Hitting the road for single-payer

Donna Smith is featured in the Michael Moore documentary Sicko. Since her appearance in the movie, Donna founded American Patients for Universal Health Care and has toured the country, speaking about her experience from the movie and about the struggle for health care rights for all.

In December, prior to a screening of Sicko in Seattle, she spoke to Kate Johnson and John Dimond of the Seattle activist group Right To Health Care Now!

MICHAEL MOORE'S documentary shows that almost everyone in America has a health care horror story. Can you talk about your story and how you came to be featured in the movie?

MY HUSBAND, Larry, started having heart and artery trouble about 1990, when he had his first heart attack. For a period of years, he was in and out of the hospital, and he had a lot of things done. He was only 46 when he started having trouble.

At the time, our insurance was good, but not great, but it did at least cover the things that he needed to have done. But like many Americans, our premiums started to creep up, and our co-pays and deductibles started to go up, and the coverage started to get worse. So just at the time when his health care needs were growing, our coverage was shrinking, and we were feeling some bad financial pressure from that.

What you can do

The American Patients for Universal Health Care Web site has more information on the struggle for health care rights. For more on Donna's story, see her own Web site.

The California Nurses Association Web site is filled with health care horror stories from both patients and providers, plus ideas of how to get involved in organizing for a change. Healthcare-Now posts a regularly updated calendar showing events around the issue of health care.

Physicians for a National Health Program has a Web site that makes the case for a government-administered single-payer program and has information on single-payer legislation sponsored by Rep. John Conyers.

Donald Barlett and James Steele's Critical Condition: How Health Care in America Became Big Business--and Bad Medicine is a fact-packed expose of the for-profit health care industry. Marcia Angell, a former editor of the New England Journal of Medicine, takes on Big Pharma in The Truth About the Drug Companies: How They Deceive Us and What to Do About It.

Just as the new century turned, I was diagnosed with uterine cancer. We had been able to weather one of us being sick, and get through that without too much difficulty, but when I got sick and had to take time off of work, and then went back to work too soon because I was afraid of losing benefits and losing pay, I developed a huge hernia in the cancer incision site. So in addition to having radiation, I had to have another surgery done almost immediately, and lost another eight weeks of work and pay.

Like so many families go through in this country, it was just too much to handle financially. We limped along. We borrowed from friends, we sold things, we tried to pare down as many of our expenses as we could. But things just kept getting more desperate.

In about February 2006, my husband was due to have his fourth heart surgery. A friend of mine called me while he was still in the hospital and told me that Michael Moore was working on a movie about health care. I more or less discounted her call, and told her I didn't think he'd be interested in doing a story about people with insurance, and what was happening to them.

But she encouraged me to go to the Web site and look, so I went, late one night. I was lonely and tired, and I saw a little call for health care horror stories. So I a left little message and told him a little of the story of what happened to us, and that [former Senate Majority Leader Tom] Daschle had spoken about us on the Senate floor, and what was happening to Americans with insurance. And I asked him, if you're going to make this movie, please include something about middle-class families that are losing everything they have.

I didn't really expect to hear anything, but about six weeks later, I got an e-mail back, saying that they wanted to talk to us. And the dialogue eventually resulted in us being in the movie.

SINCE THE release of Sicko, you've been touring the country, speaking about the movie and encouraging people to get active around the issue. What has that experience been like?

I THINK the most amazing thing that's happening right at the moment is there truly is a movement forming in this country, and it involves health care as the primary issue.

But there's a more generalized issue that's a little bit more exciting to me in that Americans, for the first time in a generation, are saying that they're unwilling to watch the nation continue to go down such a selfish and destructive road in the future--not only with health care, but with our attitude toward other nations in this world, with our attitude toward education, and just in general.

The people I'm meeting along the way love Sicko, and almost 90 percent of the people I talk to support a single-payer, universal health care system, but they also support us being more just generally, in how we deal with one another in the world community. That's very encouraging to me.

Wherever we've gone, we take groups of people to congressional offices. One of the reasons we're going on the tour is that we go meet with local constituents and help them frame the issues, and take them in to their congressional representatives.

But you still meet this resistance at the level of the congressional offices. You may have 10 constituents, some of whom have worked on campaigns or donated money, and yet their own congressional representatives have a very different view of the world. They're not living in the same world that their constituents are.

I think that's why we're seeing that Congress has such a low approval rating. It's because they're not listening to the people.

So I think that's the challenge. We're in this grassroots effort, which really is growing from coast to coast through the road show. There's efforts here in Seattle; there's an awesome group in Chicago, the Chicago Single-Payer Action Network; there are great groups in California, pushed by the California Nurses Association and the National Nurses Organizing Committee. State to state, there's such awesome organizing going on.

But our challenge is how do we get our leadership to really listen to us? How do we make our voices loud enough so that they hear?

YOU WERE recently on a hunger strike to protest Bush's veto of the bill to expand the State Children's Health Insurance Program, or SCHIP. Why did you decide to take this action?

THERE WERE three of us in the movie: Reggie Cervantes, a 9/11 rescue worker who has two children; Adrian Campbell in Michigan, who has a little girl; and myself, a mother of six and grandmother of thirteen.

We found it incomprehensible that anyone would want to veto children's health insurance--that anyone would argue against giving whatever we can, and the best of health care to our kids. It just seems so diametrically opposed to anything that speaks of family values or a love of God or a love of anything. We were all very frustrated and felt like "What can we do? How can we make a statement that says we don't agree with this?"

So we came up with this idea--under my organization, called American Patients for Universal Health Care--for the Hunger for Health Care strike. We asked a few people to join us--not too many, because we knew most would probably think that we were a little over the top in doing something like that. We came up with a date that we wanted to start, and then we agreed to it and got information out.

We actually had to convince Michael Moore's folks to put something on their Web site, because they were a little bit concerned. First, I think, for our health because they obviously know a little bit about all three of us and our health status, so they were worried about that. But they were also worried that the action wouldn't generate the desired result--which is to get people to pay attention to SCHIP and get the president not to veto it, and if he did veto it, get Congress to override that veto.

When we started our hunger strike, Adrian was very concerned about getting through Halloween with her little girl, so she went through Halloween eating sugar, which we told her might not be the best entrée into a hunger strike, but nonetheless that's what she did.

So we started our hunger strike on November 1, all three of us together in different locations, supporting one another by Internet. Reggie got a little bit of publicity in Oklahoma, and I got a little bit of publicity in Colorado.

Adrian had a tougher time in Michigan. Michigan generally is having a lot of terrible stuff happen in terms of closures of businesses, so as one little voice on a hunger strike, it was hard for her to get publicity. She did speak at an antiwar rally where she mentioned it, but she was a little more discouraged about not getting PR.

Adrian made it about 11 days before she had a doctor's visit, and the doctor told her that she probably shouldn't continue. Reggie and I continued 16 days before we had friends and relatives say that we need to take a break from it.

We did. We decided we'd go back to eating right now, but that does not mean we're not committed to SCHIP. We still are, and we're reserving the right to go back to another hunger strike in the future, maybe with more people joining us, if we feel like that will generate some publicity and generate some true compassion for what families are going through.

WHY DO you think Bush decided to veto SCHIP funding when over 70 percent of the public wanted to see it expanded?

I THINK he was honest when he first answered the question. When he first answered it, he said he thought it was a step toward socialized medicine. He believes it will hurt the private insurance carriers if more families qualify, and therefore fewer families will buy private health insurance--and God forbid that George Bush take a step that would move him away from his friends in Corporate America.

I think it's that simple. He doesn't want to hurt his friends who are at the corporate level. I always want to shake my fellow Americans and say, "Do you truly believe this man's heart is in family values? Do you truly believe that this man cares about American families--middle-class, working families? Do you think that's what he really cares about?"

The answer has to be no, if you look at his positions. I think he was honest when he said why. He doesn't want to see an expansion of socialized medicine, even though SCHIP is not socialized medicine. He didn't want to hurt private insurance companies.

DO YOU think it was part of an effort in the lead-up to the 2008 elections to keep the debate as far to the right of true single-payer reform as they can?

IT MAY be partly a political calculation, although I think that--and this is my own view--that on the health care issue, the conservatives don't believe there really should be health care reform. They believe there should be reform so that nobody can sue when there's a medical error. That's basically what they believe health care reform is. So I think, no, they're too cocky in their position--they're too sure of themselves.

I heard someone say that Gandhi once said: "First, they ignore you, then they ridicule you, then they fight you, and then you win." These are the stages of any political battle. And I thought, "This is interesting. If George Bush has to veto SCHIP, that's not a ridicule-you phase, it's a fight-you phase." So that shows great hope to me.

WITH ALL the Democratic presidential candidates, with the exception of Dennis Kucinich, refusing to support single-payer, and instead proposing market-based solutions like the Massachusetts plan, what should activists committed to the passage of single-payer do in the next year?

WHAT I think would be of primary importance is to work for progressive congressional candidates to get them in office. Don't contribute a dime to any candidate who does not support single-payer, universal health care.

I know many of us in the activist community aren't the real big money-givers anyway, but we often give of our time and our energy pretty freely when Democrats ask us, because we assume that they're going to be along our general ideology.

If somebody calls you and they want your time or they want your commitment, ask "Where does your candidate stand on single-payer?" If they say, "I don't know" or they say they don't stand with single-payer, put your work behind someone who does. Let's get a Congress elected that's progressive enough to pass HR676, which is the single-payer bill that's already there, with 86 co-sponsors.

That's 20 percent of the Congress that already believes single-payer is the right way to go. That's an awesome accomplishment already. We can make it happen. But we need to elect a Congress that will pass it.

RECENTLY, YOU were in Kentucky, where there's a strike in Harlan County of thousands of nurses. You've also worked closely with the California Nurses Association/National Nurses Organizing Committee. What role do you think labor struggles will pay in the passage of single-payer?

I THINK they'll play an awesome role. I'm so humbled and honored to watch nurses when they organize and when they speak with one voice. Talk about a powerful group of voices. They are succinct, they are intelligent, they know exactly what they're talking about in terms of patient care, and in terms of what's humane and decent, and what's best medically.

And they are powerful. They're not out for any other political agenda except what's best in nursing and in patient care, and the power of the simplicity in that message is amazing.

It's almost like when I've listened to Iraq Veterans Against the War. When they speak, they speak with a kind of clarity and authority that I can't speak with against the war. And I can't speak with the same level of clarity about what's going on behind the scenes in health care as a nurse can, because they can say, "This is what I see every day with my patients."

And they're so diligent. One of the most amazing rallies that we've ever participated in was in Sacramento. We went with a thousand nurses to the California State Capitol, to Arnold Schwarzenegger's office, where the nurses were lobbying in favor of SB840 [state single-payer legislation].

A thousand of them were so organized that when we left the location, everybody was handed a sign, 250 went to each of the four entrances, so that security would not be able to bunch up at one place. So we all entered from different entrances of that building. And once inside and in place, they chanted such amazing pro-health care and pro-health legislation chants that it echoed around that building.

It was incredible. Then, when they decided it was time for them to go, they left. They didn't wait. They had a rally on the steps, which was amazing. That's what I call power.

It's also invigorating to see the effect on labor in general. The California Nurses Association just became a member of the AFL-CIO, and Rose Anne DeMoro, their executive director, is now one of the vice presidents of the AFL-CIO. They bring an amazing amount of energy to that level of labor.

Labor has suffered in recent years in the United States. It's taken a real hit. I think workers are finally starting to realize that it's not necessarily a good thing that they haven't bargained together--that they have not stood strong together. The nurses are sending a lot of messages, not just on health care, but on what it means to be organized labor.

YOU WERE recently in New Orleans as part of the Sicko road show. What were people's reactions like there, and what do you think about what's going on there after Hurricane Katrina?

I WANT to put in a huge vote of support for the work that people in New Orleans are doing about every social justice issue we can imagine.

I met an amazing young man named Brad Ott who is working on the effort to reopen Charity Hospital and to prevent the demolition of 3,900 public housing units that weren't severely damaged by Katrina and are salvageable.

The problem for New Orleans residents is that it was somewhat difficult to add to the level of work that they need to do in organizing around HR676 when they're trying to get their public hospital reopened, and they're trying to have enough housing for people to come back to their homes in New Orleans.

At the Mississippi-Louisiana border, we drove by a sea--and I'm not over-estimating this--of probably 20,000 unused FEMA trailers. The reason they're unused is that FEMA required, as part of their rules, that the areas where the trailers were set up had to have sewer and electricity. In the early days after Katrina, all of the power resources were diverted to the French Quarter and to the areas that were needed to bring business back to the city.

In the early days, someone might understand part of that. But now, we're two-and-a-half years post-Katrina, and all of the American taxpayers paid for those trailers to be brought down so that families would have somewhere to live on their property while their homes were being rebuilt, and we paid $2,000 each for independent contractors to transport those trailers into the vicinity. Now they're all sitting there, unused.

On the front page of the New York Times, I saw an article about how FEMA is saying that those who are in trailers, many of them in trailer parks, will have to be out within the next six months. The problem with that is that there is nowhere for these low-income, working families to go in New Orleans that they can afford.

What I'm hearing from activists like Brad Ott is that the very social fabric of New Orleans is being readjusted. Where we used to have over 60 percent Black people living in New Orleans, now we have under 50 percent.

Part of that has to do with low-income issues, and what's happening to people. In some of those low-income housing units set to be demolished, they boarded them up and locked them so that the people couldn't even go back in and get their personal belongings. They haven't been able to go back in to get their photographs or anything, and they will be bulldozed.

And there's no replacement housing for these folks, so you wonder what it is that New Orleans is becoming, and what was meant when President Bush stood there in the light of that beautiful church in the French Quarter and told us all that we would rebuild New Orleans.

Did they mean that we're going to rebuild it in the image of a rich, prosperous, Republican city, or did they mean that we're going to rebuild New Orleans to be the rich, wonderful and culturally diverse place that New Orleans was? Apparently, they meant something very different than what I think the rest of the nation wants.

The community is still suffering severe loss and severe trauma, and they need our help as Americans, and I hope that people will reach out and say, "What can I do to help in New Orleans and what can I demand that we do differently?"

YOU MEET a lot of people who don't know what single-payer health care means. How do you explain it to people?

I MAKE it as simple as I can. It means that we're all going to pay into one public pool. We're going to have publicly financed, privately delivered health care. You will still choose your doctor, you'll still choose your hospital, you'll still choose your clinic, but we'll all pay into one, central pool, and everything will be paid out of that pool. It will be administered by a government agency, and that's all we mean by single-payer.

Right now, we all pay an insurance company or we're part of a government program, and claims go to all of these various locations, or payers, so we have a multiple-payer system. Single-payer just means that we'll have a one-payer system, and it isn't going to be a private insurance company. It's going to be something that's controlled by other Americans just like ourselves, who administer it fairly and make sure that all of us get the health care that we need.

Everybody in, nobody out.