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May 22, 2009

BILL MOYERS: Welcome to the JOURNAL. Health care reform. It's the talk of the town - if the town is Washington, D.C. But some possible reforms aren't being talked about at all. Not officially, that is.

The White House and Congress have kept the lid on one of the most controversial but popular options, known as single-payer. It's a story the mainstream press has largely ignored and that's why we are covering it in this broadcast.

You don't expect to see these people demonstrating in our nation's capitol. You'll most likely encounter them in the examining room, the operating theater, the clinic or the laboratory.

They're doctors, nurses, and other health care professionals, unaccustomed to making themselves heard in the streets.

GERI JENKINS: People are fed up with seeing the process hijacked by the insurance industry. So, we have to keep the heat on. We have to keep putting the pressure on them to have the voice of the people heard and what people in this country really want is, which is a single-payer system, publicly funded, privately administered. And we're going to keep pushing to make sure that message gets out there.

PROTESTERS: Single-payer! Single-payer! Single-payer!

BILL MOYERS: That's exactly what brought them here. They want the White House and Congress to know they can't do their job taking care of us under the health care system the way it is today.

DR. MARGARET FLOWERS: I wanted to take care of patients. And to have insurance companies and administrators that don't know anything about medicine, telling us what we can and can't do, was really ridiculous to me. You know, I couldn't understand it.

DAN HENDERSON: Are we going to let insurance giants decide what's best for Americans?


BILL MOYERS: They've come here to tell policy makers how the life-and-death choices they make in caregiving are affected by decisions made in corporate board rooms and behind closed doors in Washington.

DR. PAT SALOMON: There were all these arbitrary decisions, which were not about people's health care. They were about profits. How can I get away with the least amount of care offered to this person, so that their premium is going to give me the most profit? That's not the way health care decisions should be made. It's wrong. It's wrong for us as a nation.

GERI JENKINS: We're there around the clock. So we feel a real sense of obligation to advocate for the best interests of our patients and the public. You know, you can talk about policy but when you're staring at a human face, it's a whole different story. So I think sometimes people who define policy haven't seen the human side up close and personal like we see it every day.

BILL MOYERS: What the protestors want is single-payer health care - a non-profit system that would remove the role of the insurance companies and unify the financing of the health care system under one entity, a government run organization, like Medicare, that would collect all health care fees, and pay out all health care costs.

DEANN MCEWEN: Single-payer is really the only solution. It's the only way we're going to be able to equitably distribute the resources that we have. It's the best system that it can possibly be and serve the most number of people.

PROTESTERS: Health care! Not warfare!

BILL MOYERS: A day earlier some of these nurses and doctors showed up at the Senate Finance Committee where Democratic Chairman Max Baucus was holding hearings on health care reform.

SEN. MAX BAUCUS: Today we host the third of our three roundtable discussions on health care reform.

BILL MOYERS: To protest that no advocate of single-payer had been allowed a place at the table, some stood, turned their backs to the committee, then walked out.

Five stayed. Speaking out one by one, interrupting the proceedings.

PROTESTER: We want guaranteed health care. We want to see our doctors when we need.

SEN. MAX BAUCUS: Can we have a recess until order can be restored?

PROTESTER: We want a single-payer system.

PROTESTER: Health care should be for patients, not for profits.

BILL MOYERS: They were quickly gaveled down, escorted out, and arrested.

PROTESTERS: Free Deann now! Free Deann now!

BILL MOYERS: For nurse Deann McEwen it was worth a little jail time just to be heard.

DEANN MCEWEN: They're our public representatives. You know? They're supposed to represent us. And here they are, representing the interests of the corporations.

And it's outrageous. And it's almost like how dare you not listen to us? You know? We're here to tell you what we see. We're the experts, not you. You sit in that chair and you bring the gavel down on single-payer. You're bringing the gavel down on democracy. And you know, not in my lifetime. Not on my profession.

BILL MOYERS: The next day, with several hundred reinforcements, they marched on Congress.

DR MARGARET FLOWERS: Guess what Senator Baucus? You need the police because you're the criminals, we are not committing a crime, you are committing the crime of not listening to our voice and not being responsible to the American people.

BILL MOYERS: Two members of Congress spoke up in support. Freshman Representative Eric Massa from upstate New York, a Democrat...

REP. ERIC MASSA: Allow us to get President Obama on the right track, cover his back, give him the political cover he needs to make the tough decisions.

PROTESTER: Thank you Senator Sanders.

BILL MOYERS: And Vermont's Independent Senator, Bernie Sanders.

SEN. BERNIE SANDERS: All over this place, there are thousands of lobbyists representing greed and short-term profits. And it's nice to see ordinary people coming here to Washington fighting for the rights of their patients and all of our people.

Our current health care system is disintegrating. We need a new system. And what we need is a system not based on the profits of the private health insurance. We don't need a system mired down in bureaucracy and waste.

We don't need a system where CEOs earn all kinds of outrageous salaries. We don't need a system in which companies are paying out huge profits to their stockholders. What we need is a single-payer, national health care system.

BILL MOYERS: After the rally, they fanned out through the halls of Congress, to make the case for single-payer. But they're battling the odds - against deep pockets and swarms of highly-paid lobbyists for huge corporations that reap billions from health care profits. But, they say they're not giving up.

DONNA SMITH: The people still matter. We do matter in this process, and it's the only thing. If we give up, then we do hand it over to the corporate interests. No human rights struggle in the history of this country's been an easy one. This is a human rights struggle. We're going to win it, but we're going to have to keep fighting and struggling and speaking out. There may have to be more people arrested. There may have to be more brave nurses out there speaking out, but we're going to win this.

BILL MOYERS: Donna Smith is with me now. She works as a community organizer and legislative advocate for the California Nurses Association, whose 85 thousand members across the country were early champions for a single-payer program. Welcome to the Journal.

DONNA SMITH: Thank you very much, Bill.

BILL MOYERS: What's going on that you have to take to the streets?

DONNA SMITH: They're not listening. Congress is not listening to advocates of a single-payer system. In fact, they seem to be bent on one direction and one direction only.

BILL MOYERS: What is that?

DONNA SMITH: Expanding the broken system that we have now. We have so many insurance companies involved in making health care decisions in this country, and so many Americans suffering at the hands of those insurance companies, whether it's through higher premiums and higher co-pays and deductibles, and all the things that American citizens deal with - not to mention 14 thousand of us losing employer-based health care benefits every day. So having-

BILL MOYERS: 14 thousand-

DONNA SMITH: A day, during this economic recession.

BILL MOYERS: Regular people?

DONNA SMITH: Regular people losing their employer-based system. And yet Congress, certainly the Senate, and certainly - as evidenced through Senator Baucus's committee - seems to be just on the bee line to make a system where we all have to purchase that private health insurance product that has not been serving us very well as patients, and certainly as nurses and doctors, in this country for many years.

BILL MOYERS: So that moves you out to the streets? That says this is the only way we're going to be heard?

DONNA SMITH: I think it's the only way we can. So many formal requests have gone in to the, not only to Congress, but to the administration. President Obama set out to have White House forums on health care reform. He had his first one at the White House. Single-payer advocates had to really protest and get quite active and fax and call, and doctors and nurses threatened to go to the streets to be outside the White House advocating for single-payer, to be let into that discussion. And finally two representatives were invited into that White House forum. They didn't speak, however, they were invited in.

BILL MOYERS: Now, you must have an opinion as to why that is.

DONNA SMITH: Because they've already made a choice. They've already made a choice, I think, to stay with the moneyed interest, the people who fund the campaigns, the people who fuel the government system as we know it now. You know, certainly where Senator Baucus is concerned, he's the third highest recipient of donations from the health insurance and health care industry in general. The third. The highest Democratic recipient. And sometimes I feel so strongly that he ought to have to disclose that at the beginning of every single hearing that he chairs.

BILL MOYERS: But he says, of course, "That doesn't affect my judgment. This doesn't affect my decision."

DONNA SMITH: I don't think I'd buy that. And I don't think there's very many people in this country that would buy that. If you have someone who's giving you money to insure that your position to stay in a very powerful role in the United States Senate - that's a prime position politically.

BILL MOYERS: What is it you would like those folks to know, those regular citizens to know about this issue, about single-payer and why it's important to them?

DONNA SMITH: I tell people, I always ask them to tell me if they understand single-payer and what it's all about. It's a great idea from the left, which is public financing, combined with a great idea from the right, which is private delivery. And you put it together in one system that takes out the waste and the abuse that's really happening, which is where all the money goes into the health insurance. Up to 30 percent of the costs have nothing to do with health care at all and everything to do with fueling the health insurance needs.

And I've had so many tell me, doctors and nurses who work in offices where doctors have had to spend hours of every day not in patient care but on the phone, hassling with insurance companies, trying to negotiate to get a patient a treatment. It makes it very difficult to deliver the right kind of care.

BILL MOYERS: I saw your testimony before Congress two years ago, 2007. And you were angry.

DONNA SMITH: Very angry.

DONNA SMITH AT SENATE HEARING: You left me broken and battered because you failed to act on health care reform. Just as I have come out of the shadows of economic ruin and shame, so, too, will others come forward to hold you accountable. Remember the hard-working people who elected you. Their bankruptcy shame, my bankruptcy shame due to medical crisis, really is your shame. You are the body that could have acted and has yet not done so.

BILL MOYERS: You had had cancer of the uterus, and while your husband was suffering from heart disease. And you went bankrupt even though you were insured?

DONNA SMITH: Yep. That's why I was asked to testify. I tell people that our story, my husband's and my story's not unique. It's not because we're so unique that people talk about us because we're not unique. So many millions of Americans do what all middle-class families do. You hang on. You watch your premiums rise over time and your benefits shrink. And as long as you're healthy, you absorb some of that cost and you deal with it and you make decisions.

But if you get sick, you find out just how inadequate that insurance may be. And I tell people not only did I have health insurance, I had Aflac disability insurance and a health care savings account on top of that. So we were like the prime example of responsible people who try and keep ourselves covered. And yet when we got sick, there was no way the deductibles and out-of-pocket maximum exposure added up so quickly that we were buried very quickly financially.

BILL MOYERS: There are people who would listen sympathetically to that story and nonetheless say that to move to single-payer now would be disruptive of the health care system. That's the term they use, disruptive.

Do you think that moving to a single-payer plan, even if it were politically feasible, would disrupt the health care system?

DONNA SMITH: What a great question. And you used some of my favorite words in that, "political feasibility." I often answer that real quickly in saying I hear tell a year and a half ago that a man named Barack Obama, when polled against John McCain, would have lost in every state but Hawaií and Illinois. So political feasibility is all a relative thing, isn't it?

And I trust that if he wanted to make single-payer happen, he could make it happen. Would it be politically difficult? Absolutely. I sat in a committee meeting with some staff members of Senate Finance some time ago. And somebody gave this argument, it's not politically feasible to do single-payer. So many people who will say, "Don't let the perfect be the enemy of the good."

And I think, well, that's an interesting analogy, acknowledging that the perfect may be single-payer but that you can't do it 'cause it's politically not feasible. So I sat there and I let this person talk. And he said, there's a visceral reaction to single-payer.

And I let him talk for a minute. I said, "From whom? Who's the visceral reaction from?" The Congress, he said, because elections are reality. These people have to run for new terms every so often. The money and the power that's exerted in Washington on them from the health insurance and health industry lobbies is very powerful. It's hard for them to break out of that loop. It takes an awful lot of nurses and doctors in the streets and being arrested, apparently, and more than 60 percent of the American public to say to them, "We're behind this. This is what we want you to do."

And in terms of disrupting the system, oh, my god, talk about disruption. I just saw Max Baucus's white paper has just been released on what he envisions or what his committee, not just him, but his committee envisions for the future of health care reform financially in this nation. Wow. You talk about complexity and difficulty with what we'll all have to deal with.

They envision mandates going into effect January 1st of 2013. But any insurance reforms or any tightening up of what happens to insurance companies would be allowed to phase in over a ten-year period.

BILL MOYERS: So what is your strategy? The clock is ticking. The President and Congress have said we want health care reform by the 1st of August. That's just a few months away. What will you be doing between now and then?

DONNA SMITH: We're going to stay very active. The nurses, of course, are going to stay in the streets wherever they need to, and very much on the minds of these folks to say this has not been an intellectually honest or policy honest discussion that we've had so far in this country. And don't you think we owe that to each other to at least be intellectually honest about this discussion? And let's put it all out on the table and argue on the merits. Let's have a debate on the merits of single-payer on the floor of the Congress and see where it goes from there.

BILL MOYERS: You've been saying that, though, Donna Smith. You've been saying that, but last week during your rally, only four members of Congress showed up.

DONNA SMITH: You get louder. You get more insistent. You do what many of our nurses are doing. We're going to do a little more action in California next week. You know, California's passed single-payer legislation twice now. Governor Schwarzenegger has vetoed it twice. I suspect that California will continue to pass it until they have a governor who signs it.

There are some people who believe that passing single-payer will have to come through a state level first. And that once one of the major states passes it, that it will topple over into the rest of the nation. As people see it as the most cost-effective, smartest way to do it not only for governments but for American families.

BILL MOYERS: When we did a report on the Journal 12 or 15 months ago on the California nurses and the fight out there for single-payer, we were inundated with mail saying they're socialists and you're a fellow traveler. What do you say to people like that, who read into what you're doing a call for state government-run socialistic medical care?

DONNA SMITH: I laugh a little bit in light of the last six months on how much money we've thrown into Wall Street and how much money we've thrown in keeping financial markets stable in this country. In three days, we were able to come up with three quarters of a trillion dollars to throw into Wall Street. So the argument about socializing things and making things government-run seems a little bit yesterday to me, just intellectually.

But I tell people, you know, look, don't fear this. This is not- you're not turning into a Communist red nation. Please don't be afraid. Even in polling data where the words "socialized medicine" is used, even in that polling data, almost 50 percent of the American public say, "Okay. Do it." And data where we just ask about a national health insurance system, and that's through "The New York Times" and CNN and Yahoo! and a number of polls, 60 percent of the American public say we've got to have a national health program. We just have to do it. It's the only way we fix this mess. It's spun out of control. It's going to bury us financially. It's going to mortgage our children, and it kills people. It just is not working.

BILL MOYERS: Donna Smith, thank you very much for being with me on The Journal.

DONNA SMITH: Thank you so much, Bill.

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