The White House
Health Care Summit
By Oliver Fein, M.D.
Thanks to many grassroots activists and physicians who called the White House and threatened to demonstrate outside its gates, I was at the Health Care Summit at the White House on March 5 along with Rep. John Conyers Jr. (D-Mich.). And it was good thing. It meant that the single-payer position was recognized as one pathway to health care reform. It also meant that one of our concerns was present: namely, that any health care reform that includes the for-profit, private health insurance companies will fail to provide universal coverage, will not be able to reduce heath care costs, and will increase the number of underinsured.
It’s important to note that there were others at the summit who are known to be sympathetic to single payer, including some past and present co-sponsors of H.R. 676 and Sen. Bernie Sanders of Vermont. (More on Sanders below.)
That said, it is true that the summit was carefully choreographed. The opening plenary featured Travis Ulerick, a 24-year-old firefighter from Dublin, Ind., who had sponsored a “health care community discussion” (house party) in his fire station in December. He read off the names of six other people who had hosted similar house parties who had been invited to participate in the summit.
Ulerick called attention to a booklet, “Report on Health Care Community Discussions,” which was distributed to all summit participants. It focuses on cost, access, quality and system performance as the major problems facing the American health care system. As solutions, it offers creation of a health insurance exchange, reducing prescription drug costs, research and standards to improve quality and efficiency, simplification and information technology, education for wellness and the promotion of healthy lifestyles.
Interestingly, in the middle of the report, there is a box labeled Single-Payer System, which states: “Over one-quarter (27 percent) of the groups discussed the merits of a single-payer system, and the majority of those groups supported this idea. These groups argue that this radical change was a necessary step for reform.”
President Obama then spoke about the urgency of the problem, focusing heavily on the need to rein in skyrocketing health care costs that are straining the budgets of families, businesses and federal and state governments. Health care reform is “not just a moral imperative, but also a fiscal imperative,” he said. He warned “special interests” not to stand in the way of reform and then dispatched the assembled group with “Let’s get to work.”
The approximately 150 participants were then split up into five breakout groups. I conferred with Rep. Conyers, author of H.R. 676, the major single-payer bill in the House of Representatives, about what we might be able to accomplish during the breakouts. He was assigned to Breakout Session One, chaired by Melody Barnes and Bob Kocher, the principal staffers who had organized the summit. I was assigned and attended Breakout Session Two, chaired by Valerie Jarrett, a senior adviser to the president, and Ezekiel Emanuel, an oncologist and former bioethicist for the NIH, now one of the chief health care advisers in the White House.
My panel had four senators: Robert Bennett (R-Utah), Christopher Dodd (D-Conn.), Bernie Sanders (I-Vt.) and Debbie Stabenow (D-Mich.); nine House reps: Roy Blunt (R-Mo.), Michael Burgess (R-Texas), Donna Christensen (D-VI), Nathan Deal (R-Ga.), Rosa DeLauro (D-Conn.), Steny Hoyer (D-Md.), Buck McKeon (R-Calif.), George Miller (D-Calif.), Tim Murphy (D-Pa.); and the following constituency representatives: John Engler (National Association of Manufacturers), Jeff Kindler (Pfizer), Chip Kahn (Federation of American Hospitals), Eric Whitaker (University of Chicago Medical School), Debra Ness (National partnership for Women and Families), Fredette West (Racial and Ethnic Disparities Coalition), Ed Coyle (Alliance for Retired Americans) and Scott Hersey Reed (PICO – a faith-based organization).
The discussion in my breakout group was relatively unfocused. Most agreed the time and circumstances were different from 1993-94, when the Clinton health plan was defeated by special interests. The opportunity for reform now was real. The major problem was high costs and access. Solutions ranged from community health centers to malpractice reform, physician payment reform, reduction of medical errors, wellness programs, comparative effectiveness research, and health information technology.
Because no one had yet mentioned for-profit, private health insurance companies as the source of our problems, I was preparing to speak. But at that moment Sen. Sanders burst in and pointed out that private health insurance added cost but no value. He then announced that he intends to introduce a bill in the Senate resembling the McDermott bill in the House, a national single-payer program administered through the states.
The only panel member who advocated for an existing bill was Sen. Bennett. He spoke on behalf of the Wyden-Bennett bill, which would remove the tax deduction that employers who sponsor private health insurance have, thrusting everyone into the individual market, which he claims would reduce costs through market competition. He had not heard of the “health insurance death spiral,” in which the healthy pay less for premiums and the sick pay more, although he understood the concept.
After an hour and half of discussion and without reaching consensus, we reconvened in the East Room of the White House, which had been reconfigured into a “theater in the round” with lectern in the middle for the president. The president had a list of names to call upon and started with Sen. Ted Kennedy (D-Mass.). He then proceeded to name the important Congressional committee chairs (Democrats) and their ranking members (Republicans). This gave each an opportunity to make a statement and/or ask the president a question.
It was clear that the main message that President Obama wanted to communicate was bipartisanship and transparency, since he avoided most of the truly contentious issues, such as an individual mandate to carry health insurance either for children and/or adults; an employer mandate to pay for coverage; a public plan to compete the private plans in a health insurance exchange; elimination of pre-existing conditions exclusions from private health insurance; taxation of health benefits offered by employers; or permitting Medicare to negotiate with pharmaceutical companies for drug prices. These are all issues left for discussion and resolution within Congress. While this is the opposite of the Clinton administration’s approach, the president may be seeking to lay a broad foundation for making hard choices in the future.
Besides the lawmakers, it is interesting to note which organizational leaders he called on to make statements. These included Karen Ignagni, president of America’s Health Insurance Plans; Dan Danner, president of the National Federation of Independent Businesses; and Ted Epperly, president of the American Academy of Family Physicians. A few other audience members were called on for statements, including Fredette West, president of Racial and Ethnic Disparities Health Coalition, and Irwin Redliner (a recently mentioned candidate for U.S. surgeon general) from National Center for Disaster Preparedness at the Columbia University Mailman School of Public Health.
What was my role in all of this? Despite my best efforts, I was unable to make a public statement at the meeting, although thanks to the PNHP staff in Chicago we were able distribute my prepared remarks to the media while the summit was under way. Our staff member in Washington, Danielle Alexander, also handed out hard copies to summit participants as they left the White House.
I took the opportunity to talk one-on-one with six senators and seven representatives and suggested that if their committees held hearings on health reform, at least one or two single-payer advocates should be included on the hearing panel. I also said that single-payer bills like H.R. 676 should be compared with all other proposals for health care reform by the Congressional Budget Office. There was considerable receptivity to these ideas among some of the Congress members. We will pursue these leads.
The media took great interest in the successful battle by Rep. Conyers and myself to get into the summit, with stories in the Congressional Quarterly, The Wall Street Journal, and The New York Times, among other places. We have also been able get the single-payer message out on radio, with myself and Drs. Walter Tsou, Steffie Woolhandler, David Himmelstein and Quentin Young, among others, being invited to appear on the air, often on programs with national reach. This was a plus.
In sum, I came out of the White House Health Care Summit with conviction that single payer – that is, publicly funded, privately delivered health care, which removes the wasteful for-profit, private health insurance companies as middlemen, remains the only solution that can guarantee access to comprehensive, quality health care with choice of doctor and hospital, and reduce overall cost. Single-payer, an improved and expanded Medicare-for-All, is the gold standard against which all other proposals for health care reform should be measured.
Advocates need to focus on Congress during the next few months. We need to make the case that co-sponsorship of H.R. 676 raises its legitimacy as a gold standard, and that single-payer advocates should be called to testify at congressional hearings.
- Oliver Fein, MD
Beaver County Blue: Voice of the 17th CD of Progressive Democrats of America 
This is going to be a tough fight..But it is a fight worth fighting and a fight that can be won.. Single payer healthcare needs to win this fight.. We may never get another chance if this fails!!!!
I would love nothing more than to see single payer, universal health care as a reality in this country. I however don’t believe it will happen in the current climate. I believe that we have a real opportunity to put real legislation in place that limits the damage that the for profit system puts on patients. Stopping preexisting condition clauses and allowing for Americans to choose the government plan over the employer offered plan will do allot to repair the system for those that have insurance. Offering government plans to those on the bottom of the economic ladder at income based cost will allow for all to have access to insurance.
Maybe we need to take a smaller bite and get a little more down the road once America has seen the benefits of the government option.
Thanks to Olivier and Randy for this report. There are lots of us who would love to see single payer universal health care access. My belief is that the for profit insurance lobbyists and supporters try to minimize our numbers. Yes, it will be a difficult fight to make this happen but I believe it can be done. We need to get Pres. Obama to open his eyes on this issue. He does not seem to be listening to all views equally. Keep up the fight!!!
Thanks to all for the comments. Indeed this is a difficult, complex, and possibly long term battle for our human rights. Rights that, by the way, are enjoyed by the people of all other advanced industrial nations as well as some not so advanced nations.
I believe that if we fight for what the wealthy corporations are willing to give us, we will end up with less than we have now. As I look at the news from around the nation I see jobs slashed everywhere, healthcare is also lost by the unemployed, and as the movie Sicko showed, even those with insurance are denied care.
The problem is that the health insurance companies offer no value added to healthcare. They are only willing to expand care to the uninsured or those with pre-existing conditions if the taxpayers pay the premium and if everyone is forced to buy insurance. Their political allies also want to tax workers’ current healthcare benefits as income.
The bottom line is we cannot afford the cost of anything but single payer healthcare and we cannot survive anything but universal healthcare.
Thank you for a very fine summary of what goes on at these confabs.
I advocate going BEYOND the expansion of Medicare to all ages.
I want to see what I get at the VA: first class doctors from the adjacent med school [this type of affiliation goes on here in FL, also in NY and OR and points in between]. They are superb at prevention and at minimizing unnecessary procedures. Plus, they have the ability–explicitly denied to Medicare by the GOP congress a few yeas back–to use the organization’s purchasing power to negotiate with pharmaceutical companies about drug prices.
I am aware of studies in peer-reviewed journals about the quality of VA care. See, for instance, Am J of Man Care 2004; 10 (part 2) 828-836.
Help/assist Terry Gross on getting a single payer healthcare discussion on her program “Fresh Air”.
See for example last Thursday March 12 program second segment for a ‘moderate’ healthcare ‘expert’ who doesn’t get it. She needs help First segment is good case study in insurance denial. “Fresh Air” allows audio downloads. Look carefully for listener comments at the bottom of the page. They take awhile to download. There are dozens of them related to the second segment alone. Some — more than a few — advocate Single Payer Healthcare.
The attached report was well worth reading and distributing to others. I wish the Labor Movement would stop burying their heads in the sand and get on board. As someone who was denied health care coverage by my employer in Memphis for pre-existing disease I greatly understand the health care crisis. It is now up to President Obama and the Democrats in Congress to push the ball across the goal line. Single payer health care is the only way to see that everyone great proper health and prevent costly procedures later. And God bless Congressman Conyers.
Thank you Dr. Fein for a very articulate and fair report on the Health Care Summit. I imagine there were things that give one hope and others that present the reality of how hard it’s going to be to successful reform our health care system.
I am particularly interested in how the reform will address the racial and ethnic health disparities that have become embedded in our health care systems and outcomes.
Finally, the time has arrived to fix Americas Healthcare crisis, and Americas healthcare nightmare. Hundreds of thousands of you are killed needlessly every year by your healthcare delivery system in a rush to profit. And because of a rush to profit Hundreds of thousands more of you are needlessly dying from treatable illness that people in other developed and civilized countries don’t DIE! from. Rich, middle class, and poor alike. Insured, and uninsured. Men, women, children, and babies.
Additionally, thousands more of you are driven into financial ruin, and bankruptcy just because you, or one of your loved ones got sick or injured. And all of this is happening at a time when America spends twice as much of it’s GDP (Gross Domestic Productivity) on health care than any other country in the developed world. Individual Americans spend about ten times as much on health care as any other people in the developed world. This is a CRIME AGAINST HUMANITY. AND IT MUST END!
But before we can truly fix this healthcare crisis and disgrace, everyone needs to clearly understand what the problem is. And everyone needs to clearly understand the real enormity of the problem. The problem is that HEALTHCARE AND MEDICAL DELIVERY IN AMERICA IS SEVERELY CORRUPTED AND COMPROMISED BY GREED! AND THE PRIVATE FOR PROFIT MOTIVE. And it is corrupted, and compromised IN EVERY ASPECT, AND EVERY PLACE OF HEALTHCARE AND MEDICAL DELIVERY. Unfortunately for all Americans, compromised healthcare ALWAYS results in needless suffering, injury, disability, and or death. Which is exactly what is happening now in America in shocking numbers.
Health care is NOT! a private for profit business. Healthcare is an essential public service. Like police, and fire. And healthcare is also a human right! PRIVATE FOR PROFIT HEALTHCARE IS AN OXYMORON, AND AN IMMORAL AND UNETHICAL PERVERSION OF HEALTHCARE AND HUMAN RIGHTS.
So how do we fix this healthcare disgrace? I believe the fix for Americas healthcare disaster is essentially the same thing that every other developed country in the World has essentially done. “NOT FOR PROFIT, TAX PAYER SUPPORTED, SINGLE PAYER, AUTOMATIC, FREE UNIVERSAL HEALTHCARE FOR ALL”. Essentially HR676 (enhanced, and improved medicare for all). Just like every other CIVILIZED! country in the developed World has. There is no other way to truly fix and reform our current disastrous healthcare delivery system.
All Universal health care systems work best when everyone participates. But I know that the healthcare lobby, and some politicians will try and undermine “Not For Profit, Tax payer supported, Single payer, Automatic, Free Universal Healthcare for all” by falsely claiming that it will limit your choice, and require you to participate.
So, I propose that everyone be included in the national plan unless they choose to opt out. If you opt out and need medical care the national plan will insure your provider that they will be reimbursed under the rules for members in the national plan. But those who opted out, and their insurer will be responsible for the FULL! cost to the national plan for providing your care if you or your private insurer fails to reimburse the provider or the national plan in a timely manor to at least the standards of the national plan.
Including reporting you to credit agencies, withholding of taxes, leans, and garnishment of wages for unpaid medical bills. Just like you have now under private for profit healthcare, and private for profit health insurance.
Further, people who opted out will be required to provide proof of financial responsibility for future illness or be required to participate in the national plan. And everyone with children will be required to participate in the national plan. Or provide proof of insurance coverage on each child to the standards of the national plan. It will be against the law to report anyone in the national plan to a credit agency for unpaid medical bills.
Frankly, only a dope would want to opt out of the national plan and opt to keep our current disastrous private for profit medical, and insurance plans. But they will be free to choose. The most important thing is that the vast majority of Americans that want the protection, benefits, and higher quality of a universal national plan have that choice.
You see, one of the most important aspects of a universal healthcare system is easy access, and patient protection. This is accomplished by having a single payer without a conflict of interest in patient care. And by having a payer who has the power to enforce minimum standards of excellence in healthcare delivery for everyone in the plan. This is much of what Medicare does now for senors. “Aeger Primo” (The patient comes first). Unfortunately in our healthcare system the patient comes last. We are just a peace of meat to them. Cash cows to be slaughtered for profit.
So this is IT! my fellow Americans, My fellow human beings, My fellow World Citizens. And my fellow Cyber Warriors. 🙂 The time has come. D day. H hour. HEALTHCARE REFORM THIS YEAR! Let no one stand in our way. Contact your representative and tell them you want “Not For Profit, Tax Payer Supported, Single Payer, Automatic, Free Universal healthcare for all. And tell them you want that choice now. Tell them you want President Obama’s budget passed without delay. President Obama’s budget is brilliant. And exactly what is needed now.
President Obama, and his allies will need all the support you can give them. The healthcare lobby will try to take out his people if they can, like they did with Tom Daschle and Nancy Killefer. And they will try to neutralize President Obama’s popularity, and political power. Or they will try to take him down someway. Don’t stand for it. If they attack him. Go after them ten times harder and remove them from office. We had an election. And you the people chose President Obama’s leadership, and change agenda. Let no one in government disrespect the will of the American people and remain in office.
SPREAD THE WORD! And talk it up with your families, friends, and coworkers. Keep ratcheting up the pressure until there is a ROAR! across America for “NOT FOR PROFIT, TAX PAYER SUPPORTED, SINGLE PAYER, AUTOMATIC, FREE UNIVERSAL HEALTHCARE FOR ALL”.
Let’s get this healthcare reform done now my fellow Americans. This year. Take no prisoners.
God Bless All Of You
Jack Smith — Working Class 🙂
http://jacksmithworkingclass.blogspot.com/
(http://jacksmithworkingclass.blogspot.com/)
Today Rep. Conyers and others will be speaking in Albany NY about health care.