control etc:
Hacker & Pierson (Winner-Take-All Politics, American Amnesia)
Economic Policy Institute (EPI): &
Center for Economic and Policy Research (CEPR):
Saez (& Piketty & Zucman): & World Inequality Report:
Robert Reich (Saving Capitalism), Dean Baker (Rigged), Thomas Frank (Listen Liberal), Kim Phillips-Fein (Invisible Hands)
Single Payer:
Resources:
Slides: &
Big Slideset:
Business Case for Single Payer:
Your role as an activist:
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: &