universal health care

Now That Skinny Repeal Is Squashed, What’s Next for Health Care?

Published by Anonymous (not verified) on Wed, 02/08/2017 - 6:31am in

This Q&A is part of Sarah Jaffe’s series Interviews for Resistance, in which she speaks with organizers, troublemakers and thinkers who are doing the hard work of fighting back against America’s corporate and political powers.

Today we bring you a conversation with Mari Cordes of Vermont, a registered nurse, union leader, candidate for local office, stalwart of the single-payer campaign and founding board member of Rights and Democracy. This interview has been edited for length and clarity.

 

 

Sarah Jaffe: You were in Washington, DC, on Thursday when the vote went down on health care reform, right?

Mari Cordes: I have been here since Thursday. I am running for the Vermont House of Representatives again in 2018 and I am here for the Progressive Change Campaign Committee’s national candidate training. I was selected as one of 300 candidates to attend this amazing training, which coincided with more actions by the amazing Center for Popular Democracy and Housing Works in the Senate offices, in the Capitol, and at senators’ offices. I was part of the protest and the rally outside of the Capitol building the night the vote came down.

SJ: Tell us a little bit about what that was like, while you were waiting to hear about the vote.

MC: It was an amazing experience to hear, once again, many stories of how everyone not only would have been impacted by the repeal of the Affordable Care Act, but by the reality that our elected leaders intentionally were [basically] attacking the American people.

As my friend Sampson and I were heading toward the rally that night at the Capitol, we passed near an outdoor movie theater and it turns out they were playing Star Wars. It was the perfect setting to hear that bombastic, symphonic music, because all of this still feels so unreal, so surreal, that this actually is happening in the United States.

Representatives from the Center for Popular Democracy, Housing Works and Rights and Democracy thank Sens. Collins, Murkowski and McCain. (Photo courtesy of Jennifer Flynn Walker)

Representatives from the Center for Popular Democracy, Housing Works and Rights and Democracy thank Sens. Collins, Murkowski and McCain. (Photo courtesy of Jennifer Flynn Walker)

We heard so many incredible and painful and heartbreaking stories about friends, people that we know, people that we don’t know that would have died and/or families that would have lost their homes and/or gone bankrupt, all in the name of an obsession with an ideology, an obsession with a hatred that a black man was president of the United States and was successful in creating policy that was definitely not perfect, but did help millions of people. It was very powerful to be in that circle, that communion of sorts, and hold a vigil for our country, whatever the outcome [was] going to be.

In that moment, there was the moment of “We are going to lose” and that feeling of hopelessness and despair. Then, a pause and a quiet moment and Ben Wikler [the Washington Director of MoveOn.org] delivered it beautifully. He became really somber. I thought it meant that we had lost, but it created this silent space for us to hear the statement that the vote was “No.” I don’t think I have ever experienced anything so powerful in my life. It was incredible.

SJ: That vote was “No,” but you are not stopping. We are talking on Saturday evening and you are about to head to another rally for health care. Tell us about that and tell us about why the fight is still going on.

MC: We got to bed at 4:30 that morning. We did rest a little bit, but with the awareness that the American people are still under attack on many fronts, not just health care, but the freedom and liberation of many individuals in this country is at risk. So, we can’t stop. In fact, there is no better time to increase the pressure and increase our activism than after a win like this, because especially those who were at risk of losing so much and especially those who have been working so hard in this fight, we have that lived experience of collective power of movement building, the organizing work. We cannot stop. We have to take this momentum and move forward.

SJ: You went to DC a few times. You were involved in a lot of organizing, even though Vermont, obviously, didn’t have a senator that was going to vote “Yes” on this thing. But, what are some of the important lessons that you learned from the seven months of fighting to try to stave off cuts to health care?

MC: I think the most important lesson is to never give up. In a fight like this, never give up. I have been very active working in Vermont towards a universal publicly funded health care system that gets rid of the highly profitable insurance companies and creates a real system. We have had our successes, like when Act 48 in Vermont passed, and we have lost in Vermont when Gov. Shumlin pulled the plug on that. We are still working hard in Vermont to move towards a universal publicly funded system. I would say that is the most important thing. We have to keep going. It is OK to rest for a little bit and take care of each other and ourselves, but we have to keep moving forward.

SJ: I want to go back to the situation in Vermont in a minute, but was there a particular moment or a particular tactic around Trumpcare that you thought was particularly successful? Some moment that maybe you saw somebody’s mind change?

MC: I think there were many moments that were successful, but they were most powerful because each action, each arrest — I was in the first group of people of 150 or more and 40 of us were arrested; I was in the second group, I don’t remember how many were in there, but 80 of us were arrested. Then, the third time, I was a legal support for ADAPT. Hundreds were arrested, I believe, in that action.

I think it was a cumulative effect, in addition to all of the actions and emails and calls from people across the country that created enough pressure on senators. All of these actions, and the media that they generated, including all of the social media, I could see on my own personal social media sites people getting engaged that might not have gotten engaged before and taking actions. It is a cumulative thing. That is the thing about collective power and movement building — it is generative. It is obvious now that people are rising up and that more people realize that organizing does work.

SJ: As you said, you are a nurse, you have been a union leader, and you have been working on health care for your entire adult life. Why is this such a powerful issue to get people organized around?

MC: Health care is a very powerful issue to get people organized around because it impacts every single person personally, often in potentially devastating ways. As I mentioned earlier, many people that I have met though doing these actions and then all the patients that I work with every day, I hear, I see how critically important having access to health care is for them and their families.

I work in a busy cardiology unit at the University of Vermont Medical Center and every day I am at work, when I have three or four patients, I look at each one of them and wonder: “What if they didn’t have access to health care, if they didn’t have insurance? If they couldn’t get health care when they needed it, would they be alive right now?” The huge majority of the time, the answer is “No.”

Then, it is personal for me, too. I have health issues, like most of us do. I would say, more than anything, it is such a huge area of injustice in our country and the fact that in 2017 we are having to fight to stay alive is ludicrous beyond ludicrous.

Mari Cordes and her Rights and Democracy colleagues leave for their delegation to DC. (Photo courtesy of Rights and Democracy)Mari Cordes and her Rights and Democracy colleagues leave for their delegation to DC. (Photo courtesy of Rights and Democracy)

SJ: You were involved in a fight to end insurance discrimination against transgender people. Of course, this week while the health care fight was going on, Trump came out and said he was going to ban trans people from the military because their health care was too expensive. I wonder if you could talk a little bit about that particular fight that you were in and what we can learn from that.

MC: My friends and I were just at the rally at the White House today around Trump tweeting military policy changes. I was involved in some major change work in Vermont, in co-leading a coalition of organizations and people, including physicians that provide medical care for transgender individuals. The organizations we worked with have been working on transgender justice issues for a long time. Vermont, at the time, I think it was 2011 or 2012, did have a law that said it was illegal for health insurance companies not to provide insurance for transgender individuals, but that was a pretty broad statement and, of course, what the health insurance companies did was refuse to cover medically necessary care for transgender people.

I became aware of that when an amazing nurse friend who is also transgender came to me and told me that he needed to have surgery and it was not covered by our hospital insurance. The University of Vermont Medical Center self-insures, so they get to decide what their policy looks like. This person and I and the other leaders of these organizations worked together on a campaign that eventually led the commissioner of the Department of Financial Regulation, which oversees insured companies in Vermont, to issue a clarifying bulletin that made Vermont, at the time, the fourth state in the nation to have such clear language that denying medically necessary care for transgender individuals was against the law.

SJ: I am wondering if there is something about this happening in the midst of the health care fight, your experience on both these issues, that you think we can learn from going forward, as Trump is clearly going to keep doubling down on attacking marginalized groups, especially as he is losing?

MC: More than anything. Because of all the attacks against marginalized groups, more than ever we need to be unified. I do see that happening. I do see people in organizations working toward being as unified as possible. I believe it is the only way that we are not only going to survive, but thrive.

SJ: Let’s go back to the single-payer struggle in Vermont. Vermont was the first state to vote for a universal publicly funded health care system but had trouble getting it implemented. I wonder if you could tell people a little bit about that process, the organizing that got the bill passed, and then the efforts to move forward with it.

MC: We began around 2008 — “we” meaning the Vermont Workers Center — started the Healthcare Is a Human Right Campaign, which was an amazing grass-roots mobilization and education project all across the state of Vermont that got thousands of people involved in not only the education of people in the community about how our health care system, or lack of it, is broken and what we can do to fix it.

We did things like holding peoples’ forums across the state where the people led the forums with legislators present. It was a chance for people to ask legislators questions, but also ask them the main question: Do you and will you actively work to support universal health care, publicly funded? The Workers Center organized annual rallies. I think before the Women’s March, it was one of the Healthcare Is a Human Right rallies on May Day that was the largest rally in Vermont’s history. Eventually, working with other organizations like Vermont for Single Payer Now [part of Dr. Deb Richter’s Physicians for a National Health Program], working with other organizations across the state led to us winning by putting pressure on legislators and supporting those who were doing the policy and taking the political risks. We did win Act 48, which has embedded in it the five universal human rights principles.

I was appointed as a commissioner to two, at the time, of Gov. Shumlin’s workgroups: the Consumer Workgroup for Health care to try to move toward this new system and another commission. We did a fair amount of good work there, but in retrospect it seemed like a farce. What was really being planned was not happening in those groups with members of the public and health care professionals. It was happening at the governor’s office. That meant that eventually Gov. Shumlin and some of the legislators decided that they didn’t have the political capital to pull this off, so they pulled the plug on it.

SJ: Where are things now? You have a different governor now. So, what are things like on the ground in Vermont, working on health care on the state level?

MC: We are organizing. Always organizing. Actively … the main organizations that are working toward a universal publicly funded health care system are now working together to figure out what that looks like going forward. We are back on the ground organizing in communities, setting up town halls, talking with legislators.

The one possible step that actually was in the state house as a bill last year is universal primary care, which would do just what it says: provide access to health care for everyone in Vermont as primary care. Primary care is often one of the obstacles that people face when they are sick or have something going on and they can’t afford it. They can’t access it. So, they don’t go and then, they get sicker and end up in the emergency department with a worse condition. A patient that I remember … had a simple infection [and] waited too long, and it turned into a devastating full-system infection that killed him. It was something pretty simple that could have been fixed had he been able to access primary care. That is what we are working on now.

SJ: You mentioned at the beginning that you are running for office. Tell us what your platform is. I presume that universal health care will be part of it.

MC: Yes, it is and it was. I ran in 2016. My main platform items are working toward an economy that works for us all. That includes having a health care system and working toward progressive tax reform that [e]nsures corporations and the wealthy pay their fair share, further developing and safeguarding the public services that are the foundation of strong communities. Also, that Vermont must lead on climate change. I am also a board member of 350Vermont.

And quality education — we have had some major changes in how school governance is run in Vermont with the passage of Act 46, which is very controversial and in many ways, took the local direct engagement away from small towns. The intent, or the stated intent of Act 46, one of them, is to help reduce property tax burdens. I am not sure how effective that is going to be. There are some one-time savings that we will see, but the real issue is that the biggest line item in a school district’s budget is health insurance for educators and staff. So until we get control over that, it is still going to be a major issue.

Then, I will continue to work very hard in organizing and also as a representative [of] my district to develop a health care system that is financed and administered publicly with strong and transparent government regulations and ample public engagement.

SJ: How can people keep up with you and your campaign and your health care organizing?

MC: A couple of different ways, they can go to www.maricordes.org. There are Facebook and Twitter links on my website. You can also find me on my personal Facebook page: Mari Cordes. I am working with Rights and Democracy a lot, so I would encourage people to follow Rights and Democracy Vermont and New Hampshire.

 
Interviews for Resistance is a project of Sarah Jaffe, with assistance from Laura Feuillebois and support from the Nation Institute. It is also available as a podcast on iTunes. Not to be reprinted without permission.

The post Now That Skinny Repeal Is Squashed, What’s Next for Health Care? appeared first on BillMoyers.com.

LBJ Launches Medicare: ‘You Can’t Treat Grandma This Way’

Published by Anonymous (not verified) on Mon, 31/07/2017 - 12:53am in

Watching the craziness in the Senate this week, as Mitch McConnell and the GOP’s zealots drove their clown car into a brick wall and yet another effort to take away health care coverage from millions crashed and burned, I thought back to a different turn of events.

It was 52 years ago this Sunday — July 30, 1965. Two American presidents celebrated the birth of Medicare, the most significant advance toward national health insurance in America’s history.   

I was a White House assistant at the time, working for President Lyndon B. Johnson as he coaxed, cajoled, badgered, buttonholed and maneuvered Congress into enacting Medicare for the aging and Medicaid to help low-income people. For all the public displays over the years of his outsized personae and powers of persuasion, this time he had kept a low profile, working behind the scenes as his legislative team and career health care experts practically lived on Capitol Hill, negotiating with members of Congress and their staffs.

From the White House, LBJ worked the phones; invited senators and representatives singly and collectively in for coffee, drinks or dinner; listened attentively in private to opponents and proponents from interests as varied as business, labor, medicine and religion; and kept in his head a running tally of the fluctuating vote count.
 
As it had been for decades, it was a tough fight down to the wire. A look back is instructive, not only to show how long it can take to move a legislative dream to reality but also to illustrate how a president with a grasp of history and knowledge of how government works is crucial to making success possible.

In 1935, when President Franklin Roosevelt first tried and failed to get health insurance included as part of Social Security, I was 1 year old and my family was broke. The Great Depression had ended my father’s tenant farming. He took a job for a dollar a day as a laborer on the construction of a highway in southeast Oklahoma.

Earlier, my mother had lost twin girls — one at birth, the other some months later — because the nearest doctor was too far away to arrive in time to help. My parents moved into town. To pay the doctor who delivered me, my father lugged large stones by hand to the site the physician had bought to build his first office. It’s still there.

At about this time in Washington, Republicans, conservative Democrats and the American Medical Association (AMA) were winning their fight to sink President Roosevelt’s proposal for health insurance. Congress was intimidated, and in August 1935 FDR gave up, signing the Social Security Act without health coverage.   

Eight years later, in the midst of World War II, he once again called for social insurance “that will extend from the cradle to the grave.” And again, his proposal went nowhere.

On FDR’s death, Harry Truman became president. In his 1948 Message to Congress on the State of the Union, he said:  

This great nation cannot afford to allow its citizens to suffer needlessly from the lack of proper medical care. Our ultimate aim must be a comprehensive insurance system to protect all our people equally against insecurity and ill health.

 

Congress still refused to budge. Running for election in his own right that year, and way behind in the polls, Truman won an upset victory after demanding that health care insurance and civil rights be included in the Democratic Party platform. That same year, congressman Lyndon Johnson of Texas, whose home district was Democratic and liberal in a state turning increasingly Republican and conservative, was running for election to the US Senate. He opposed Truman’s health care plan as socialistic and was elected.  

In 1952, Republicans won control of Congress for the first time since 1932 and hardened their stand against a national health care program. War hero Dwight Eisenhower won the presidency for the Republicans. He, too, opposed the plan that had been shelved by Congress before Truman left office.

Ike only was willing to support subsidizing private insurers to cover certain low-income groups and no more. With the continuing opposition of the nation’s doctors — amplified through their political lobby, the AMA, as well as the US Chamber of Commerce — the notion of Medicare appeared finished once and for all.    

Yet when he yielded the presidency to Eisenhower, Truman lamented his failure but was prophetic when he said: “[It] has only delayed and cannot stop the adoption of an indispensable health insurance plan.”

He was right. The battle heated up. In 1957, the AFL-CIO brought its 14 million members to the fight. The American Hospital Association, which bore the brunt of the problems older people encountered as they aged, signed on, too.

Public opinion was swinging in favor of national health insurance. When John F. Kennedy and Lyndon Johnson were nominated as the Democratic ticket in 1960, they made health care for Social Security retirees a major plank in the platform and endorsed a bill in the Senate that in time would become Medicare.

Though he was Kennedy’s running mate, Johnson was still the powerful Senate majority leader, that body’s top Democrat, and responsible for steering its legislative agenda. After a long day on the campaign road, or in the Senate, we would get to his home late and he would stay up until after midnight, making phone calls to one or another member of Congress urging passage of the Medicare bill.

Despite his efforts, it failed by four votes. LBJ had studied the polls and knew public opinion was building for national health insurance; he feared this defeat might cost Democrats the election. It didn’t, although the margin of victory was incredibly slim. As soon as they were inaugurated, now President Kennedy and Vice President Johnson championed yet another effort known as the Medical Care for the Aged bill. Still adamantly opposed by the Republicans and the AMA, it also failed — this time by two votes.

In early 1963, the bill was reintroduced in Congress, only to fail again. Some observers again pronounced it once and forever toast. But in November of that year, an assassin killed John Kennedy, tragically catapulting Lyndon Johnson into the White House. Just days later, in a dramatic speech to Congress and the nation, he slowly and deliberately drawled: “Let us continue!” With that challenge, LBJ set out to enact Kennedy’s legislative agenda — with a good chance, he thought, of passing the Medicare bill.

As before, the opposition fought back with everything they had, which now included the AMA’s new pitchman, Ronald Reagan. Not yet a candidate for public office, the actor was hired to warn the country against letting government get between doctors and their patients. He made a popular recording played at thousands of small meetings around the country in which attendees heard his pitch warning of “socialized medicine” and predicting “behind [Medicare] will come other federal programs that will invade every area of freedom as we have known it in this country.” Just think if he’d had Twitter.

Our strategy that year came to naught, producing in the early fall a stalemate. The Senate actually did pass a national health care bill for the elderly (despite the opposition of the Republican nominee for president, Barry Goldwater of Arizona, who interrupted his campaign and returned to Washington to vote no). But the powerful and conservative Democratic chairman of the House Ways and Means Committee, Wilbur Mills, would not agree to a medical care provision of any kind. A conference meeting to work out differences between the House and Senate ended in deadlock.

Johnson gritted his teeth and returned to the campaign, winning a four-year term in his own right.

Elections matter — surely no one doubts that fact anymore — and the ’64 election mattered dramatically. Not only did it deliver LBJ a landslide victory, but it brought Democrats their biggest majorities in the House and Senate since FDR. “If we can’t get Medicare through now,” the president told me after the election, “we don’t deserve what we just won.”

So as soon as he and Vice President Hubert Humphrey were inaugurated in January 1965, we started over. You can get a glimpse of the intensity of LBJ’s drive from a conversation I had with him around that time. With others, I had urged that the new bill include a provision for a retroactive increase in Social Security payments as an economic stimulus. He called me to say okay, but wanted me to understand it wasn’t because of the economy:

…My inclination would be … that it ought to retroactive as far back as you can get… because none [of the elderly] ever get enough. They are entitled to it. That’s an obligation of ours. It’s just like your mother writing you and saying she wants $20, and I’d always sent mine a $100 when she did. I never did it because I thought it was going to be good for the economy of Austin. I always did it because I thought she was entitled to it. And I think that’s a much better reason and a much better cause and I think it can be defended on a hell of a better basis…. We do know that it affects the economy… it helps us in that respect. But that’s not the basis to go to the Hill, or the justification. We’ve just got to say that, by God, you can’t treat grandma this way. She’s entitled and we promised it to her.

 

He understood the legislative process like no one I ever met. “Nothing given, nothing gotten — that’s the rule!” he told us in an Oval Office meeting on how to break yet another Capitol Hill deadlock. He sent his senior legislative aide to play sweet with a still-recalcitrant Wilbur Mills and warned, “I’ll tell you this, Wilbur Mills will take your pants off unless you’ve got something that he’s got to trade for.” When Mills still wouldn’t budge, the president let loose a string of invectives that would have made even Anthony Scaramucci blush. The next day he was courting Mills again, as if nothing had happened.

As the cherry blossoms bloomed that spring of ‘65, the president thought Congress was moving too slowly. The civil rights movement was under siege in the South, violence was continuing against blacks and we were working around the clock to pass legislation  to end discrimination. Even so, he wouldn’t let us slow down on Medicare — or other pending priorities. When he thought we were lagging, he took us to the woodshed, as you can see in a telephone conversation with Vice President Humphrey and me:

They [the House and Senate] are bogged down. The House had nothing this week — all goddamn week. You and Moyers and Larry O’Brien [his chief congressional expert] have got to get something for them. And the Senate had nothing… So we just wasted three weeks… Now we are here in the first week in March [1965], and we have just got to get these things passed… You’ve got to look each week and say, what is the Senate doing in committee this week and when will they be through, what is the House doing… You’ve got to be running into these guys [members of Congress] in the halls, and going over and having a drink with them in the evenings… I’ll put every Cabinet officer behind you, I’ll put every banker behind you, I’ll put every organization that I can deliver behind you… I’ll put the labor unions behind you.

A few days later, breakthrough. LBJ’s now-gentler courting of Wilbur Mills paid off, and the House Ways and Means chairman pieced together a bill from several options championed by different interests. He got it past the committee’s conservative coalition with a straight party vote, 17-8.   

Remembering our defeat the previous fall, our team fretted over how to make the final sale to the full House and Senate. The president had some more advice for us. As he told Larry O’Brien, the White House chief legislative honcho: Give bragging rights to anyone who voted on the final version of both Medicare — and the big education bill also in the pipeline:     

[Tell them] that every guy that votes for Medicare and education, his grandchildren will say my grandpa was in the Congress that enacted these two… So it makes ‘em proud. And they can go back home and say I was one of the 54 [who voted yes], or my daddy was one of the 54… so all his children and grandchildren are bragging about being one of the 54.

 

Medicare passed the House by a vote of 313-115. But in the Senate, liberal Democrats added $800 million to its cost, outraging conservatives (and vexing LBJ, who knew such overreach would give opponents more fuel to attack).  

Back the bill went to a conference committee between the House and Senate. Then to the House floor again, where it survived more than 500 amendments before passing on July 27 by majority vote, 307-116. One day later the Senate passed it, 70-24. All that was needed now was the president’s signature and Medicare and Medicaid would become the nation’s first public health insurance programs.  

And that’s how it came to pass that 52 years ago, on the morning of July 30, 1965. President Johnson loaded up two planeloads of dignitaries and headed toward Independence, Missouri, hometown of former President Harry Truman. He intended to sign the bill at the side of the man whose original proposal LBJ had dismissed as socialism. Now he revered Truman as “the real daddy of Medicare.” Here’s the actual moment Medicare became the law of the land:

President Lyndon Johnson flips through the pages of the Medicare bill for former President Harry Truman in Independence, Missouri on July 30, 1965. Johnson flew to Independence to sign the bill in front of Truman, the man who originally proposed the legislation almost two decades before. Behind Johnson and Truman are Mrs. Johnson (left), Vice President Hubert Humphrey and Mrs. Truman. (Photo by Bettmann Collection via Getty Images)

President Lyndon Johnson flips through the pages of the Medicare bill for former President Harry Truman in Independence, Missouri on July 30, 1965. Behind Johnson and Truman are Mrs. Johnson (left), Vice President Hubert Humphrey and Mrs. Truman. (Photo by Bettmann Collection via Getty Images)

 

After signing the bill, Lyndon Johnson turned to Harry Truman and signed him up as Medicare’s first beneficiary. It was high drama, touched with history, politics, sentimentality, showmanship and compromise.

The legislation was far from perfect. LBJ once told me never to watch hogs slaughtered before breakfast and never ever show young children how legislation gets enacted.

Too much secrecy surrounded the bill’s passage. Even as the president signed it into law, we weren’t sure of all that was in there. As some principled conservatives warned, there were too few cost controls. The experts feared copays and deductibles would become a burden.  

“Those can be fixed,” LBJ said, “once it sinks in that Medicare is here to stay.”

Meanwhile, as historian Robert Dallek has written, although Medicare and Medicaid did not solve the problem of care at reasonable cost for all Americans, “the benefits to the elderly and the indigent… are indisputable.”

Perhaps the biggest mistake was one of imagination — our failure to anticipate the advent of new and expensive technology to treat the sick or the demand on the system that would rise from a burgeoning population. That spring President Johnson had warned, “We will face a new challenge and that will be what to do within our economy to adjust ourselves to a life span and a work span for the average man or woman of 100 years.”

That, and the cost, we reckon with today.

Now that the eight-year effort of conservatives to repeal the Affordable Care Act (itself a flawed but significant extension of the effort to help more people get decent coverage) is stalled, the next steps are crucial. Going back to the status quo — a system driven by the profit motive and rationed health care based on income — is unthinkable. At the website Common Dreams, Dr. Carol Paris, president of Physicians for a National Health Program, writes:

“Clearly, the system is broken. Like a cracked pipe, money gushes into our health care system but steadily leaks out. Money is siphoned into the advertising budgets of insurance companies and the army of corporate bureaucrats working to deny claims. Even more dollars are soaked up by the pockets of insurance CEOs who have collectively earned $9.8 billion since the Affordable Care Act was passed in 2010. Nearly a third of our health care dollars go to something other than health care.”

Yes, our health system is broken, but broken systems can be fixed — not easily, but they can be fixed.  

Watching recent events, I thought of the long and arduous process I’ve just related, the many steps that brought Medicare into being, and how I was afforded a modest role in the supporting cast.

I came away from the experience with three lessons. First, whether health care is a right may be debatable, but it assuredly fulfills a basic human need — and without it, human beings without means will live and die suffering unduly.

Second, building that more perfect union which the founders of this republic defined as the mission of government has always been slow, hard, acrimonious, frustrating, tiring and elusive, because we as individuals are ourselves imperfect and because there are always among us those predators who regard democracy as an obstacle to their avarice.

Against such realities, the only way for democracy to succeed is for enough people to take up the cause where and when they can, as so many did for Medicare and are doing now for our eroding social covenant. That’s the third lesson I learned: It is harder to build something than to burn it down, but build we must.

 
Note: I am greatly indebted to Larry DeWitt, the historian of the US Social Security Administration, whose outstanding research and organizing talents have helped so many of us recollect with greater accuracy and context such experiences as I have recounted here. The author of numerous articles and essays — including “The Medicare Program as a Capstone to the Great Society — Recent Revelations in the LBJ White House Tapes,” on which  I have often relied — Mr. DeWitt also created http://www.socialsecurity.gov/history, one of the largest history-related web sites in the federal government. It’s a national treasure.  Check it out.

— Bill Moyers

The post LBJ Launches Medicare: ‘You Can’t Treat Grandma This Way’ appeared first on BillMoyers.com.

A Physician Urges Americans to Stand Up to Trumpcare

Published by Anonymous (not verified) on Thu, 11/05/2017 - 7:47am in

This Q&A is part of Sarah Jaffe’s series Interviews for Resistance, in which she speaks with organizers, troublemakers and thinkers who are doing the hard work of fighting back against America’s corporate and political powers.

After the House of Representatives approved legislation to repeal and replace significant parts of the Affordable Care Act last week, Sarah Jaffe spoke with Adam Gaffney, a physician in pulmonary and critical care, as well as an instructor at Harvard Medical School. Gaffney, who is a member of Physicians for a National Health Program, which supports single-payer national health insurance, talked to Jaffe about the latest Trumpcare plan and what needs to happen next. It has been lightly edited for length and clarity.

 

 

Sarah Jaffe: Adam, what are the Republicans trying to do to us?

Adam Gaffney: Well, if you look at this plan, I don’t really consider it much of a health care plan as a conduit of dollars from working class people to rich people. It keeps [some] of the Affordable Care Act in place, but it denigrates it, it twists it and it corrupts it to the benefit of the very wealthy.

Just from the big-picture perspective, what are some of the things it is doing? Well, on the one hand, it is cutting programs, including a major cut to Medicaid. Over 10 years, we are talking about over $800 billion in Medicaid cuts; that is about a quarter of federal spending. That is going to throw millions of people off of Medicaid. As you know, Medicaid is a program for lower-income people that covers more than 70 million people.


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BY Michael Winship | May 5, 2017

The second thing it’s going to do is weaken the subsidies that people use to buy health plans on the marketplaces, the so-called “Obamacare” plans. Those are still going to be around — the private insurance industry will still be subsidized — but those subsidies are going to be worse, they are going to be more regressive [meaning they take a proportionally greater amount from those on lower incomes] and they are going to be less adequate for many folks. That is one side of the ledger.

On the other side of the ledger there’s just a huge redistribution of wealth upward. Essentially, it eliminates a variety of taxes that the Affordable Care Act put in place, and that is almost entirely going to benefit the very wealthy. Here’s some numbers from the Congressional Budget Office’s latest estimates. We are talking about $127 billion that people making over $200,000 for lower Medicare tax cuts; $145 billion over 10 years to the health insurance industry; and $172 billion over 10 years for lowered capital gains taxes or high-income earners. And that isn’t even everything. Big picture, we are weakening the health care safety net, we are taking those dollars and we are funneling them upward.

SJ: Because, of course, cutting capital gains taxes is very related to health insurance. Right?

AG: They would argue that this is part of the Affordable Care Act and that they are simply repealing it, but functionally speaking, this is an upward redistribution of wealth.

SJ: This is the second time, the Republicans finally managed to butter and squirt this thing through with one vote to spare. What happens next here?

AG: It goes to the Senate, where it faces serious headwinds. A lot of senators are very wary about its effects, particularly on Medicaid. There is much less room for error in the Senate. They can’t lose more than a couple of senators and still pass it through. My gut feeling — and I am not very good at political prognostication — is that they are going to pass something, but it is going to be a much more watered-down version of the House bill. Then the question will be: Is the House willing to pass that? I don’t know.

The version 1.0 of Trumpcare was sunk mainly because of the resistance from the hard right within the House, the House Freedom Caucus. They did not feel like the wall went far enough. And that was a pretty ugly law. The question is: How much can the Senate change this bill and still have it be passable in the House? That remains to be seen.

SJ: There is a definite sense right now that a lot of the so-called “moderates” who wound up voting for this, did so with the expectation that the Senate would change it anyway.

AG: That is certainly the case. I think the expectation and the hope is that they would change it. I think there is a realization on the part of many moderates in the House — so-called “moderates” — that this is an ugly, unpopular bill. The last poll I saw was the one that was being cited around the time of version 1.0 that showed 17 percent support for Trumpcare. That is a dismal level of support.

Trump promised more health care, not less. This is just less health care. It is less money going into the health care safety net and more money going into the pockets of high-income people and health care companies.

— Adam Gaffney

Part of that is because of what Trump actually campaigned on. His health care promises were vague, but they aren’t what he is doing now. He said he wasn’t going to cut Medicaid. He said he wasn’t going to cut Medicare. He basically promised more health care for everybody. So, every time people sort of chuckle and say, “Oh, I can’t wait to see the Trump voters get what they voted for,” on the one hand, I think that is really nasty and is not how we should be approaching politics.

On the other hand — and you can fault them for being poorly informed — but Trump did promise something different. He promised more health care, not less. This is just less health care. It is really a quantitative switch on health care spending. It is less money going into the health care safety net and more money going into the pockets of high-income people and health care companies.

SJ: Talk a little bit about the process by which the Affordable Care Act itself came to be. That was after a summer of yelling at town hall meetings from the tea party trying to stop Obamacare. Can you could talk a little bit about that process and where the weak spots in that process were?

AG: I think if you want to look at the weak spots in that process, you have to go back to the beginning, which was a rejection from Day One of single-payer, of something more expansive. In the 2008 Democratic primaries, there was already an assumption that single-payer was not going to be an option and basically all of the candidates were opposed to it. The candidates and [Sen.] Max Baucus (D-MT) certainly conceived of a very much middle-of-the-road compromise bill from Day One.

I think the biggest flaw in the Obamacare process was actually before the summer of discontent and before the tea party were involved and really starting from the assumption that we had to do something much more narrow.

People talk about this sort of origins of the Affordable Care Act. Some people say it is a Heritage [Foundation] plan, which is true only in so far as it incorporated the individual mandate, but it is true that the Affordable Care Act was largely modeled on an even older plan. It was sort of modeled on Nixon’s plan for the 1970s. Ted Kennedy in 1970 put something out there called the Health Security Act, which is basically a single-payer plan. Nixon put up a counterproposal that included employer mandates and an expansion of a Medicaid-like program. So, in many ways, the fatal flaw of Obamacare was its assumption from the beginning that we had to involve the private insurance industry as a key element within our health care system.

SJ: I think it is also worth talking a little bit about the way that the politics around so-called “Obamacare” have played out. You find that people either don’t know that what they have is the Affordable Care Act or people were frustrated because of the jump from being eligible for the Medicaid expansion to then suddenly having to pay out of pocket even for subsidized care. Can you talk about the way that the construction of this bill made it easier to attack?

AG: Well, the construction of the bill was that it reinforced an existing fragmented system. It did not create a new public benefit. So as soon as you do that, you are sacrificing popular support. If you look at a program like Medicare, which is a universal benefit that you get when you turn 65, obviously, it is extraordinarily popular. People know what they are getting.

Under Obamacare, it is very unclear. Most people are unsure of how they are affected by the law. It doesn’t create social solidarity in the same way that the universal public program does.


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Outside Trump Tower in New York, health care justice advocates and other grass roots groups gathered to demand that Trump not to repeal the Affordable Care Act. (Photo by Erik McGregor/Pacific Press/LightRocket via Getty Images)

The GOP’s Attacks on the Poor Are About to Get Stealthier

BY Kai Wright | May 1, 2017

I think the Medicaid expansion was good and it helped a large number of people, but as you say, many people in the middle ground are still being squeezed. Deductibles have been rising dramatically in recent years. It is not the fault of Obamacare. It preceded Obamacare. But, Obamacare has been blamed for it.

Copayments, deductibles, coinsurance are rising. People are finding that although they are insured, they are unable to afford going to the physician or getting a prescription filled. That is a major problem. I think that is feeding into a lot of discontent around this law. I think Obamacare has not created the social support necessary for its own propagation as a result of those inherent weaknesses.

SJ: That said, one of the interesting things that it did do was reinforce the idea that the government should do something about your health care problems. Then, we do see people, again, reacting to the Republican plan to take away what health care people do have with this intense anger.

AG: There has been a whole shift in the way we think about health care toward, at least, an implicit recognition of health care as a right. Conservative columnist Charles Krauthammer sort of said this on Fox the other day. As he said, and I agree, even conservatives are having to defend their health care plan with this implicit argument that everybody deserves coverage. In a way, that suggests that the battle in the discursive realm is actually already being won. People increasingly believe that health care should be a right.

The fact that the Congressional Budget Office released its estimates of Trumpcare and said that 24 million people would be uninsured was shocking. That was terrible for the bill’s popularity. Nobody could defend that. In a real free market sense, that should be fine. If 24 million people “elect” to not buy insurance, who are we to say that that is a problem?
Nobody really thinks that way outside of a very narrow spectrum of zany and cold-hearted libertarians.

I think there has been an implicit, progressive acceptance of the notion that the government should ensure that everybody has access to health care. That is one good thing that has certainly been happening.

SJ: On that note, how do people stop this thing from proceeding through the Senate?

AG: We have to stop it. Even those of us that believe that we need to go well beyond the Affordable Care Act should absolutely recognize the harm that this would do, the deaths that it would cause. A lot of people have put out estimates of potential deaths that could result in something like this. As I wrote in my recent article in The Guardian, around 24,000 people a year will die each year if 24 million people lose their health insurance.

I think every US senator has to be picketed and targeted. I think that they should know that if they vote for this they are going to face the full wrath of the citizenry.

— Adam Gaffney

Lives are on the line and suffering will increase. We have to stop it. It is an all-hands-on-deck approach. I think every US senator has to be picketed and targeted. I think that they should know that if they vote for this they are going to face the full wrath of the citizenry. I think the more protests, the more activism around this in the very short-term, the better.

It is obviously going to play out one way or the other very soon. The Trumpcare battle is a short-term fight in that if they don’t get this through soon, and they need to to use reconciliation to get it passed, it is dead.

SJ: Explain reconciliation for people who don’t understand how that process works.

AG: In general, a filibuster in the Senate means you need to have 60 votes to overcome it. There’s going to be no Democrats who will go along with the health care bill, the Trumpcare bill, as far as we know. In order to get around the 60-vote requirement, there is a provision of reconciliation that allows bills that have a predominantly budgetary impact to be passed with a simple majority. There is a timeline for that. It has to be done relatively soon.

There is actually some question whether some provisions in the House bill would even be allowed to be passed through reconciliation. There is something called the Byrd Rule that describes what sorts of things are allowed to be included. We don’t even know if the House bill in its current form could actually pass as reconciliation. But regardless, if they want to pass anything, it is going to have to be through reconciliation because unless they really come to the center in some way, they are not going to get enough Democratic senators (or any) to get to the 60 votes.

SJ: You have been part of the fight for single-payer for quite a long time now. Talk about where you think that fight is and why it is important to keep it up even as we are trying to stop the health care apocalypse here.

Trumpcare is going to increase the number of uninsured by 24 million and in 2016, according to the National Health Interview Survey, there are already 28 million people uninsured today.

— Adam Gaffney

AG: It is critical because the status quo is very unjust. Think of it this way: Trumpcare is going to increase the number of uninsured by 24 million and in 2016, according to the National Health Interview Survey, there are already 28 million people uninsured. Then, there are even more people than that who are underinsured who are, again, having high copayments, high deductibles, unable to go to the doctor, unable to fill prescriptions.

The status quo is bad and people are suffering. As long as that is the case, we are going to keep the door open to right-wing attacks. There will always be a right-wing economic populist like Trump who is going to say they will make health care better. Well, we are opening the door to that if we don’t do something about it.

It is critical that we keep the fight going for a better tomorrow, for a better future of health care, and not just rear-guard defensive battles of keeping things the way they are. The reality is that people are not happy with the way things are today. It is not good enough. The counter argument might be: Well, what is the likelihood? Are we ever going to get single-payer passed under this current government? No, we are not. But we could under the next government. This is the time when we coalesce. This is the time when we put together our arguments, we put together our coalitions, when we begin to turn on senators and representatives to single-payer so that when the political tide turns, we are prepared. We need the grass roots armies in place now to do that.

SJ: How can people be part of those grass roots armies? Where can they get involved with health care organizing?

AG: There are so many different organizations out there that are focusing on single-payer health insurance. My organization is Physicians for a National Health Program. It is centered around medical professionals, although we certainly have other members as well. There is Healthcare Now and various labor organizations who are very involved in this. National Nurses United, which is the largest nurses union in the country is very much behind single-payer.

I think it depends on where you are and what sort of work you want to do, if you want to get involved in a group that is maybe affiliated with your profession or not. There are a host of groups out there under something called the Campaign for Guaranteed Healthcare, which is a coalition of different groups. You can go to that website and see some of those groups. There is lots of activism on this issue.

From a larger perspective, health care activism can really be a critical pillar of the left moving forward. I think it is an issue that does bring people together and resonates with the general population. A Gallup poll from last year finds 58 percent support among the general public for single-payer health care. This is a good cause that could help galvanize energy on the left.

SJ: How can people keep up with you and your work?

AG: Well, like some other people, I am on Twitter: @awgaffney, and I have a website: theprogressivephysician.net. I would also send people to my organization’s website, which is pnhp.org. It has some great resources on single-payer health care and on the policy issues behind it so that we can really mount our most effective arguments.

 
Interviews for Resistance is a project of Sarah Jaffe, with assistance from Laura Feuillebois and support from the Nation Institute. It is also available as a podcast on iTunes. Not to be reprinted without permission. 

The post A Physician Urges Americans to Stand Up to Trumpcare appeared first on BillMoyers.com.

America’s Health Is in the Hands of GOP Frat Boys

Published by Anonymous (not verified) on Sat, 06/05/2017 - 8:14am in

This just in: Health care is not a game. It’s a matter life or death for millions and millions of Americans. But you sure wouldn’t know it from watching Donald Trump and House Republicans celebrate their narrow victory on Thursday.

The House managed to pass a bill, the American Health Care Act (AHCA), aimed at altering or eradicating provisions of Obamacare, a somewhat muted version of the “repeal and replace” battle cry screamed throughout the election campaign but one that nevertheless will still devastate all but the richest of society with exorbitant medical costs that many cannot afford. Medicaid would be slashed by hundreds of billions. Twenty-four million fewer would be left without health insurance.


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 Patrick Geraghty, CEO of Florida Blue; Vice President Mike Pence; Stephen Hemsley, CEO of UnitedHealth Group; David Cordani, CEO of Cigna; Scott P. Serota, president and CEO of Blue Cross Blue Shield Association; Andrew Bremberg, director of the Domestic Policy Council; Joseph R. Swedish, CEO of Anthem; Bernard Tyson, CEO of Kaiser Permanente; and Daniel J. Hilferty, president and CEO of Independence Blue Cross, Feb. 27, 2017 in Washington, DC. (Photo by Brendan Smialowski/AFP/Getty Images)

Why Big Insurance Adores the American Health Care Act

BY Wendell Potter | March 23, 2017

But the Republicans celebrated this impending tragedy with cheers on Capitol Hill and then got on buses to the White House for some further revelry in the Rose Garden.

“Trump basked in adulation as lawmakers heaped praise on him,” Ashley Parker reported in The Washington Post:

“… Including Trump and [vice president Mike] Pence, a dozen lawmakers and officials spoke, a snaking queue — nearly all white men — who took turns stepping to the lectern to claim their reward: cable news coverage, orchestrated by a president who values it above almost all else.”

Trump shouted, “How am I doing? I’m president. Hey, I’m president. Can you believe it?” Not if I don’t want to. It all felt like a chintzy version of the victory party after a high school football championship, except no one dared douse Coach Trump or assistant coaches Pence and Paul Ryan with Gatorade. Which was unfortunate.

Democrats got into the act, too, singing, “Hey hey hey, goodbye!” at the Republicans in the House chamber, reminding the GOP that they had just cast a vote that may cost many of them their seats in the 2018 midterms.


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ADAPT protesting in the Capitol against the American Health Care Act of 2017 and cuts to Medicaid on Wednesday, March 22, 2017. (Photo By Bill Clark/CQ Roll Call)

Kansas Republicans Are Finally Embracing Obamacare — Just as Trump Is Trying to Kill It

BY Patrick Caldwell | March 23, 2017

The whole thing was very classy, as if the Founders high-fived, fist-bumped and burst into “We Are the Champions” after signing the Declaration of Independence.

The fact is, few Republicans have even read the bill. They did not wait for a cost estimate from the Congressional Budget Office before ramming it through. No hearings were held; no group was given the opportunity to raise its objections in such a public forum: no American Cancer Society, AARP, the March of Dimes, the American Hospital Association — all of which, along with many other professional and advocacy organizations, have made their opposition known. No American Medical Association, which announced, “millions of Americans will lose their health insurance as a direct result of this proposal…”

“Not only would the AHCA eliminate health insurance coverage for millions of Americans, the legislation would, in many cases, eliminate the ban against charging those with underlying medical conditions vastly more for their coverage.”

But if you’re looking for the real reasons Republicans were throwing themselves a frat party on Thursday, heed first the words of Sister Carol Keehan, president of the Catholic Health Association of the United States:

“It is critically important to look at this bill for what it is. It is not in any way a health care bill. Rather, it is legislation whose aim is to take significant funding allocated by Congress for health care for very low-income people and use that money for tax cuts for some of our wealthiest citizens. This is contrary to the spirit of who we are as a nation, a giant step backward that should be resisted.”


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Fourth–-year medical student Kellie Lim checks one of her patients during rounds at the UCLA Medical Center pediatrics ward. (Photo by Mark Boster/Los Angeles Times via Getty Images)

Is Health Care Doomed?

BY Bill Moyers | March 4, 2017

Then remember, as Paul Kane noted in The Post, that the GOP “viewed the measure as a necessary step to demonstrate some sense of momentum and some ability to govern in GOP-controlled Washington… inside the White House, President Trumps advisers became increasingly concerned about how little they had to show in terms of early victories.”

And so they were willing to vote for a lousy, misbegotten piece of legislation just so they could get the first round of tax cuts for the rich and to make it look as if they had accomplished something. Not exactly the Age of Pericles..

I remembered that old poem, After Blenheim, in which Robert Southey recounts the 1704 battle in which Britain’s Duke of Marlborough (ancestor of Winston Churchill) defeated the forces of France’s Louis XIV.

The poem concludes:

“And everybody praised the Duke

Who this great fight did win.

‘But what good came of it at last?’

Quoth little Peterkin.

‘Why that I cannot tell,’ said he,

‘But ’twas a famous victory.'”

Never confuse motion for action, Republicans. And your “famous” victory may be Pyrrhic. Fortunately, this horrible health care legislation has a long way to go through the Senate before Donald Trump gets the chance to affix his EKG-like signature. As South Carolina Sen. Lindsey Graham tweeted yesterday, “A bill — finalized yesterday, has not been scored, amendments not allowed, and 3 hours final debate — should be viewed with caution.”

Perhaps the most relevant — if unintentional — comment came from Trump himself Thursday night when he told Australian Prime Minister Malcolm Turnbull, “You have better health care than we do.” The Land Down Under has universal health care with a private insurance option. They call it Medicare.

If the Democrats don’t immediately start playing Trump’s statement on a constant video loop between now and November 2018, they’ve lost the will to live. The White House said Trump didn’t mean anything by it (although he then doubled down on his words with a tweet) but if you’re in the mood to have a celebration of your own, lift a glass to what he told the Australian PM and make a toast to blowing up this bogus health care reform bill and giving us what Americans truly need — Medicare for all.

The post America’s Health Is in the Hands of GOP Frat Boys appeared first on BillMoyers.com.