Really, Mr. President

By Andrew Coates, MD

The Democratic National Committee (DNC), at its Organizing for America website,, has initiated nationally coordinated local events in June, the “Health Care Organizing Kickoff.”

Organizers will call local contacts using an “Invite Call Script:”

“For decades, health care reform has been blocked by special interest lobbying and political point-scoring in Washington. We’re doing everything we can to make sure real reform happens this year. We’re starting by doing something real here in our own community.”

The DNC hope is to solicit personal stories “about the importance of health care reform in your life” and to organize house parties to discuss the President’s “principles” and to plan volunteer activities on the weekend of June 27, a “local Health Care Day of Service.” Participants will be asked to “brainstorm” about volunteering for a day at a community health center, or hosting an SCHIP education program, or holding a blood donation drive, or running “a healthy food drive/health care fair.”

Back in December the Obama-Biden transition team organized thousands of “Health Care Community Discussions.” The President-elect (with Tom Daschle) issued a call for “health care reform that comes from the ground up.”

As the community meetings occurred, PNHP received a flood of reports from participants that single payer was the unanimous recommendation from hundreds of gatherings. The official report confirmed that single-payer reform was discussed by 27% of 3,276 house parties (at least 884 meetings) and admitted that “the majority of those groups supported this idea.”

This support came in spite of the fact that participants and moderators were instructed to follow a script that appeared custom-tailored to keep single payer out of the discussion. The official instructions offered reform based upon employer-sponsored health insurance as the only option:

“In addition to employer-based coverage, would the group like the option to purchase a private plan through an insurance-exchange or a public plan like Medicare?”

Even so, more than 1 of 4 meetings proposed that a single publicly financed national health program was the answer to the American health care crisis.

The transition team report blamed the popularity of single payer on “encouragement by advocacy groups,” characterized the proposal as “radical change” and devoted about one solitary page in a 122-page document, enough to dismiss single payer proposal and its advocates. So much for health reform that comes from the ground up.

This year a nationwide movement for single payer national health insurance has taken root progressively. At every turn — from the White House summit to the regional White House forums to the Senate Committee on Finance to the halls of the Capitol to our home congressional districts — single payer advocates have been there. So often now we are the only ones at the meeting not paid to attend. Our movement has grown strong enough to inspire righteous and dignified civil disobedience.

Obviously it is time for the Democratic National Committee to “kickoff” and do “something real” for “real reform.” Let us hope that millions join the campaign. Really.

Imagine a day of service in which volunteers organize a free personal bankruptcy clinic, or a bus trip to Canada to purchase prescription drugs, or an advance-planning workshop about Medicaid enrollment to cover nursing home costs, or a session on how to appeal the hospital bill, or a day of tabulations of insurance industry profits, overhead and campaign donations, or a seminar on how to raise the most money — raffles, dances and bake sales — when the volunteer fire company goes all out for the local child with leukemia who has exhausted the parents’ insurance benefit…

The majority of the nation knows that the only proposal that will fulfill your principles, Mr. President — reduce costs, expand our choice of health care provider and give access to excellent health care to everyone — is a single payer national health program.

Mr. President, your nation needs you to get real, get back to health reform that comes from the ground up and keep the promise:

“The system we have now might work for the powerful and well-connected interests that have run Washington for far too long, but I don’t. I work for the American people. I didn’t come here to do the same thing we’ve been doing or to take small steps forward, I came to provide the sweeping change that this country demanded when it went to the polls in November.”
— President Obama, February 28, 2009, “Keeping Promises.”


  1. Alexander Hamilton on May 29, 2009 at 9:36 am

    Simon Stevens, who worked at 10 Downing Street as Tony Blair’s Health Policy Director from 1997 to 2004, announced yesterday his plan for “saving” the U.S. government $540 billion in health care costs over the next decade, by applying brutal cost-cutting measures to the federal Medicare program which serves the elderly in the United States.

    As part of the build-up to President Obama’s June 1 unveiling of his Hitler health care program, private health insurance companies are putting out their own proposals. This follows their pledge at the White House earlier this month, to help Obama find $2 trillion in cost savings, under the pretext of finding the funds to provide medical coverage for 50 million uninsured Americans.

    Stevens, speaking for the United Health Group, which claims to finance and manage health care for over 70 million Americans, issued UnitedHealth’s report on Wednesday, arguing that many of the cost-saving measures it is already using, could be applied to the Medicare program. Steven’s report sets out 15 steps which he claims could save over half a trillion dollars.

    Of his 15 steps, the largest grouping (6 steps) is under the category “Reducing Avoidable and Inappropriate Care.” Better keep an eye on your grandmother.

  2. MOCKBADOC on May 29, 2009 at 2:00 pm

    “The majority of the nation knows that the only proposal that will fulfill your principles, Mr. President — reduce costs, expand our choice of health care provider and give access to excellent health care to everyone — is a single payer national health program.”

    If the majority of the nation was truly calling for this sort of reform, it would have happened already. The insurance industry is immensely powerful, but not as powerful as the voters when unified.

    Of course, if the majority of the nation “knows” this to be true, then they must be looking somewhere for evidence other than the examples provided by “every other industrialized nation”. Those nations, without exception, have discovered that they can not provide the needed services under the single-payer model, and have been forced to begin to rely on the private sector to fill the gaps. In France, for example, the “single-payer” you folks support has found it impossible to cover more than about 70% of the costs, so over 90% of the French citizenry has had to purchase additional private coverage through the same kinds of insurance companies you so clearly despise.

    Insurance is a horrible intruder in the health care business. But claiming that health care that is controlled by a government (that is as unresponsive as your own “Baucus Eight” have found it to be recently) is somehow better for the average person than health care controlled by insurance is disingenuous and misguided, at best.

  3. Christine Adams on May 29, 2009 at 6:07 pm

    After the Obama Adminstration and Sen. Baucus blocked single payer, I began to return the DNC pledge cards with $0.00 written in as the amount donated with a note saying I would not contribution to the DNC until the Dems supported single payer. I also unsubscribed to the DNC email requests and in the box allowing me to say why I was unsubscribing I told them I would not contribute to the DNC again until they supported single payer. If enough people made it clear they would not support the Dems/DNC if they block single payer, it might show that collectively, we contribute more than the for-profit health plans contribute because we represent votes not just dollars.

  4. Alexander Hamilton on June 1, 2009 at 9:17 am

    Ezekiel Emanuel, MD, called for a reinterpretation of the physician’s Hippocratic Oath to take account of “costs” and “effect on others” (like HMOs), in an article in JAMA of June 18, 2008. The brother of Obama’s chief of staff, Ezekiel Emanuel is a top designer of Obama’s medical-care “reform,” as health-care advisor to Peter Orszag’s OMB and a member of the Federal Council on Comparative Effectiveness research. He wrote:

    “At least 7 factors drive overuse [of medical care], 4 related to physicians and 3 related to patients. First, there is the matter of physician culture. Medical school education and postgraduate training emphasize thoroughness. When evaluating a patient, students, interns, and residents are trained to identify and praised for and graded on enumerating all possible diagnoses and tests that would confirm or exclude them. The thought is that the more thorough the evaluation, the more intelligent the student or house officer. Trainees who ignore the improbable ‘zebra’ diagnoses are not deemed insightful. In medical training, meticulousness, not effectiveness, is rewarded.

    “This mentality carries over into practice. Peer recognition goes to the most thorough and aggressive physicians. The prudent physician is not deemed particularly competent, but rather inadequate. This culture is further reinforced by A UNIQUE UNDERSTANDING OF PROFESSIONAL OBLIGATIONS, SPECIFICALLY, THE HIPPOCRATIC OATH’S ADMONITION TO ‘USE MY POWER TO HELP THE SICK TO THE BEST OF MY ABILITY AND JUDGMENT’ AS AN IMPERATIVE TO DO EVERYTHING FOR THE PATIENT REGARDLESS OF COST OR EFFECT ON OTHERS.” [emphasis added].