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Donna Smith is a community-based journalist, organizer and legislative advocate for National Nurses United and the California Nurses Association and for the single-payer, Medicare for all reform.
Dr Mandy Cohen Executive Director of Doctors for America and a primary care physician. Prior to joining Doctors for America, Dr. Cohen was the Deputy Director of Comprehensive Women’s Health at the Department of Veterans Affairs in Washington DC. Dr. Cohen received her medical degree from Yale University.
Donna Smith and Mandy Cohen Interview (Part 1)PAUL JAY, SENIOR EDITOR, TRNN: Welcome to The Real News Network. I'm Paul Jay in Washington. And also in Washington, President Obama invited the leaders of the Democratic and Republican parties to talk health-care reform. Here's a little bit of President Obama's introduction.~~~PRES. BARACK OBAMA: ... here's the bottom line. We all know this is urgent. And unfortunately over the course of the year, despite all the hearings that took place and all the negotiations that took place and people on both sides of the aisle worked long and hard on this issue andÂ—this became a very ideological battle. It became a very partisan battle. And politics I think ended up trumping practical common sense. . . . The basic concept is that we would set up an exchange, meaning a place where individuals and small businesses could go and get choice and competition for private health-care plans, the same way that members of Congress get choice and competition for their health-care plans. For people who couldn't afford it, we would provide them some subsidies. But because people would have some pooling power, the costs overall would be lower because they'd be in a stronger position to negotiate. . . . We also have some insurance reforms in there that, for example, prohibit people who have preexisting conditions from being banned from getting coverage. We also talk about how we can help to make the Medicare system more effective and provide better quality care.~~~JAY: Now joining us for their take on health-care reform is Donna Smith. She's a legislative advocate for National Nurses United and the California Nurses Association. And Dr. Mandy Cohen. She's executive director of Doctors for America. Thanks for joining us.DR. MANDY COHEN, DOCTORS FOR AMERICA: Thanks for having meDONNA SMITH, NATIONAL NURSES UNITED, CALIFORNIA NURSES ASSOC.: Thank you for having me.JAY: So let me, just for our audience, get the kind of framing of who's here. You're both for health-care reform. You're both been beating your brains out for a year, two years on this issue. I expect you're both tired. So just so the audience knows, this isn't a Democrat-Republican conversation. But within the health-care reform community, you could say, there's a lot of differences on strategy, tactics, maybe not so much on the end objective. But let's start from where we're at now. So the legislation that President Obama's now proposing, Donna, do you want it to pass?SMITH: Paul, that's such a tough question for health-care professionals, you know, the 150,000 nurses in our organization who know that patients are suffering every day. And that's really the bottom line for them is being able to deliver the kind of care to patientsÂ—a single standard of high-quality care to all of their patients, and being able to be patient advocates. And passing this legislation, we feel, falls far short of allowing most nurses to practice the way they want to practice. Having said that, we also know that 45,000 Americans every year are dying without access to health care. We're not even talking about where we get with medical error and all the other issues, but preventable deaths, 45,000. So if by way of passing some legislation those deaths would have dropped by a few percentage points, that might be something important to nurses. We also see some benefit, obviously, to extending Medicaid coverage to more individuals who just can't afford any kind of health-care coverage. We support that. There's also a portion of the Senate legislation that allows states to innovate and to develop plans that they feel would be best for their citizens. So we support that part of the legislation. So there are parts of the legislation that we think would be important, but we're concerned.JAY: Because you've been part of the movement for Medicare-for-all, earlier for some odd reason called "single-payer", which I think probably a lot of people regret that formulation ever came upÂ—. But some of your gang have been saying better nothing right now, like, don't pass this is at all, because they think this legislation falls so far short. You're not in aÂ—.SMITH: Some have. You know, some have been in a kill-the-bill mode, obviously. You know. And we have a very broad coalition of groups that are working on Medicare-for-all, single-payer legislation. And I think you're right: sometimes we look at that framing and we wonder, because Medicare is not a socialist kind of environment, and, you know, those who've heard me talk about it before say great idea from the left, which is public financing, combined with a great idea from the right, which is private delivery, into one centrist position. So getting that message across is very difficult. But there are members of the single-payer coalitions who want to just kill the bill, be done with it, "It does more damage than it does good." The other issue that our nurses have been very concerned about isÂ—this issue of an excise tax is a big concern for not only our members, but when you lookÂ—. Let's take a state like Massachusetts, where we just had that fallout from the election battle there, with Senator Brown becoming the replacement for Senator Ted Kennedy. You watch how that transpired with union householdsÂ—you know, they went to the mats for this president on the issue of "John McCain will tax your benefits; Barack Obama will not tax your benefits."JAY: And you're talking about this tax on what they're calling the "Cadillac plan".SMITH: "Cadillac plans". But if you go to a state like Massachusetts, because the cost of getting into a plan is much higher overall, a lot of plans will fall into that realm considered "Cadillac" taxation.JAY: So, Mandy, you watched the roundtable today. What were your impressions?COHEN: Well, I think it was nice to see an exchange of ideas, and everyone in the same room, and certainly the president getting another shot to talk about health-care reform with the American people, 'cause clearly the message has gotten lost, and there's a lot of myths and a lot of confusion out there, so any more opportunities that we can get to explain what's in the bill, to have people understand there's a lot of great stuff in the bill that's going to move the system forwardÂ—. It's not perfect. I think we have a lot of agreement on that. So I like that all in the same room, you know, that, you know, if you have ideas, great, let's hear them and let's move forward. And it's not about "no"; it's about, you know, progress.JAY: I guess what I don't get, watching the session today, is that as much reasonable discourse as they're going to have, it's still pretty clear the Republicans are going to vote against this. So if that's the case and they're going to get to reconciliation, whichÂ—I suppose by now everybody knows what reconciliation is, but if you don't, it's this process that allows the Senate to pass something with 51 votes and bypass the 60-vote filibuster. If they're going to go to reconciliation anyway, then why not go back to the plan, at least the public-option plan, 'cause they were arguing, for more than a year, you can't lower costs without the public option. Now, all of a sudden, supposedly they can.COHEN: Well, I think the important thingÂ—.JAY: In which case, are you guys going to be sayingÂ—what are you going to be saying in terms of your lobbying?COHEN: Well, I think we have one very simple message: get it done and get it done quickly, because every day that we wait, in terms of passing reform, is another person that is left out of the system, that dies, that gets hurt by the system. So this delay because of the political process is really, I think, whatÂ—what people and the American public don't like is the delay. You know, come together and get it done. And so our message is very simple, is that doctors and nurses support health-care reform. The system is too broken. Yes, this is not the perfect plan, but it is the right step forward to fixing our health-care system.JAY: 'Cause I've interviewed people that were pro-public option. There's a pointÂ—I would ask, is there a point where you won't support the bill if public option's completely gone? And is there any point where this gets so watered down? Or you'll take whatever you can get?COHEN: Well, I think that, you know, a lot of people have been working to get any sort of comprehensive legislation through Congress for decades, and really we're on the precipice of getting that done. And so when we say "watered-down", I think we were so close to getting a mansion, and now we're getting a starter home. I think Senator Rockefeller used that example, that we want a mansion, and I think we can get there. And it might take a couple of incremental years to get there. But if we don't have that starter home, then I don't know that we have a place to begin. And I think that's what's so crucial in my mind and, I think, a lot of the doctors' that we hear from in our organizationÂ—17,000 doctors across the countryÂ—who want to, you know, start the process, move towards bringing everyone into the system, and change the delivery system and keep downÂ—you know, all of those things.JAY: So what do you makeÂ—Donna, is there a point where this bill gets so watered down? And if they're not getting Republican buying in anyway, then why go in with such a watered-down Bill?SMITH: Well, what a great question you have. And anybody who's gone through any negotiating for anything, whether it be health-care reform or anything else, knows you don't start with a weaker position than what you really want. And even President Obama has said, you know, that the only way you really get to universal coverage across the board is a single-payer Medicare-for-all plan. Now, he wasn't going to get there with this Congress. That's pretty clear, as much as the nurses would like that to happen. But having started at that place as a bargaining point might have made us in a much better position. The nurses have already issued one statement that says that if the legislation includes that excise tax that will harm lots of American families and tax their benefits and make the costs higher, we would ask House members to vote against the legislation. We don't like having to issue that kind of statement. We have not yet issued a further statement beyond that, based on President Obama'sÂ—his own plan, yet we may yet do that in the next several days. The nurses have not been shy about weighing in on what they believe. But the bottom line for them is if we're not moving closer to a single standard of high-quality care for every patient, progressively financed, then we're not going in the right direction.JAY: Now, is part of what's happening here partly hitting the roadblock of the Republicans or the brick wall of the Republicans? But, also, are people getting tired? I mean, people are lobbying and being activists on this. And what I mean by that is this, is that if you wind up with legislation that has a deal with PhRMA, so the price of PhRMA stays, you know, ridiculously high for another decade, and then you deliver a guaranteed market, guaranteed userÂ—what are they calling it?Â—pool of everyone to the insurance companies, but without any public optionÂ—and they've been arguing forever that only the public option would keep rates downÂ—how are they going to stop this from just being a bonanza for the insurance companies, which Robert Reich, for example, said that's what it's going to be?SMITH: It's a great question.COHEN: Well, two things that I'm very hopeful that were in the president's plan. So one of them is this new health-insurance rate authority that he proposed in this plan, I think, that he put up on Monday, where the federal government would assist states in actually looking into why are insurance companies raising rates. And so you can't go on this bonanza of just raising rates; you have to have some accountability for where are these rate increases coming from. So I think that's one step in the right direction. And second, with the health-insurance exchanges themselves, they put, you know, the patient and the consumer in the driver's seat, 'cause they are able to aggregate the market power for individuals. Right now they're all on their own; they aren't able to pool together and purchase insurance. And that's what the exchanges will do for them. So I think those are the two, you know, keys for me, you know, in this bill, that I cling to, that I want to see passed, and I want to see them done soon.JAY: So the exchange. And this issue of regulatoryÂ—but is it advice to the states? Or do they actually have any regulatory power?COHEN: So it's financial help to allow the states to do their own regulation. I think we need to see what the legislative language [is], right? This was an outline. I think we need to see what the legislative language would be on exactly how it'd get set up and things like that. And it would be a board that's under HHS [Health and Human Services] authority. So I think we have to see the details on how that works out. But it's certainly a step in the right direction in terms of making insurance companies accountable.JAY: Now, Donna, you haven't given up on Medicare-for-all. You spent the whole day lobbying.SMITH: Oh, we did.JAY: So what do you hope to expect? And what are you telling people?SMITH: What we're telling our activists is don't give up on Medicare-for-all. We've got at least 20 states in this country are working on a way to get to single-payer through a state-level legislation. California's senate just passed single-payer for a third time just a couple weeks ago. Their full legislature has passed it twice. It's been vetoed by Governor Schwarzenegger twice. When their other legislative body, the House, passes it, it'll probably be vetoed again by Governor Schwarzenegger. California will continue to pass single-payer legislation until it's approved by a governor. Pennsylvania also has an incredibly strong effort to get single-payer legislation passed right now. They actually have Republican cosponsors on their bill. They have worked very hard to educate Republican members that single-payer does not equate to you're turning your health-care decisions over to the government. In fact what you're doing is you're just creating one public financing pool that the decisions about patient care will finally be made between the doctor and the patient, rather than the insurance company stepping in. So we're telling people: have great courage surrounding this moment. You know, the federal government we all know is rife with some issues related to campaign finance and how that's impacted this whole process of our being able to move forward on health-care reform. The states have some of those same issues endemic in their systemÂ—they're not exempt from campaign-finance pressure from insurance companies and lobbyists and so forth. But there's an awful lot of people in this country who have reached their limit on what they can tolerate. I sent a story in to the White House earlier this week because it enraged me. I thought I was beyond having patient stories enrage me. And I saw a clip of this woman in Iowa. Deb is her name. She has cancer. She got to the point in her illness where she could no longer work. When she could no longer work, she didn't have income that would support her being able to buy COBRA [Consolidated Omnibus Budget Reconciliation Act of 1985] coverage, to keep it any longer. She now has to come up with $2,000 out-of-pocket up front every month in order to get her chemotherapy. This is in Iowa. We have Senator Harkin and Senator GrassleyÂ—I wrote a piece about this on the Internet 'cause it made me so angry. Here's a state, Iowa, that catapulted Barack Obama's campaign forward in the presidency. We have two senators who've been very out-front talking about health-care reform. You know what? Deb's cancer doesn't care whether they're Republicans or Democrats or what Barack Obama did in those freezing snows of Iowa in 2008. Deb's cancerÂ—she has to have pasta dinner fundraisers. This is humiliating for patients in this country. So we've got toÂ—you know, the energy, the people who believe that Medicare-for-all is the way to go need to keep telling those stories, unfortunately, until our leaders internalize them.JAY: So do you see this is a process where this piece of legislation gets passed and you continue to fight for Medicare-for-all?SMITH: Absolutely.JAY: Okay. Then in the next segment of our interview let's talk about what lessons can be learned from this last year. If the fight continues, what do you learn from why we're where we are? So please join us for the next segment of this interview on The Real News Network.
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