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June 3, 2012 Single Payer Activist Conference Call Notes Thank you to everyone who participated in Sunday night's monthly Activist Call. We would just like to re-emphasize that the state-based healthcare bill being worked on by McDermott's office that we discussed on the call has not yet been introduced and is still in development. McDermott has suspended work on the bill at this time and the discussion was about components of the bill that will likely be included, but are by no means definite. We will alert you to further developments on the bill as they emerge. We apologize for any confusion if that wasn't clear on the call. And, as always, please feel free to contact us at [email protected] with any suggestions for future Activist Call agenda items. Your input is much desired and needed! CNA/NNU Rally in Chicago The California Nurses Association/National Nurses United held an amazing rally calling for a financial transaction tax -- or Robin hood tax -- on Wall Street in Chicago two weeks ago during the NATO summit. Here to tell us about it is Donna Smith, Community Organizer and Legislative Advocate for CNA/NNU. Donna: Were having staff nurses' assembly downtown in Chicago that time. A few weeks before rally Rahm Emanuel (mayor of Chicago) and cohorts at City hall decided they were uncomfortable with Tom Morello playing at rally, and decided to raise permit concerns for rally and march at Daley Plaza. We disputed it. We had been planning on having this event for much time because the G-8 was supposed to be happening in Chicago. They decided not to, but NATO was still going forward so we decided to keep it there -- we were also having our Staff Nurses' Assembly there. The publicity surrounding the permit dispute was massive. We held a press conference about freedom of speech, etc. The mayor's office wasn't very clear about why they wanted to withdraw our permit because those of you who know Daley Plaza know it can fit a lot of people. We felt the concern was more about the message the nurses were bringing than about the size of the rally. Agreed we wouldn't hold march through downtown Chicago through the loop, but we held the rally. The mayor's office making this big stink really helped us because we got a lot of good press -- AP picked it up, nurses from Boston, LA came. On the day of the rally we did have to make it from the hotel to the plaza. We did agree not to march so we have to step off in groups of 25 or less so we couldn't converge in one large march. But anyone knows you can't keep people that far apart in big cities -street lights, big groups of people get in the way. So we didn't march, we walked, but it was fun. We actually had press risers because we had so many press people. The city estimated 6,000 people at the rally, which we think is conservative. There were a ton of single-payer banners, signs, etc. in the crowd. The front page of The Chicago Tribune next day had a "Medicare for all" sign in full color above the fold. There was an awful lot of police presence. We told the police the nurses had no interest in letting the rally become violent or anything, but we did say we had a strong interest in asserting our point about our solution to the problem. The Harken-DeFazio bill, that's not what we're looking at. We're asking for half a penny on a dollar on stocks and derivatives and such -- which used to be taxed -- but which haven't been in the past 40 years. In any case our feeling is that you and I pay taxes on everything so why shouldn't Wall Street do the same? With this tax we could raise $350 billion a year -- and this would go a long way to alleviating the tragedy we've seen in this country. We don't want to see the austerity we've seen people all over the world struggle with. We want to protect Social Security, Medicare, etc. -- we want to protect and strengthen those things. The energy was fantastic -- the organizing was fantastic. The most exciting thing was that so many single-payer allies and friends get it and they turned out -- really helped make it a big message for the city of Chicago and for even wider than that. The nurses are also -- with the PNHP docs -- going on a bus tour in California to get the message out there. Also great interview with RoseAnn Demoro on Bill Moyers show about the financial transaction tax and the need for single-payer healthcare. McDermott State Single-Payer Bill in progress Some of you may have heard that Representative Jim McDermott -- US Rep from Washington state -- is crafting new legislation called the "State-Based Universal Health Care Act of 2012." The bill has NOT yet been introduced and McDermott's office has suspended work on the bill for an undetermined period of time, but I thought it was still important to create a space to get some feedback from HCN members on what you all think about the proposal so far. So I'm going to go over a couple key parts of the bill and then open up the call for discussion. The bill's stated purpose is to "provide a legal pathway for states that wish to implement a large publicly financed self-insured plan instead of one based on commercial insurance." The main features of the bill are as follows: • once a state makes a "preliminary showing of its projected ability" to create a universal healthcare system, it will immediately be given permission to use all ACA money (including money that was supposed to be used to set up an Exchange) for the new system ◦ In addition, all federal funds that would be otherwise spent under Medicare, Medicaid, CHIP, TRICARE, and FEHBP will be paid to the state, as appropriate, to cover those populations. The funds will be disbursed quarterly, using the framework established under Medicaid. Funds may not be used for any purpose other than to finance the health plan. • automatic eligibility is for "all lawful US residents," but states can choose to cover • • • • • undocumented workers if they so wish for benefits, "enrollees must receive, at a minimum, the same benefits package as the most popular plan in the Federal Employees Health Benefits Plan Patients may not be denied a choice of provider The state must create "uniform fees for each service" and providers must accept fees as payment in full. Plan must be publicly administered. States individually get to decide 1) Whether and how to include employer responsibility; 2) Whether and how to include patient responsibility; 3) Structure of state financing, if any. Chuck: I have concerns that this might be a sneaky trick to derail the entire program. We could have two things that we're focusing. I'm afraid that that's the old trick of divide and conquer -- divide the single-payer movement into two parts. Francesca: Good concern. Healthcare-NOW! hasn't endorsed this bill -- the bill hasn't even been finalized or introduced so there's nothing to even endorse or not endorse right now -- but I think it's helpful for us to discuss what is happening and hear these concerns. Lynn: Jim McDermott has always been a supporter of single-payer. He was a co-author of HR676. McDermott is a retired psychiatrist who's been in the field. I trust him even if this is an incremental bill. You know in California 6 Democratic senators wouldn't sign onto our bill so we know how hard this is. Don: McDermott's office is still working on the details of the bill and it's too early to say where it's going to be at when it's done. Unfortunately, I released this not knowing it was under embargo and so more people know about it then McDermott's office really wanted. They still need to determine if it's going to be a single-payer bill or if it's going to be a state's rights bill. The positive of a state's rights bill is that you can get conservatives on board. But we just don't know yet what the final bill will look like. Kay: I believe that it makes no sense to pull back to trying to implement state bills when the best example that we have of a single-payer bill that works and is beloved by the whole country is Medicare. So for some reason that we'd want to bust it up into state-sized pieces in the hope that some states can create a single-payer plan doesn't make sense. I think it's a backwards step -- especially at this time when, who knows, the Supreme Court could throw out the whole ACA. So many people talk about how Canada did it first in one little province, but the truth is that they didn't have any national legislation at the time that they needed to get around. It's a backwards step to hand over Medicare to the states. And the fact is McDermott -- and I do respect him -- I think is a good person. But I don't think it makes any sense. If we had the power to pass a piece of legislation that created state single-payer plans, then we would have the power to pass a national single-payer plan. Don: PNHP's position nationally is that we support a national single-payer health program, Medicare-for-all. Our organization thinks the states should each deal with their issues individually and for some states if this bill works out for them it might be something for them to look at it, but it's not something PNHP is going to endorse as a national organization. If you look at what Vermont actually passed it's a promise for universal healthcare and a wishlist. When you look at states like that and the problems they're facing as they're trying to come up with a state single-payer model, the McDermott bill looks really great. The problem is that if we make it -- if it has enough stipulations in it that really make the state single-payer system, then you're not going to get the bill passed anyway. However, if you do have enough flexibility that some states like Kansas can go ahead and set up some kind of voucher system with Medicare and some of the other horrible plans they're discussing, then they're ruining the system in those states. And you could muck that up for decades with terrible systems. So either way it does look like a bad choice. Delphine: Can someone clarify Bernie Sanders' bill? Don: Sanders bill was S703 and now it's S915, and then and now it is a state-based bill. It would create 56 single-payer plans (including DC, the territories, etc.). Kay: The problem with the Sanders bill is that it specifically excludes undocumented workers, and includes for-profit hospitals and nursing homes. Unlike HR 676 which removes the for-profit hospitals and nursing homes, the Sanders bill allows these monsters like HCA, Tenet, the for-profit dialysis centers, etc. to continue just as before. All the studies show that the for-profit hospitals have lower quality and higher costs. If they are left in they will continue to feast on our health care dollars to the detriment of the patients. It's a crucial difference that we all have to understand--especially at a time when the insurance companies are buying up clinics, care centers and other providers. If we do not close this loophole, we will see the insurance companies morph into hospitals and other providers to continue their profits. So the two key problems with the Sanders (S 915) and McDermott bills (HR 1200) are that they specifically exclude the undocumented from coverage (violating our principle of everybody, in nobody out) and they do not exclude the for-profit hospitals. Lynn: The California Bill that we have here -- which I think is one of the strongest -would take Medicare and MediCal (Medicaid) funds. The issue is ERISA. George: I think Kay has outlined very sound ideas about the McDermott bill, and I certainly agree. I think the idea of locking up states for many years with complex laws and seeing that happen is a foolish idea. I think McDermott kind of has an ego problem and a misunderstanding of single-payer. I would encourage that we oppose the McDermott bill. Activist: I think there's some misinformation. Jim McDermott is very familiar with the single-payer issue and co-sponsored a bill with Wellstone. State based bills allows states to do a lot things that they couldn't under the Conyers bills. Something I think people need to look at more is healthcare delivery in rural areas which is something I think state-based bills might work better for. Either one will work, but the I think the reason this is gaining traction is because we've seen so little from Conyers in terms of traction on HR676. We have yet to have Democratic sponsors of the Medicare for all type system who are moving forward or demanding action. Don B.: The problem with both the Sanders and McDermott bills that makes them no gos for me is because of the exclusion of undocumented workers. Back in 1994, our California bill didn't discriminate, but we released an ad that made it seem like it did, and we are still trying to heal our relations with the immigrant communities. And I don't think we can do that. Conyers bill specifically says all residents and doesn't make a distinction between legal or illegal residents, and when he was challenged on that -- to his credit -- he said "This is a healthcare bill, not an immigration bill." The fact that the McDermott bill says that this is only for citizens with legal document discriminates us and we can't afford that. Donna: Since we're not at the position of endorsing or not endorsing since the bill has been suspended for now, I would just like to say that I commend McDermott's office for reaching out to some folks who work on state-single payer work and others for our feedback. I want to praise them for doing that since single-payer people weren't even approached the last time around. And though I hear what people are saying about state single-payer bills we also have to recognize that some of these state bills -- if passed -would alleviate the suffering of millions of people, and I know I and the nurses would find that hard to oppose. National Health Care for the Homeless Council Conference Francesca: The National Health Care for the Homeless Council held their annual conference in Kansas City, MO several weeks ago. The conference is a place where hundreds of health care for the homeless providers and advocates can get together to share resources and learn from each other. There were about 800 people in attendance. Myself and Jonathan Kissam from the Vermont Workers' Center were there and held a workshop on organizing for universal healthcare by using human rights principles. We had about 20 or 25 people in our workshop. Individual Updates Don B: Paul Ryan for some reason decided to come to San Francisco for a fundraiser. He's a Republican -- wants to create a Constitutional amendment against gay marriage and is the point person for privatizing Medicare and Social Security so we have no idea why he came here. He was going to hold a fundraiser at The Gap headquarters. People called The Gap and said what are you doing and so they threw him out -- wouldn't let him have his fundraiser there. We had been planning on having a rally outside of the headquarters, but we couldn't figure out where he went. So we had a press conference outside The Gap headquarters anyway as his last known whereabouts. We also were at a big festival in San Francisco today and collected 93 more names for our database. Betty: Just wanted to let everyone know we now have 48 groups in our new coalition in Oregon with the mission of creating universal healthcare for everyone in our state and in the entire United States. We're really moving forward with this coalition. Kay: We are planning to take action the day after the Supreme Court decision comes out on the ACA. We have a news release prepared for here in Kentucky, and we're planning a march and rally for when that decision comes out to say we still need single-payer healthcare. I encourage everyone to do something because I really think that decision is a great opportunity to talk about single-payer. Bev: I'm working with Tom Knoche and doing some Win-Wins up here in NY state for local school districts, and I hope to bring them to my union and some others. Right now they are very involved in re-electing Obama, but I'd like to move forward on that in the future. Betty K.: I'm really glad McDermott's office isn't moving forward on that new bill yet because I think it's really important to wait until the Supreme Court decision. I also want to second what Kay said about being prepared for the decision and taking advantage of that earned media opportunity. I think on this whole issue of state or national bills, although I would love for the entire country to have healthcare for all, I think it still needs to have some local control. I think what could work in California would be very very different than what will work in New Hampshire or Vermont. I think being able to work with different cultures, different needs is very important. I mean Europe doesn't have one continental plan. They all have different plans even though many of their countries are smaller than many of our states. We may need regional plans or something. I also don't want to have a national plan held back around the immigration issue if not all states agree on it. Bev: I'd like to ask, if you were to talk to Congressman Conyers and give him a message, what would it be? Francesca: I think first it'd be encouragement -- that we'd really like to see him move forward with his bill. It's something that means a lot to a lot of people, and we'd like to see him supporting it more actively. Activist: There's a long history of interaction with Conyers and McDermott, and at times they are helpful and at other times drag their feet. It's a very complicated history over the years. Delphine: I am going to the Retirees meeting tomorrow, and Conyers is frequently there. So I would be happy to relay any message to him. I think he has such extensive experience that I really trust him as to be very sensitive as to when the time is right, but if he needs nudging, I think we should do that. And he has 5 people running against him now because of how they did the redistricting -- and they did that on purpose. Kay: What could help Conyers so much is if we could get additional co-sponsors. We're at 76 right now, and if we could get to 100, it'd be incredibly inspiring. Bev: Some good news is that even conservatives up here -- and I live in the Adirondacks -- are starting to see the importance of single-payer. Bob S.: We had a guy from Organizing for America at a UAW meeting recently and he was talking about Obama, and one of my board members got on there and said we need to talk about healthcare and single-payer. It's not just us nudging Conyers, but it's important for us to get out there too. We have to find some way of reaching new people, younger people. We have to be attuned to building connections to others. Beth: We have several churches here in Connecticut who are on board with single-payer. Unitarians, Methodists, reformed Jewish churches, etc. Some of these churches even have social action clubs. Bob H.: Just want to emphasize what Kay and Bob said. Two people expressed concern about Conyers -- this is in our hands. Until there are well over 100 co-sponsors, Conyers can't do much. Betty K: My expectation is that if the Supreme Court upholds the whole ACA then we just keep doing what we're doing. But if they knock down parts of it or the whole thing, then messaging should really be on full steam ahead to show that single-payer is the only option left and what we need. Francesca: Yeah, Healthcare-NOW!'s position has always been that we need single-payer regardless of the decision. Bob S.: I've noticed something about these calls. I've been on since the beginning with Marilyn and I think the point was always dedicated to a national single-payer system, but now we're talking about state stuff. I think that should be a separate call. This call is supposed to be about HR676. Francesca: Well I think this is all related. The strategy has evolved since HCN was founded. There was no ACA when HCN was founded. Betty: You might want to survey people who have participated over the past 6 months since there's different people on the call every month and hear how they want the calls to be. Peg: I think this call opens the opportunity to learn strategy from other states. I'm still blown away that Chicago was able to rally 6,000 people because I don't think that could ever happen in Houston. And it's nice to know it's happening. After all this is all local. We're pushing for a national issue, but we're all working locally. I don't know how you could ever distinguish between what should be on the statewide call or what should be on the national call if you try and separate it.