Early Lessons from Oregon’s 2002 Measure 23 Campaign

by Mark Lindgren, Chair, Health Care for All-Oregon

Our experience in Oregon provides both a positive example of how much an under-funded, volunteer-based health care campaign can achieve, as well as the limitations of this approach. Volunteers collected most of the 98,000 signatures needed to place the initiative on the ballot (we did pay for signatures at the end of the signature-gathering phase, to ensure its success). After an October 11 poll showed a virtually dead heat, the insurance industry tripled its spending to at least $1.2 million, some from out of state; our campaign, by contrast, raised and spent about $90,000, $55,000 to qualify the measure for the ballot (about half of that to pay signature gatherers), and $35,000 for the subsequent campaign. The final yes vote was only 21%, just over a quarter of a million votes.

Measure 23. We proposed a single-payer model, firmly believing that this is the only way to achieve access to secure, affordable health care for all, with support from numerous studies, most recently California?s Health Care Options Project.

Measure 23 was to be financed in three ways. More than a third of the necessary funding would have come from money already being spent by federal, state, and local governments. A progressive income tax of up to 8% of taxable income exempted families with incomes 150% or less of the federal poverty level. Lastly, a progressive employer payroll tax from 3% to 11.5%.

The list of covered services was comprehensive, and included prescription drugs, inpatient and outpatient services, vision, dental, mental health, long-term care, and alternative medicine. The language said that the plan would cover “medically necessary services” “by licensed, certified, or registered health care practitioners.” No copays or deductibles.

Oversight and administration would be by a publicly accountable nonprofit Board. Two members were to be elected from each congressional district, and five additional members (including a consumer advocate) would be appointed by the governor. The Board would negotiate compensation with providers.

Major strengths and weaknesses of our campaign. Obviously, our biggest problem was our lack of money to counter the deep pockets of the insurance industry. A poll in October showed us at 36%, the opposition at 39% and 25%
undecided, at which point the opposition, which had not taken us seriously before, began spending serious money. The state?s best-known independent pollster was of the opinion that we would have been able to run a competitive race if we had had as much money as our opponents.

We were also hampered by our lack of major institutional supporters. The AFL-CIO came out in opposition, and the organizations that did endorse us did little to actually help. People who would have benefited greatly from Measure 23 nonetheless failed to support us, in part because of the measure?s complexity and our inability to get our explanations out to them.

Our major strength was our volunteer base. Single-payer universal health care is an issue that brings out idealistic hard-working activists. The HCAO secretary died during the signature-gathering portion of the campaign; while he was in the hospital, he kept a signature sheet on his bed, and demanded all his visitors and medical staff sign it.

The unexpected recession was both a source of support and a problem for us.
On the positive side, more middle-class voters were feeling insecure in their employer-provided health insurance. But everyone was also feeling the economic pinch, and that made it much less likely that a majority would vote for additional taxes. In addition, the recession caused lower 2005 health plan revenue projections, leading to less progressivity in income taxes.

Problems with initiative language. A degree of blame for the defeat of Measure 23 lies with the language itself, which was written by a small language committee with insufficient input from stakeholders, none of whom took our campaign seriously enough at its start to choose to become involved. The initiative represented a broad policy outline, and several details that were left for the plan?s Administrative Board to resolve drew criticism.

Opponents seized on the vague phrase “covers medically necessary services”
“by licensed, certified, or registered health care practitioners” to portray the measure as providing unlimited services. Also, the coverage of alternative medicine offered an easy target for opponents, who claimed repeatedly that the measure would cover aromatherapy, music therapy, and marriage counseling, even hairdressing. Alternative medicine providers themselves generally were nervous about being treated as second-class citizens under the proposed system, and so did not contribute meaningful support.

Physicians and hospitals were nervous about getting adequate reimbursement,
fearing the Administrative Board would negotiate below-cost payment schedules to providers, as current government programs do, and not recognizing the system would have permitted higher reimbursement. There was also some question about whether anti-trust laws would permit group negotiations to take place.

Some physicians, a key stakeholder group, would likely have paid the highest
tax rate under the plan, which also did not make them happy about the measure.

Measure 23 depended on getting federal Medicare and Medicaid waivers. Some
critics said such waivers would be difficult to get, especially from an administration hostile to single payer.

Many voters and physicians were nervous about over-utilization, citing the lack of co-pays and the lack of a spelled-out gatekeeper system. While it costs far more to administer co-pays than they bring in, and they may cause low-income people to defer needed treatment, co-pays may have to be considered from a political standpoint in future legislation.

The cap on the health care tax that the very rich would pay was capped at $25,000 annually. Opponents seized on this number, claiming that many people would pay this much.

State legal counsel advised us that a state could not limit a health-care entitlement simply on the basis of time of residency. Critics claimed the
resulting vague definition of Oregon residency would result in a flood of
out-of-staters and illegal aliens seeking free care.

Campaign issues. As noted above, many of our problems were caused by the simple lack of adequate money and campaign workers.

The refusal of AFL-CIO leadership to become involved in the drafting of the language and its subsequent opposition to the measure scared off endorsement
by many office-holders and lowered our fundraising effectiveness. Labor’s bottom line was that they did not want more than 20% of the new funding for the plan to come from income taxes (under the plan this number was about 43%). In Oregon, labor has an electoral machine at least as powerful as the Democratic Party?s, so labor?s opposition was devastating. In addition, as we approached many civic groups, labor usually had preceded us, spreading negativity about the initiative.

Since the campaign was so under-financed, we had to rely on the state Legislative Revenue Office to develop estimates of what individuals and business might pay under Measure 23 . Because the legislature was called to five special sessions to address budget shortfalls, the LRO was too busy to provide these until very late in the campaign.

Under-funding also did not allow us to do any polling. As a result, we did not know what messages would resonate with voters, which demographic groups
to target, etc. We finally went with “Secure, Affordable Health Care for All.” The Tribune poll showed us up 8 points with women and down 4 points with men.

Our under-financed Yes on 23 campaign was not able to respond to insurance
industry media blitzes, so most voters only heard one side of the story, focussing on TAXES. About 100 of our ?Max and Maxine? seniors spots and attack ads costing $15,000 aired on extended cable in the last days of the campaign. This may have been a mistake. However, many voters already been swayed by prime-time network TV No on 23 ads by the time these aired.

Supporters and others. Notable endorsers included the Democratic Party of Oregon, Consumers Union (publisher of Consumer Reports), Ecumenical Ministries of Oregon, National Organization for Women (Oregon), a handful of courageous politicians, the Pacific Green Party, PNHP, and, of course, UHCAN. As noted above, we were disappointed by the opposition of much of organized labor, but a handful of individual unions did endorse and support our efforts.

Faith community organizing played little role. It was difficult to get churches involved in a specific piece of legislation. The Catholic Church did not participate, as Measure 23 would have provided funding for reproductive services and assisted suicide and put a nonprofit health insurance organization sponsored by the church out of business.

The Oregon Nurses Association remained neutral. Most of the medical organizations opposed the measure, though a good number of individual physicians endorsed it.

We were not able to do enough outreach to small businesses. The problem is that most small business owners are not joiners and so organizing them was a one-on-one process. J.L. Wilson of the NFIB, who became one of the main faces of the opposition, stated that businesses simply did not want a mandate to participate. (The insurance industry did not appear much in the public debate, but instead allowed business to fight their battle).

The National Association of Retired Federal Workers attacked Measure 23 in emails to its members, even though they would have been exempt under the plan.

How we campaigned.
The HCAO website has been vital in making campaign materials and information available around the state (and country). And the availability of email has been invaluable both in discussing issues among supporters and in organizing.

While HCAO printed materials have generally been professional-looking, they tended to be ?college-ey? in both language and appearance, and hence may not have appealed to some prospective voters. This problem was, of course, exacerbated by the difficult of explaining a complex issue in a few short phrases and soundbites. A summary of the initiative, backed with compelling facts and an expanding list of endorsers, was one of our most important handouts during the signature-gathering phase. During the electoral campaign, we relied on a more user-friendly brochure.

Canvassing and phonebanking efforts did not have enough volunteers to make them effective.

3000 bumperstickers were printed and most distributed. The left side featured  “Yes on 23,” with “Secure, affordable health care for all” on the right, with white lettering on a green field. In future, we will use blue as a campaign color (as we did for the lawn signs). We are trying to be perceived as non-partisan, and green may reinforce a perception that this is only a “Green” issue.

2000 lawn signs were printed and most distributed. They were handsome,
durable and great for visibility events. 1500 buttons were produced and were
effective in one-to-one outreach.

House meetings did not work well, even after the measure qualified for the ballot. Therefore, we concentrated on making presentations to organizations and leafleting and tabling at events.

There are HCAO chapters in Portland, Corvallis, Eugene, and Ashland. Sheer driving distance made it difficult to organize effectively in rural areas that would have had significantly better health and economic outcomes under Measure 23.

The fundraising firm we put on retainer did a failed mail appeal to grocery store managers and simply relied on our existing donor and contact base thereafter.

A campaign manager and communications director were hired from a failed governor’s campaign in June. Their main achievement was improving our press work. There was not enough money to establish a campaign office.

Oregon sends a Voters Pamphlet to every voter. We placed three times the number of Arguments in Favor than the Opposition placed. We even placed the first Argument in Opposition, a satire, that got good publicity and was fun, too. We used our awesome signature gathering machine to set an Oregon record by collecting enough signatures to place eight Arguments in Favor, instead of plunking down $500 for each one.

We were hurt by demographic voting patterns: poor uninsured people tend not to vote. But we tried to capitalize on widespread middle-class worry about health care, and not to portray this as only an effort to expand access to the uninsured. Clearly, this approach was more likely to resonate in the current uncertain economic climate. In a poll the Kennedy School of Government and the Kaiser Foundation conducted of more than a thousand people with health insurance, a full 28 percent said they are very worried they will no longer be able to afford their coverage. Another 22 percent are very worried that their benefits will be cut substantially and 18 percent are very worried they will lose their coverage altogether.

Achievements of the campaign. While other organizations have only complained about the problems of the current health-care system and suggested band-aid solutions, we put a concrete proposal on the table. Our campaign raised the visibility of the single-payer solution in the national media; articles on the campaign appeared in numerous newspapers nationwide, including the Christian Science Monitor, Wall Street Journal, L.A. Times,. etc. I spoke on radio talk shows nationwide putting the concept of a single-payer solution on people’s radar screens. Bringing a concrete measure to the table was galvanizing, and inclusion of a funding mechanism forced people to think more critically about funding health care.

The campaign has made many valuable contacts and gained Oregon healthcare activists on-the-job political experience. The No on 23 campaign provides an opposition blueprint for HCAO and other single-payer activists around the country to refer to.

The public debate over the last few months has generated valuable feedback on what Oregonians want in their health-care system. Even some opponents encouraged us to modify Measure 23?s language and to try again. Single-payer universal health care was not taken seriously when we began this campaign. The successes of the Measure 23 campaign mean that many organizations that did not return our calls last time will do so in the future.

Next steps. It is my hope that, in the coming months, key stakeholder groups will work with Health Care for All-Oregon to shape a revised measure, perhaps for 2004. If so, we plan to incorporate members from these stakeholder groups in the our decision making structure. A partial stakeholder list would include: Oregon Nursing Association, Oregon Academy of Family Physicians, progressive business groups, AFL-CIO, The Oregon Association of Hospitals and Health Systems, Portland City Club, public health agencies, Pacific Green Party, the Democratic Party of Oregon, the American Federation of Teachers-Oregon, Oregon Education Association, Oregon School Boards Assn., etc.

A bill with modified language could be submitted again to the Oregon legislature, as we did with HB 3801. While it would probably have little chance of getting out of committee, it might get a hearing and could serve as an organizing tool.

HCAO is also considering other organizing avenues, although the group is split on organizing on issues considered to be incrementalism. It has been suggested, for example, that HCAO could put forward a municipal resolution supporting universal health care in Portland or Eugene, the most liberal cities in the state. SEIU’s Oregonians for Health Security has several policy initiatives ongoing, as well as a goal of electing legislators supportive of health care reform. Some HCAO members are working with a coalition seeking to place a campaign finance reform initiative on the 2004 ballot, seeing this as a long-term solution.

Organized labor appears to be focussing on a possible “Health Care for All Children” initiative. Unions have already trimmed members’ salaries, services, and choice of providers, and boosted their co-pays and deductibles; the next cost-cutting measure is likely to be to drop workers’ dependents from their insurance. In anticipation of this, unions propose a measure that would cover all Oregon children from families under 300%  of the federal poverty level, funded by a 2% employer payroll tax.

If we want to get organized labor’s support, we will need to find a funding source to lessen the percentage of funding paid by individuals. If we succeed, this would also have the practical effect of stabilizing system funding in lean times. Increasing the employer payroll tax is probably impractical.

Avoid reinventing the wheel. We were able to take some lessons from previous campaigns, such as Massachusetts? Question 5 and California’s Prop. 186. I hope health care reform activists can learn from this campaign as well, and encourage them to contact us with questions.

-=-=-=-=
from Jim Ramsel:

Do You really want to get a health care initiative passed?

If You do then:

1. Leave the initiative alone except remove the income tax cap. The initiative, as written, is not the reason it didn’t get passed; HCAO did not have the support of Oregonians and !!if you do your “homework” you will find that no matter what else you do without their support it WONT happen!! Study history to learn how Social Security and Medicare came into being and study our government to learn why programs that redistribute wealth to or for social programs either are under funded or don’t become law.

2. Make a plan to educate Oregonians about how Measure 23 would make it possible for EVERYONE to get medically necessary treatment without copayments or deductables and that people in lower income tax brackets would pay less than the do now or nothing if they were at or below 150% of the federal poverty level. Study Chapter 8 of “Profit Fever” by Charles Andrews if you want to re-enforce the idea that this is the proper – the only – path to getting access to health care for all Oregonians.

3. Raise the money to fund your plan. See 4.

4. As per your plan, set an up organization with an organizer and staff at different points throughout Oregon. Talk to Don Bechler to come up with a set of instructions on how to manage house meetings. From this. the placement and the total number or organizers required can be derived once a time schedule has been set. !!Tell the organizers what you want them to do.!! DO NOT LET THEM TURN THIS INTO A POLITICAL CAMPAIGN. As Andrews says “Don’t fight in TV
Alley.” Isn’t it obvious that no matter how hard you try you’ll never raise enough money to win there.

ote well that wise council from a member of a Carpenters Union in the AFL-CIO said that the only way to get support from the top brass was to go to the branches and convince the workers to support you and then they would force the brass to support a Measure 23. Sounds like education to me.

Either you educate Oregonians and get a large majority supporting you or you will fail again to get universal health care passed; remember too that *evolution* wont succeed. No matter what anyone tells you, there is no other way. I know; I’ve done my homework.

jim r

P.S. Visit my websites to see where my knowledge comes from. Most
of the sources are shown on the two reading lists shown there which
represent hundreds and hundreds hours of study.
http://www.efn.org/~ramselj/

October 31, 2002
Harry and Louise:  The Missing Years
Steve Genova

As Oregon’s hotly contested single-payer initiative heads into the home stretch, it seemed like a good time to revisit my old pals Harry and Louise.  You remember them; they were the managed care industry’s mascots in the early ’90s and, according to industry observers, had more to do with sinking the 1994 Clinton health care proposal than all the rest of the negative campaigning combined.

Most people naturally assumed Harry and Louise were creatures of the PR and advertising industries.  They’re very much alive, however; they were friends of my parents from way back when.  They were frequent guests at our house when I was a kid and we at theirs.

They were always doing just a little bit better than my folks, so we gradually drifted apart the way people seem to when their fortunes head in opposite directions.

Still, I had stayed in touch with them over the years and, when they ended up in Oregon, I thought it might be time to check in with them again.  I hadn’t seen them since about 1997 and, at the time, things were going pretty well.  Their house was paid for, their stock portfolios were growing, Harry had been promoted to a regional management position, Louise had taken up quilting and golf, and Harry was making noises about retiring to a golf course community by 2004.

So you can imagine my shock when I looked them up at their new Oregon place a couple of months ago.  Gone were dreams of the bungalow on the seventh fairway.  They’d been replaced by a used doublewide in a squalid trailer park well within earshot of I-5.  Louise was at the doctor’s and Harry brought me up to speed. 

He’d been laid off from his job in early 2001, which not only cut his income to near zero, but cut off his and Louise’s health care coverage as well.  “My COBRA coverage ran out this June, but that’s not even the worst part,” he said.  “Louise has breast cancer.  She had a series of operations last December, while we still had coverage thank God, but she needs another operation and a round of chemo to stay in remission and I don’t see how we can afford it.  We’ve sold the house to raise cash, but I don’t even think that’s going to cover her expenses.  I honestly don’t know what the hell we’re going to do.”

Harry and Louise go Chapter 13
I picked up a copy of the local paper a few weeks ago and saw a brief news story describing how medical expenses drove Harry and Louise into bankruptcy court.  I called them up and they confirmed what I’d read.

I asked them if they knew medical expenses are the leading cause of bankruptcy in the US — and nowhere else in the civilized world.  They hadn’t heard that one, but they were less interested in stats than in where to come up with medical and legal fees. 

We rang off after a short conversation that I can only describe as surly and panicky — a drastic change from the usual. 

Harry and Louise Turn to Crime
The news just gets worse.  Harry has been busted for sales of controlled substances — in this case, Demerol, which Louise was using to try to control the pain from her untreated breast cancer. 

She and Harry agreed that they needed money more than pain relief, so Harry apparently joined the bangers and the mules on a well-known drug commerce corner.  The cops pulled a sweep and, of course, Harry was the only guy there who couldn’t do the 60-yard dash in less than seven seconds.  So the cops rousted him. 

His bail was insanely high, given his age and the reasons for his behavior.  So he stayed in the local lock-up for 10 days until his case finally came up.  He was sentenced to time served and a $10,000 fine (which of course he can’t possibly pay), and Harry and Louise were left wondering what the hell to do next.

Harry and Louise Found Dead in Apparent Murder-Suicide Pact
The end came abruptly but not unexpectedly.  Harry and Louise were always decent people with a profound sense of pride in the American system and their place in it.  When that very system boomeranged on them, they couldn’t handle it.  Nor could they envision an old age of poverty, untreated disease and constant pain.

The papers and local newscasts gave the story minimal, though dignified, coverage.  But the suicide note got the headlines.  With their last earthly acts, Harry and Louise went down swinging, rejecting an “unworkable, utopian” single-payer system and defiantly embracing the U.S. employment-based health care model. 

“At least we didn’t lose our choice of doctors or buy into a system that would have rationed health care, created an army of bureaucrats to make health care decisions and turned medical care over to the government,” the note read.  Just so.

Next time:  Harry and Louise go to hell.  As John Prine might have written, their Blue Cross cards won’t get them into heaven anymore.

# # #

The author is a freelance writer, communications consultant and member of the Portland Yes on Measure 23 steering committee.  Send comments to steveng@sonic.net

Oregons are voting by mail from now until Nov 5, 2002 on Initiative 23, a measure to create a single payer system in the state.   Organizers are still doing last minute fundraising, and could use your support.  If you’d like to contribute to this historic effort, go to www.healthcareforalloregon.org.
       The full text of the measure, and both pro and con arguments, are on line at the state’s elections division at www.sos.state.or.us/elections/nov52002/guide/measures/m23.htm.
       In PNHP’s opinion Health Care for All Oregon has already won because of the tremendous job local activists – of all ages and from all walks of life – have done in educating Oregonians about reform.  More work may be needed to counter the influence of the powerful special interests, but Oregon is off to an incredible start, and could become the first state to implement a single payer system! 
       We look forward to working with activists in Oregon and all over the country until health care is a right all across the land.  Salud!

http://www.sos.state.or.us/elections/nov52002/guide/measures/m23fav.htm

Also see “Economics at heart of Measure 23 debate,” from the Bend Bulletin, and “Universal health care hinges on cost,” an article by the Courant.

By Michelle Hillman
Wednesday, October 23, 2002

WALTHAM – Increases in health-care spending are in the double digits, insurance premiums are rising faster than the rate of inflation and there’s no solution on the horizon.

That sentiment was echoed by several health-care policy experts who spoke at the Massachusetts Medical Society here yesterday as part of the “State of the State’s Health Care” annual forum.

Drew E. Altman, president and CEO of the Kaiser Family Foundation in California, told 125 physicians and policymakers that health-care costs will continue to rise sharply while coverage erodes.

Total premiums this year rose 12.7 percent nationally. The average individual premium increased from $2,650 last year to $3,060 this year, and an average family premium increased by $901 this year to $7,954.

There are currently 41 million Americans without insurance coverage, a problem expected to get worse as many states, including Massachusetts, reduce Medicaid programs for the poor and disabled.

In Massachusetts, 50,000 residents stand to lose coverage under its version of the federal Medicaid program – MassHealth Basic – effective April 1, 2003.

Nancy Turnbull, director of educational programs at the Harvard School of Public Health, said pressure will continue to be put on MassHealth as the financial picture to erodes.

She said cutting eligibility will cause the ranks of the uninsured to rise, which will have a “tremendous” effect on hospitals and health-care providers left to care for the poor and disabled.

The cost of insurance is rising at a faster percentage rate than earnings for the first time in a decade, Altman said. He said rising insurance costs are creating problems for employers, but even bigger problems for employees who are being asked to pay more for fewer benefits.

In a national survey of firms with 200 or more workers this year, Altman said 78 percent said they would increase the amount employees pay for health insurance.

Health-care spending per capita was up 10 percent in 2001, which is the first double-digit increase since 1990, said Paul B. Ginsburg, president of the Center for Studying Health System Change in Washington, D.C.

Ginsburg said the elderly aren’t to blame for rising health-care costs. Increased hospital spending on wages and new technology is the culprit. He said in 2000, the average hourly wage for health-care workers increased by 3 percent, followed by a 6 percent hike last year.

Hospitals are spending more on wages because they are better paid by health plans. In the 1990s, many hospitals merged or consolidated giving them more leverage to negotiate higher prices for services with health plans.

Ginsburg said long-term drivers of health-care costs are physicians and patients’ penchant for the best technology medicine has to offer.

While technology can help reduce costs with faster and better ways to treat people, it also creates more volume because more people want the latest in treatments.

The “big ticket” problems in health-care spending are figuring out how to cover the uninsured and creating a prescription drug benefit for seniors. He said it was a “national shame” that seniors don’t have drug coverage, and people without insurance coverage are left to fend for themselves.

Altman said to cover 41 million uninsured people costs from $85 billion to $125 billion a year, and to provide a comprehensive drug plan for seniors would cost $350 billion to $800 billion over 10 years.

The problems will be addressed only when there is enough concern in the public, said health policy experts at yesterday’s event. When enough people become uninsured, or the cost of insurance increases beyond what people can afford, is when change will occur, Ginsburg said.

In response to Marcia Angell’s Op-Ed piece on single payer, the New York Times received a number of supportive letters to the editor:

Prescriptions for an Ailing Patient

October 19, 2002

To the Editor:

Re “The Forgotten Domestic Crisis,” by Marcia Angell
(Op-Ed, Oct. 13):

The solution to the American health care crisis is a single-payer system. It is painfully clear that our health care system is a business run for profit and not for thebenefit of the patient. Few Americans now believe the myththat the market distributes health care in the most efficient or effective way.

If the Democrats want to regain their credibility and moral high ground, they should stop accepting money from any interest that might prevent them from speaking the truth about this. They could then fight forcefully for a single-payer system. High risk, high reward: Americans might wholeheartedly give them the White House in 2004.

JANET HEROUX
Princeton, N.J., Oct. 15, 2002

To the Editor:

Re “The Forgotten Domestic Crisis,” by Marcia Angell (Op-Ed, Oct. 13): As a psychotherapist with many patients in their 20’s, I can attest to the fact that not only do most of them not have any health insurance, but they also do not expect it as a condition of living in this country.

Dr. Angell is correct about the remedy, but I fear that we cannot rely on those who profit from the current system to redistribute the “profits.” Yet that is exactly what would have to happen if all of our citizens were given adequate
health insurance.

Don’t those who pay taxes and vote in this country deserve at least the minimum of essential services?

JUDITH GREENE
New York, Oct. 13, 2002

To the Editor:

Marcia Angell (Op-Ed, Oct. 13) is correct when she says the health care system “would be front and center in this fall’s political debate” were it not for national defense issues and a looming war with Iraq crowding political agendas. Why can’t we kill two birds with one stone? Why not have a quid pro quo health care system?

Instead of a national single-payment system as Dr. Angell proposes, provide free coverage for all health care needs in exchange for mandatory military or civil service. Not only would this save money, but it would also promote unity, nationalism and provide better health care coverage than many Americans already have.

PAUL LIEBESKIND
Dumont, N.J., Oct. 13, 2002

To the Editor:

Marcia Angell (Op-Ed, Oct. 13) recommends a single-payer system similar to those in Britain and Canada. This prefers a nationalized managed care collective over the dominant H.M.O.-managed care collectives.

Managed care fails for the same reason that nationalized industrial collectives failed in Western Europe. Ill-informed centralized authoritative decisions result in
poor-quality products, unhappy customers, inflation and erosion of infrastructure – problems that in varying degrees afflict the British, Canadian and the American
corporate-style managed health care collectives. There is a better way.

ROBERT W. GEIST, M.D.
St. Paul, Oct. 14, 2002

To the Editor:

Re “The Forgotten Domestic Crisis,” by Marcia Angell (Op-Ed, Oct. 13): In addition to placing health care increasingly out of the economic reach of individuals and businesses, our commodity approach guarantees that the pool of insurable individuals will continue to shrink, thereby undermining the very essence of affordable insurance.

Insurance works because a lot of people pay premiums and not everyone uses services. The more healthy people insured, the stronger the system. A single-payer, broadly financed health insurance system is hardly socialism; it is the only way health care can become universally accessible and even remotely cost-effective.

SUSAN POOR
San Francisco, Oct. 15,
2002

http://www.nytimes.com/2002/10/19/opinion/L19HEAL.html?ex=1036034356&ei=1&en=dc3b077de7e982ea

Speakers at SR forum call for universal care plan to replace present insurance

October 20, 2002

By JEREMY HAY
THE PRESS DEMOCRAT

Experts at a forum Saturday in Santa Rosa pronounced America’s health care system terminally ill and worse.

“It is a crazy and cruel system we are now struggling with,” said Jack Glaser, senior vice president of theology and ethics for St. Joseph’s Health Care System, the parent of Santa Rosa Memorial Hospital and Petaluma Valley Hospital.

Glaser was among two dozen speakers — physicians, nurses, public health administrators and educators — during a daylong forum at Santa Rosa Junior College. Though they differed on the formula, they overwhelmingly supported a universal health care system.

Past proposals — including a California ballot measure in 1994 and a Clinton administration plan a year earlier — have failed. But supporters of universal health care are closely watching Oregon, where voters next month will consider a proposal for the state to insure all of its residents.

“It’s a new political climate,” said Dr. Quentin Young of Chicago, national coordinator for the 10,000-member Physicians for a National Health Program, which advocates a single-payer government-financed system.

He said the present system’s woes — including 41.2 million Americans without health insurance, skyrocketing premiums for those who are insured, and soaring medical costs — are “fertile soil” for change.

“The people are ready,” said Mike Smith, a Sonoma Valley Health Care District board member and a lead organizer of the forum, “Health Care Crisis 2002: A Search for Solutions.”

The conference was co-sponsored by the junior college and nurses belonging to Service Employees International Union Local 707. Its urgent tone was underscored by the collapse of Health Plan of the Redwoods, which declared bankruptcy in June and closes its doors this month, leaving about 64,000 people to find other coverage.

Speakers cited a variety of strains on the system, including low reimbursement rates from insurers and the government, and a shortage of skilled workers that leaves many in the health care field feeling overworked and demoralized.

In Sonoma County, they said, lower pay scales and higher housing costs have contributed to doctors leaving and nurses choosing to work elsewhere.

Those who remain must contend with a population where 11 percent of children and 14 percent of adults under 65 are without health insurance, further taxing the system, said county Public Health Officer Mary Maddux-Gonzalez.

Without systemic changes, many expect the problems to get worse.

“The stress on the health care system within the next decade will demolish it; it’s an inexorable, inevitable demographic fact,” said Santa Rosa physician Robert Dozor, referring to when the first of the 76 million-strong baby-boom generation qualifies for Medicare benefits in 2011.

About 200 people, many of them medical professionals, attended the forum, and among the audience and panelists there was a broad sentiment that health maintenance organizations and private insurance plans should be replaced with a system along the lines of Medicare, which covers all citizens over age 65.

“We need some sort of national care system,” said Maria Angel of Sonoma, a government studies student at Sacramento State University who plans a career in public health policy.

Smith, from the Sonoma Valley Health Care District, said the time is ripe for change.

“The reason we don’t have universal health care is because we don’t have a broad-based movement to put fire under the politicians,” he said.

Others warned that without a firm sorting of priorities, any movement will suffer.

“You cannot have everything,” said Glaser. “If we cannot constrain ourselves to face that about health care … we will not see this in 50 years.”

You can reach Staff Writer Jeremy Hay at 521-5212 or jhay@pressdemocrat.com.