Due to a car accident on I-5 somewhere, Dr. Dean is an hour late. The meeting hall at PCC Cascade is slowly filling up. It’s hard to figure out who got selected to be at this meeting. About 75 protesters are being kept out. The people inside seem to be part of some unidentified political scene--perhaps the Multnomah County Democratic Party? Or Health Care Reformists? A couple of people I talk to define themselves as “political junkies”.
Many of the people gathered outside are with jobs with justice. I try to have a conversation with a couple of people, who are proselytizing about why there is no solution acceptable outside a single payer system. I am not buying their arguments. They keep regurgitating the same things they have written on their signs: "Corporate Profits out of Health Care.” I agree that there needs to be a complete overhaul and reform on the way corporations who are part of the health care delivery system are allowed to do business. HOWEVER, As someone working in health care, I also want to see access for every single person in America--NOW. The protesters come across as anti-corporate purists who will derail efforts that don’t give them EXACTLY what they want, which is a complete reinvention of American capitalism.
Inside, once the meeting starts, there are two speakers. The first is Judith -a person who is living with chronic disease. She requires more medical care than the average person, including a list of pharmaceuticals, all of which she has, in a pile for us to see on the podium. She has had many run-ins with insurance companies, fighting to get the care she requires with the ‘pre-existing condition’ that she has.
Somehow, she got lucky and won the lottery to be accepted into OHP. She works part time and earns just over the federal poverty level, so she will no longer be accepted to OHP. She is going to have to apply for disability benefits. Her self worth is a big question. Through all her appeal processes she has to maintain the idea that she is worth treatment. She thinks that she is worth keeping alive, but does the state? Do insurance companies? What give the insurance companies the right to determine if she is kept alive? We need a federal initiative to make this right.
The second speaker is Terry Mills, PCC nursing educator and President of the National Nursing Association. She argues that we have made some gains in modern medicine, but on balance, our health care system is SICK. It is not doing what it needs to, despite spending so much money. We are 29th in the world in infant mortality rates. We spend $1.3 trillion on preventable chronic disease.
Judith and Terry both state that they believe everyone in this room would like to see a single payer system in this country. In the same light, we must come together and make change happen. The urgency of NOW propels us forward on this. We have the power to make a change in health care now and we must do it despite the disappointment of not getting a single payer system.
Finally Earl Blumenauer is introduced, and he then introduces Dr. Howard Dean. As the two gentlemen exchange their admiration for each other’s work, the door at the back of the room opens for a second and the chanting voices of the protesters outside echo through the auditorium: “Single payer now!” 
Highlights from Howard Dean’s speech:
There will be disagreements in this debate.
The recent election was all about people under the age of 35 and bipartisanship. However, health care should not be sacrificed on the altar of bipartisanship.
(Obama has said that if he gets 85% of what he wants with a bipartesian majority it would be preferred to getting 100% of what he wants with a 51% democrat-only passage).
The arguments for and against single payer are currently being re-framed.
We can’t have an economic system without health care.
Dr. Dean acknowledges the people outside shouting for single payer. There are people across the county who want that, but there are also many who want to keep what they have with their company or private insurance. There should be a choice: If you like what you have, you keep it; if you want single payer (medicare) you can choose that too. It is good that the protesters are out there making noise. We really have to drag this conversation as far to the left as possible, because the republicans and ‘blue-dog’ dems will drag it back to the right.
Insurance companies are going to be forced to change (part of the bill as introduced makes it illegal to deny coverage based on pre-existing conditions as well as life-time limits on payouts) We have learned that the free market does not work in health care.
Highlights from Earl Blumenauer’s speech:
We will fail if we create false choices. (ie. the choice between single-payer and nothing).
The veterans administration has managed to do what we would like to see the rest of the health care in this country do: Things like negotiation of prescription prices, cost cutting and providing good care. Portland (with the community coalition of clinics) provides better outcomes for people with less money.
Q & A from the audience:
Q: Are you incorporating food safety into the bill on the floor?
A: We need to change the illness-based system to a wellness-based system. This involves a change in the American ideals. We do need to educate people about what the heck is in our food. As a doctor, Dr. Dean is concerned when the animals who provide meat need to be covered in antibiotics. We also need to encourage people to get a living will to stop sucking money out in the last few months of life. We are working on a way to pay doctors to sit down with patients and talk to them about death instead of ordering thousands of tests.
Blumenauer: The real value of food is not reflected in its cost. Why does a Twinkie which has a dozen highly processed ingredients cost less than a local organically grown carrot?
-He doesn’t really answer the question…there is a food safety bill currently getting mulled over and torn up in the congress… but it is not being linked to the health care bill, per se.
Q: What is being done about workforce development in all of this reform?
A: We need to kick things down the chain. Let nurse practitioners do the job they are trained to do. Etc. (this should include NDs –trained to be PCPs).
We also need to eliminate the fee-for-service model.
How do we help the field of primary care, we should start by making sure that medical students don’t leave school with hundreds of thousands of dollars in debt. We need to incentivize vertical care models such as Kaiser. The way the system is currently set up hospitals will see the prevention of major surgery as a loss to their bottom line.
Doctors are not paid to listen to patients and plan for their wellness and death with dignity. They are trained and paid to perform procedures on them. This is the way capitalism interacts with health care.
We need to reverse that.
We have to change the financing system of health care first, then work on health care reform.
-When we have people in the ‘business’ of health care , investing in things that are not on board with creating a well society, the system is stacked against itself. Legislation can control and reverse this situation, and it should.
There were some suggestions for the people in the room to connect to a network, start sending articles, educating people, have house parties, raise the temperature.
2009 is the year for this reform to happen.
Quiet conversations can have a big effect.
Ron Wyden? Where are you on this? Will you pass the reform? Dr. Dean and Mr. Blumenauer encourage people to contact Mr. Wyden’s office to get his support. We need Ron to get right with the idea of getting the legislation passed to get everyone covered. He will respond to his constituents.
The focused message here is: There must be a public health opinion.
Health Care Town Hall
Prescription for the Planet
This year I was lucky enough to be chosen by Student PSR for a travel scholarship to attend the annual national conference in NYC at the Mount Sinai School of Medicine. The theme for this years event was “Prescription for a Healthy and Secure Planet”.
The conference featured medical, public health, environment and security experts. Keynote speakers, plenary sessions, and workshops, as well as a performance of Damaged Care-The Musical Comedy about Health Care in America and the film "Scarred Lands and Wounded Lives".
Spring break was hard to give up, but for three days I soaked up the words of many inspired speakers –people who give a damn and then DO something concrete about issues of Environmental Health Justice and Nuclear non-proliferation. I came back ready to reinvigorate the sPSR chapter at NCNM and hopeful about the direction that national politics are headed.
Some highlights from two of the presentations I attended. (I’ll try to post the rest soon)
Talk: Back from the Brink.
Speaker: Ira Shorr- national field director for PSR.
Considering the topic of nuclear disaster, prevention is the only cure.
PSR as an organization- We are about changing direction. Right now.
*Chinese saying “if you don’t change direction, you are likely to end up where you are headed”
There is a global health crisis coming at us as a result of global warming. We need to determine what the role of the physician is in determining the need to prevent by changing course.
Coal-is currently the biggest pollutant, but nuclear-is not the answer. The cost of nuclear power is too high.
Use your physician voice, advocate for global preventive medicine.
Speaker: Peggy Shepard “WeACT”
WeACT is New York City’s First environmental justice organization, it is community based in partnership with Columbia University. They take action on transportation, air pollution, land use, etc.
WeACT envisions a world where everyone has access to clean air and water. A framework of health status in relation to socio-economic status helps to determine priorities. Improvements in treatments are too late in the trajectory of health disparities. The community and build environment –affect health through; access to nutrition, transportation, health care as well as other factors such as; ready access to cigarettes, alcohol and fast foods. People are marginalized and there is a lack of participation by residents to democratic processes and any ‘green’ living situation.
Residents must be encouraged to participate. Clinicians can work more effectively by empowering residents with training and information.
WeACT has waged an18 year campaign ‘clean air, clean fuel, clean health.’ To sustain motivation for that time, they focused on seeing small victories and got the community totally empowered on the one issue of a stronger lead poison bill. Victories in that arena have carried over to the other issues.
A lack of scientific literacy has really been a problem this is where we have the opportunity to empower people. Engage the youth. Taught by researchers to give quizzes to understand where exposure is coming from. Collect the data through the youth. Engage technicians in the fields that are affected. What are people being exposed to? Answer these questions with partners from the community. High levels of involvement from the community in the collection of the data can be more effective in the ultimate goal of passing the legislation. When people get confused they feel that they can do nothing at all.
We must find ways to translate the research findings.
-Looking at pesticide exposure at home. They documented widespread exposure that had led to low birth weight and developmental delays in 1/3 of those surveyed. Legislation was subsequently passed.
-Diesel fuel has been documented as a carcinogen. Research was done in the community by giving people back-pack monitors. They found that school buses are the dirtiest vehicles on the road and that older buses are more dangerous. The City council passed a law that will retro-fit.
There needs to be a clear dialog between researchers and clinicians. When clinicians and researchers live in another area besides the one they work in -what kinds of things will they overlook? Taking clinicians on a toxic tour of the area that residents live in so that they have some understanding.
In allowing permits for polluting facilities, the health of the community should be a key indicator. Cap and trade is not the way to go, it is not going to build healthier communities. Trade sets up the situation where a dirty facility can continue to pollute a poor community.
We must educate ourselves, and our profession about what these things mean.
