Let me begin by saying that I don’t have any desire to be arrested. I am a pediatrician with 3 teenagers and a husband who would prefer that I do not spend time in jail. I have never actually spent the night in jail and I imagine it’s not very pleasant. To be honest, I am a bit frightened. But, I expect that these are normal feelings and I am dedicated to act despite my reservations because there comes a time when our conscience dictates that we act. That time is now (or "way past now" as doctors and patients whom I’ve met in my travels have told me).
In short, I am going to be arrested because I believe that it is my professional responsibility to advocate on behalf of those patients who are suffering and because it is clear that traditional advocacy tools are not working. The phrase that runs continuously through my mind is "To be silent is to be complicit." I cannot be complicit in the face of an industry that profits at the cost of human lives and in the face of an administration and Congress that are too dysfunctional to stop this practice.
I left practice more than 2 years ago to advocate for health reform. This year I traveled on a particularly unexpected and eye-opening journey. In January, I celebrated the inauguration of a new President who I hoped would be the agent to create real change in America I hoped we would see changes that benefited the people of America (more than the corporations). I joined the steering committee of the Leadership Conference for Guaranteed Health Care because I believed that if we built the grassroots movement for real health care reform: a national publicly-financed health system that was truly universal and accountable, Medicare for all, then we would provide the political cover so that the new administration and the Congress could pass it, or at the very least discuss it. I believed when the administration said that it wanted to hear from the Americans, that we would actually have a debate about how to improve health care in this nation.
Early in the year, I lobbied with many other members of the LCGHC who represented health professionals, patients, labor and faith groups. We had two simple requests: include advocates of single payer Medicare for all in the hearings and do an economic study of single payer legislation so that it could be compared to the plans being put together in Congress. We were assured by members, such as Majority Leader Steny Hoyer, that this would happen. However, before long, we saw quotes from the leadership that essentially said all options were on the table except single payer. Ever the optimist, I thought this was simply a signal to work harder. "OK," I told myself, "they aren’t going to make this easy. No surprise there."
We continued to meet with members, we pressured the White House to invite single payer representatives to the Health Summit in March (which they did) and we continued to reach out to organizations to join our movement.
We thought the health care debate would include the stakeholders (health providers and patients), but found that only the stockholders were invited to the table. When it came time for the first series of public hearings on health care, which were held in the Senate Finance Committee, we requested that one single payer advocate be included with the 41 other witnesses (many of whom represented the private insurance industry, pharmaceutical corporations and big business). Despite thousands of calls and emails from across the country, our request was denied. That is when it became clear that we would have to use stronger tools. On the day of the second hearing, May 5th, 8 of us traveled to Washington to attend the hearing. As it began, we stood up one by one and requested a seat at the table. And one by one we were arrested to the sounds of nervous laughter from the members of the committee and audience. It reminded me of a quote from Gandhi, something like "first they ignore you, then they laugh at you, then they fight you and then you win." We returned the following week with nurses and more people were arrested in the committee. This time there was no laughter. I guess that meant we were on to phase three: the fight.
I was invited shortly afterwards to testify before the Senate Health, Education, Labor and Pensions Committee. In fact, I was the first of 24 people to testify there. I was shocked to hear other members of the panel give poor or misleading information to the committee. I wondered why we weren’t required to testify under oath.
For decades, I and other health providers have found it more and more difficult to provide quality health care. The private insurance industry has placed more and more obstacles in the way of providers and patients in the forms of co-pays, deductibles, networks, uncovered services, the need for authorization, pre-existing conditions, rescissions, rapidly rising health insurance premiums, etc. And we, the doctors and patients, have done our best to comply with the complex and confusing maze of requirements. We’ve seen medicine turned into a business rather than a healing art. Patients have become consumers and health care has become available only to those who could afford it or were eligible for government programs. Doctors have become frustrated and started leaving practice or opening "boutique" practices.
I traveled with a group of physicians this summer who drove across the country to speak about health reform (see www.madashelldoctorsvideo.com). The level of desperation we encountered was tremendous. Many of the doctors I spoke with said things like, "well, up until about five years ago I could still get care for my patients, but now, I can’t." We heard stories of people fired because they or a family member became ill, people who delayed tests or medications due to costs who subsequently died of preventable causes or ended up in the intensive care unit and people leaving the country to have surgery or treatment done in Mexico or Canada where they could afford it.
For decades, legislators at the state and federal levels have tried incremental health reform. I have heard legislators and health advocates say that they are "diehard incrementalists" or "political pragmatists". Despite patchwork efforts to expand Medicaid, provide tax credits or subsidies towards the purchase of private insurance or to provide competing public insurances, the number of uninsured and underinsured has continued to grow. The cost of health care in this country has increased faster than wages, inflation and the GDP. How practical is it to keep trying the same thing and expecting a different result?
We, as a nation, have put off the fight we know we will have to wage if we want real health reform. The fight is against the market model of health care and the foe is formidable. The medical-industrial complex has billions of dollars and strong influence over the politicians. The revolving door between the M-I complex and the Congressional staffers is spinning so fast that it is hard to keep track. For instance, Liz Fowler worked for Sen. Baucus, then became Vice President of Public Policy for Wellpoint (one of the largest health insurers) and then returned to the Senate Finance Committee this year to oversee the legislative process for the health bill. There are 6 health insurance lobbyists for each member of Congress and at least 350 of these lobbyists were former staffers. The industry is spending around $1.4 million each day on lobbying.
We are the only industrialized nation to use this market model for health care and it has failed to be either universal or affordable for a very simple reason: the business of private health insurers is to make a profit for their investors, which is done by charging high premiums, avoiding the sick and restricting and denying payment for care. Decisions are made based on what is best for the bottom line, not the health of the patient.
The United States ranks at the top in only one area when it comes to health care and that is for how much we spend. We spend twice as much or more per person than any other industrialized nation and for that we are ranked 37th in the world on health outcomes. We have high infant and maternal mortalities, growing health disparities and low life expectancy. The other industrialized nations guarantee health care to almost everybody living on their soil. We leave at least 46 million out entirely and have millions more who are insured but unprotected and so they lose their home or go bankrupt trying to pay for needed health care. We rank the highest of the top 19 industrialized nations for the number of preventable deaths, estimated at 110,000 per year in 2007.
It doesn’t have to be this way. We have a model that does work for the population it serves, those 65 years of age and over and the disabled. It is traditional Medicare. Medicare is already nationwide. It finances health care with a very low overhead (3% instead of the 31% spent on private insurance) and allows doctors and patients to make medical decisions without jumping through numerous hoops (like private insurers do). The politicians know this, but they try to shut it out because adopting Medicare for all means giving up those generous campaign contributions.
There comes a time when we must ask ourselves if we can continue to delay doing what we know is right. Can we be silent and allow thousands of our fellow Americans to die each year? Is it acceptable to close our eyes and pretend we don’t see because we may believe that we have "good insurance"?
A dear friend recently wrote a song about the health care situation that contains the question "Isn’t this America?" And I ask the same question. If we are spending the most, why aren’t we trying to be the best? Or at least in the top ten? Why aren’t fiscal conservatives demanding that we spend our health care dollars wisely to get the most health for our dollars? A national single payer health system, such as Medicare for All, is civilized medicine. It is what civilized societies do for their people. It allows people the freedom to go to school, change jobs, open their own businesses, and provide for their families without the stress of worrying about losing everything if they become ill.
I have decided to join other doctors and citizens in the mobilization for health care reform – a nationwide coordinated nonviolent civil disobedience campaign for Medicare for all. As we saw in other social justice movements such as women’s suffrage and civil rights in the 1960′s, change will not come unless we take a stand. There are some who disagree with or do not understand the purpose of nonviolent civil disobedience. To me, it is clear that this is the path we must take in order to overcome the stranglehold the medical-industrial complex has on our nation. Other methods have failed. We cannot wait. The number of people suffering and dying in this nation every day is unacceptable.
I do this reluctantly but with resolve for those who would like to act but cannot. We will ask to speak with insurance company CEOs and we will demand that they stop denying care and influencing members of Congress. We will spread the message of Medicare for all to the public. I hope that others will join and support the campaign in whatever way they can. The website is www.mobilizeforhealthcare.org. There is still an opportunity to get real health reform if enough of us take action.
Margaret Flowers, M.D., is Congressional Fellow, Physicians for a National Health Program.