Election moves Vermont closer to single payer, plus new challenges

November 18, 2010

Dear PNHP colleagues and friends,

Fresh from PNHP’s Annual Meeting in Denver, we have much to report! 

Surprisingly, the Nov. 2 election included some bright spots for single payer.  Vermont is now poised to be the first state to pass single payer (see below).  At the same time, advocates for an improved Medicare for All face new challenges, including from the Deficit Commission and the powerful interests opposing reform. 

Your help - by donating to support efforts in Vermont and elsewhere, opposing cuts to Medicare, and speaking out in support of single payer - is needed now more than ever.

1. PNHP hosts "spectacular" Annual Meeting in Denver

Amy Goodman

First, if you weren’t able to get to Denver, you missed a terrific program and exchange among 250 physicians, medical students, and activists from all over the country about the way forward for single payer. The mood was decidedly upbeat, particularly in view of developments in Vermont and elsewhere (see below).

As a small taste of what transpired last weekend, you can watch the remarks of Democracy Now’s Amy Goodman here. In addition, some photos of the participants can be viewed here.

An interview with PNHP's incoming President Dr. Garrett Adams appeared in this month's Louisville Medicine.

2. Vermont is closer to winning single payer

Former PNHP President Dr. Deb Richter reports that Peter Shumlin, a strong advocate for single-payer health reform, won his race for governor. Since the election he has reaffirmed his commitment to implementing a single-payer plan in Vermont and has already spoken to President Obama and Kathleen Sebelius, the head of Health and Human Services, about getting the required federal waivers.

Shumlin’s win, combined with (1) the support of other pro-single-payer lawmakers in the state, (2) an impending report to the state Legislature by Harvard health economist William Hsiao about the merits of three health reform models, one of which is single payer, and (3) the existence of a vibrant movement for single payer in the Green Mountain State, has laid the basis for a historic breakthrough there.

You can help by making a tax-deductible donation to PNHP and designating that it be used for organizing in Vermont. Dr. Richter's goal is to raise $50,000 by December 1.  Help us meet or exceed that goal!

3. More single-payer election news

  • All but one of the 88 congressional sponsors of H.R. 676, Rep. John Conyers’ single-payer bill, were re-elected to office on Nov. 2, often by hefty margins.

  • Pro-single-payer gubernatorial candidates were also elected in California (Jerry Brown), where single payer legislation has twice passed the state's legislature, and in Hawaii (Neil Abercrombie), where single-payer also enjoys substantial support.  Brown supported single payer in his 1992 primary race for the presidency against Bill Clinton.

  • In Massachusetts, in 14 of 14 legislative districts a ballot question for single payer in Massachusetts won a majority vote, including in some of the most conservative districts in the state and several that went for Republican Sen. Scott Brown last year. This follows a similar referendum in 2008 that swept 10 other districts.  Needless to say, coming from Massachusetts, the incubator of the new health law, this resounding vote of support for a single-payer Medicare-for-all program packs a wallop. So, too, does a new survey of the state’s physicians by the Massachusetts Medical Society. The MMS survey shows a plurality of the state’s doctors, 34 percent, favor a single-payer system, with only 14 percent supporting the Massachusetts plan as a model for reform.

  • PNHP National Coordinator Dr. Quentin Young's latest Huffington Post article with a full election roundup is below.

4. Deficit Commission urges cuts to Medicare  

On Nov. 11, the co-chairs of the president’s National Commission on Fiscal Responsibility and Reform, businessman Erskine Bowles and former Sen. Alan Simpson, issued a draft document calling for an increase in the eligibility age for Social Security benefits to 69, cuts in Medicare payments to providers, an increase in cost-sharing by Medicare beneficiaries, and increased powers for the Independent Payment Advisory Board created under the new health law.  Since then another group of lawmakers has issued similar recommendations.

All of these measures (and more) move in a bad direction, as this assessment by Dr. Don McCanne and this testimony by Dr. Margaret Flowers point out.  PNHP hosted a Congressional briefing opposing the cuts featuring economist Tsung-Mei Cheng in late September.

5. Insurance industry whistleblower Wendell Potter speaks out

The former head of PR for Cigna, Wendell Potter, revealed new details about the insurance industry's campaign to keep single payer "off the table" in the health reform debate, including their coordinated attack to discredit the film "Sicko" by Michael Moore.

Potter appeared on Democracy Now with Amy Goodman to discuss his new book, "Deadly Spin."  A transcript of his interview is here.

On a lighter note, a tongue-in-cheek critique of the insurance industry by Dr. Carol Paris, "Private Insurance Induced Stress Disorder" or "PIISD," appeared in Psychiatric Times.

6. What You Can Do

  • Donate - A victory for single payer in Vermont would reverberate nationwide. Help us raise funds for an educational and organizing campaign in Vermont.  Donors of $250 or more also renew their membership for 2011.  Donors of $100 or more receive a free copy of "Hijacked: The Road to Single Payer in the Aftermath of Stolen Health Care Reform" by former PNHP president Dr. John Geyman.

    If you can, please consider an end-of-year donation of $1,000 or more. You know more than anyone how important PNHP's work is.  We'll put your gift to immediate good use in Vermont and elsewhere where the needs and opportunities for single payer organizing are greatest. 

  • Stop the Deficit Commission - Call the Senate - PNHP activists are encouraged to ask their senators to vote against any attempt to privatize Social Security or Medicare, in whole or in part; any proposals to raise the eligibility ages for Social Security or Medicare; any recommendations for means-testing for these programs; and any proposal for benefit cuts for current and future beneficiaries.  The Capitol Switchboard number is 202-224-3121.

  • Speak out - Please join the growing number of physicians who have given talks or published op-eds in support of single payer, Medicare for All.  PNHP Congressional Fellow Dr. Margaret Flowers is giving several talks this week in Wisconsin (organized by chapter leaders and PNHP national organizer Ali Thebert); Flowers' latest op-ed just appeared in the Charlotte (N.C.) Observer.

7. One more thought: if you missed this year’s meeting, just think of all the money you saved in airfare and other travel expenses. Then think about what you can contribute to PNHP’s next steps forward! 


Quentin Young Signature
Quentin Young, M.D.
National Coordinator

Ida Hellander Signature
Ida Hellander, M.D.
Executive Director

Mark Almberg Signature
Mark Almberg
Communications Director

They Said They Would Push Me "Off a Cliff"

By Michael Moore, Open Mike Blog
17 November 2010

Michael Moore

Yesterday, on the TV and radio show "Democracy Now" hosted by Amy Goodman, the former Vice President of CIGNA, one of the nation's largest health insurance companies, revealed that CIGNA met with the other big health insurers to hatch a plan to "push" yours truly "off a cliff."

The interview contains new revelations about just how frightened the health industry was that "Sicko" might ignite a public wave of support for "socialized medicine." So the large health insurance companies came together over a common cause: Stop the American people from going to see "Sicko" - and the way to do that was to cause some form of harm to me (either personally, professionally or ... physically?).

Take a look at this stunning section of the interview with Wendell Potter:

WENDELL POTTER [former executive, CIGNA]: ... We were concerned that the movie ["Sicko"] would be as successful as "Fahrenheit 9/11" had been. And we knew that if it were, it really would change public opinion about our health care system in ways that would be harmful to the profits of health insurers. So, it was very important for this [attack] campaign to succeed. At one point during a strategy meeting, one of the people from [the insurance companies' public relations firm] APCO said that if our efforts, our initial efforts, were not successful, then we'd have to move to an element of the campaign to push Michael Moore off a cliff. And not meaning to do that literally, but to -

AMY GOODMAN: Are you sure?

WENDELL POTTER: Well, I'm not sure. To tell you the truth, when I started doing what I'm doing [as a whistleblower], I was concerned about my own health and well-being, maybe just from paranoia. But these companies play to win. And we're talking about some big bucks at stake here - billions and billions and billions of dollars.

AMY GOODMAN: So what were they talking about when they said, "If this doesn't work, we're going to push him off the cliff"?

WENDELL POTTER: Well, it would be just an incredibly intense PR effort, if necessary, to spend more premium dollars to defame Michael Moore, to discredit him even more as a filmmaker.

AMY GOODMAN: So, were you doing research on him?

WENDELL POTTER: Oh, yeah. Oh, yeah.

AMY GOODMAN: You were going - personally?

WENDELL POTTER: Well, I was a part of the effort. I didn't - that was part of the reason for hiring APCO and to work with a trade association, is that it relieved me of the responsibility of doing that kind of work. You paid for it to be done by people who were experts in doing that kind of research.

AMY GOODMAN: But they were doing an investigation into him personally?

WENDELL POTTER: Well, absolutely. We knew as much about him probably as he knows about himself.

AMY GOODMAN: About his wife, about his kid, about -

WENDELL POTTER: Oh, yeah. You know, it's important to know everything that you might be able to use in some kind of a campaign against someone, to discredit them professionally and often personally.

AMY GOODMAN: And did you use that?

WENDELL POTTER: You use it if necessary.

The interview goes on as Potter reveals how his front group was able to get its talking points and smears into stories in the New York Times and CNN. It is a chilling look inside how easy it is to manipulate our mainstream media - and just how worried the health insurance companies were that the American people might demand a true universal health care system.

In particular, Potter talks about how they may have succeeded in influencing CNN to run a factually untrue story about "Sicko" by its reporter, Sanjay Gupta (which led to my infamous encounter with Wolf Blitzer and later, an apology from CNN for getting their facts wrong).

 Potter believes his work to defame "Sicko" succeeded, as the film didn't end up posting "Fahrenheit 9/11" grosses. To be clear, "Sicko" went on to become the 3rd largest grossing documentary of all time at that point. And as the release of "Sicko" in June of 2007 was the first time since the defeat of Hillary Clinton's healthcare bill in 1994 that the issue of health insurance was brought to the forefront of the national media, I believe it helped to reignite the issue during the 2008 election year by exposing millions of Americans to the truth about the health insurance industry. More than one person on Capitol Hill will admit that "Sicko" was a big help in rallying public support for the compromise bill that eventually passed earlier this year. But I agree, their smear campaign was effective and did create the dent they were hoping for - single payer and the public option never even made it into the real discussion on the floor of Congress.

(There was really only one reason "Sicko" didn't sell as many tickets as "Fahrenheit" and that was because of a felony that was committed - a felony that I will discuss for the first time on this site in the coming weeks or months ahead. Stay tuned.)

Please read or watch the entire interview with Wendell Potter. It's a fascinating peek behind the curtain of how corporate America really runs this country. And how if any of us get in their way, then those people must be stopped. It begs the question: Seeing how there's more of us than there are of them, how long will we let their takeover of our democracy continue?

God Bless the Ruling Class,

Michael Moore

P.S. Over the next few days I will continue this examination of the Wendell Potter revelations on "Democracy Now" and in his new book. Please check in here on

Single Payer after the Midterm Elections

By Quentin Young, M.D.
The Huffington Post
November 17, 2010

While it's clear from post-election surveys that having voted for "health care reform" was not a major cause of the Democrats' defeats, the new health law didn't help. What should have been a feather in the administration's cap - i.e. a genuine reform that guaranteed truly universal, comprehensive care - instead became an albatross.

Many Democrats, sensing the electorate's unease with the new health law's mandates to buy private insurance, its lack of cost controls, and its limited reach - e.g. 23 million will remain uninsured in 2019 - found it difficult to defend. Some even boasted they voted against it.

In a fundamental sense, health care reform was botched by Congress. People wanted serious reform and didn't get it. The big insurance and drug companies got their way, making a few concessions that they are already trying to wriggle out of.

As a result, what was adopted last March was so defective that ultra-conservatives were actually able use it against the president's party.

Yet those who might interpret the election results as a repudiation of any health care reform should pause for a moment and consider these developments:

In Vermont, Peter Shumlin, an outspoken supporter of single-payer health reform who defeated four opponents (some of whom also supported single payer) in the primary, went on to win the governor's race.

Shumlin reports that he has already spoken with President Obama and Health and Human Services Secretary Kathleen Sebelius about getting the necessary federal waivers to implement a single-payer system in the state of Vermont.

Besides Shumlin, four other political heavyweights in the state also support single payer: former governor Howard Dean, Senators Bernie Sanders and Patrick Leahy, and Rep. Peter Welch.

Dr. Deb Richter, a family physician in the Green Mountain State, says, "Peter Shumlin's election shows Vermonters want a single-payer health care system. We're going to get this done."

In California, Jerry Brown won the governorship, defeating Meg Whitman, who spent $141 million of her own money in her failed campaign. In his 1992 presidential primary bid, Brown declared his support for single-payer health reform, and California activists hope he will sign a single-payer bill in 2011 when it comes to his desk. (The Legislature there has twice passed a single-payer bill, only to have it vetoed both times by Gov. Arnold Schwarzenegger.)

In Hawaii, former congressman Neil Abercrombie, a co-sponsor of Rep. John Conyers' single-payer bill, H.R. 676, was also elected governor. He, too, takes office in a state where many lawmakers have signaled their openness to the single-payer alternative.

Significantly, in the House races, only one of 88 co-sponsors of H.R. 676, Rep. Phil Hare, D-Ill., was defeated in the general election by a Republican. Seven other co-sponsors were lost due to death, resignation, defeat in the primary or retirement. Just one of those went to a Republican, Tom Reed, who won Rep. Eric Massa's old seat in New York.

The Congressional Progressive Caucus also did well, losing only three of its 69 members. In contrast, over half of the 54-member conservative Blue Dog Democrats went down to defeat.

In Massachusetts, voters in 14 of 14 legislative districts affirmed their support for single-payer health reform by turning in a majority of "Yes" votes (overall, around 2 to 1) for the following ballot question: "Shall the representative from this district be instructed to support legislation that would establish health care as a human right regardless of age, state of health or employment status, by creating a single payer health insurance system like Medicare that is comprehensive, cost effective, and publicly provided to all residents of Massachusetts?"

Benjamin Day, executive director of MassCare, writes: "The ballots spanned 80 different cities and towns in a state of 351 municipalities, winning in every city and town reporting results so far [as of Nov. 3] except two. Five of the districts backing single-payer reform voted for Scott Brown in last year's special Senate election, which was largely seen as a referendum on national health reform, showing that the goal of improved and expanded Medicare for All is supported by a diverse range of communities across the state."

A similar referendum in 2008 swept 10 of 10 different legislative districts in Massachusetts, refuting the Republican boast that single-payer health care reform is unpopular.

Apparently, whenever people are given serious choices, single payer's popularity is sustained, even in the face of scurrilous attacks from the right claiming it is "socialistic" or "un-American."

There were also setbacks to the single-payer cause, too.

The defeat of Sen. Russ Feingold of Wisconsin was a very heavy loss. Just last February, Feingold had reaffirmed his longtime support for single payer. He should be sought out to help lead the movement for single payer in this new phase.

One of the most egregious results was the election of former hospital company executive Rick Scott to the governor's mansion in Florida. In 1997, Scott was forced to resign his post as CEO of Columbia/HCA, a giant hospital chain, amid a scandal pointing to massive Medicare fraud and other improper billing practices. The company ultimately admitted to 14 felonies and agreed to pay the federal government over $1.7 billion in fines. Scott spent at least $73 million of his own money to get elected to Florida's top office.

In Arizona and Oklahoma, ballot initiatives purporting to uphold "freedom of choice" in health care passed. Couched in anti-mandate language, these initiatives are in fact intended to keep patients prisoner of their insurance company networks and are really directed against enactment of single-payer systems.

So what to do going forward?

Aside from the very promising prospects for fundamental reform in Vermont, one of the immediate tasks of single-payer supporters is to block the proposals from the co-chairs of the Deficit Commission to reduce Social Security and Medicare benefits. The commission is set to make its recommendations to Congress by Dec. 1.

As my colleague Dr. Margaret Flowers has testified, the best way to safeguard Medicare is to improve its benefits and to expand it to cover everyone.

Otherwise the battle for fundamental health reform remains front and center, on both the state and national levels. The Medicare-for-all proposal is simple, clear, legitimate and compelling in its logic. The destructive role of private corporations in our health system is also plainly evident.

Just as women's suffrage and civil rights laws were widely seen as unattainable - sometimes just a few years before they were enacted - single payer is an idea whose time has come. It is unstoppable.

New health law falls short

By Margaret Flowers
The Charlotte Observer
Thursday, Nov. 18, 2010

It's been said that a society can be judged by how it treats its most vulnerable. If that's the case, what can we say about today's United States?

I recently toured several cities in North Carolina to speak about national health insurance. I had the pleasure of meeting with physicians, health advocates and citizens from all walks of life.

Many of the physicians I met are working in health centers that treat the uninsured. While such efforts are important and commendable, the doctors are saying that they are unable to meet the growing need.

The Census Bureau reports that the number of uninsured in the U.S. jumped 10 percent to 51 million people in 2009. In North Carolina, about 1.7 million - nearly 1 in 5 residents - lacked coverage last year. That's 300,000 more than the year before. Much of the increase, of course, can be chalked up to job losses.

Lack of insurance fatal for many

We know that people who lack insurance suffer much more than their insured counterparts. They also more frequently die of preventable causes. A recent study in the American Journal of Public Health, for example, shows about 45,000 deaths annually can be linked to lack of health insurance. That's about 120 preventable deaths a day.

And then there's the problem of underinsurance - people having poor-quality insurance policies that require high co-pays, deductibles and other out-of-pocket expenses. These onerous "cost sharing" measures are obstacles to getting care. The gaps in such policies can easily lead to personal bankruptcy in the event of serious illness.

Sadly, the new federal health law falls short of the remedy we need.

Most of the provisions in the legislation do not take effect until 2014. Thus, for the foreseeable future, literally tens of millions of Americans will remain uninsured. In fact, the Congressional Budget Office estimates that about 23 million people will still lack coverage in 2019. That's a deadly scenario.

I'm a pediatrician, so I was particularly interested in two provisions in the federal bill relating to children that kicked in last month. One measure allows children under 26 to remain on their parents' policies. While beneficial, this provision will expand coverage to only about 20 percent of the young adults who need it.

Insurors screen out the sick

Another measure would prevent health insurers from denying new policies to children with pre-existing conditions. However, just before it went into effect, insurers like WellPoint, UnitedHealth Group, Aetna, Cigna and Humana announced that they would no longer offer new policies to individual children.

What can we conclude from these and similar episodes? As long as private insurers occupy a commanding role in our health system, we will never be able to achieve truly universal or affordable care. The insurers make money by enrolling the healthy, screening out the sick, denying claims and raising premiums. They do not put patients' interests first; they do not provide care.

And yet the new health law keeps the big insurers - the main obstacle to care - at the heart of our system.

There is a better alternative: a national health insurance program that is publicly financed and privately delivered. This solution is commonly referred to as improved Medicare for all. It's supported by about two-thirds of the population and a solid majority of physicians, according to national surveys.

Make it Medicare for all

Improved Medicare for all would be truly universal - every person living in the United States would be guaranteed high-quality care from birth to death. People would no longer worry about losing coverage if they changed jobs or became unemployed. Coverage would be comprehensive, including dental care, vision care, mental health services and prescriptions.

Patients would be able to go to any physician and any health facility of their choice, and decisions about treatment would be made by patients and their health professionals without interference by insurance company administrators.

By replacing our inefficient, dysfunctional patchwork of private insurers with a streamlined, single payer of all medical bills, much like Medicare operates today, our nation would save about $400 billion annually in reduced administrative costs.

That's enough to cover everyone, with no co-pays or deductibles. We'd also acquire very strong cost-control tools like the ability to negotiate fees and purchase medications in bulk.

I urge you to learn more about the improved-Medicare-for-all approach to health care. Let's be the great society that we have the potential to be.

Margaret Flowers, M.D., lives in Baltimore and is congressional fellow for Physicians for a National Health Program ( She is also a board member of Healthcare-Now (