By Chris Gray

An Arizona ballot measure to forbid government-mandated health care was voted down two years ago, but it’s back as part of a much larger national campaign this time around. The proponents’ main target? Single-payer, universal health care.

A statement by the American Legislative Exchange Council denounces the insurance mandates proposed by Congress and the Obama administration, but the bulk of the group’s news release in pushing for “freedom of choice” makes it clear that the real target is publicly financed universal health care, commonly referred to as a single-payer system or an improved Medicare for all.

“ALEC’s Freedom of Choice in Health Care Act ensures a person’s right to pay directly for medical care,” states a release from the American Legislative Exchange Council or ALEC, a national right-wing, pro-industry group. “[The] Act will prevent patients from being enrolled in a single-payer health system that will simultaneously pay for everyone’s health care and limit access to it.”

The council’s “Freedom of Choice in Health Care” proposal was drawn up with the support of corporate supporters PhRMA (the trade association of the large drug companies), Johnson & Johnson, and the Blue Cross Blue Shield Association.

The Arizona ballot measure, which is also a concurrent resolution in the state’s House, has strong similarities to ALEC’s draft resolution, which was written with the guidance of Joan Gardner of Blue Cross Blue Shield, an insurance lobby group that publicly pressured Obama to mandate private insurance for all Americans. Even as it continues to support the federal mandates publicly (while arguing the penalties for noncompliance be higher), Blue Cross Blue Shield has been working to undermine the administration’s bill, along with the prospects for single-payer legislation, through the stealth campaign of the American Legislative Exchange Council.

The original “Freedom to Choose Act” in 2008 was boosted primarily by a group called Medical Choice for Arizona, headed by Eric Novack, an orthopedic surgeon in Glendale, Ariz., who had teamed up with conservative groups like the Phoenix-based Goldwater Institute. Its unsuccessful campaign received over $400,000 in donations, much of it from out of state.

The current measure is once again being backed by Novack’s group, which has been renamed Arizonans for Health Care Freedom, in alliance with ALEC and others. The statewide ballot initiative, which would amend Arizona’s constitution, will appear on the Nov. 2 ballot.

ALEC stepped in to support the second go-round not long after Americans elected Barack Obama president on a platform of health care reform. ALEC hopes to use Arizona as a model to block universal health programs across the nation.

The attack on single payer in ALEC’s campaign could be seen as a sign that ALEC views state-based single-payer campaigns as a credible threat to the private insurance companies that help fund the organization. Several states where the ALEC legislation is being introduced have strong single-payer movements that could greatly cut into private insurance company profits if a publicly financed health plan gets passed in those states.

Supporters of ALEC’s Freedom of Choice in Health Care Act argue that the bill is all about the “right to choose” one’s health care coverage. However, if such a bill were enacted in Arizona, its residents would still be unable to freely choose their doctor or hospital. Their choices would be restricted by the private health plan they belong to, plans which themselves are becoming increasingly unaffordable.

In contrast, one of the hallmarks of the single-payer proposal is the guarantee that patients will have full freedom to choose their doctor, hospital or other provider.

The Orwellian title of the bill — “Freedom of Choice in Health Care Act” — is another ALEC hallmark. Much of ALEC’s previous work has involved opposing environmental protection legislation. The deceptively named Environmental Good Samaritan Act, Groundwater Protection Act and the Environmental Literacy Improvement Act were all designed to weaken environmental laws in favor of industry and curtail the regulatory powers of the Environmental Protection Agency.

The council has managed to stay well under the radar of the mainstream media, passing as advocates of “limited government and free markets” in a recent New York Times article. But, in fact, the council is much less concerned with limited government than with bolstering the business interests that fund the tax-exempt organization and vote on its proposals, according to the Nieman Foundation at Harvard University.

ALEC was founded by Paul Weyrich of the Heritage Foundation in 1973 to offer sample legislation to conservative state legislators who would support ALEC’s industry backers. Legislators pay nominal dues to receive trips to conferences as well as model legislation, written courtesy of the big corporations that finance the council. Officially a legislators’ association, membership dues account for only 1 percent of the group’s funding, while donations come from corporations like ExxonMobil and Philip Morris make up much of the balance of the group’s $5 million budget.

Alan Rosenthal, a public policy professor at Rutgers University, told the Washington Post that ALEC is unique in state-legislature lobbying groups in that it allows corporations a direct vote on platform decisions.

In the Clinton era, ALEC championed the interests of tobacco companies R.J. Reynolds and Philip Morris. In the early Bush years, the organization pushed back against environmental regulation and climate change legislation that might hinder the business of key donor ExxonMobil. A recent expose in the Washington Post outlined how ALEC won state legislation in Virginia shielding a single asbestos company from liability in cancer-related deaths.

If the measure passes in Arizona, ALEC has stated that it has model legislation lined up in at least five other states (Indiana, Minnesota, New Mexico, North Dakota, and Wyoming). Bills have been introduced in 24 states to prevent single-payer health care and/or nullify Obama’s insurance mandate. A more limited version of the Arizona ballot measure already passed in Virginia on March 10.

Any state bill written to nullify a federal law such as the insurance mandate would be “constitutionally impossible” and serve as “political theater,” according to Timothy Jost, a Washington and Lee University law professor who wrote on the subject for the New England Journal of Medicine. But that’s not to say it would be shot down without a legal fight. Clint Bolick of the Goldwater Institute told the Boston Globe that he would like to test federal insurance mandates in the U.S. Supreme Court.

In order for a publicly financed, single-payer health system to work effectively and save on administration costs, it must cover everyone. By preventing such a system and enshrining into law the status quo, the “Freedom of Choice in Health Care” leaves Arizonans’ freedom of choice determined more by their income level or their luck than anything else.

Chris Gray is an intern at Physicians for a National Health Program (www.pnhp.org).

Any doctor with a brain and a heart who practices medicine these days has daily experiences with the many disastrous shortcomings of our medical system. As the graph below shows we spend nearly $8000 per person per year on health services involving 18% of our GDP and we have worse out comes. We all know that medical care in the United States is poorly distributed, has less than optimal outcomes, and is hugely expensive.

In the last year we have witnessed a vociferous and prolonged public debate about health care reform – the most vigorous and comprehensive in 50 years. This has had the beneficial effect of bringing knowledge of the failings of our health care system into the daily discussions and awareness of large numbers of Americans. While passage of the resulting legislation seems imminent, the process and the outcome in the public square, while often passionate, have been greatly askew – one could even say deceitful, distorted and ineffective. We all know it is shocking to see the proposed reform revolve around tax subsidized premiums to health insurance companies – which are the source of huge administrative  complexity and inefficiencies, thus wasted monies. It is shocking to listen to national experts tell us that more emphasis on information technology and preventive medicine will go a long way to cure our systemic problems. It is shocking not to hear about the excess burden of disease and mortality born by minority citizens. It is shocking not to hear about the expanding deficit of primary doctors, of the shortage of trained nurses, of the huge debt burden of many medical students, or the excessive proliferation of MRI machines and other profit producing technologies. At the same time it is even more shocking, one might say even repulsive, to hear the shrill and distorted rhetoric of the opponents of health reform – focusing on topics like “love of my insurance company,” “insurance required abortions,” “death panels,” “socialism” and government takeover, denial of care due to recommendations of expert panels using evidenced based medicine studies, and the declaration that the United States can be proud of its exemplary health outcomes. For those of us committed to health reform, it is imperative to review and understand the events and the process of the past year in order to formulate a better strategy for accomplishing the reforms  which will improve the health of Americans at a reasonable cost.

Any analysis of contemporary national public policy on health reform must be based on the insight that the health insurance companies had successfully structured the process in their interest before it even began. Single payer health reform, the elimination of the private health insurance sector, was firmly and totally “off the table” from the very start. President Obama was so opposed to the idea that none of the 140 luminaries invited to the First White House Conference on Health Reform were single payer proponents – until 2 were invited at the last minute after protests were being organized outside. It is important to get past the statistics of the huge amounts of money spent by the health insurance industry on lobbying and campaign contributions, of the many former Congressional, White House, and government officials who became health reform lobbyists. Insight comes when you realize that the chief health aide to Senator Max Baucus, Chairman of the Senate Finance Committee is Elizabeth J. Fowler, JD, PhD, who after serving many years as Health and Entitlements Counsel to the Committee left to become a Vice President of Wellpoint Health Insurance and then returned to the Senate Committee to literally write Senator Baucus’ bill. It would also be prudent to recognize that Senator (fmr D, Conn) Joe Lieberman’s wife was a former health insurance company lobbyist and Senator (D, Indiana) Evan Bayh’s wife was on the Board of Directors of Wellpoint insurance, and so on. All the activists’ efforts to educate, confront or otherwise influence Washington principals, all the think tanks, academics, and accumulated data had a vanishing little impact on the final legislative proposals. It is important to remember that the so-called “public option” was first introduced as a pro-competitive, cost-cutting government program as a practical compromise short of single payer and preserving the private insurance market. This could have had an improved competition in the system and based on market principles had the potential to be a real cost saver. When a study showed that up to 135 million Americans might be eligible and able to choose it, it was quickly disparaged and the insurance lobby saw to it that it was whittled away to an impotent remnant that might cover 5 to 8 million people, and then eliminated. Now we have “Health Insurance Exchanges” which especially if done on the state level will be impotent as well. A brief enthusiastic compromise  effort to expand Medicare to age 55 was snuffed out quietly and quickly by the same insurance lobbyists as soon as it was realized that it could be the first step to universal Medicare.

Toward the fall, the health insurance industry was still anxious about the direction of the legislation and showed its anxiety by conducting and releasing several reports predicting the failure and excessive costs of the then proposed reforms. These reports were so obviously self serving that there was a brief, vociferous backlash. This brought to light the previously neglected, extraordinary fact that the insurance industry, along with baseball, is exempt from federal regulation and anti-trust law. This was due to the McCarran-Ferguson Act  (15 U.S.C. 1001) which was passed by Congress in 1945 to nullify a Supreme Court ruling that insurance could be regulated by the federal government via the Commerce Clause of the Constitution and the Sherman Anti-Trust Act as interstate commerce. This law naturally covered developing health insurance products leaving them to state regulation and supervision. This law also forced health care financing to be subjected to the perversities of ERISA law and to intra-state monopolies by health insurance companies. For a brief moment of anger and insight repeal of McCarran-Ferguson was included in the draft health reform legislation. Then it was quickly and quietly removed.

The idea that the problems with medical care outcomes, or even with health care financing, could be solved by the currently proposed legislation falsely follows the Massachusetts model which is currently demonstrating its lack of cost control, lack of restraint on insurance company behavior, and strain on primary care. The politicians have grabbed a model that optimizes the outcomes for the health insurance companies. L. Randall Wray, an economist at the University of Missouri-KC put it best last October 11, 2009:

“Here’s Wall Street’s newest and bestest gamble: there is a huge untapped market of some 50 million people who are not paying insurance premiums—and the number grows every year because employers drop coverage and people can’t afford premiums. Solution? Health insurance “reform” that requires everyone to turn over their pay to Wall Street. Can’t afford the premiums? That is OK—Uncle Sam will kick in a few hundred billion to help out the insurers. Of course, do not expect more health care or better health outcomes because that has nothing to do with “reform”. …They’ll collect the extra premiums and deny the claims. This is just another bailout of the financial system, because the tens of trillions of dollars already committed are not nearly enough.

“You might wonder about the connection between insurance and Wall Street finance. They are two peas in a pod. Indeed, we threw out the Glass-Steagall Act that separated commercial banking from investment banking and insurance with the Gramm-Leach-Bliley Act of 1999 … that let Wall Street form Bank Holding Companies that integrate the full range of “financial services” such as loans and deposits, that sell toxic waste mortgage securities to your pension funds, that create commodity futures indexes for university endowments to drive up the price of your petrol, and that take bets on the deaths [and health] of firms, countries, and your loved ones. “

In fact, it should have been apparent to anyone who was watching that any movement toward real health reform would peter out and fail after there was a wholly inadequate institutional, political, cultural, and media response to the economic debacle in the fall of 2008. The only major public figure who confessed to a failure of ideology was Alan Greenspan. No other main stream political leader or public institution diagnosed the financial collapse as a total failure and repudiation of the government de-regulated, laissez faire, market driven, profit making, financial institutional dominance political philosophy (facilitated by both the Republican and the Democratic Parties)which had sucked our country into a dark hole. Without a clear and strategic, articulate insight into the nature and breadth of the economic crisis and courageous leadership, real financial and health reform and remediation have been impossible. President Obama selected his financial and economic team from the very Wall Street players who were intimately part of the debacle. Then, as the Republicans have properly observed, unconscionable amounts of tax payer money have been thrown into the banking and finance system with astonishingly little targeting, oversight or fiduciary supervision. And even to this day there has been no legislative reform of the regulation of the financial system, nor substantive governmental intervention in its functioning.  In this context, the barriers to real health reform are only a side show. White House town halls, brief visits to the Cleveland or Mayo Clinics, noting the cost of medical education, discussions about electronic medical records, or primary care deficiencies, or obesity or touting the medical home or preventive medicine were all media enticing diversions and mere window dressing. As finance capital continues to control all 3 branches of our national government, it was to be expected that public policy about health care reform would end up seeking to maximize profits by the insurance industry. As Michael Moore has said, “There has been a coup d’etat in this country and Goldman Sacks won.”

Due to the dominant importance of the financial interests of the health insurance industry (and our politicians’ subservience to them) all of the hard facts, rational analysis, objective national and international data, and all of the reform planning and policy projects – whether in the clinical realm or in the areas of administration and finance – done by the many government agencies, private foundations, academic institutions, grass roots organizations, and think tanks have been basically impotent and irrelevant. The political movers of public policy and, especially, the opponents of reform have studiously avoided dealing with any of the tragic hard facts about the contemporary provision of medical care and its financing. It was painful to hear Senate Minority Leader (R-Kentucky) Mitch McConnell declare, “We have the best health care system in the world.” Or Senator (R-Iowa) Chuck Grassley complain in August that “(You) should not have a government run plan to decide when to pull the plug on grandma.” Or to hear House Minority Leader, Congressman (R-Ohio) John Boehner tell the press, “I’m still trying to find the first American to talk to who’s in favor of the public option….This is about as unpopular as a garlic milkshake.” The Republicans are clearly handicapped by their one note ideological opposition to government agency to solve any problem short of war or protection of the unborn, even in the face of a total objective failure of their philosophy. And the Democrats have become equally impotent by their refusal to acknowledge the fundamental foundational significance and origins of the economic crisis and by their attempts to accommodate and build bipartisanship with the obstreperous Republicans. The Republicans are patently absurd to propose income tax refunds or health savings accounts as the public policy for optimal funding of health insurance for the working poor or the unemployed. It is tragic to see the political leadership of our country so purposefully turning a blind eye to the hardship and suffering of millions of their constituents. It is certainly demoralizing for involved citizens to see our elected officials, whether in support or in opposition, promote rhetorical name calling, deceitful analyses and avoid honest debate on the issues.

It has been even more provocative and threatening to have experienced – as we did this summer – the angry hatred of the so-called Tea Party protesters, the Palin People and their friends. It is crucially important to understand the origin and implications of this phenomenon in order to plan for success in the future. In fact, it is only by understanding their forceful energy and beliefs that we can make any sense of this phenomenon at all. Clearly the issues and fears of these citizens are not based on the facts nor any reality concerning clinical medical care, actual government policies,  or its proposed administration and financing. Furthermore it must be recognized that these protests have been mobilized and magnified with hundreds of millions of dollars from the same well documented vast array of very wealthy donors and foundations (Including the health insurance industry) which have undertaken to destroy good government over the past twenty years. In addition, their vehement disruptiveness and distain for civil discourse has been explicitly and eagerly endorsed by and participated in by the Republican Party itself. One can accept the legitimacy of the vehemence of their  energies, even if it is impossible to agree with the actual content of what they are saying. The content of their fears, and the source of their opposition, is both emotional and ideological. The emotional issues are serious and very important because they fuel their anger and its threat of violence. Their fervor has two sources: (1) the perceived disruption of personal security and the natural order of things created by the election of a Black President and (2) the huge economic dislocations and economic insecurity our country and each family are experiencing at this time. Only by understanding how threatening and tumultuous these circumstances are to those involved can we make sense of the forceful deceived rhetoric and the mass psychology of this summer’s protests. While the racism of these folks has its origin in their primal immaturity and class culture and cannot be excused, frankly it is important to respect their economic fears – and this is crucial for successful health care reform. As will be demonstrated below, the President, both political parties, major cultural leaders and commentators, and most main stream media as well as most bloggers and critics, both currently and in the past, have been desperately trying to get the country to ignore or minimize the economic and social painful transformation and decline of the United States over the past few decades and the tragic harm-multiplier of last year’s economic collapse and its continuing impact. This neglect of our true economic circumstances is analogous the past President’s attempts to minimize the costs of war by forbidding photographs of returning dead soldiers.

GROUPS 1, 2, AND 3 (the top 10% of all income producers) ADD TO A TOTAL OF 50% 0F TOTAL NATIONAL FAMILY INCOME

We must now delve into the suppressed economic circumstances of the contemporary United States. As you can see from the figures above, from 1943 through 1983 our country had a stable sharing and distribution of incomes – and prosperity – which carried us forward from a recovery after a horrible war through the awakening and the challenges of the civil rights movement and beyond.  It was this period which created and supported our cultural self image of a generous, pluralistic, idealistic, humanistic, equitable civil American society. First, note that this graph ends before the additional impact of the current depression. Second, note that the period since 1998 has created a concentration of wealth among the top 1% of families unseen since the years immediately preceding the Great Depression.  And third note that this transformation in our society started in 1983 with the Presidential election victory of Ronald Reagan and the ascendency of the deregulating, laissez faire, anti-government economic philosophy of the Republic Party. Yes, the Tea Party and Palin People folks have every right to be angry. The economic evolution of our country has stolen their birthright and the current economic mess has put the nail in the coffin of their hopes. And it is more than their problem:  while we have been looking the other way, the economic catastrophe of the last 18 months has been destroying the middle class. Today about 20% of Americans are unemployed, underemployed, or stopped looking for work. In the past decade the United States economy has had zero net job creation. Almost 10% cannot make the minimum payment of their credit cards; 12.5% are on food stamps (over 37 million people). A total of 10,000,000 Americans may lose their homes (6.2% of mortgages are in default). The current economic depression has wiped out $5 trillion in pensions and savings assets and another $13 trillion in housing assts. In 2008 median household income, adjusted for inflation, fell 3.6% to $50,303, the steepest drop in 40 years. The poverty rate in 2008 rose to 13.2%, the highest since 1997. And about 700,000 more Americans did not have health insurance in 2008 than in 2007. It goes without saying that the data for 2009 when it is in will be much worse.

If this shocking description does not motivate you to want to join the outrage of the Tea Party and Palin People, let me introduce you to a statistic called the Gini coefficient. This is a statistical index which can be used to quantify the level of income or wealth inequality in a country. It is compiled by such organizations as the United Nations and the CIA.  Sweden captures the “world’s best” title (with an index of 23 (CIA) or 25 (UN). It keeps company with countries like Denmark (24), Austria (26) and Belgium (28). The average EU index is 31; Canada has an index of 32; and Great Britain has an index of 34. Before the current economic turmoil the United Sates had an index of 47 (its highest ever) and it keeps company with countries like Cameroon (44.5), Jamaica (45.5), Mexico (46.1), and the People’s Republic of China (46.9). Yes, while you weren’t looking our country has been turned into a banana republic. The ascendency of Wall Street, the crash of 2008 and the failure of health reform are prime symptoms of a much bigger problem. One way to look at the angst created by the gap between President Obama’s charisma and rhetoric and his performance in office is to see that it reflects our gut feeling that our Country has been taken in the wrong direction into a period of massive decline.  We are responding to his abject failure to acknowledge these tragic facts and lead us in a better direction. Even worse – and his paradigm of health care reform proves it – he has chosen to kowtow to the interests of the financial sector.

Because these economic circumstances are so different from the prosperity of the sixties, contemporary political activism must use different strategies and tactics to achieve our aims. It is myopic and fraught with failure to merely pursue health reform in the era of what Kevin Phillips calls the rule of the plutocracy. This country needs a more fundamental transformation. Many Americans do not yet feel the anguish and failure in their gut like the Tea Party and Palin People folks but there is every reason we should. If we look at the Palin People and Tea Party as alien, we can see the seeds of fascism in their alienation and anger, similar to that experienced in Germany, Italy and Argentina before their takeover by the far right. On the other hand, if we identify with their distress – and get past our still relatively comfortable circumstances – we will have allies in taking our country back. We cannot be limited to our rational, professional analyses. Facts and data will not rule the day. There is no rational, beneficent debate going on. It has become clear and evident that all the foundation work, all the macro and micro system modeling, all the vital statistics of health outcomes and service maldistribution, all the shocking case studies, all the bankruptcies, and the morbidity, not to mention, mortality statistics have had little impact on the outcome of last year’s health reform process.

These observations lead to two complimentary paths which will help further the achievement of real health reform. For make no mistake about it, it is highly likely that the currently proposed federal legislation, if it is passed, will not greatly improve medical outcomes, will be an unacceptable financial burden both on individual families and on individual state and federal governments, and will not eliminate the horribly expensive administrative inefficiencies of our current private health insurance based system. Thus it is likely to become highly unpopular and its impact will further erode faith in government agency and the Democratic Party. Our approach to the current circumstances needs to be more strategic, more tightly organized, facilitated by better communication and coordination, and directed toward mobilizing a broader army of reform activists. First, working within the political system, we should focus on the strategy of creating state based initiatives to legislate state single payer systems. The practical fact is that at this time of economic contraction each and every state will be desperate for truly budget saving measures – and because of Medicaid and public employee health costs, real health reform will have major beneficial outcomes. The specific goal should be an amendment to the federal ERISA law to permit states to develop their own single payer systems. This focus will both continue to highlight the fundamental target in the health system debacle – the insurance companies – and energize political action at a level that is more strategically amenable to grass roots impact.

The second path of action lies in dramatically changing the tactics of progressive reform advocates. To put it plainly we must transcend our reliance on facts and data and get out there with an emotional message and captivating activities. As health care providers doctors and other practitioners are taught to maintain a professional demeanor and to maintain an emotional distance from their patients’ suffering and, furthermore, at the core our technical skills are based on analytical knowledge. It is obvious that carrying these habits into the political arena has not been effective. We have to catch up to our opponents – first in the passionate expression of the anguish and suffering that is abroad in the land and secondly in the enthusiastic demand for political attention. It is evident that physicians and nurses alone cannot create the momentum for change. We must actively recruit our own patients who have suffered the shortcomings of the system in large numbers as well as the staffs of institutions serving the underserved, such as municipal hospitals and free and community clinics, and those religious who will stand up for social justice. This outreach must occur in an on-going organized way so that we can create a critical mass. We cannot effectively bring our insights to the public square without a broader coalition at our side. Along with those mentioned above, the Tea Party and Palin People are, in fact, our allies and constituents, for it is they – whether rural plain folk, farmers, manual service workers, employed poor, family shopkeepers, restaurant servers and so on – who are most severely impacted by the expensive, poorly functioning health care system and by our failing national economy. And you can bet they are about to be joined by hordes of former middle class folk. Their conventional wisdom, that government is the problem, just happens to be wrong. We are now in an era of catastrophic decline and disarray generated by 30 years of the dominance of that political philosophy. It has dramatically failed. The alternative conservative or libertarian model of Individual and independent initiative surely will not be enough to solve these problems. We must reach out to fundamentalist churches, talk radio and other conservative media, for example, to respect their anxieties and debate their political paradigm. We need to broadly mobilize as many of these disaffected citizens as we can. We must directly challenge the conservative religious activists morally devoted to protecting the life of an unborn child to see that their morals must encompass and give priority to the duty to relieve the suffering of the living. Collective communal action through an effective democratic government is the major prerequisite for successfully solving our economic problems as well as the expensive dysfunction in health services. The only way forward on health reform is to correctly diagnose the massive economic disaster that has befallen our country and create an integrated, energized broad coalition to implement political change. Those professional groups, those labor unions, those in progressive political organizations must not only unite, but also reach out to enroll and involve the disaffected among us. Then we will be successful.

We recently interviewed Dr. David Himmelstein and Dr. Steffie Woolhandler, co-founders of Physicians for a National Health Program (PNHP), about the health bills emerging in Congress and the status of the movement for single-payer Medicare for All. Both are faculty members at Harvard Medical School and primary care physicians at Cambridge Hospital in Massachusetts. The telephone interview took place on Nov. 30, several weeks before the Senate adopted its version of the bill. On the eve of the Senate vote, PNHP called for the defeat of the bill, saying it would do more harm than good and that it would make genuine reform more difficult in the future.

PNHP: What’s your assessment of the health legislation that is emerging in Congress?

DAVID HIMMELSTEIN: The bills are largely a sideways move. They will have very little impact on resolving or stabilizing the health care system. They improve things for some people and make things worse for some people.

For example, some poor patients or near-poor patients would benefit from federal subsidies for private insurance or by getting Medicaid, which they’re presently not eligible for. That would be an improvement.

However, patients who remain uninsured – and there will be at least 17 million of them – would probably see the resources available to them dwindle, because the bill takes part of its funding out of the hides of safety-net hospitals. Part of the proposed Medicare savings is derived from decreasing the funding for hospitals that care for a lot of poor, uninsured patients. So, for the remaining uninsured, the safety net would be even more threadbare than it is now.

Another example of an adverse impact: young people who have private coverage today would have to pay higher premiums because of the limits on premium differentials on age.

Almost no one would see an improvement before 2013 if the House version is passed, or 2014 if the Senate version passes. One thing is certain: the bills would entrench the insurance industry and pharmaceutical industry even further in their control of the health care system.

STEFFIE WOOLHANDLER: I guess the way I’d summarize it is that some patients would be better off, some would be worse off, but what is completely clear is that this is not a solution.

DH: The private health insurance industry would be very much strengthened with $500 billion in new money coming their way, much of it in the form of public subsidy. And the pharmaceutical industry, similarly, would be getting more money – again, much of it from the public treasury. So those industries would be financially stronger.

PNHP: But aren’t the private insurers and Big Pharma complaining about the bills? Doesn’t that suggest there’s something positive for patients in them?

DH: The pharmaceutical industry hasn’t been complaining much, really – only a little around the edges. In fact they’ve been running television ads in some places supportive of the administration’s proposals. As for the insurance industry, they’ve traditionally taken the tack that they’ll never settle for half the pie. They always want the whole thing. They want the $500 billion in government subsidies without any of the very modest incursions on their business practices that are in the bills today.

PNHP: To what extent does the national legislation follow the Massachusetts model?

SW: I think the national plan is like Massachusetts. If anything, the national plan is a little bit worse, in that in during the first three years of the reform in Massachusetts, the insurance exchange offered only nonprofit subsidized plans. The national bill will mostly offer for-profit plans, maybe exclusively so.

The other thing is that the Massachusetts plan went into effect right away, so whatever benefits it contained were actually there at the beginning – you didn’t have to wait three or four years for them to kick in.

Yet another difference, according to press reports here, is that the subsidies in the national bill are likely to be lower than they are in Massachusetts. I haven’t seen the details on that, but that’s what’s being reported. The subsidies in the national bill will be less than what we presently have in the state.

DH: Keep in mind also that Massachusetts started from the vantage point of having the lowest uninsurance rate in the country. The 2006 reform cut it roughly in half. We also had and still have a tradition of quite generously funding the safety net in the state, although that’s been cut back as part of the state legislation. So the access to care was better in Massachusetts than almost anywhere else in the country before the reform.

We won’t be starting from nearly as good a position nationally, so what we arrive at on the national level is certainly not going to be as good as what we’ve got in Massachusetts.

That said, on the ground in Massachusetts things are not so rosy. We still have more than 300,000 people uninsured in our state and face grave difficulties in getting care for them. In fact, access to care for them is worse now than before the reform was passed, because the institutions that provide care for the uninsured have seen very sharp funding cuts.

We’re now beginning to see cutbacks in coverage because of the very high costs of implementing the plan. Some 30,000 immigrants – these are legal immigrants – have seen their rights to care sharply cut. Co-payments have risen and premiums are continuing to rise quite sharply in the state. A number of patients who were entitled to free care under the old Massachusetts free care system now face quite steep out-of-pocket costs.

The other thing worth saying is that the Massachusetts reform has done nothing for the vast majority of people who had insurance at the outset but were strained financially by the premiums and out-of-pocket costs. They continue to face great difficulty.

So, after an improvement in the first year in access to care in Massachusetts, things have now started to reverse. And the fiscal strains on the state and the program promise to make things even worse in the near future.

PNHP: How much has the Massachusetts reform cost? Is the plan financially solvent?

SW: That’s a very politically contested subject. The actual cost of the state reform is one of those very hot-button numbers. If you include the total cost to everyone in the state, public or private, you’re looking at a figure about $1 billion a year higher than it would have been without the reform. So public and private costs combined have been driven up health spending by more than a billion annually.

DH: The Congressional Budget Office estimates that nationally it costs $4,000 to insure someone, and I think that’s likely true in Massachusetts as well. The reform insured about 300,000 people, so you get a figure like $1.2 billion, but exactly where those costs have fallen is very difficult to track down because the state budget has obfuscated that enormously.

There’s also been a large dollop of federal money coming into the state in partial support for the plan. State officials claim, “We’ve only spent $300 million or $400 million a year on it,” but that excludes the federal funding. And, as part of the stimulus package, there was actually an increase in the federal matching rate for Medicaid – it went from 58 percent to 62 percent of every Medicaid dollar coming in from federal sources – and that wasn’t just for the newly insured, that was for all Medicaid patients.

So there’s been a large infusion of new federal funds that have helped to keep the plan afloat. Exactly how much of that is attributable to the reform is hard to track down. And as to private spending, we won’t have exact figures on that for another year or two, because the state doesn’t really track it and the feds won’t have their numbers out for another year or two.

PNHP: How do you reply to people who say, “Yes, the bill that’s emerging in Congress is flawed, but it’s a start and it can be improved upon later, just like Medicare was”?

DH: Historically, the way we’ve made progress in health reform has not been by incremental steps, but by major steps at propitious moments that often, in the ensuing years, get eaten away.

We haven’t actually been able to enlarge on many improvements in Medicare, and it has really been largely eroded since it was first passed, not pushed forward.

SW: Medicare has certainly been eroded since the late 1970s. After it was passed and the program took form, Congress actually extended Medicare to two additional groups in the 1970s – people with end-stage renal disease and people who have been totally and permanently disabled for more than two years. But in terms of what the program offers, it was never actually improved on, and even in terms of the number of people covered, there have been no improvements since the late ’70s, just an erosion of it.

DH: And whereas Medicare was a fully public program at the outset, the “private option” has been added to Medicare in the last few decades. It’s gone from being a sort-of-single-payer system for the elderly to being a public option program that is unfairly competed against by private insurers who receive extra government subsidies.

PNHP: But some people say that, politically speaking, the Obama administration needs to have a victory on this front, even if it is imperfect. It’s the administration’s momentum that’s important. What do you say to that?

SW: I think there’s two ways for the Obama administration to fail. One way would be to fail to pass any legislation, and the other would be to pass legislation that is worthless, that doesn’t solve the problem.

If you don’t pass legislation, at least you can blame the Republicans the next time around. If you pass something that doesn’t solve the problem, you’ve failed and plus you’re in much worse shape than you would have been otherwise.

DH: It’s like saying if Roosevelt had passed a fake Social Security bill, that that would have sustained the momentum of the Roosevelt administration. In fact, people would have eventually understood that a fake Social Security bill wasn’t real. Similarly, people will understand in 2014, when this bill finally comes into effect, that the Democrats passed a piece of legislation that was nearly worthless. To stake the future of progress on a piece of Potemkin-village-like legislation, a fake front, is a dangerous game to play.

PNHP: What’s your reaction to the Stupak amendment in the House bill restricting insurance coverage for abortion?

DH: It’s completely unacceptable as part of the bill and it signals several things. One is that the right has been perfectly willing to hold people hostage to its ideology, whereas progressives by and large have not. But the second is that, under any health reform, we’re going to have a huge fight to preserve the right to choose. That’s going to be true under single payer as well: we’re going to have to defend the right to choose over and over again and keep pushing on.

PNHP: Some people say we should embrace a highly regulated system like Switzerland or Germany has instead of adopting single payer. Others suggest gradually lowering the eligibility age for Medicare as a stepping stone to single payer.

DH: These proposals are based on the presumption that politically it’s easier to do lesser measures than single payer. I think the behavior of the insurance industry in the current round of debate suggests that’s actually a false precept. Even the most minor regulations have evoked enormous opposition from the insurance industry.

So, for example, the view that we can completely change the nature of the insurance industry but leave them in the health care system and that that’s going to mollify them – that we’re going to turn them into extraordinarily tightly regulated, not-for-profit organizations whose executives can’t be paid extraordinary sums, whose shareholders receive no compensation, whose behavior is really completely different than their behavior today and that somehow that will attenuate their political opposition – I mean even the most minor regulations in the current bill have been enough for them to come out and oppose it, despite getting an extra $500 billion from it.

I think the view that, politically, we head off their opposition in this way is demonstrably incorrect. This gives rise to two additional questions. First, if the opposition from the insurance industry to these lesser measures is every bit as strong as it is to single payer, are we likely to enlist a much larger number of people to win that sort of reform? I think answer to that is, probably not. There’s not a strong principled group of people saying, “We want a German-style system rather than national health insurance.”

The second question is: Does it work better as policy? That is, which system ultimately works better once you get it in place? There I think the answer is demonstrably clear that in a single-payer system you get more and better care for people than any given amount of money you spend than under one of these regulated systems like what T.R. Reid has been speaking about, for example the German system or the Swiss or Dutch systems.

The political compromise that some people suggest doesn’t get you very far politically, and the policy compromise gets you a worse health care system.

On reducing the Medicare eligibility age to 55, where it’s done automatically for everyone in that group (as opposed to a so-called buy-in, which would create very big problems), in some ways it’s a similar calculus. Do you really substantially reduce the political opposition? I would say probably not. The policy is a little different, because it’s a better policy than going to a regulated system, but the problem there is that until you get everybody in, you don’t get many of the financial advantages of a single-payer system. And as you phase it in, you’re adding money in order to keep the system afloat and only at the end of that process do you get the savings that make it financially viable. So the phase-in is really a big problem.

PNHP: What should supporters of single-payer health reform be doing during this period?

DH: One very important task for single-payer people is to make it clear to others that this bill is not ours, and that this reform is not real health reform. Then, when it’s passed and fails, we need to make it clear that Congress and the administration never did health reform, not that health reform didn’t work.

Until the bill is finished being debated, the one piece of salvage that would be worthwhile at this point would be for Congress to adopt an amendment allowing individual states to experiment with their own single-payer systems should they choose to do so. Rep. Dennis Kucinich is trying to get his state single-payer amendment back into the bill; Sen. Bernie Sanders has something similar on the Senate side. The message to our lawmakers would be something like, “We think this is a horrible bill. Can’t you at least get the option for our state to do better?”

PNHP: Are you worried that the single-payer movement will turn away from national legislative efforts and instead focus on state-based campaigns?

SW: I don’t worry about that because the state work and national work are complementary. I think we do need a national single-payer bill, so I hope people don’t think we should abandon the idea of national reform. But working at the state level can help build the knowledge and movement that can get us to single payer nationally.

DH: Steffie is from Louisiana and, as she’s fond of reminding me, if Louisiana is ever going to have decent health care program, we can’t do it state by state.

PNHP: How would you assess PNHP’s and the single-payer movement’s efforts in this round of reform? What has been most effective in advancing cause – lobbying, testimony before Congress, civil disobedience, rallies? What lessons do you draw?

DH: All of those things have been effective, except for the testimony, to be honest. The testimony is the result, not the cause, of such activity. When Congress asks people to come testify, that’s a signal that they’ve been getting pressure from below.

The mobilization in communities around the country, particularly some of the dramatic activities like civil disobedience and the Mad as Hell Doctors’ caravan – especially when they attracted media attention – have been quite effective.

But I think that the lesson is that we haven’t built nearly a big and strong enough movement. And it’s not just in health care, frankly – we need a movement that takes back the country in many respects and that goes beyond health care. Health care is going to be an important part of it, but I think having organizations throughout the nation that are pressuring our political leaders in a much more serious way than we’ve even been able to do in this round of pushing for single payer is clearly going to be essential. That’s the message for us now, and if the next debate about health reform is five or seven years from now, that’s how long we have to really build a movement five times as large as what we have.

SW: It will take a much bigger movement to take back power from the corporations, who are now actually running the country.

DH: The nation’s political process needs to be responsive not just to corporate power. And at some level single-payer forces should unite with folks who say we need much more regulation of the financial sector, for example, and of many other aspects of life.

PNHP: Has PNHP been growing and if so, why?

DH: PNHP has been growing. Doctors have a different perspective on this than politicians. We’re in this for our whole careers, and the fact that the health reform debate may die down for a couple of years doesn’t actually mean we go on to another issue.

We’re in this issue for life, and if the health care system would let us do our work and accomplish with our patients what we want to accomplish then the need for PNHP would evaporate and we would close down. But unfortunately that need continues to mount. That means that doctors – more and more of us – feel the need to be active. And that’s not going to go away when the Congress stops debating this issue actively.

Yes, there will be some disappointment if a bad bill is passed, and a feeling of regret that the issue is not being debated as actively as one would want, but I think within the medical profession it’s clear that the urge for reform is going to continue and likely strengthen through time because the situation is continuing to get worse for our patients and our work.

PNHP: What’s behind PNHP’s tenacity for these 20-odd years?

SW: I think the health system’s problems have continued and in some ways mounted, but our members are people who actually work every day in health care, so it’s not like people move on to some issue like world peace, however valuable that might be. These are people whose lives are in the health care system, trying to take care of patients.

DH: We actually don’t have alternatives. One can work on world peace and on issues we face in our everyday work, but unless you’re going to say, “Well, I spend 55 hours a week in a terrible health care system and I’m going to ignore that,” I think doctors of conscience increasingly feel driven to do something about the distortion and corrosion of their work.

PNHP: You’ve been extremely prolific in your research this year, publishing seven or eight studies, including one showing that 62 percent of personal bankruptcies are linked to medical bills or illness, and another showing that 45,000 deaths annually are linked to lack of health insurance. How do you evaluate the impact of this work?

DH: The research is the product of a research team that includes several colleagues — Andy Wilper, David Bor, Danny McCormick and (for the bankruptcy study) Deborah Thorne and Elizabeth Warren. Obviously the circumstance of the nation being very actively focused on health reform is part of the reason why the research has received so much media attention.

But while we’re gratified that the work has been useful in helping to open debate, the actual use of the findings by politicians – the arguments that they’ve made with the data – have often been very disappointing.

I think Steffie has remarked that the work has helped push the wagon of health reform forward, but someone else has been steering the wagon in a very different direction than we would want it to go.

We’ve tried to highlight the major problems in the health care system and some of the reasons why the alternatives to single payer won’t work. The pieces that highlight the irrationality and the problems of the health care system have gained attention, but the pieces that speak to why the alternatives won’t work have been selectively ignored.

SW: Some politicians love to bring in the left or the left-liberals to create research and create a movement and create some energy, but that’s pretty different from then putting you in charge of things and letting you make decisions.

PNHP: Are there any final comments you’d like to make?

DH: One thing that has been striking in this year’s push for single payer has been the tremendous degree of cohesion and the sense of camaraderie within PNHP. That’s somewhat different than the feeling during the 1993 round of health policy debate, where there was more controversy within PNHP and, frankly, within the single-payer movement. At that time, some colleagues were saying we had to stop pushing for single payer and hop on board the Clinton health plan.

There’s been a very clear-eyed sense and consensus within the organization that our role is to say what’s right in this debate and to bring forward a principled stance and not to play political games that end up with disastrous consequences.

It’s also gratifying to see how PNHP has helped create a platform for people to speak in their communities and speak in public and really use their creative energies in a progressive way on health policy, as has been amply demonstrated in this round of debate. There’s no way we could have raised enough money to do the work that PNHP members have done on a volunteer basis. The organization is there to provide resources and opportunities to work, and our members have taken advantage of those opportunities in extraordinary ways.

Fifty-nine members of the Harvard Medical School Class of 1959 are convinced that reform of the American health care system is essential, must be substantial and carefully designed, and must include a public health insurance option.

We present our position in this statement, a result of intense discussions begun at our June reunion commemorating 50 years since graduation. We are a majority of our 112 living American classmates. Six declined to sign the statement because they disagree with it, 3 more because it is not detailed enough, and 44 expressed no opinion.

Each of the signers has 50 years of experience and leadership in clinical practice, medical education, administration, and/or research. Our collective careers cover a wide variety of primary care and specialty fields in a range of organizational settings, in both private practice and academia, across the United States.

We believe that our humane and enlightened country, committed to “life, liberty and the pursuit of happiness”, has the obligation to provide everyone with the opportunity to obtain affordable insurance and quality health care.

We support President Obama’s proposal that all citizens should be offered the option of a government-sponsored medical insurance plan, along with private options. In our opinion, health care reform will fail without the discipline of competition from a public option.

Excluding a public option would throw away a vital opportunity to test different ways to provide quality care for all. A public plan would help develop and evaluate new standards of practice, malpractice reform, and reimbursement of physicians, and would emphasize preventive care. To be affordable, it would have to avoid financial incentives for unnecessary services and contain measures that curb financial abuse and waste by some hospitals and, unfortunately, by some of our medical colleagues.

A public option would also identify and encourage use of demonstrated best practices shown to be effective at less cost, offer greater access, and provide higher quality of care. Administrative overhead, as now in Medicare, would be significantly lower without for-profit intermediaries. These innovations could help lift the competitive burden that health care places on American employers in the global marketplace, while also offering portability and continuity of coverage during job changes and illness.

Common sense demands a planned, full comparison of the relative benefits of public vs. private options. At the outset, there must be clear and uniform ground rules for measuring, reporting, and evaluating cost, access, and quality of care for all plans.

We urge Congress and the President to take this courageous step at a vital time in our nation’s history.

Names and relevant positions of signers are attached. This statement represents only their opinions, not necessarily those of other 1959 graduates of Harvard Medical School or of that institution.

CO-SIGNERS, HARVARD MEDICAL SCHOOL CLASS OF 1959

Norman O. Aarestad, M.D., F.A.C.R.
Radiation oncology, retired
Denver, CO

Eugene M. Abroms, M.D.,
Formerly Prof of Psychiatry,
University of Wisconsin Medical School
Ardmore, PA

Robert S. Adelstein MD
Bethesda, MD

James E. Barrett, M.D.,
Research Professor Emeritus of Community and Family Medicine and Psychiatry,
Dartmouth Medical School
Hanover, NH

Harvey H. Barten, M.D.
Psychiatry
Scarsdale, NY

Costan W. Berard, M.D.
Formerly Chairman, Department of Pathology and Laboratory Medicine,
St. Jude Children’s Research Hospital,
Past President, United States and Canadian Academy of Pathology,
St. Helena Island, SC

Robert S. Blacklow, M.D.
Formerly Dean, Northeast Ohio college of Medicine
Currently, Department of Global Health and Social Medicine,
Harvard Medical School
Lincoln, MA

Forst E. Brown, M.D.
Professor Emeritus of Surgery,
Dartmouth Medical School
White River Junction, VT

Charles E. Burden, M. D.
Pediatrician,
Bath, ME

Boyd R. Burkhardt, M.D,
Clinical Plastic Surgeon,
Tucson, AZ.

Savelly B. Chirman, M.D.
Internal Medicine, retired
Santa Barbara, CA

Norman A. Clemens, M.D.
Clinical Professor of Psychiatry,
Case Western Reserve University School of Medicine,
Cleveland, Ohio

Richard E. Conway, M.D.
Orthopedic Surgery
Rockport, MA

Richard W Darrell, M.D, ScD
Clinical Professor Emeritus of Ophthalmology,
Columbia University
Fort Myers, FL

Donald E. Dillon, M.D.
Hematology/Oncology, retired
Ocean View, DE

Hall Downes, M.D.
Professor Emeritus of Physiology and Pharmacology,
Oregon Health Sciences University
Portland, OR

Karl Engelman, M.D.
Professor Emeritus of Medicine,
University of Pennsylvania
Hilton Head, SC

Charles J. Epstein, M.D., D.Sc.(h.c.)
Professor Emeritus of Pediatrics, , and
Former Director of the Program in Human Genetics,
University of California School of Medicine, San Francisco
Tiburon, CA

Lois Barth Epstein, M..D., D.Sc.(h.c.)
Professor of Pediatrics, Emerita, and
Former Director of the Tumor Immunology and Interferon Laboratory,
Cancer Research Institute,
University of California School of Medicine, San Francisco
Tiburon, CA

Gerald C. Finkel M.D.
Clinical Professor of Pathology,
Univ. of Washington
Seattle, WA

Frederick B. Glaser, M.D., F.R.C.P. (Canada)
Professor Emeritus of Psychiatry,
Brody School of Medicine, East Carolina University
Greenville, NC

Warren M. Gold, M.D.
Professor of Medicine,
University of California, San Francisco
San Francisco, CA

Robert A. Goldstone, M.D.
Orthopedic Surgery
Glen Rock, NJ

Anne M. Haywood, M.D.
Associate Professor of Pediatrics and of Microbiology & Immunology,
University of Rochester
Rochester, NY

Arthur L. Herbst, M.D
Joseph B Delee Distinguished Service Professor Emeritus,
University of Chicago
Chicago, IL

Kenneth Herrmann, M.D.
Research Virologist,
Centers for Disease Control & Prevention, retired
Atlanta, GA

David Korn, M. D.
Vice Provost for Research,
Harvard University
Professor of Pathology,
Harvard Medical School
Boston, MA

Anton O. Kris, M.D.
Clinical Professor of Psychiatry,
Harvard Medical School
Cambridge, MA

Nelson R. Lampert, M.D.
Clinical Professor of Surgery, retired
University of California, San Francisco
Ross, CA

Lucian L .Leape, M.D.
Adjunct Professor of Health Policy,
Harvard School of Public Health
Cambridge, MA

Cavin P. Leeman, M.D.
Clinical Professor Emeritus of Psychiatry,
SUNY Downstate Medical Center
New York, NY

Herbert Lessow, M.D.
Psychiatry
New York, NY

John T. Maltsberger, M.D.
Associate Clinical Professor of Psychiatry,
Harvard Medical School
Boston, MA

Ira Marks, M.D., F.A.A.P.
Pediatrics, retired
Old Chatham, NY

Kilmer McCully, M.D.
Chief, Pathology and Laboratory Medicine,
VA Boston Healthcare System
Winchester, MA

John F. Merrifield, M.D.
Psychiatry, retired
Lexington, MA

Eli C. Messinger, M.D.,
Formerly Clinical Associate Professor of Psychiatry,
New York Medical College
New York, NY

Roger V. Moseley, M.D.
Formerly Asst. Clinical Professor of Surgery,
College of Medicine and Dentistry (NJ)
Princeton, NJ

J. David Poutasse, M.D.
Radiology, retired
Pittsfield, MA

James W. Prichard, M.D.
Professor Emeritus of Neurology,
Yale Medical School,
West Tisbury, MA

Judith L. Rapoport, M.D.
Washington, DC

Stanley I. Rapoport, M.D.
Washington, DC.

George D. Raymond, M.D.
Gastroenterology, retired
West Palm Beach, FL

William Reed, M.D.
Internal Medicine, retired
Albuquerque, NM

Richard S. Rivlin, M.D.
Formerly Professor of Medicine, and
Director, Career Development Program,
Nutrition and Cancer Prevention,
Weill-Cornell Medical College
Scarsdale, NY

John J. Roach, M.D.
Seattle, WA

Norman Robbins, M.D., Ph.D.
Professor Emeritus of Neurosciences,
Case Western Reserve University School of Medicine
Shaker Heights, OH

Irwin H. Rosenberg, M.D.
University Professor and Dean Emeritus,
Tufts University and Friedman School of Nutrition Science and Policy
Boston, MA

David Rush, M.D.
Professor Emeritus of Nutrition, Community Health and Pediatrics,
Tufts University
Cambridge, MA

Kevin G. Ryan, M.D.
Radiologist, retired
Port Ludlow, WA

Richard G. Sanderson, M.D.
Cardiothoracic Surgery, retired
Tucson, AZ

Paul E. Sapir, M.D.
Clinical Assistant Professor of Psychiatry & Human Behavior,
Warren Alpert Medical School, Brown University
Providence, RI

Peter B. Schneider, M.D.
Professor of Medicine and Radiology (Nuclear Medicine),
University of Massachusetts Medical School
Worcester, MA

Richard Lee Schoenbrun, M.D., Ph.D.
Psychiatry, San Francisco Community Mental Health Center
Belvedere, CA

Gordon M. Shepherd, M.D., D.Phil.
Professor of Neurobiology,
Yale University School of Medicine
Hamden, CT

John J. Soltys, M.D.
Professor of Psychiatry, retired
Univ. Of North Carolina Medical School
Chapel Hill, NC

Bruce W. Steinhauer, M.D.
Professor, Internal Medicine,
College of Medicine of the University of Tennessee
Memphis, TN

John Urquhart, MD, FRCPE, FAAAS, FRSE
Emeritus Extra-ordinary Professor of Pharmaco-epidemiology,
Maastricht University (Netherlands)
Adjunct Professor of Bioengineering and Therapeutic Sciences,
Center for Drug Development Science,
University of California San Francisco Medical Center
Chief Scientist, AARDEX Group
Palo Alto, CA

Elliot S. Vesell, M.D., Sc.D.
Founding Chairman of Pharmacology,
Evan Pugh Professor of Pharmacology,
Pennsylvania State University College of Medicine
Hershey, PA