Chat Questions from Wendell Potter Zoom Conference


1. What is the strategy of opponents of M4A? They have always used the same tools to stall reformfor the past 100 years. They will use their financial power and the inertia of the current system to make a case for the devil we know. What are their tactics? Divide, mislead, misinform, frighten, confuse, bribe, obstruct, and flat out lie. We can easily think of examples of each of these tactics.


2. What percentage of total health care dollars in the U.S. go to the health insurance industry? The total private spending is about 40% of the dollars but their profits are only about 1% of the dollars.


3. Do you see Obamacare as a help or hindrance to Medicare for All? This is complicated. There is no question that it divided activists (see tactics above). People who wanted reform were seeking any relief from the worst abuses of the insurance industry and we did get some relief from pre-existing condition exclusions and partial relief for the working poor via the Medicaid expansion. It settled the argument about needing everybody covered. 71% of Americans including a plurality of Republicans think that the government should guarantee coverage although it did not settle who, what, where, when and how.

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4. Given the political power of insurance corporations to fundamental health care reform, what's your view on fundamental democracy reform -- specifically the We the People constitutional amendment introduced by Pramila Jayapal that would abolish political money in elections defined as free speech and abolish corporate constitutional rights? 30 years ago Dr. John Ross was told by health reform activists in Maine that they had decided that they needed to get money out of politics before they could accomplish the fundamental reforms they envisioned in their state including single payer health care. They passed spending limits. They still do not have universal healthcare coverage. This was all before the Citizens United decision. I think we need to work on both. This is a yes and…. not a no but… situation.


5. I understand that the funding coming to hospitals from the latest stimulus packages is being run through United Health Care instead of HHS. What can be done about that? How does that work if a hospital is not in United Health Care’s network? We can do nothing about that travesty but point out that this is how the corporate enablers always think. Right wingers hate the government. They go into government to divert public dollars to private (usually corporate) hands.


6. Are you working with candidates that are down-ticket at the state level? In states like Ohio whereas of 2018 election 63% of seats were Republican while only 52% of the voters are republican? I doubt too many Republicans are backing single payer at this time? How are you helping change that dynamic at the state level? Yes, Wendell Potter is. We should continue to support fair districting since it is gerrymandering that is the cause of the disparity. One of the
advantages of having a single payer bill introduced at the state level is to educate local and state
representatives about single payer reform.


7. What would it take to convince Joe, Amy and Pete that the concept of the Affordable Care Act
is basically flawed and any attempts to strengthen it will be thwarted by moneyed interests? I
suspect they all understand why single payer is a good idea but they have not heard the demand
for it from voters and are afraid of the fight with the powerful vested interests who control our
elections with their money. They are willing to bend the knee to these moneyed interests.
Sadly, I suspect that the moneyed interests will support some enhanced version of the ACA to
head off single payer again if demand for single payer grows.


8. Biden’s nomination was fueled in large part by strong support from African American voters.
Sen. Sanders struggled to put together a diverse coalition. What are some strategies for
making the Medicare for All movement more diverse? We need to tailor our message for
different groups with different concerns. Medicare forced the integration of hospitals which
had not been willing to integrate especially in the south. Medicare for all could increase the
access of all Americans but in particular for minorities and people of color who often face
greater access barriers. Engage in conversations to find out what the issues are in non support.
Invite people of color to present information concerning their situation so we can better
understand where they are coming from.


9. How can Biden and the Democratic Party be pressured to support M4 All? First, he would
need to be elected. Second, we need to have strong support in the House and 60 votes in the
Senate and support among committee leadership. This will only happen if there is demand by
Americans for this kind of change. It is possible that the healthcare and economic disaster of
CoViD-19 could bring about single payer Medicare for all. Tens of millions who are uninsured or
underinsured face health and economic crises while physicians and hospital systems are seeing
the healthcare and economic catastrophe all at the same time. The financial crisis facing the
states may also push forward the desirability of a Medicare for all solution since the states
cannot deficit finance while the federal government can. Single payer Medicare for all would
help us find our way out of this healthcare and economic disaster. We would save money, save
lives, and guarantee stability for local and state governments as well as patients and providers in
the face of disaster.


10. How can we speak to physicians (beyond the BETTER PATIENT CARE) about how the transition
would look and how the structure of their practices would look with single payer? They could
do a thought experiment. What would it be like if you had guaranteed immediate full payment
by credit card for patient care at Medicare rate for all patients who see you (no bad debt) and
never had to pre-certify any referral or test a patient needed. The appropriateness of care
patterns would be monitored for quality of care issues but not for financial reasons unless the
pattern suggested fraud or abuse just as traditional Medicare does now.


11. Can you address the fact that states are out of money. Would MFA help in this immediate
crisis? From the report the health insurance companies sent out: ICU care costs: Medicare
Advantage $17,000: Commercial $38,450: Medicaid MCO $16,250. See above #9 The economic
impact study done for Ohio shows that we would save $25 billion per year just here in Ohio.
SPAN Ohio: Single Payer Action Network Ohio Nationally, the savings $400-500 billion annually.


12. Biden’s plan is a so called public option. Will that be beneficial for moving Medicare for All
forward? See #3. The public option might make a very small difference but PNHP analyzed this
back in 2009 when the ACA was being built and we did not feel it would help. We felt that
private insurers would use it as a dumping ground for chronically ill and expensive patients. We
know this is already happening in the Medicare Advantage market. The privatized Medicare
Advantage plans cherry pick and lemon drop

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13. Sen. Warren attempted to shift the conversation away from the rhetoric of “taxes” and to
focus Americans on total cost. She’s obviously completely correct in terms of the policy. But
the political reality appears to be that Americans are obsessed with “taxes” in particular
(thank you, Grover Norquist!), even if it isn’t rational or even efficient. How does the M4A
movement deal with this particular fixation on taxes? First, we need to make fun of it. Who
cares if it is a premium or a tax? If the money out of your pocket is fair and affordable and you
get the care you need without having to worry about co-pays and deductibles and narrow
networks of providers and surprises bills. Our skit about the fire department comes to mind. Fire
Department Skit We need to also point out that taxes are very efficient to collect vs. the
insurance premium collection bureaucracy.

14. Ohio, we’ve watched our Governor & Department of Health Director continually defer to the
Ohio Hospital Association for data and guidance. OHA is a trade organization, whose purpose
is protecting the business interests of hospitals, NOT the health of the public, yet they’ve been
the de facto gatekeepers and filters for key information in this crisis. What can we do to help
diminish government and Public Health’s dependence on lobbying groups like this? Much like
the insurers they are an obstruction to reform and need to be confronted as over 90% are 501c3
organizations and have a duty to serve the public interest to receive that tax exemption. To
some extent the larger more powerful hospitals are being run by MBA types who are now the
highest paid health care workers so they will resist change.


15. Isn’t a good argument to large corporations that they are losing out to international
competitors in countries that supply public health insurance? Warren Buffet says so but so far
the rest of the corporate world doesn’t buy in yet

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16. What about overcoming the resistance from unions who fear the loss of the benefits they
have negotiated? Very true that they have sacrificed wages and other benefits to get the health
care that they have. Some unions self-insure and have jobs and control at stake running these
health programs. Most unions are strong for single payer. Much like the hospitals, they need to
be confronted about their mission for all working people. We need to start with local unions and
work our way up to the top. We also need to be supportive of labor unions and support them in
contract negotiations. We also need to make sure we are using union labor for SPAN materials
and goods

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17. Can a part of opening up the country be letting any company buy in to Medicare and drop
their for profit private insurance? Sounds interesting but we would need the same coalition and
political support to get this as to get Medicare for all I suspect.


18. Could you talk about the astronomical increases in drug prices and how that would be brought
down in Medicare for All? We know that the VA and even small European countries like
Denmark have been able to negotiate half off or better on drugs. Drugs make up about 8% of
total health care costs and other countries spend 1-3%. If we could get down to 3-4% we would
save about 100 billion annually.


19. How can we explain that a single payer national health care system could have efficiently
handled procurement, stockpiling and distribution of pandemic testing, PPE, ventilators and
contact tracing? A unified system of care would include public health and disaster planning.
Care and prevention would be intimately intertwined. Medical care would be directed to places
where it is needed in a single payer system, rural and safety net hospitals would not be
underfunded or isolated. Most importantly, we need a national leader.


20. Would switching the rules of the road help a little with the Medicare for all funding? Example,
What if citizens were responsible for their annual/ Bi-annual physicals out of pocket. Make
those regularly scheduled physicals fully comprehensive, eyes, ears, blood etc., and
reasonably affordable say $200 - $500/year - max. THEN if the doctor wants to "Run some
tests" - then - get Medicare insurance to kick in? Maybe keeping folks involved in their own
healthcare yet providing the safety net we lack now? Maybe that $200 - $500 go straight to
the doctors to increase their willingness to serve a better system? I think the question here is-
How do we get the patients and the doctors to focus on staying healthy? I do not think that
having people pay out of pocket would help in any way. There have been multiple studies over
the years that shows that out of pocket expenses simply prevent people from getting the care
they need. In addition, it adds to the complexity and cost of the system. We need to be
creative. I think that we should give a paid day off for regular preventive care and encourage
doctors by paying very well for this service so they will encourage their patients to get their
preventive care.


21. Has your organization looked into what appears to be a monopoly in the prescription drug
industry and associated PDMs? Yes- Pharma and the Pharmacy Benefit Managers and the
Insurance industry are all intertwined and ripping us off. We can do better.


22. Medicare for all would certainly require premiums and deductible as Medicare does now.
Nope. There is no advantage to any of this per the health policy literature. In fact, high co-pays
and deductibles prevent 4 times as much needed care as unneeded care. People with high copays
and deductibles just fail to see the doctor when they should and they sicker and even die
more often than those without cost barriers. Premiums are very costly to collect. Taxes would
be more simple, fair and efficient to collect the money needed for covering everyone.


23. What do you know about health coverage for the National Guard members who were called
up to help in various communities? I heard that they were limited to 30 days service, missing
by one day Guard coverage so they’d be on their own if they were infected. This seems like it
would be useful information to show the craziness of what is happening. Agreed. This sounds
unfair and Medicare for all would cure this injustice and so many others.


24. How would you counter the argument, "I worked hard to get my healthcare, let them do that
too!" We all pay for all of it. Most of the uninsured and underinsured are working but do not
have good insurance as part of their benefits. (agricultural workers, gig economy, small
businesses etc.) Most people who think they have good insurance have probably never had to
test it. Many find out that their employer based coverage is an umbrella that melts when it
rains.


25. Personal question: I'm curious about how those in the insurance industry who are lobbying
against national care justify their position? Are they genuinely not aware of the problem? Is it
the money? Surely, they are good people, but what gives? Have you heard from them,
privately or otherwise? What do they say? I do not think that we can answer this. We heard
Wendell say he could not ethically or morally continue to serve the insurance industry seeing
what was happening in the country. (He talked about his visit the Remote Area Medical event in
Tennessee. I have my own horror stories from my days as a Medical Director I could share.) It is
the money.


26. When did you write Nation On The Take? It was released in March of 2016.


27. Aren’t the Medicare expansions just off loading from pvt. Ins the chronic ill to Medicare?
Likely yes. See the public option.

Bullet Points for Legislators

  • Single Payer saves money.  For the past 20 years, states have commissioned studies on different types of health care systems.   In EVERY case, single payer was shown to be the only way to cover everyone and the only system that saved money and controlled costs.

  • Publicly financed does not mean government run health care.  YOU have publicly financed health coverage, but the government does not make decisions regarding your health care.

  • Cost conscious patients often don't get the care they need.   Most decisions are made by the doctor in concert with the patient, but the patient relies on the doctor's knowledge to make a decision.  Expensive tests and treatments cannot be ordered by the patient, only the doctor.

  • Lifestyle choices are not what is fueling high costs in health care.   The United States ranks low in general health indicators, but high in good health habits.  We smoke less, drink less and consume less animal fat that many other countries with better health indicators and much lower health care costs.

  • Businesses can accurately determine their health care costs and are not subject to unanticipated large premium increases.

  • It will reduce labor costs due to a more efficient way of financing health care, eliminating much wasteful administration.

  • Workers' Compensation costs will be reduced, likely by half, due to the fact that everyone has health coverage and there is no need for the medical portion.

  • It reduces the need for part time employees and provides easier recruiting.  There are no pre-existing conditions or Cobra issues.

  • Eliminates the oversight of health benefits and bargaining health coverage with employees.

  • It creates healthier personnel and more stable employees, reduces absenteeism and eliminates employer health coverage complaints.

  • It reduces employee health related debt and personal bankruptcies.

  • It frees up family income that can be spent on other goods and services, thus stimulating the economy.

Tips for Writing Letters to Editor

Follow guidelines for your local paper (word count, submission instructions, etc.)

Frame your letter in relation to a recent news item Use state specific data whenever possible (let us know if you need help finding some!)

Address counter arguments

Be aware of your audience and emphasize how Medicare for All is good for ALL residents of the state

Criticize other positions, not people Include your credentials (especially if you work in the healthcare field)

Avoid jargon and abbreviations

Don’t overload on statistics and minor details

Cover only one or two points in a single letter

Avoid rambling and vagueness

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