[Editor’s note: you can follow these updates on a daily basis at madashelldoctors.com.]

California Road Trip, Day 9, Santa Barbara
October 1, 2010

By all accounts, last evenings presentation in Santa Barbara was packed and powerful. The “local” speakers were superb. I wasn’t there. I rejoined the MAHD California road trip today, after three days at the American College of Emergency Physicians meeting in Las Vegas, where I was startled by the number of docs who hadn’t heard of PNHP. There were a few (very few) talks of relevance to health reform, but I had the extreme pleasure of hearing ER Dr. Brent Asplin, from Minnesota, in a very well attended session, addressing the question, “How do we get VALUE for all the money were are spending on health care?”… and then go on to say, “The problem is cost. The solution is organization.” He stresses, as a society, we will never get value for our money unless everybody is covered. The cost of caring for people before they get sick is trivial compared to treating them after they fall into the ranks for the ill.

When a portion of the population isn’t “covered,” the hidden and not so hidden costs, both financial and social, to everybody are substantial. Though he didn’t mention single payer, he appears to make a case that without an inclusive, real system, we will never find value and never control costs. And how will we EVER find value while we literally waste 20-25% of ALL our health care dollars servicing the insurance industry that adds nothing to health and complicates the lives of those who actually care for you?

On the escalator, after the talk, I asked an older doc, even older than I, what he thought. With great angst, he stated, “Whenever we mix money, politics and medicine, we will get nowhere. I used to care. Now, I am just trying to finish my career.” I identify with his despondency, but can we really afford to not care?

-paul hochfeld

California Road Trip, Day 8
September 30, 2010

Sarcastic News Flash!!! Insert tongue into cheek now.

Today we learned from our friends in San Luis Obispo that California has solved the problem of obtaining health care for their 6.5 million uninsured and their millions of underinsured! Two days ago the Governator signed into law a bill that allows health care clinicians from out of state to come to California to provide free medical care, just like clinicians do in other third world countries.

This legislation was sparked by the group Remote Area Medicine who first brought their medical and dental teams to Los Angeles last year. On the first day, they were overwhelmed as thousands of people lined up at their door. Many of the people who showed up had insurance but had found that they still couldn’t afford necessary care. Welcome to third world America!

But let’s get serious, the news isn’t all bad. Our experience in San Luis Obispo is that this is a passionate community of physicians and health advocates. We had lunch with 4 local doctors who wanted to learn more about single payer. One doctor had spent the past ten months organizing a comprehensive free clinic for the community.

Our forum at the local library was attended by over 120 people who shared their caring and their stories with us. One physician told us that he was happy to be employed by the state prison system. The pay is good and he can focus on taking care of his patients without insurance company hassles. He reminded us that prisoners cannot legally be denied necessary medical care, unlike those outside of prison. He was able to spearhead an initiative to ban all tobacco products in the prison which resulted in a 40% decrease in referrals to cardiologists. Oh the horrors of socialized medicine!

We need a health care system that is universal and promotes preventative measures to improve health, just like those in the California prison system. We need single payer now.

California Road Trip, Day 8, Las Vegas
September 30, 201

Special report from Paul Hochfeld…

Since when is Las Vegas in California? Explanation. After the Santa Cruz event, I left the Road Trip for three days to attend the American College of Emergency Physicians meeting, in Las Vegas, where PNHP has a table among the other “exhibitors.” Every so often, a supporter shakes our hands then shakes his/her head in agreement, “We didn’t fix it, did we?” Occasionally, someone questions, “What are you selling?” We explain the history and purpose of Physicians for a National Health Program. Single payer supporter or not, every doctor agrees that our sick care non-system is profoundly broken.

The Exhibit Hall

Vegas is surreal. The exhibit hall is equally surreal. Our humble PNHP table is surrounded by multi-hospital emergency groups (who charge local groups up to 32% for “management fees”), billing/coding companies, drug pushers, purveyors of a variety of software packages, and assorted medical gizmo manufacturers.

“Vendors” use every trick imaginable to seduce emergency physicians to ask about their wares. Examples includes shapely ladies (of course), free ice cream serves by a ’50s era candy store owner, raffles, and plenty of other giveaways, including the usual pens, bags, candy, coffee, and water bottles. The most insulting was the Elvis impersonator bedecked with sequins! That’s the depths to which our sick care non-system has sunk.

Their shared goal is to “game” the system to maximize collections from patients and third party payer. More revenue for providers translates into more money to share with those providing products and services to physicians. Sadly, the complexity of dealing with fourteen hundred insurance carriers makes so many of these vendors valuable. After all, health care is a commodity and the goal is maximum profits.

I rejoin the MAHD Road trip tomorrow night after our Santa Barbara presentation. We will “lose” Margaret Flowers on Friday, but Carol Paris, also of Baucus Eight notoriety, will join us for several presentations in the L.A. area. We’re like a well oiled machine with replaceable parts.

California Road Trip, Day 7
September 29, 2010

“The evidence is conclusive that our people do not yet receive all the benefits they could from modern medicine. For the rich and near-rich there is no real problem since they can command the very best science has to offer.… Among the majority of the population, however, there are great islands of untreated or partially treated cases.…Although it is a principle of far-reaching and, perhaps, of revolutionary significance, I think there are few who would deny that our ultimate objective should be to make these benefits available in full measure to all of the people.”

This quote was spoken by Dr. Ray Lyman Wilbur, the first President of Stanford University, in 1932 and sadly it is still appropriate now. Today we traveled to Stanford to speak to faculty and medical students about PPACA and Single Payer.

In defense of the political feasibility of PPACA, but not really explaining its nuances or fatal flaws, was Dr. Arnold Milstein. Out of only a handful of slides was a photo tribute to a woman he considers a “friend” and “smart and reasonable.” The infamous Nancy Ann DeParle. This is the same DeParle who earned $6 million from sitting on the boards of at least 6 companies that were targets of federal investigations, whistleblower lawsuits and other regulatory actions, and now is commonly known as Obama’s “Healthcare Czar.” Dr. Milstein’s main point focused on the fact that smart people in Washington did the best they could.

In defense of single payer was Mad As Hell Doc Margaret Flowers. Her job was simple because all that she had to do was show the evidence of the failure of the market when it comes to health care and the evidence of the success of single payer. Margaret compared PPACA to HR 676 based on 9 criteria such as universality, affordability, and sustainability and the striking differences couldn’t have been more obvious.

Following the presentations, the MAHD marched with local single payer advocates to the “Gates of Hell” in the Rodin Sculpture Garden where we expressed our anger at health injustice in this nation and our conviction to end it.

“Political feasibility” ignores true human suffering and continues to tie our sick care non-system to a sinking ship. We just rearranged the deck chairs on the Titanic and think we’ll miss the iceberg.

California Road Trip, Day 6
September 28, 2010

Santa Cruz, Sept. 28

“We’re number 1!” Not hardly.

During our “physician briefing,” prior to our Santa Cruz presentation, we learned that the Public Health Agency of Canada has published a travel advisory for, of all places. California, which is in the midst of the biggest outbreak of pertussis (whooping cough) in 50 years. Because of four thousand cases and nine infant deaths, so far, this year, California is being treated as we treat underdeveloped countries, whose health care systems are primitive or otherwise failing, thereby putting travelers at risk.

How can this be? Don’t we have the best health care system in the world? Nope. Number 37th actually. Many health insurance plans don’t cover routine immunizations, many of which are recommended as for public health. Isn’t PPACA going to change this by covering preventive care? Nah. It only applies to new/renewed policies and many older group policies will remain “grandfathered” which means that some provisions will never apply to them. They will pay for a portion of expensive treatment, but not for prevention. Their profits will put YOUR infant at risk by keeping whooping cough endemic in your community.

That’s why I call it a sick care non-system.

California Road Trip, Day 5
September 27, 2010

Yesterday, Margaret Flowers joined us on the stage at La Pena Cultural Center and will remain with us through Santa Barbara. As expected, the “standing room only” crowd was mostly the choir. One might ask, “What’s the point?” The choir is our best tool, but only if they get out of the choir pews. Only by giving them (you?) the intellectual tools, insights and confidence to speak with friends, neighbors and communities we will be able to educate those who don’t yet understand the subtleties of the single payer solution and why PPACA didn’t fix it. We surely can’t count on media to do this for us.

As an aside, en route to our morning event at Santa Clare Valley Medical Center, I visited a grade school friend and his wife, who recently underwent an outpatient “lumpectomy.” The hospital bill, not including physicians fees, was $50,000, which will be discounted substantially for her insurance carrier. Without insurance, she would be expected to pay the full bill. Of course, different carriers “settle” for different amounts. Are there ANY other “industries” where different customers pay such drastically different amounts for the same services? With everybody in the same risk pool, everybody would pay the same amount… and the average primary care provider would not have to spent more than $60,000 per year on billing services to navigate the chaos… as they do today.

California Road Trip, Day 4
September 26, 2010

NEWSFLASH!!!! Yesterday, the Associated Press released the results of a poll performed in partnership with the Robert Wood Johnson Foundation and Stanford University that confirms what Fox has been telling us. It’s true that 60% of Americans are NOT supportive of the Patient Protection and Affordable Care Act (aka PPACA, Obama Care, Baucus Care, PeePee-Caca). As it turns out, however, twice as many of those who don’t support it think it should have gone farther. They believe we need more government involvement in health care so we can have a real system that isn’t designed to service the insurance industry. We are not alone.

On the road again…Days 1 – 3, posts by Paul Hochfeld
September 23, 2010

Morning #1, Willow Creek, Sept. 23.

On the road again… Yesterday, we wound our way through the fabulous Trinity Alps to our host’s house near Willow Creek, half way up the side of a mountain. As the near-full moon sets and the Sun is about to illuminate the valley below, let’s call this Morning #1.

Fittingly, the first phase of health care reform – PPACA (aka Obama Care) – begins today. Is it good or bad? Over the last few days, the Mad As Hell Doctors have explored this important question through a series of meandering email exchanges that resemble yesterday’s mountain roads. Winding and harrowing.

Here’s our “party line”… Undeniably, PPACA does a few good things that are beneficial to a few people, but overall it further entrenches Health Insurance Industry by subsidizing their flawed product with more tax dollars. We still don’t have anything resembling a real system, with true universal and equal access to care. Rising costs remain a cancer to our economy and, without question, some of your neighbors will continue to suffer unnecessarily because of financial barriers to care. We can do better.

Morning #2, hosted in the wooded hills behind Arcata, the Hippie Capital of the West.

Last evening, our event at the Bayside Grange drew an enthusiastic audience of over two hundred who, I hope, learned something that they can share with their friends and neighbors. Since, it’s apparent that we can’t count on Major Media, it up to YOU to take the discussion to your communities, either one-on-one or in small gatherings. It’s OUR job to make sure you have the tools to answer difficult questions about Single Payer health care. Isn’t that Socialism? What about choice? How can we afford it?

The easy answer to the last question is “We can’t afford not to do it!” Consider all the money we are now spending on health care as our “health tax,” as do just about all the other industrialized countries. That’s over $7,000 per capita. By putting everybody in the same risk pool, getting rid of the 1,400 middlemen (insurance companies) that don’t add anything to our “health,” we can save 20-25% of the total. With those savings, we can accomplish true universal access and make sure everybody gets the care they need when they need it… instead of wandering into our emergency rooms in critical condition costing ALL of us more money in our sometimes futile attempts to “save them.”

We’re all paying for everybody anyway so why don’t we create a system to reflect it!

Morning #3, Santa Rosa, Sept. 25

Before leaving Eureka, Philip (dwarfed by the tree) and I shared a couple of beers with a dear friend and his grown son who own the local concrete/gravel company. Of course, the talk turned to health care. By their accounts, like other small businessmen, virtually, every time they interface with the “government,” whether dealing with environmental regulators or marketing/supplying their products to local, county or state governments, they find waste and workers who have little regard for the efficiencies they cherish in the private sector. I can’t argue with their experience, yet I explain that the laws of supply and demand are upside down in health care. The suppliers (that would be doctors) dictate demand by the tests/interventions that we order. Furthermore, unlike any other industry, we are all paying for everybody anyway and the for-profit private health insurance industry is a middle man that adds NOTHING to the quality of the product (health) while adding 20-25% to total cost. My friends “get it,” but when it comes to discussing the solution, they go right, embracing smaller, less intrusive government, while I go left, to a single payer system managed by those charged with the well being of all of us, aka government.

The following day, en route to Santa Rosa, I stopped briefly to gawk at the Redwoods, where it occurred to me that without government regulations, all of the large groves would eventually disappear into lumber for our decks. Isn’t it the responsibility of government to reign in the self-serving urges of private (and corporate) interests, who have a long history of profiting from plundering the planet while leaving the REAL cost of repairing their damage to all of us? It may be a stretch, but so it is with health care.

The for-profit private health insurance industry spends a lot of money dividing us into risk pools: Medicare, Medicaid (Medi-Cal), the Vets, Employees of large/small companies, and Individuals with/without previous medical conditions. Using taxpayer subsidies, they profit from being the middle man in the care of those who are least expensive, while the government (that would be the taxpayer) pays for the care of those who are most expensive … the old, the sick, and the disabled. The taxpayer gets screwed again while corporations manipulate the political process thereby ensuring their continued profits.

By simply putting everybody in the same risk pool, we could save a substantial amount of money which would give us more resources to care for everybody. Who administers the risk pool? That would be the single payer. The government. Can we trust them to do it? Wait, wait. “Them” is “we.” We trust the government to run the post office, we have cheapest postal rates in the world, and they never lose a package. The VA Health System gets better results that the community, has high patient satisfaction, and does so at less cost. Virtually every other developed country of the world has some form of “single risk pool”… and they get better results at half the cost. In the meantime, United Health Care spends “our” money on very slick, expensive television ads try to convince you they are more concerned about YOU than their profits.

Back to my friends, throughout the (late) evening, we laughed, listened, agreed to disagree, caught up on family stuff and looked forward to our next opportunity to verbally spar, while sharing our friendship. Respectful conversations with those who don’t yet share our insights are crucial to the “cause” of single payer. Don’t be afraid to talk to those who aren’t already part of the choir. Are we going to change their minds? Probably not in the short run, but we’ll have fun trying.

After hearing someone say that health care reform is the civil rights issue of this decade, I retrieved the 1966 speech on civil disobedience by Dr. Martin Luther King. The two strategies described were marches and boycotts. His marches were successful because large target populations could be found in cities like Chicago and Atlanta , and quickly reached through churches. The single-payer movement has not been able to find such concentrated populations. Our rallies in D.C. and the Mad Docs tour in 2009 did not produce numbers of sufficient size to command attention. Let’s consider boycotts.

Dr. King said, “There is nothing quite so effective as refusal to cooperate economically with the forces and institutions which perpetuate evil in our communities.” Under the leadership of SCLC, refusing to buy products from companies which do not hire Negroes (sic), resulted in an increase of income in that community by more than $2 million annually.

Another example is the boycott organized by the Committee of African Organizations (CAO) with support from South Africa ’s Liberal Party in 1959. Additional support grew in British organizations and international labor movements. South African products came off the shelves. Eventually apartheid ended.

Paul Krugman recently commented on the sharp increase in premiums announced by WellPoint in their California individual market. WellPoint is not the villain. The current system invites a death spiral for the insurance industry which relies on large a large pool containing healthy clients to keep costs down. In the current economy, cash-strapped workers drop coverage resulting in a smaller, sicker pool. Legislation which bans discriminatory practices will further increase premiums and hasten the death spiral.

I suggest that PNHP and other organizations support disinvestment in companies which are on an unsustainable path. A precedent exists for pension fund managers to do this: In 2002, CALPERS embarked on a series of “socially responsible” investment boycotts starting with Asian companies which violated guidelines on human rights and labor standards. Also targeted were companies like Disney, Safeway, the New York Stock Exchange, and health maintenance organizations.

We could begin with encouraging PNHP members to purge their personal portfolios of health insurance companies; I have already done so. I intend to approach the STRS board with a request to divest from companies likely to see a sharp stock price reduction. Money talks.

From Alice Faryna M.D.

At a presentation to Concerned Ohio Retired Educators on March 17th, I used Paul Krugman’s recent article on the “death spiral” of for profit insurance industry to call on pension plans to divest from this industry. This is the latest financial bubble and is unsustainable. Private insurance is headed for the cliff. We should give it a push. We will take this proposal to State Teachers Retirement Board next.

On Monday, January 11th, over 1,000 people rallied for California Single Payer on the steps of the Sacramento Capitol building. Following the rally, 500 health professional students from over 20 different California campuses, and ten different professional programs held over 90 legislative meetings. Through their efforts, state single-payer gained at least 3 additional co-authorships and a fresh cohort of legislators and staffers were educated in the midst of a pessimistic national debate.

The event was preceded by a six-hour training day on top of 8-hour bus rides for half of the students who left Southern California at 4 a.m. on Sunday morning. The two-day CaHPSA “Lobby Day” event was itself preceded by over 10 statewide conference calls, two regional conferences (with many days of preparation each), multiple press releases from the student media team, one leadership conference, and countless hours of work from local campus student teams including speakers’ series and fundraising drives. The event will be followed-up by selecting statewide student leaders, and campus student teams; by holding regional and campus training workshops; and by continuing to build partnerships with pro-single payer organizations and in key legislative offices through, with a little luck, summer student internships.

All of this should be seen as a phenomenal success, especially considering that it is 100% student run and that the students receive little if any support for their activities. So how can we explain such success amidst an unfriendly environment and when reform at the national level is struggling so dismally? And how can this success be replicated in other states? Two words: Enthusiasm and Organization.

Let’s start with enthusiasm. No one can go to CaHPSA Lobby Day and not come down with a case of infectious enthusiasm. Students sit through hours of preparation and vigorously engage in discussions with often unfriendly opponents of healthcare reform and come away more excited than ever. Young health professionals, with little or no previous exposure to any policy, effectively engage in the democratic process and come out the other end ready for more.

How does this happen? The first step is building enthusiasm at the campus level to get people to the event. This is usually a process of having strong single-payer speakers visit each campus at least once, with follow-up and endorsement from well regarded local student leaders. The leaders get involved because they have real control over the event and input into the formation of the activities. The final push to register students for the lobby day builds on this foundation and is often a combination of blast emails and appeals to friends and social networks. Once at the CaHPSA Lobby Day, the enthusiasm continues because the training day speakers are engaging, the community supporters at the rally are boisterous, and we have an unlimited supply of coffee. And most importantly, learning that you can actively engage in the democratic process is fun! And being well prepared with a group of your peers beforehand to knock down the arguments of your opponents feels great! (This should be seen in contrast to events that are not student led, where students play a secondary role in joint student-physician teams, or where the students feel poorly prepared, or discouraged by not having autonomy over their student group.) By being empowered to make decisions, we are learning that our actions today make a difference tomorrow.

Equally important to enthusiasm is organization. Lobby Day would not be possible without active campus teams and statewide coordination. And of these two, some form of active campus leadership/organization is especially important. In fact, on campuses where we are unable to establish a team or at least a first contact, we often lose the participation of the entire campus even if our event makes it to their local listserv. Over the past couple of years, the existing infrastructure of AMSA campus chapters has been key to our success, but as we try to continually expand beyond the medical student population to other health professional students and students in general, a new form of organization is emerging: CaHPSA, or the California Health Professional Student Alliance. Because we are “campus-based,” CaHPSA ties into the fundamental unit of identity for most students: the on-campus community.

A final essential component of our organization’s success has been community partnership. California Chapter of PNHP, the California Physicians’ Alliance, California School Employee’s Association, California Nurses Association, California OneCare, California Alliance of Retired Americans, Single Payer Now!, and others have been essential community partners both helping us with material supplies and cheering us on at the CaHPSA Lobby Day Rally. As we continue to grow our organization it will be crucial to maintain and further develop organizational partnerships with community partners who each bring their own high levels of enthusiasm and strong sense of organizational identity.

Lessons learned? Incredible success is possible by mobilizing students. And two keys to this success are enthusiasm and organization.

Educate. Advocate. Grow.

I posed this to him: “Many Democratic politicians, including our Blue Dog Rep. Baron Hill, tell us in private conversations that they believe we have to get to single payer eventually. What advice would you give on how to get there?” Without a blink, he replied it’s “going to be a long haul”, and if we don’t pass this bill it’s going to be even longer. He asserted that this bill begins building the required infrastructure for any future progress.

Since then, with the loss of the Democrats’ super-majority in the Senate everything is up in the air. Which brings us back to the recurring question – Should we Kill the Bill? There has been an incredible amount written in the Progressive community about this. At one end is Helen Redmond (CounterPunch 12/23) Beware the Progressive Democrat arguing that we can’t trust Sanders, Weiner, or Conyers and that we’ve got to build our movement without any of that unreliable crew (kind of a rough “logical”conclusion”, if you ask me).

At the other end is Nate Silver of FIveThirtyEight (12/16) Health Care: The Elevator Pitch (and a number of other posts) where this bright political analyst makes the case for incrementalism. Silver also notes “I’ve gotten as many nasty comments and e-mails from Democrats on this issue [over the last two weeks] as I have in the past six months from conservatives on all issues. That emotion is a factor in this debate seems self-evident to me.”

All that emotion is evident as the blame is ladled out for Scott Brown’s Senate victory. Is the message that the country is turning against the Progressives’ urge to legislate change, or that Obama has compromised the hope for change he promised by reverting to Washington business-as-usual and disappointing his base?

The healthcare bill will be at the center of this cyclone, and it’s too soon to say what gyrations the Dems will attempt to push it through. Our response as single payer advocates should remain unchanged – we have strong, informed positions on the poor policy provisions in the bill. I think we are best to remain silent on the political strategy (tragedy?) to be pursued. I see an important distinction between being a pointed, persistent, insistent, carping, kvetching, nagging critic of this bill for policy reasons on the one hand, and joining in the political discussion about the merits of killing the bill on the other.

Let’s not be drawn into the classic Progressive Circular Firing Squad. Our message is clear. If the Democrats still manage to pass some form of health reform, they can celebrate, but WE’RE STILL FOR HEALTH REFORM, AND THIS AIN’T IT!

If no bill passes, then we have a different set of problems/opportunities. If those who predict Republican ascendancy in the ’10 elections are right, then our work is really cut out for us. Meanwhile, all those who forsook single payer for the allure of the public option are ripe to be brought back into our fold. Movement building will continue. Opportunities to form coalitions will appear. As the business community becomes even more frustrated they will open to our message.

Here are the real lessons learned as we look back to the Iowa caucuses last January, from our vantage point looking out on the chaos this January:

1. As much as we had hoped that this was a historic opportunity to make drastic, needed changes in our healthcare system, there really wasn’t the support to go all the way to single payer. We can second guess Obama and Rahm forever, but I don’t believe there ever was a chance in hell that Evan Bayh, much less Lieberman or Ben Nelson would have ever voted for single payer.

2. We should look again at a strategy of incremental reforms, a strategy that has been fruitful for many movements. That is a longer story to explore later.

3. No matter how hard we try to predict the future, we will always be surprised. Remember that even if single payer had passed in the full glory of HR 676 without amendment, we would have to defend it, improve it, and deal with its unintended consequences. This work will never end.

How can we ever hope to win? As Bill Moyers asked David Corn on his PBS show January 8, “Have people been so politically abused that the will to fight for democracy, the political will has been dissipated? “

Will it first take campaign finance reform, to break the grip of the big money? Where will that movement come from? What other options do we have?

There is no better issue to organize around than universal health care. In the environmental movement we learned the word NIMBY – Not In My Back Yard. Sometimes people distain NIMBY’s, but many a NIMBY activist has started locally before coming around to a global perspective. Healthcare is everyone’s back yard, front yard, and right inside the house. Our issue’s not going away, even if some politicians do.

We will stay in this fight for the long haul. There is no real alternative except to quit. When I get discouraged, I turn to one of the original crusading journalists and a real hero, IF Stone (no relation):

“The only kinds of fights worth fighting are those you are going to lose, because somebody has to fight them and lose and lose and lose until someday, somebody who believes as you do wins. In order for somebody to win an important, major fight 100 years hence, a lot of other people have go to be willing – for the sheer fun and joy of it – to go right ahead and fight, knowing you’re going to lose. You mustn’t feel like a martyr. You’ve got to enjoy it.”

One of the great joys of being in PNHP has been the joy of meeting and working with so many wonderful people. I’m in this for the long haul and look forward to seeing you all many more times in the years to come.

With Congress advancing their health reform bills and the President’s vow to improve our health care crisis, I wish I could be hopeful and encouraged. But I’m neither. Instead, I’m dismayed. And listening to my fellow classmates, I’m not alone.

A little over a month ago I stood with 50 other medical students, faculty, and community members in front of Albany Medical College to remember the 45,000 Americans who die each year because they lacked health insurance.

The vigil was called, “Treat! Don’t Trick”, because we stood to ask Congress for reform that will help us treat our future patients, not fool us with hyperbole. I was moved to be a part of the vigil because I am appalled that deaths due to lack of health insurance has more than doubled since 2003.

Ryan McIntyre explained that he wished we could meet to celebrate; however there is not much to celebrate. He is a third year medical student and President of Physicians for a National Health Program student chapter.

“Obama is quoted as saying that if he could start from scratch he would support a single payer system,” Ryan said. “However, instead of starting from there, he started from a compromised position. What if Hippocrates started with a compromised position when he outlined the Hippocratic Oath?”

“For-profit, private insurance has not worked to control costs and cover everyone, and it will not work,” Megan Ash, a first year medical student, told us. “Improved and expanded Medicare for all is the best solution.”

“Health reform is the civil rights movement of our time,” Naazia Husein announced. She is a second year medical student and Co-President of the club Student Perspectives in Advocacy. “A single payer system is not a dream,” Naazia added, “it’s a demand.”

Reverend Harlan E. Ratmeyer, a pastoral care-giver at Albany Medical Center, explained: “The elite group is in the [healthcare coverage] pool, everyone else out of the pool. From the perspective of justice, and the spiritual, economical perspective, we should all be in the pool.”

Other vigil participants spontaneously began telling their stories too. John Wax, a first year medical student talked about how his father, self-employed, only received treatment for his herniated disc because he was a Vietnam Veteran and could get health insurance through the VA.

James Kelley, a first year medical student, shared that his mother was a nurse for 10 years providing health care in a women’s shelter. But when she needed to use her health insurance, she needed to hire an attorney in order to battle insurance claim denials.

The reforms touted on Capitol Hill will not solve these problems. Not even close.

Millions of Americans will still be without health insurance, private insurance companies will continue to deny health care in order to satisfy their stock holders (yes, even if exclusion due to preexisting conditions are unlawful), rapidly increasing health care costs will not be contained and healthcare coverage will still be tied to employment. As future physicians, and from our own life experiences, my classmates and I see that these these are the very things that demand to be changed.

If President Obama wants to be the last president to take up health care reform, then he must reconsider expanding and improving Medicare to include everyone.

Danielle E. Alexander, Albany Medical College Class of 2013, belongs to the American Medical Student Association and Physicians for a National Health Program.

Dear Joseph Frick,

We recognize that Independence Blue Cross was founded with the social mission of providing affordable healthcare to citizens in the Philadelphia area. We know Independence Blue Cross is concerned about the 200,000 Philadelphians and 46 million Americans who cannot afford health insurance. We also know that you’re concerned about the rapidly rising costs of healthcare in this country.

We are concerned, however, with the fact that Independence Blue Cross continues to deny its members life-saving care and is currently funding efforts to kill meaningful healthcare reform in this country, which would bring more affordable healthcare to more people. You have done well at cloaking your efforts behind the slogan “get healthcare reform right,” but your scare tactics and accusations that even a public health care option will have “dangerous consequences” are not benefiting your policy-holders. You are using millions of dollars worth of our insurance premiums to spread that message, too.

The information is in, and it shows that the best option to insure all Americans and provide the best quality care is a single -payer universal healthcare plan. The time has come for Independence Blue Cross to stop blocking the meaningful reform that Americans need and to carry out its mission of serving the “public good”, not its own bottom line.

We are demanding, therefore, that you agree to the following:

3. You will join us at a press conference in one week to announce IBC’s support for both state and national efforts to create a single-payer health insurance system.

Sincerely,

Student Healthcare Action Network
Healthcare NOW!
Mobilization for Healthcare for All

I, Joseph Frick, in order to fulfill Independence Blue Cross’ mission to provide affordable healthcare to residents of the Philadelphia area, agree to the aboe demands. I will join you at a press conference in front of Independence Blue Cross offices one week from today to confirm that we have met your demands and to announce Independence Blue Cross’ support for a single-payer healthcare system.

Signed,

__________________ (Frick never came down to sign this)

Today thousands more called Speaker Pelosi’s office demanding that the Kucinich and Weiner amendments be put forward for a vote as previously promised. Their office was apparently instructed to transfer all such calls to an answering machine. We should be appalled at this effort to dismiss single payer advocates. Short of single payer, this 1,990 page effort to reform health care will be indecipherable for the American public and will quickly become unaffordable. We will be trying to build a house on a crumbling foundation. It will not work and we will be back here again in four years asking what went wrong.

Let me begin by saying that I don’t have any desire to be arrested. I am a pediatrician with three teenagers and a husband who would prefer that I do not spend time in jail. I have never actually spent the night in jail and I imagine it’s not very pleasant.

To be honest, I am a bit frightened. But, I expect that these are normal feelings and I am dedicated to act despite my reservations because there comes a time when our conscience dictates that we act. That time is now (or “way past now” as doctors and patients whom I’ve met in my travels have told me).

In short, I am going to be arrested because I believe that it is my professional responsibility to advocate on behalf of those patients who are suffering and because it is clear that traditional advocacy tools are not working.

The phrase that runs continuously through my mind is “To be silent is to be complicit.” I cannot be complicit in the face of an industry that profits at the cost of human lives and in the face of an administration and Congress that are too dysfunctional to stop this practice.

I left practice more than two years ago to advocate for health reform. This year I traveled on a particularly unexpected and eye-opening journey. In January, I celebrated the inauguration of a new President who I hoped would be the agent to create real change in America. I hoped we would see changes that benefited the people of America (more than the corporations).

I joined the steering committee of the Leadership Conference for Guaranteed Health Care because I believed that if we built the grassroots movement for real health care reform: a national publicly financed health system that was truly universal and accountable, Medicare for all, then we would provide the political cover so that the new administration and the Congress could pass it, or at the very least discuss it. I believed when the administration said that it wanted to hear from the Americans, that we would actually have a debate about how to improve health care in this nation.

Early in the year, I lobbied with many other members of the LCGHC who represented health professionals, patients, labor and faith groups. We had two simple requests: include advocates of single-payer Medicare for all in the hearings and do an economic study of single-payer legislation so that it could be compared to the plans being put together in Congress.

We were assured by members, such as Majority Leader Steny Hoyer, that this would happen. However, before long, we saw quotes from the leadership that essentially said all options were on the table except single payer. Ever the optimist, I thought this was simply a signal to work harder. “OK,” I told myself, “they aren’t going to make this easy. No surprise there.”

We continued to meet with members, we pressured the White House to invite single-payer representatives to the Health Summit in March (which they did) and we continued to reach out to organizations to join our movement.

We thought the health care debate would include the stakeholders (health providers and patients), but found that only the stockholders were invited to the table. When it came time for the first series of public hearings on health care, which were held in the Senate Finance Committee, we requested that one single-payer advocate be included with the 41 other witnesses (many of whom represented the private insurance industry, pharmaceutical corporations and big business).

Despite thousands of calls and emails from across the country, our request was denied. That is when it became clear that we would have to use stronger tools. On the day of the second hearing, May 5, eight of us traveled to Washington to attend the hearing. As it began, we stood up one by one and requested a seat at the table. And one by one we were arrested to the sounds of nervous laughter from the members of the committee and audience.

It reminded me of a quote from Gandhi, something like “first they ignore you, then they laugh at you, then they fight you and then you win.” We returned the following week with nurses and more people were arrested in the committee. This time there was no laughter. I guess that meant we were on to phase three: the fight.

I was invited shortly afterwards to testify before the Senate Health, Education, Labor and Pensions Committee. In fact, I was the first of 24 people to testify there. I was shocked to hear other members of the panel give poor or misleading information to the committee. I wondered why we weren’t required to testify under oath.

For decades, I and other health providers have found it more and more difficult to provide quality health care. The private insurance industry has placed more and more obstacles in the way of providers and patients in the forms of co-pays, deductibles, networks, uncovered services, the need for authorization, pre-existing conditions, rescissions, rapidly rising health insurance premiums, etc.

And we, the doctors and patients, have done our best to comply with the complex and confusing maze of requirements. We’ve seen medicine turned into a business rather than a healing art. Patients have become consumers and health care has become available only to those who could afford it or were eligible for government programs. Doctors have become frustrated and started leaving practice or opening “boutique” practices.

I traveled with a group of physicians this summer who drove across the country to speak about health reform (see www.madashelldoctorsvideo.com). The level of desperation we encountered was tremendous. Many of the doctors I spoke with said things like, “Well, up until about five years ago I could still get care for my patients, but now, I can’t.” We heard stories of people fired because they or a family member became ill, people who delayed tests or medications due to costs who subsequently died of preventable causes or ended up in the intensive care unit and people leaving the country to have surgery or treatment done in Mexico or Canada where they could afford it.

For decades, legislators at the state and federal levels have tried incremental health reform. I have heard legislators and health advocates say that they are “diehard incrementalists” or “political pragmatists.”

Despite patchwork efforts to expand Medicaid, provide tax credits or subsidies towards the purchase of private insurance or to provide competing public insurances, the number of uninsured and underinsured has continued to grow. The cost of health care in this country has increased faster than wages, inflation and the GDP.

How practical is it to keep trying the same thing and expecting a different result?

We, as a nation, have put off the fight we know we will have to wage if we want real health reform. The fight is against the market model of health care and the foe is formidable. The medical-industrial complex has billions of dollars and strong influence over the politicians.

The revolving door between the medical-industrial complex and the congressional staffers is spinning so fast that it is hard to keep track. For instance, Liz Fowler worked for Sen. Baucus, then became vice president of public policy for Wellpoint (one of the largest health insurers) and then returned to the Senate Finance Committee this year to oversee the legislative process for the health bill.

There are six health insurance lobbyists for each member of Congress and at least 350 of these lobbyists were former staffers. The industry is spending around $1.4 million each day on lobbying.

We are the only industrialized nation to use this market model for health care and it has failed to be either universal or affordable for a very simple reason: the business of private health insurers is to make a profit for their investors, which is done by charging high premiums, avoiding the sick and restricting and denying payment for care. Decisions are made based on what is best for the bottom line, not the health of the patient.

The United States ranks at the top in only one area when it comes to health care and that is for how much we spend. We spend twice as much or more per person than any other industrialized nation and for that we are ranked 37th in the world on health outcomes. We have high infant and maternal mortalities, growing health disparities and low life expectancy.

The other industrialized nations guarantee health care to almost everybody living on their soil. We leave at least 46 million out entirely and have millions more who are insured but unprotected and so they lose their home or go bankrupt trying to pay for needed health care. We rank the highest of the top 19 industrialized nations for the number of preventable deaths, estimated at 110,000 per year in 2007.

It doesn’t have to be this way. We have a model that does work for the population it serves, those 65 years of age and over and the disabled. It is traditional Medicare. Medicare is already nationwide. It finances health care with a very low overhead (3 percent instead of five times that figure for private insurers) and allows doctors and patients to make medical decisions without jumping through numerous hoops (like private insurers do).

The politicians know this, but they try to shut it out because adopting Medicare for all means giving up those generous campaign contributions.

There comes a time when we must ask ourselves if we can continue to delay doing what we know is right. Can we be silent and allow thousands of our fellow Americans to die each year? Is it acceptable to close our eyes and pretend we don’t see because we may believe that we have “good insurance”?

A dear friend recently wrote a song about the health care situation that contains the question “Isn’t this America?” And I ask the same question. If we are spending the most, why aren’t we trying to be the best? Or at least in the top 10? Why aren’t fiscal conservatives demanding that we spend our health care dollars wisely to get the most health for our dollars?

A national single-payer health system, such as Medicare for All, is civilized medicine. It is what civilized societies do for their people. It allows people the freedom to go to school, change jobs, open their own businesses, and provide for their families without the stress of worrying about losing everything if they become ill.

I have decided to join other doctors and citizens in the mobilization for health care reform — a nationwide coordinated nonviolent civil disobedience campaign for Medicare for all. As we saw in other social justice movements such as women’s suffrage and civil rights in the 1960s, change will not come unless we take a stand.

There are some who disagree with or do not understand the purpose of nonviolent civil disobedience. To me, it is clear that this is the path we must take in order to overcome the stranglehold the medical-industrial complex has on our nation. Other methods have failed. We cannot wait. The number of people suffering and dying in this nation every day is unacceptable.

I do this reluctantly but with resolve for those who would like to act but cannot. We will ask to speak with insurance company CEOs and we will demand that they stop denying care and influencing members of Congress. We will spread the message of Medicare for all to the public. I hope that others will join and support the campaign in whatever way they can. The web site is www.mobilizeforhealthcare.org. There is still an opportunity to get real health reform if enough of us take action.

With hopes for peace and a better future,

Margaret Flowers, M.D.
Sparks, MD
Congressional Fellow, Physicians for a National Health Program