From PNHP Annual Fall Meeting, November 11, 2002, Philadelphia, PA
Speech of Dr. Carlos Trotta, MD

Argentina has a population of 37 million people living in a geographic area ten times larger than Japan’s. Argentina posted a trade surplus of 12 billion dollars in the first nine months of 2002.

Oil exports produces 6 billion dollars annually, but the rent thus generated is almost totally captured by the banks and financial institutions, by foreign oil companies, and by private firms. The money does not go toward social causes.

Our country has closely followed the demands of the World Bank and of the International Monetary Fund who have called us…“ their best pupil ” The IMF has forced privatization. In Argentina the national oil company, the national air lines, the water, the railways, the river and sea fleets, the telephones and the retirement contributions were all sold and became private enterprises. The result has almost bankrupted my country and has had a profound impact on our social, economical, educational and health areas.

Even after following the IMF advice, our present gross domestic product of 140 billion dollars is 23% lower than that of 1975 and has a foreign debt that consumes 23% of next year’s budget only for paying interests, not capital.

Our country produces enough food for 300 million inhabitants The agricultural sector exports 9 billion dollars coming from more than 23 million hectares of soybean, corn, wheat and sunflower. It annually exports 300 million dollars of beef.

Yet 53 % of our inhabitants live under the poverty line and 25% are indigent that is to say that in their homes the income is not enough to cover the minimum basic protein and nutrition needs.
Seven out of ten children in Argentina are poor.

These figures are greatly unfair for a country that produces and exports foods. They clearly show the consequences of a failed economic model.

We consider it a planned genocide because nothing, except a political decision, justifies that children’s mortality be 16 per 1000 (in Cuba it is 6 per thousand). In the province of Corrientes, it goes up to 30 per thousand.

The Argentine Pediatrics Association considers that 60% of this problem is due to avoidable reasons. More than 13 % of infants born in public institutions weigh less than 2.5 kilograms as compared to Sweden where the rate is less than 3% of newborns.

Cases of measles climbed nationally from 0 to 9,469 cases between 1996 and 1998.

Pathologies like dengue, malaria, leishmaniasis, trichinosis, Hantaan virus, typhus and tuberculosis have re-emerged or increased (the latter having increased 25% between 1995 and 2000 in the city of Buenos Aires).

It is getting more and more difficult to follow a proper treatment in chronic diseases due to the increasing cost of drugs

Life expectancy in Buenos Aires and outskirts, where 40% of the Argentine population lives is going backwards during the last ten years and has dropped 3%in males and 7%in females.

There has been an increase in family and social violence (the number of homicides has doubled during the last decade in Buenos Aires Province).
The suicide rate in teenagers has grown from 30 per 10,000 in 1991 to 64 per 10,000 in the year 2000.

It has been calculated that, daily, 40,000 people go through the garbage bins searching for food or for elements to recycle in the city of Buenos Aires.
The richer 10% of the population in Buenos Aires city earns 26 times more than the poorest 10%. In the 1970’s this difference, in Argentina, was only ten times greater.

Within this context and in opposition to what would be reasonable to expect from the government. It has not strengthened the social network; it has deserted its constitutional role of health warranter and its response is to lower the health budget (from 8% in 1996, to 6 % in the next year). Total health expenditures fell from 650 dollars per person per year in 1997 to 184 dollars per person per year in 2002 yielding to the pressure of multilateral lending agencies that demand contraction of public expenditures, control of monetary expansion and reform of the state itself which in the health sector means the gradual adoption of managed care tactics (Iriart, Merhy and Waitzkin).

These demands find a fragmented health sector, with strong inner struggles about distribution. This makes it specially vulnerable to these pressures.

We have neither a national health service nor a health insurance system

In Argentina the health sector is composed of three main subsectors-public, private and social security- that have been sequentially reformed wanting to impose an administrative financial logic, that is to say, new actors (i.e. insurance companies and other intermediaries), new forms of contracting (shift from a fee-for-system basis to a capitation-based system that concentrates the risk in the provider organization), and greater role of the private subsector.

The public subsector is financed by the government and provides services through the public network (public hospitals and community health centers) irrationally fragmented in municipal, provincial and national jurisdictions. After a prolonged process, many hospitals were decentralized in 1991 to force them into a self financial management.

The social security plans consist of a system of compulsory social insurance with financing coming from employer and employee. The government is expediting deregulation of the sector to foster competition between the social security plans and private (prepaid) health insurance companies. It only guarantees a basic benefit package.

The private subsector has two main sub-groups a) professionals who provide independent care services to members of the security plans and
b) health care facilities contracted by social security.
The abrupt and generalized empoverishment that Argentina is suffering as a consequence of these policies has had a negative repercussion on each of the previously named subsectors. The crisis generated by the policies of financial capitalism has spared nobody.

Nearly five million people have lost their social security as a consequence of the high rate of unemployment (already reaching 22 %) and to the fact that 40% of the people who receive a salary do not contribute to the system.

Private medicine has lost more than 12% of the subscribers or members since the beginning of the year 2000 and 20% have switched to less expensive plans.

More than 50% of the population goes to public state hospitals which are overcrowded. The State, trying to fulfill the obligation of managing them with the scanty budget imposed by the already mentioned economical policies has left the hospitals lacking medicines and the most simple things needed for the care of patients, even those as elementary as gloves and sponges.

There are long waiting lists of patients to be treated or operated on. Some of them do not even get to the hospital. They are admitted through the emergency room very late in the evolution of their problems with a lousy physical condition.

Doctors have already denounced our shortages before our judges and courts and even at the international level and some of our patients have died while waiting.

Obviously the physician a worker whose only asset is himself, suffers the consequences. He feels overwhelmed when facing the social and health problems brought to him by his patients. He must divide his time working exhaustingly in different subsectors to increase his income – in the city of La Plata, Capital of Buenos Aires Province, the most densely populated of the country, the average income collected from social security (which represents 80 % of its income) is 170 dollars. It is economically difficult (or should we say impossible) to keep updated going to meetings or buying didactic materials.

Generally physicians feels alienated- others decide how to treat their patients, and they do it with a strict criterion of profit. Physicians are frustrated because of our inability to provide proper care for our patients.

As I said before the government responses are not sanitary but only financial: reduction of costs, fiscal regulation, and a more or less hidden privatization.

I want to clarify what we understand by privatization:.
Even though , generally speaking, the word “privatization” refers to the selling or concession of some state enterprises to the private sector, we consider it a much broader phenomenon. We understand the word as meaning the process by means of which the logic of profit gets into the public field affecting its essence of property, provision or financing.

During the meeting that took place in Islas Baleares, Spain, in May this year debating public health, a final declaration was issued and one of its points says that the disassembling and privatization of public health systems are being applied by means of strategies disguised as apparently neutral proposals , like those of separating financing from provision and care making the health centers become enterprises, diversifying insurance or increasing the participation of the private sector . T heir aim is to divide and make private the most profitable areas of public health systems. This strategy known as public/private mix has shown an increase in inequality in every country where it has been applied, but mostly in Latin American countries. Our National States, very weakened by the neoliberal model are not able to minimally regulate the public/ private mix.

We believe that the public hospital which is deeply rooted in Argentina is the pet target of these policies and it is being submitted to a slow, silent and tortuous process of transformation through the lack of financing, the emptying, the outsourcing of services, the loss of prestige, and the flexibility of the contracts for health workers.
We center our action here, in the public hospital, but we realize that our resistance can only grow if we join with the other resistance demonstrations of our citizens.
In Argentina we have more than enough experience with this kind of neoliberal privatizing policies and their consequences in the social and health areas. That’s why resistance in Argentina is greater and a mobilized community expresses its rejection in various and creative manners.

We believe that the multiplicity of insurance plans which comes next in the agenda is a rather crude instrument for matching health care services with individual health care needs.

The group I belong to -CICOP- represents more than 60 public hospitals and community health centers and it has 8,000 professionals associated in Buenos Aires Province.
We understand that what is happening to health is part of a much greater package: the social area; that what is happening to us, health workers, is not disconnected from what is happening to other sectors of our community and that is why our fight must not be limited to the hospital or to the professionals.

We need the community in our fight to keep health as a right and they need us.
Every Monday, our professional union, has meetings with neighbors of our city. We make rounds inside the hospital showing them how patients are living, the precarious condition the hospital is in, and the working condition of the rest of the personnel and staff.

And they mobilize with us on the streets, and we claim for our rights in front of the Town Hall, in public hearings and we also caught the Health Secretary of State when he was trying to escape through a lateral door after visiting the hospital.
With them we occupied the hospital pharmacy claiming for the medicines that were not given to the patients because of absurd bureaucratic reasons.
Also with them we made a human chain of arms and we surrounded the hospital building in a symbolic embrace.

We get together with people from the university- for us public education and public health go hand in hand- hoping that working together our city can have its own plant to make cheaper medicines for all the population that needs them.

And we know that if our people, you and I, are not pressing them altogether, the resistance of the pharmaceutical companies will stop the project.

Every Saturday afternoon we also have meetings with assemblies of different neighborhoods to work in a health plan which includes new ways of participation, including community health educators and health councils of neighbors.

Every Saturday at 9 a.m.. we have a space on the radio, and we try to have the health subject permanently on the air and on the city agenda wanting to get a public discussion of our next budget.

We made stickers to place in every car that enters the hospital. We give away fliers. We have put signs in strategic places of the city and in football stadiums opposing privatization and support public health.

We have a web site on internet (www. elhospitalregional.com.ar)

We have taken our hospital case to our courts and we had a favourable verdict.

We have asked the students of architecture to collaborate in improving some areas of the hospital and the art students of Escuela de Artes Visuales (Art School) to paint allegoric murals on the walls of the central hall and of the emergency room.

Finally and not wanting to be boring, we got together with all the organizations in a Social Forum for Health that has just taken place at the School of Medicine in Buenos Aires with the motto “Another health is possible”

We know it is a long road but we know that we will finally get there, because in defending health we are defending life.

CICOP is trying to rebuild our health system supported by some fundamental issues:

Integrated health care equal and free for every body. Being a constitutional right for all the inhabitants it should be respected.

The State must create an instrument, a SINGLE PUBLIC PLAN whose mission will be to guarantee this right.

This SINGLE PUBLIC PLAN will converge all the available public resources, the public budgets and the resources of Social Security to guard them from the voracity of the financial investors putting it under the social control

WE KNOW THAT HEALTH IS A RIGHT OF OURS. WE ARE THE PEOPLE, AND WE HOPE TO JOIN WITH PNHP IN THAT DIRECTION.

From PNHP Annual Fall Meeting, November 11, 2002, Philadelphia, PA
Speech of Dr. Carlos Trotta, MD

Argentina has a population of 37 million people living in a geographic area ten times larger than Japan’s. Argentina posted a trade surplus of 12 billion dollars in the first nine months of 2002.

Oil exports produces 6 billion dollars annually, but the rent thus generated is almost totally captured by the banks and financial institutions, by foreign oil companies, and by private firms. The money does not go toward social causes.

Our country has closely followed the demands of the World Bank and of the International Monetary Fund who have called us…“ their best pupil ” The IMF has forced privatization. In Argentina the national oil company, the national air lines, the water, the railways, the river and sea fleets, the telephones and the retirement contributions were all sold and became private enterprises. The result has almost bankrupted my country and has had a profound impact on our social, economical, educational and health areas.

Even after following the IMF advice, our present gross domestic product of 140 billion dollars is 23% lower than that of 1975 and has a foreign debt that consumes 23% of next year’s budget only for paying interests, not capital.

Our country produces enough food for 300 million inhabitants The agricultural sector exports 9 billion dollars coming from more than 23 million hectares of soybean, corn, wheat and sunflower. It annually exports 300 million dollars of beef.

Yet 53 % of our inhabitants live under the poverty line and 25% are indigent that is to say that in their homes the income is not enough to cover the minimum basic protein and nutrition needs.
Seven out of ten children in Argentina are poor.

These figures are greatly unfair for a country that produces and exports foods. They clearly show the consequences of a failed economic model.

We consider it a planned genocide because nothing, except a political decision, justifies that children’s mortality be 16 per 1000 (in Cuba it is 6 per thousand). In the province of Corrientes, it goes up to 30 per thousand.

The Argentine Pediatrics Association considers that 60% of this problem is due to avoidable reasons. More than 13 % of infants born in public institutions weigh less than 2.5 kilograms as compared to Sweden where the rate is less than 3% of newborns.

Cases of measles climbed nationally from 0 to 9,469 cases between 1996 and 1998.

Pathologies like dengue, malaria, leishmaniasis, trichinosis, Hantaan virus, typhus and tuberculosis have re-emerged or increased (the latter having increased 25% between 1995 and 2000 in the city of Buenos Aires).

It is getting more and more difficult to follow a proper treatment in chronic diseases due to the increasing cost of drugs

Life expectancy in Buenos Aires and outskirts, where 40% of the Argentine population lives is going backwards during the last ten years and has dropped 3%in males and 7%in females.

There has been an increase in family and social violence (the number of homicides has doubled during the last decade in Buenos Aires Province).
The suicide rate in teenagers has grown from 30 per 10,000 in 1991 to 64 per 10,000 in the year 2000.

It has been calculated that, daily, 40,000 people go through the garbage bins searching for food or for elements to recycle in the city of Buenos Aires.
The richer 10% of the population in Buenos Aires city earns 26 times more than the poorest 10%. In the 1970’s this difference, in Argentina, was only ten times greater.

Within this context and in opposition to what would be reasonable to expect from the government. It has not strengthened the social network; it has deserted its constitutional role of health warranter and its response is to lower the health budget (from 8% in 1996, to 6 % in the next year). Total health expenditures fell from 650 dollars per person per year in 1997 to 184 dollars per person per year in 2002 yielding to the pressure of multilateral lending agencies that demand contraction of public expenditures, control of monetary expansion and reform of the state itself which in the health sector means the gradual adoption of managed care tactics (Iriart, Merhy and Waitzkin).

These demands find a fragmented health sector, with strong inner struggles about distribution. This makes it specially vulnerable to these pressures.

We have neither a national health service nor a health insurance system

In Argentina the health sector is composed of three main subsectors-public, private and social security- that have been sequentially reformed wanting to impose an administrative financial logic, that is to say, new actors (i.e. insurance companies and other intermediaries), new forms of contracting (shift from a fee-for-system basis to a capitation-based system that concentrates the risk in the provider organization), and greater role of the private subsector.

The public subsector is financed by the government and provides services through the public network (public hospitals and community health centers) irrationally fragmented in municipal, provincial and national jurisdictions. After a prolonged process, many hospitals were decentralized in 1991 to force them into a self financial management.

The social security plans consist of a system of compulsory social insurance with financing coming from employer and employee. The government is expediting deregulation of the sector to foster competition between the social security plans and private (prepaid) health insurance companies. It only guarantees a basic benefit package.

The private subsector has two main sub-groups a) professionals who provide independent care services to members of the security plans and
b) health care facilities contracted by social security.
The abrupt and generalized empoverishment that Argentina is suffering as a consequence of these policies has had a negative repercussion on each of the previously named subsectors. The crisis generated by the policies of financial capitalism has spared nobody.

Nearly five million people have lost their social security as a consequence of the high rate of unemployment (already reaching 22 %) and to the fact that 40% of the people who receive a salary do not contribute to the system.

Private medicine has lost more than 12% of the subscribers or members since the beginning of the year 2000 and 20% have switched to less expensive plans.

More than 50% of the population goes to public state hospitals which are overcrowded. The State, trying to fulfill the obligation of managing them with the scanty budget imposed by the already mentioned economical policies has left the hospitals lacking medicines and the most simple things needed for the care of patients, even those as elementary as gloves and sponges.

There are long waiting lists of patients to be treated or operated on. Some of them do not even get to the hospital. They are admitted through the emergency room very late in the evolution of their problems with a lousy physical condition.

Doctors have already denounced our shortages before our judges and courts and even at the international level and some of our patients have died while waiting.

Obviously the physician a worker whose only asset is himself, suffers the consequences. He feels overwhelmed when facing the social and health problems brought to him by his patients. He must divide his time working exhaustingly in different subsectors to increase his income – in the city of La Plata, Capital of Buenos Aires Province, the most densely populated of the country, the average income collected from social security (which represents 80 % of its income) is 170 dollars. It is economically difficult (or should we say impossible) to keep updated going to meetings or buying didactic materials.

Generally physicians feels alienated- others decide how to treat their patients, and they do it with a strict criterion of profit. Physicians are frustrated because of our inability to provide proper care for our patients.

As I said before the government responses are not sanitary but only financial: reduction of costs, fiscal regulation, and a more or less hidden privatization.

I want to clarify what we understand by privatization:.
Even though , generally speaking, the word “privatization” refers to the selling or concession of some state enterprises to the private sector, we consider it a much broader phenomenon. We understand the word as meaning the process by means of which the logic of profit gets into the public field affecting its essence of property, provision or financing.

During the meeting that took place in Islas Baleares, Spain, in May this year debating public health, a final declaration was issued and one of its points says that the disassembling and privatization of public health systems are being applied by means of strategies disguised as apparently neutral proposals , like those of separating financing from provision and care making the health centers become enterprises, diversifying insurance or increasing the participation of the private sector . T heir aim is to divide and make private the most profitable areas of public health systems. This strategy known as public/private mix has shown an increase in inequality in every country where it has been applied, but mostly in Latin American countries. Our National States, very weakened by the neoliberal model are not able to minimally regulate the public/ private mix.

We believe that the public hospital which is deeply rooted in Argentina is the pet target of these policies and it is being submitted to a slow, silent and tortuous process of transformation through the lack of financing, the emptying, the outsourcing of services, the loss of prestige, and the flexibility of the contracts for health workers.
We center our action here, in the public hospital, but we realize that our resistance can only grow if we join with the other resistance demonstrations of our citizens.
In Argentina we have more than enough experience with this kind of neoliberal privatizing policies and their consequences in the social and health areas. That’s why resistance in Argentina is greater and a mobilized community expresses its rejection in various and creative manners.

We believe that the multiplicity of insurance plans which comes next in the agenda is a rather crude instrument for matching health care services with individual health care needs.

The group I belong to -CICOP- represents more than 60 public hospitals and community health centers and it has 8,000 professionals associated in Buenos Aires Province.
We understand that what is happening to health is part of a much greater package: the social area; that what is happening to us, health workers, is not disconnected from what is happening to other sectors of our community and that is why our fight must not be limited to the hospital or to the professionals.

We need the community in our fight to keep health as a right and they need us.
Every Monday, our professional union, has meetings with neighbors of our city. We make rounds inside the hospital showing them how patients are living, the precarious condition the hospital is in, and the working condition of the rest of the personnel and staff.

And they mobilize with us on the streets, and we claim for our rights in front of the Town Hall, in public hearings and we also caught the Health Secretary of State when he was trying to escape through a lateral door after visiting the hospital.
With them we occupied the hospital pharmacy claiming for the medicines that were not given to the patients because of absurd bureaucratic reasons.
Also with them we made a human chain of arms and we surrounded the hospital building in a symbolic embrace.

We get together with people from the university- for us public education and public health go hand in hand- hoping that working together our city can have its own plant to make cheaper medicines for all the population that needs them.

And we know that if our people, you and I, are not pressing them altogether, the resistance of the pharmaceutical companies will stop the project.

Every Saturday afternoon we also have meetings with assemblies of different neighborhoods to work in a health plan which includes new ways of participation, including community health educators and health councils of neighbors.

Every Saturday at 9 a.m.. we have a space on the radio, and we try to have the health subject permanently on the air and on the city agenda wanting to get a public discussion of our next budget.

We made stickers to place in every car that enters the hospital. We give away fliers. We have put signs in strategic places of the city and in football stadiums opposing privatization and support public health.

We have a web site on internet (www. elhospitalregional.com.ar)

We have taken our hospital case to our courts and we had a favourable verdict.

We have asked the students of architecture to collaborate in improving some areas of the hospital and the art students of Escuela de Artes Visuales (Art School) to paint allegoric murals on the walls of the central hall and of the emergency room.

Finally and not wanting to be boring, we got together with all the organizations in a Social Forum for Health that has just taken place at the School of Medicine in Buenos Aires with the motto “Another health is possible”

We know it is a long road but we know that we will finally get there, because in defending health we are defending life.

CICOP is trying to rebuild our health system supported by some fundamental issues:

Integrated health care equal and free for every body. Being a constitutional right for all the inhabitants it should be respected.

The State must create an instrument, a SINGLE PUBLIC PLAN whose mission will be to guarantee this right.

This SINGLE PUBLIC PLAN will converge all the available public resources, the public budgets and the resources of Social Security to guard them from the voracity of the financial investors putting it under the social control

WE KNOW THAT HEALTH IS A RIGHT OF OURS. WE ARE THE PEOPLE, AND WE HOPE TO JOIN WITH PNHP IN THAT DIRECTION.

The New Freedom Bus Tour is traveling across the United States for a month bringing attention to communities struggling for Economic Human Rights. A diverse group representing organizations of the poor from across the country is carrying the message of Economic Human Rights around the country and, on December 12th, to the United Nations in New York city The Bus tour is gathering documention of economic human rights violations occuring in the United States to update our petition charging the US government with human rights violations against its citizens.

Hundreds of students, labor leaders, workers, healthcare professionals, social workers and community members gathered in Philadelphia for a march and rally demanding healthcare for all.

The march assembled at the convention center during the opening session of the American Public Health Association’s Convention.

Over 45 million Americans are without health care. The United States is the only industrialized country without universal health care. However, our system costs far more than those other systems. For-profit health care companies were the single greatest contributor to political campaigns this past year. Over 1.5 million families declared bankruptcy last year due to health care-related issues.

KWRU member and actor Mark Webber (recently appearing in the movies Hollywood Ending and Chelsea Walls) lead the marchers in chants.

Congressman John Conyers, a leader in the US House of Representatives in the fight for universal healthcare, who is now working to introduce a national single-payer health care bill, said,”We want a single payer healthcare system because – guess what? – it saves money, and it saves lives.”

Cheri Honkala, Director of KWRU and National Spokesperson for the Poor People’s Economic Human Rights Campaign said, “We will use our national bus tour to expose the hidden war taking place in America. State by state we will witness the denials of basic human rights and we will document and listen to the stories of people who are living without the basics of food, housing, living wage jobs, education, and healthcare.”

Mark Dudzic, National Organizer for the Labor Party spoke: “The Labor Party has made this struggle for Just Healhtcare at the top of our organizing agenda. And we salute the Kensington Welfare Rights Union, who are leaving today on a bus tour to carry this message of healthcare for all around the country.We belive that the only way that we are going to create a movement for national healthcare is to build a strong, independent movement of working people, of medical professionals, of poor people, of all the locked out, shut down, left out brothers and sisters around this country. Only then will the political parties listen to us and will do what every other country in this world has done for its citizens.”

Other event speakers included:

Eric Hodgson – American Medical Student Association Bill Kane – New Jersey Industrial Union Council Quentin Young – Physicians for National Health Program / American Public Health Association Claudia Fegan – Physicians National Health Association Pedro Rodriguez – Action Alliance Ellen Isaacs – American Public Health Association Special Musical Guest: Foreign

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.