February 8, 2011

Tonight we take a look at health and health care costs in Ecotopia. Our first guest is Colin Hoobler, a physical therapist out of Portland Oregon, who is interested in helping to control health care costs–active prevention through healthy living.

In the second half of the show, we talk with Forest Harlan of the Butte County Health Care Coalition who is an advocate of single-payer health insurance–Medicare for all.

At the close we have information about recent EPA decisions that are permitting Industrial Giant Monsanto to continue selling and planting its genetically modified, “Roundup Ready” alfalfa and beet seeds, despite evidence provided by Food Democracy Now and other organizations that this will continue the corruption of the nation’s (and world’s) food supply. There’s a link to a petition to President Obama to reverse these decisions.

Listen to the Show

Our discussion with Colin Hoobler:

Colin Hoobler is a physical therapist from Portland, Oregon. Colin is the author of Lose the Wait, a user’s guide to safe strengthening, stretching, and eating to promote health in those with injury and/or disease. He is dedicated to teaching people about medicinal exercise and its importance in controlling health care costs. He also hosts a health segment on NBC TV-KGW in Portland” and writes a weekly health column for the Oregonian.

  • Let’s start with a little of your history. At one point you were a championship body builder, and there are photos of you online that make the Terminator Guy look like a 97-pound weakling. What made you get into body building in the first place? What made you change your mind about that approach to health and fitness?
  • What is “medicinal exercise”?
  • You still recommend some fairly traditional exercises: pushups, dumbbells. How does that approach relate to “lighter” or naturalistic exercises such as swimming, walking, jogging, biking, snowshoeing?
  • As we shift the conversation to the hot topic of insurance, how does your approach relate control health care costs?
  • What is your opinion of the original Obama health care program? Is it a sound approach to health care? Should other elements have been included? (Please tell us your opinion of the Republican repeal efforts and their possible consequences.)
  • If you were starting from scratch to write a health care bill, what would you include?
  • What do you think our government (or other agencies) should be doing to educate and promote healthy, preventative lifestyles? among the young? among the elderly? among people in between?
  • San Francisco has recently passed a law that fast food restaurants cannot give prizes to kids if the contents of meals do not meet certain standards. Do you think that sort of rule can be effective?
  • Can you tell us about any programs—in Oregon, around the world—that are successfully educating people into healthy, preventative lives?
  • In addition to your books, articles, and TV programs, where can people go to get help and advice on these matters?

Our guest has been Colin Hoobler, physical therapist, author, and health advocate. You can learn more at his blog http://www.thefitnessshow.com/ and his website http://www.chphysicaltherapy.com/.

Our Interview with Forest Harlan

Forest Harlan is President of the Butte County Health Care Coalition:

•    The Butte County Health Care Coalition is an advocate of “single payer” health care—“Medicare for all.”  Please tell us what that means.

A great place to start might be to inform your audience of what are the guiding principles of the Butte County Health Care Coalition.  Our 6 Core Principles of Real Health Care Reform are:

* Universal-Everyone Must Be Covered-One Risk Pool
* Must Be Comprehensive with High-Quality Standards of Care

* Affordable for All, Not Just for Some or Most
* Cost Containment Through Global Budgeting

* Accountable to Consumers, Practitioners and Taxpayers
* Transparent in its Operations

If we start with these core principles, we can see that only a single payer system meets both the moral question of who is covered and the economic question of how do we pay for our health care.

In Europe, starting with the conclusion of WW II through the 60’s, there was a consensus reached that health care was an essential human right.  In every European country and many other countries at this time, national health care systems cover everyone, including Americans on vacations.  In the U. S., we appear to be far from reaching a similar consensus.

On the economic issue, we hold that the only efficient way to pay for health care is through a non-profit means.  This can be accomplished through private, non-profit companies which are heavily regulated or through a single payer system which allows for private delivery of health care through negotiated reimbursements across specialties and regions.  We believe that a single payer system is inherently more efficient than the both a government-owned public health care system and the chaotic multi payer system of relatively unregulated for-profit, investor-driven insurance companies we now are faced with.

One way to express the mechanism of single payer is to say that single payer is “Publicly Financed, Privately-Delivered Health Care,” with the emphasis on the private delivery of care.

•    Your group did not favor the final Obama health care package.  Why not?  What’s wrong with a system that requires insurance but gives the insured a choice of plans from non-governmental insurance companies?  Aren’t you proposing “socialized medicine”?

It would be fairer to say that we did not favor the initial Obama health care “reform” package either.  The closer the bill got to passage and the more “goodies” that were put in to appease the corporate players, the worse it looked to advocates of real reform.  As a movement, we chose to take no position of support or opposition to the bill as it worked its way through to passage.  The very fact that there was serious discussion of whether or not the bill did more harm than good told us all we needed to know about whether or not we wanted to support the bill at any stage.

The problem with private, for-profit health insurance is that profit can only be made when care is not delivered.  Actual care is called “medical loss.”  A choice of plans is no choice at all when every insurance company’s existence depends on not providing care.  When the for-profit enterprise is in a race to maximize its profits, the delivery of actual care sets up incentives for a company to devise multiple strategies to deny care to its customers.  To base any notion of health care reform on this model is deny the possibility of achieving actual health care reform.  On the other hand, in all non-profit models, the incentives/competition is to attract customers and are results-oriented.

Single payer is no more “socialized medicine” than the police department is socialized crime fighting.  In our pre-Revolutionary history, fire fighting services were privatized and run by insurance companies.  There were multiple firefighting crews in a jurisdiction.  If your neighbor’s house caught on fire and he/she had no insurance, then no assistance was offered.  Your insurance companies’ fire crews got busy when your house was threatened.  The final consensus was that firefighting services was one area where the government could perform the necessary service in a much more efficient manner than could the private sector.  We say that the analogy applies equally well to health care, with the caveat that private delivery works better than public ownership of the services.

“Socialized Medicine” is represented by the British Isles, the Scandinavian countries, Italy, and Cuba among others.  In the U. S., we have socialized medicine; it’s called the Veteran’s Administration.

Single Payer is represented by Canada, Taiwan, & South Korea.  In the U. S., we have single payer; it’s called Medicare.

•    Why did Obama and the democrats retreat from their original plan to at least discuss single payer?

I would take issue with the premise of the question.  Among the Democrats in Congress, only the Progressive Caucus seemed willing to push for consideration of single payer.  It’s my opinion that Senator Obama allowed single payer supporters to “hope” that his statements from 2003 in support of single payer was somehow a reflection of his true intentions.  I did a detailed analysis of the health care proposals of both Senator Clinton and Senator Obama prior to the primary in the spring of 2008.  Neither of them offered any mention of single payer.

So, when some Democrats announced that everything was “on the table,” single payer activists from various organizations, including Physicians for a National Health Program, California Nurses Association & Health Care-Now! forced their way into the Senate Finance Committee hearings to demand a voice for single payer.  Previously, President Obama held a much-heralded conference at the White House for over 50 stakeholders in the health care reform debate.  Not a single supporter of single payer was invited.  Single payer supporters were literally forced to demonstrate outside while “Let’s Make A Deal” played on the inside.  A key point to understand is that single payer advocates are not stakeholders in the traditional sense of the word.  Advocates for change are more correctly understood as stakechallengers.

•    You have worked actively with the Mad-as-Hell-Doctors who recently came to Chico advocating single-payer.  Are they representative of the medical profession generally?  Where does the AMA stand on single payer?

Let me answer your second question first.  The AMA opposes a “Medicare for All” system.  In the 1930’s, they opposed ‘Medicare for All’ and universal health care was defeated then.  In the 1960’s, they opposed ‘Medicare for All.’  At that time, a compromise of Medicare for citizens over 65 and the disabled and Medicaid for the indigent was passed as part of the War on Poverty.  It would be fair to say that the AMA has taken consistently reactionary positions in regard to health care reform.  Also, the AMA does not represent the practitioners of medicine like they have in the past.  Currently, the AMA represents around 20% of the 900,000 physicians in the U. S.  There are over 180 specialty and sub-specialty organizations for physicians.  There is no single voice for the “house of medicine.”

Do the ‘Mad as Hell Doctors’ represent the medical profession in a general manner?  I say “Yes,” in that recent polling shows that 59% of all physicians support a ‘Medicare for All’ system.  When you poll only primary care physicians, the support goes up into the high-60’s.  Single payer reform has been endorsed by the American College of Physicians, Physicians for a National Health Program, the American Public Health Association, and the California Nurses Association, among others.  Support for single payer national health insurance is growing among physicians and other health care professionals.

•    Let’s turn to California.  You are spearheading a campaign for Senate Bill 810, which would be a California single payer system. Please describe that campaign and its timetable.

California’s single payer campaign began in 1992 in support of the drive for universal health insurance encouraged by the election of President Bill Clinton.  In California, activists placed an initiative on the ballot named Proposition 186.  Reformers were grossly outspent by the insurance industry and we lost badly.  Activists regrouped around 2000 and called themselves “Health Care for All-California.”  As momentum gathered and legislators were educated, we gained the support of a majority of the legislators, but we were unable to obtain the signature of the Governor.   This year, we are reintroducing a bill, named SB 810, authored by Senator Mark Leno.   A broad coalition of statewide organizations, named the State Strategy Group, is directing the campaign.  We aim to either get a bill passed and signed by Governor Brown or we will go to the electorate via an initiative.  Key to each of our tactics is to continue to educate the general population, the new legislators and the Governor.  As the situation grows more desperate, increasing numbers of people realize that only single payer can deliver the type of health care system which truly serves every Californian.

•    Didn’t our legislature already pass this bill twice?  What are the prospects that Governor Brown will sign it if passed again this year?

Yes, the legislature did indeed pass a single payer bill, authored by Sheila Kuehl, in 2006 & 2008.  Both times, Governor Schwarzenegger vetoed the bills.  As anyone who knows our new Governor at all well, there is no easy way of predicting his behavior.  It is our best hope that he will listen to our arguments in favor of signing SB 810.  We intend to highlight the rights-based and the economic benefits arguments.  As previous economic analyses by the Lewin Group & Legislative Analysts’ Office have shown, the annual savings to the state would be at least $14 Billion (in 2005 dollars).  So, we are pinning our hopes on his listening to the economic benefits argument in case the “Health Care is a Human Right” argument fails to persuade him.

For that reason we have a Plan B, Plan C and Plan D.  Funds are being raised as we speak to finance a replication and update of the original Lewin study.  This is critical to showing the tremendous savings achievable through adoption of a single payer system.  The audience for this study is the Administration, the Legislature and the voting public.  In the event that the Legislature passes SB 810 and Governor Brown chooses to veto it, then we will go to either a legislative or voter-qualified initiative for the November 2012 election.

•    Please tell us about the ballot alternative being proposed for the November, 2012 election.

If Governor Brown vetoes SB 810, there will be an initiative placed on the ballot for the Presidential election in November of 2012.  In order to win that fight, we will need to build the grassroots and organizational capacity to pass a proposition.  In such a contest, we are likely to see money spent in the range that Meg Whitman spent in her failed campaign for governor in the last election.  That means we must raise funds in the range that Jerry Brown spent in order to be competitive in such an election.  It is important that we have a proposition with language in the affirmative in order to frame the discussion around the universal need for high-quality, comprehensive health care.   Opponents of reform will likely roll out an initiative to repeal our single payer bill.

•    Are there other states proposing or implementing single-payer systems?

At this time, Vermont is racing to the head of the class.  In 2010, their legislature commissioned Dr. William Tsaio, the designer of the very successful single payer system in Taiwan, to propose a repurposing of health care financing for the state.  He proposed 3 distinct models of health care systems.

  1. The first model is a publicly-administered single payer.
  2. One is a public option exchange called for in the new Patient Protection and Affordable Care Act law for the nation.
  3. The third one he called a “Public/Private Single Payer” Option, a “hybrid single payer.”

The final version of his report is due on Feb. 17, although there may be a delay because the private health insurance companies have refused to share essential data with the Hsaio team.

•    How can people learn more about single-payer issues?  How can they become involved in the single-payer campaign?

The Butte County single payer or “Improved Medicare for All” effort is led by the Butte County Health Care Coalition.  The best way to contact us is through our web site, www.buttesinglepayer.org.  For those listening outside of Butte County, please check out our extensive links on the web site to connect with allied groups where you live.   For tons of useful information no matter where you are, go to www.singlepayered.org.  To succeed, we need your support.  In order to win the battle for rational health care, we need at least twice as many people to dedicate themselves to activism and around $20 Million to wage an electoral contest.  Butte County is activist-rich and cash-poor, so we’re expecting to raise an army of activists.  Our two web sites will show you how to join us.

  • Even as you campaign for single-payer, your group and the Northern California State Budget Alliance are trying to prevent cuts to health and human services.  You’re going to Sacramento this Thursday and next Monday to protest.  Please tell us about that campaign and how people can participate.

The BCHCC is a member of the Northern California State Budget Alliance.  The Alliance is part of an effort to convince the legislators, especially the Democratic leadership in the Senate to rework and reduce the cuts in the Governor’s proposed budget.  We are calling for additional sources of revenue to support higher education and spare the knife from the disabled who are already living on the edge.  We support cuts to the Prison-Industrial Complex; specifically by releasing non-violent first-time offenders.  There are alternatives to the Governor’s proposals.  We want to put proposals for new revenue on the table and redirect the cuts so they do the least harm.  Under the Governor’s proposal, people will die.  They can participate by caravanning to Sacramento on the 10th, 14th or 22nd of this month.  They can write letters to the Democratic leadership.  To get detailed information, call the Independent Living Services Center of Northern California at (530) 893-8527 voice or (530) 680-3484 mobile to join the caravans or write letters or make phone calls.

I would like to close with a quote I came across recently which summarizes neatly my summary of the recently concluded process of fake reform in Washington, DC

“Politics is the conduct of public affairs for private advantage … Reform is a thing that mostly satisfies reformers opposed to reformation.”

–Ambrose Pierce (1842-1914?), American editorialist, journalist and author of The Devil’s Dictionary

Thank you, Stephen and Susan, for inviting me to be on the show.  It’s been a pleasure.