Dr. Bruce Goldberg, director of the Oregon Health Authority, speaks at a panel as Dr. Arnold Relman, Dr. Marcia Angell and Cathy Schoen look on. (All photos by David Young.)

By Samuel Metz, M.D.

From April 26-28, Oregon Physicians for a National Health Program and the Mad as Hell Doctors hosted a visit to our state by Drs. Marcia Angell and Arnold Relman, past editors of the New England Journal of Medicine.

The initial set of events took place in Portland, as this 2-page flyer illustrates. First was the Thursday Oregon Health and Science University presentation, organized primarily by Richard Bruno (OHSU medical student and winner of the Student Activist award at the national PNHP convention this year) with assistance from other members of the OHSU medical student PNHP chapter. The 150-seat auditorium was filled with students, residents, physicians, nurses, and administrators; it had standing room only.

Drs. Angell and Relman then had a brief meeting with Oregon Gov. John Kitzhaber, M.D., in which they discussed health care innovations in Oregon. The governor was urged to consider a single-payer program for Oregon.

The Thursday afternoon event at Legacy Good Samaritan Hospital was similarly well attended, with about 80 people packed into a small conference room. Dr. Stephen Jones, chair of internal medicine at Legacy Health Systems, was principally responsible. He was also a co-moderator on Friday’s panels.

Dr. Relman and Dr. Angell, past editors, New England Journal of Medicine.

The Friday morning panel, which included the participation of Cathy Schoen of the Commonwealth Fund and Dr. Bruce Goldberg, director of the Oregon Health Authority, was attended by 85 people, mostly non-physicians and non-single-payer types simply interested in learning about reform. The summary by Amanda Waldroupe of the Lund Report, titled “Panel on Health Reform Focuses on Ditching the Insurance Industry,” is accurate.

The evening panel was attended by 45 people, many of whom had not attended the morning session. Both crowds were enthusiastic.

The Saturday single-payer rally at the Majestic Theatre in Corvallis had 200-250 attendees. Many were from Eugene, Salem, and Portland. This event was organized primarily by Dr. Mike Huntington of Corvallis PNHP and MAHD, and Betty Johnson, a longtime single-payer advocate from Mid-Valley Health Care Advocates. Mike and Betty are now key participants in the newly reorganized Health Care for All Oregon.

The Saturday evening fund-raising dinner was held at my house. Thirty-five people attended and listened in rapt attention to Drs. Angell and Relman, the brief presentations from each and then a long discussion period. Most were senior physicians. Others included a county judge, the head of the port of Portland, and the president of the Oregon State Council for Retired Citizens. Valuable connections were made by the PNHP and MAHD representatives.

Dr. Marcia Angell addresses the audience.

Important results of these events, especially the Friday panels, included raising awareness among non-activist businesspeople of the critical nature of health care reform and the legitimacy of a single-payer option. For many, this was the first time single payer was discussed in a credible, nonpartisan environment.

Another valuable result was the relationship built between the organizers of these events and a variety of organizations new to single payer. These included all organizations listed on the flyer as sponsors or distributers of publicity, plus a few added after the flyer was created: The Oregon Business Council, multiple neighborhood business organizations, professional organizations for realtors, Project Access Now, and several smaller charitable organizations.

Finally, flyers were sent to each of Oregon’s 90 state legislators. Most did not reply, though a few sent regrets; but in a few cases contact was made with legislative aides, contacts valuable when the Legislature considers its next single-payer bill.

One reason so many organizations collaborated in sending out flyers was, I suspect, that nothing in the Friday panel advertising materials explicitly mentioned single payer. While each of the panel participants and moderators understood the value of single payer (and several are strident advocates), few attendees were aware of this beforehand. This permitted many neutral people to hear about single payer without their attendance showing visible support for the concept.

My lessons from this experience:

* “If you’ve got what people want, it’s easy to sell.” In this case, many people drawn to the Thursday and Friday presentations knew Drs. Angell and Relman only as distinguished senior academic physicians. Every medical organization was happy to lend a hand, as were organizations with experience in health policy (the Foundation for Medical Excellence, the Northwest Health Foundation, We Can Do Better). Featuring recognizable names helped our cause.

* We were fortunate to include Dr. Bruce Goldberg, widely respected as a calm, rational, nonpartisan advocate for Oregon’s health care needs. While he did not speak about single payer himself, his presence on stage with single-payer advocates lent great prestige to the program and enormous credibility to other panelists who did.

* The efforts to contact a large sample of business organizations provided value in itself. I now know more about who is doing what and who represents whom than I did before. My contact list includes many helpful executive directors and program administrators, now on a first name basis with me. When MAHD and PNHP plan their next event, many doors will open graciously for us.

* The Saturday rally was the only event designed and billed as a single-payer rally. This served an important need to reward, recharge, and motivate the current advocate population. In addition to the outreach to the unconverted of the previous two days, this solidified the visit of Drs. Angell and Relman. In the course of three days, our guests spoke to the choir, the pews, and a lot of people just passing by.

What would we plan for Drs. Angell and Relman during their next visit? Meetings with the editorial boards of the three largest newspapers in Oregon. Individual and group meetings with legislators and legislative caucuses. Guest appearances at physician organizations, notably the Oregon Medical Association and the Medical Society of Metropolitan Portland, both of which were happy to send flyers for the Thursday and Friday events. By the way, our guests have not ruled out another visit in a few months.