It’s 9 am in Vegas and the health care reform panel in the room Brasilica 1 is about to start. On the panel we have:
Levana Layendecker - Former online director of Health Care for America Now (and my former boss!), not at Democracy for America.
Melinda Gibson – Director of online and media at Health Care for America Now
David Welch - From the National Nurses Organizing Committee and Daily Kos contributor
Andrew McGuire – Executive Director of California OneCare
It should be an interesting discussion on health reform, where we go forward in the near future, and active campaigns for single payer around the country.
I’ll update below the fold as the panel gets started.
Levana: My colleagues here have been fighting for some time, decades, to make sure everyone has access to quality, affordable health care. We’ll have a discussion about the next steps in the health care fight.
Melinda: It’s been a long three years. I didn’t know that after March it would become more work, but it has. Health care is playing, but it’s not playing in the election cycle. People want to run from the issue. It’s the #1 attack being used by conservatives on the right against the left, whether they voted for the bill or not.
What do we have to do between now and November? Make sure we don’t lose August. It’s crucial. Last year, we lost the media narrative, organizers on the ground were on the defensive. We need to set up and go on the offensive. Many years of implementation ahead and a longer term fight to get us what we really want, more progressive health care. We have to keep that in mind as we set up and defend, and attack our opponents.
We’re prepared to set up a larger narrative, an anti-corporate narrative, to attack the insurance companies and other big corporations on other issues. So as everyone goes out and talks to voters and constituents, we can be saying the same thing against big corporations.
Data coming back from the field from Working America says that the health care conversations in the field with voters are really hard. People are afraid. But Working America has come up with a rap that works. And the health care numbers are getting better. As they see the checks in the mail, children going back on parents’ plans, we’re moving in the right direction. The big demographic we’re not picking up ground on is the 65+ demographic. Once we pass something in this country, people want to hold on to it.
We have to attack back, we have to attack and pivot. Either you’re with the American people or you’re with the insurance companies. In the next couple years we’ll have a rate regulation fight and a public option fight to get us further to where we want to be.
Andrew: California OneCare is an advocacy organization in CA with a single mission – single payer, Medicare for All. California is ahead of all the other states in the campaign for single payer. I’m working closely with other state leaders, but where we are in CA, we’ve got the policy portion of single payer through to the governor’s desk twice. Schwarzenegger has vetoed the bill twice. Our third attempt is going through by early September. We expect a third veto. The bill is SB 810.
The campaign in CA is in a sense directed by a large coalition. 27 organizations ranging from CNA, League of Women Voters, Courage Campaign, etc… I chair the group, we meet on the phone, and meet in person a few times a year for strategic planning. This has been going on for three years, we call it the State Strategy group. The organization I work for has a strategic plan on our website.
Entertainment outreach is part of our plan. We do outreach to entertainers, musicians, movie stars and the like. The musicians’ union will get their members to do massive concerts to help the cause. We have a full time blogger and a huge number of connections to the blogosphere. I have a 40 years history of working in grassroots organizing. Merging the grassroots effort with the netroots effort is the point I want to make today. That link with the entertainment community, the next target is small business, then corporate, then faith. We’ll get there within a decade. Anyone who thinks that getting single payer in CA within the next few months or years, they’re delusional. You have a half trillion dollar industry at stake.
David: Registered Nurse in Chico CA, part of National Nurses Organizing Committee/CNA. We represent nurses, engaged on a lot of fronts. We think the biggest threat to our members and our health care right now would be the election of Meg Whitman as governor. We’re putting a great deal of energy into defeating her. We engage in bills, and we engage in the fight for the long term solution for health care, which is single payer health care. Both in CA and in states where we have a large presence. We’re working both legislatively and in a conventional organizing kind of way.
I read most of the health care posts on Kos. We see the flamewars between the people who say the health care bill is wonderful because Obama passed it and the people who say it sucks because Obama is a sellout. I don’t see that debate needing to be resolved to figure out how to move forward towards a just health care system.
Coming from a labor background, our lesson from negotiations, the best way to advocate for a better compromise is to advocate for the ideal. One of the lessons I saw from the past debate, once the public option was the left alternative then the public option was doomed. As long as single payer is the left alternative, it creates better space for the public option and other kinds of improvements. When we go into a labor negotiation, we go in for the ideal. When we compromise, then we have expectations management to manage with our members, but we believe advocating for the ideal is the way to get better compromises.
Oh, and Queen Meg, our campaign against Meg Whitman, will be here later this weekend.
Question: Melinda talked about August. I’m from Missouri. We have a situation. There is nothing happening.
Melinda: For the folks not up to date on the Missouri saga. Missouri has gone through an unfortunate turn of events. There’s a ballot initiative on the ballot to repeal health care reform based on the mandate. It’s written poorly, and we’ve been organizing with other organizations to do a legal challenge.
It’s a tough road to walk. Polling says ballot measure can pass, so we don’t want to elevate this to a national debate. But there’s a tight Senate race going on, and there’s not a ground game going. Some conflict with organizations on the ground that we hope will be resolved. May not save outcome of the ballot measure, but we hope to effect the narrative coming out of it.
Our national field director is a former MO organizer, MO has been a hot topic. It’s going to be bad. We have to work hard to build this national narrative to help us insulate incidents like what’s happening in MO that we can’t prevent. FL is another one.
Question: I’m from FL, wondering about that too.
Melinda: FL situation is equally problematic. Not good rulings from the judges. It’ll become a legal battle.
Question: This panel is a good representation of pushing for more and maintaining what we have. Is OFA helping?
Melinda: I can’t speak on behalf of OFA. Due to the nature of the election year, their ability to coordinate with outside groups is reduced. Reading their emails, they’re planning on doing some of this but there’s more need to push.
In terms of the regulations coming up, most is happening through HHS. Previously HHS has been a career department in DC, not the center of politics. At this point it can no longer do that, it has to get involved. Sebelius has proven herself recently to be a fighter, which gives me some comfort. But it’s a long battle and the insurance industry knows it. They’ve been hounding HHS and the NAIC. All 2000 lobbyists are lobbying the 55 members of the NAIC.
Question: Little known provision added in the reform bill introduced by Sen. Murray. Provision would fund community coalitions and local governments to develop systems of care in their community. The money has not been appropriated. Reason it’s important is that there’s a group of moles that have outlasted Bush who want to fund communities to develop coordinated care targeted to communities. This brings communities together to solve the problem on a pilot basis. Creates an advocacy force. It’s important we get that funded.
Andrew: Every discussion of reform is fraught with landmines. I’ll throw a grenade into the room. All of that organizing in pockets around the country, I’d love to see that go into the single payer state by state movement. Let’s get out of the Rube Goldberg, trump it, and go for something people can understand.
David: We’ve involved in coalitions moving in the right direction. We’re engaged trying to elect better people, defend the good people, nudge the legislative process. When we look at incremental solutions, our bottom line is does it strengthen the public part of our health care system or the private part? The worst part of what happened was increased money to private companies, but the better part of what happened was increased access for people to public programs.
We think the split between labor organizing and politics for labor is a false choice. They feed on each other.
Question: I’m on dialysis because I couldn’t get insurance after I lost my COBRA because my employer decided to not pay me. I had pre-existing conditions, I couldn’t get insurance at all. This is how I wound up on dialysis. I’m waiting for a kidney. I’m wondering what’s going to happen before 2014 to prevent more people like me.
Melinda: As of July 1st, the pre-existing condition high risk pools have been set up. Many states already have existing pools, so people who have insurance through those pools don’t qualify for the federal pools. The pools aren’t big enough and not funded as it should be, but it’s better than we have now. People can get insurance. When the Exchanges are set up in 2014, these pools will be integrated. It’s a stop gap, not perfect, but hundreds of thousands in this country will get some relief.
Question: I’ve always assumed that the only way single payer comes about is have it evolve out of a situation where health care companies have priced themselves out of the market. What can we do to speed it up?
David: From our standpoint, it’s not a short term thing. There’s no shortcuts. Continue to educate and grow power. The insurance company model includes this death spiral. The more people who drop out of insurance the more they raise the prices of those that remain. Their model is doomed. There are no real answers other than continuing to do what we do.
Andrew: I’m of a different mind. When I got involved I though yeah, they’ll price themselves out. But then I thought about it and thought they’d hire smart people and figure it out. They have 10 to 20 year plans to figure it out.
Melinda: We just beat them, we didn’t get everything they wanted, but we did beat them. They’re not unbeatable. They got in too late, didn’t spend enough money, didn’t have a good message. They’re beneath congress in approval ratings. They’re a tough road, but we can keep chipping away at them. We can pass a public option.
Once we do that we’ve created a narrative where people demand government to step in in the face of these corporations. And once we do that, we’ve paved the way for the rest.
Andrew: The thing that’s new is we have the netroots. If anyone gets to net neutrality, we’re in trouble. When you look at the right wing billionaire types who created the right wing infrastructure that took over America. You have this long term planning, funding for decades, it’s the antithesis of the left, especially the foundation work on the left. The fundamental hope I have is we can change the images coming out of hollywood. And get the netroots connected with the grassroots. We have to inoculate 5 million voters so they understand single payer. Eventually it’ll end up on the ballot with the insurance industry putting something on the ballot to overturn what we’ve done. We can win that.
Question: What I find challenging is the managing of expectations. We tell our members we’re going to do something, and sometimes it fizzles. What do we do?
David: We’ve made a different decision, not going out in a big way for things that are only half-way compromises. We haven’t had to fight the management of expectations as much on health care, but we went out in a big way on EFCA. We’ve held up MA as a mistake, something less than satisfactory. We haven’t been in that exact position. The management of expectations is mostly in our negotiations. Settling for half and telling folks that was a big victory, we got halfway there.
Question: I used to work for insurance companies. I think with this new reform, they definitely have a plan. It includes managing expectations. There are guys working on getting around regulations, every aspect of this bill. Entering regulatory phase now. A critical fight. There’s no meaningful cost-containment, the strategy that the prices will get too high, insurance companies have a strategy for that too. Titration of medical care. My question/comment is we’ve passed the glamorous part of reform, which is passing a bill. Now it’s the less headline-attracting work, regulations and implementation and pushing this to the next level. State-wide single payer, cost controls, public option. This must be seen as the opening salvo.
Andrew: Nothing is harder when you don’t have the President or other high profile people pushing.
Question: Disturbing part of conversation was racial aspect of health reform. Illegal aliens using our dollars, welfare queens benefiting form reform. How will that play out in the states, especially with the Medicaid expansion, a program with a large racial aspect already?
David: One of the biggest fights we face is there’s a segment of America conditioned to believe anytime a government program is expanded it’ll benefit a despised group from their point of view. The concept of everyone in the same program is helpful. Medicare has such a strong support is that it is not a means-based program, it’s aged-based. Avoids being seen as a poor person’s program. Medicaid is and is seen as a poor-person’s program. As such it always gets the dregs in terms of quality.
One of the advantages we have in our group is the diversity of membership. As a nurses organization we have substantial segments of membership in minority groups. Our largest segment is Filipino.
Melinda: NAACP is starting One Nation, and NCLR has good messaging info on that.
Question: I’m from Canada. Things I was seeing in the Canadian news. Governors being threatened for implementing the law. Couldn’t understand that. There was a time in Canada where there wasn’t a public system. Our system is going the other way, insurance companies coming to Canada and trying to sell us health insurance. We’re fighting that. Yes, what’s been passed isn’t perfect, it’s a step in the right direction. In Canada our health care is provincially, every province has their own system. The freedom for me is I can go to a doctor’s office and get treating without worrying about money. I won’t be turned away at an emergency room. If you can learn from Canada. Look for some inspiration. Don’t stop.
Question: One of the most important groups to get on board with any effort for single payer is the physician community. What efforts have been made?
David: There is a very active group, one of the longest-standing groups, PNHP, and they’ve done some of the best work on the data that’s useful to others in this fight. Substantial medical student’s organization. These days polling among physicians is moving in the right direction.
I know a number of doctors who’ve left private practice and started working on a salaried basis for other people because they don’t want to deal with insurance companies. They’re not nearly the enemy anymore, and the next generation are much more on the right side of this fight. Signs are hopeful.
Andrew: A note from CA. PNHP from CA hired an executive director for the first time. A great positive step.
Question: Mentioned briefly small business. What’s the strategy for small business?
Andrew: First step hasn’t been done yet in CA. We’re just putting together experts to do cost-benefit analysis on how that will benefit small business and families. I’m working with PNHP in CA and CNA and other groups to hire an academic-based firm to do a study that can answer questions in business terms about finances of single payer.
We’ve done some work in organizing communities and businesses. We need the study first because that’s what they want to see.
Melinda: From the beginning of HCAN, we were able to pinpoint a couple of things from 93/94 fight to learn from. Involving physicians and small business were two key points. The NFIB in DC is a front for the right wing. We had to come up with a counterweight. Small Business Majority and Main Street Alliance have emerged, representing thousands of businesses at this point. These organizations have been crucial in communicating with business owners and debunking NFIB bunk information. They were targeted to turn them against what was happening.
As of July 1st, all small business owners will be notified of their tax break under the new law, so we’ve seen support increase, but there’s more to be done.
And that’s it! More later!