Strategy talk for Interfaith Health Care Committee Forum Oct 1, 2013,
by Camilo Marquez, MD
[We have created] a society in which materialism dominates moral commitment, in which the rapid growth that we have achieved is not sustainable environmentally or socially, in which we do not act together as a community to address our common needs, partly because rugged individualism and market fundamentalism have eroded any sense of community and have led to rampant exploitation of unwary and unprotected individuals and to an increasing social divide – There has been an erosion of trust – and just not in our financial institutions. It is not too late to close these fissures.
-Joseph Stiglitz, Free Fall: America, Free Markets, and the Sinking of the World Economy, Norton, 2010
Let me begin by defining some concepts that set the frame for this discussion of strategy. Health Care for All Oregon sounds straightforward, but it contains a set of various concepts and structures. First of all it is an idea that carries our standard and expresses our moral position. This idea establishes our goal and creates an objective which can be measured as a criterion of success and efficiency. Second, Health Care for All Oregon is an organization/coalition of member organizations and regional chapters. When referring to it as an organization, I will use the acronym, HCAO. Lastly, Health Care for All Oregon is the title of a legislative proposal that Representative Dembrow has introduced.
The goals of HCAO are to win passage of the Health Care for All Oregon Plan and to support a similar effort on a national level. We are focused on winning the first goal and have included in our strategic plan which is a dynamic ongoing process, the following operational objectives:
Develop membership and infrastructure of a broad, effective, statewide coalition of working/activist volunteers supported by core leadership and staff.
Secure necessary on-going financial resources.
Organize and mobilize a powerful statewide base of activists.
Develop a legislative strategy that can win the struggle for meaningful health care reform.
Develop a Communication frame that conveys our moral standard and shifts the terms of the debate.
We have made significant progress on many of these and continue to work on strengthening and implementing them. Our organization is growing and our numbers are increasing monthly. We hired a capable and professional organizer who has promoted the addition of new member organizations now totaling 88 and developed 19 local grass roots organizations around the state. A consultation from a professional fund raiser provided recommendations on our finances and a comprehensive legislative strategy is in place. We had a measure of success in the last legislative session with increased sponsorship of Rep. Dembrow’s bill and the passage of the bill to study options for financing health care delivery in the state. We intend to capitalize on these achievements to develop more activist leadership. Crucial to our strategic planning must be creating organizational capacity so that the implementation of the plan keeps pace with our strategic goal timeline.
I respectfully offer these following recommendations regarding the planning process. The development of a strategic plan must start with an analysis of the circumstances one wants to impact, before identifying the goals and operation of the plan. Without an understanding of the history, structure and function of the domain which you intend to change, your efforts will be aimless and ineffective. You must assess the context of the domain, how it functions as a system with and related to other systems, so the reforms are established on a base broad enough to be stable and sustainable. I am concerned that if our well-meaning concern for the health care crisis focuses narrowly on the health care system, even if we succeed in creating the kind of system we desire, we will still be forced to struggle for fairness in all the realms in which health is embedded: employment, education, housing and environment. A review of developments in the economy reveal that health care is but one realm, albeit perhaps the major one in which critical changes have occurred in the past 30 years. The underlying forces which produced the health care crisis impact our entire lives, so our efforts to create change in health must also comprehend the health of our community, political and economic systems. Our mobilization to organize change must relate to the issues of jobs, schools, environment, housing, social justice and governmental policy making. Is it a coincidence that we gather today on the day that government operations were threatened with shutdown unless Obamacare is defunded? Coincidentally the same day as the start of enrollment in the insurance exchange. No, it is all part of the same process. The one which will bring the XL Pipeline and Trans-Pacific Partnership, unless we join together to stop the corporate control of everything for the benefit of the few.
These conditions: declining wages and benefits, out-sourcing of well-paid jobs, challenges to collective bargaining, contraction of work hours to avoid eligibility for benefits, deregulation, outrageous income and wealth inequality, privatization, financialization, globalization, ownership of politicians and media have resulted in a pervasive cynicism that nothing can be done about them. On the issue of health care reform, we saw the intense battle over The Affordable Care Act which was throttled with compromises to satisfy insurance and drug companies and forced to abandon the public option. Despite its passage and a convincing Presidential mandate, we have witnessed 41 fruitless attempts by Congress to overturn it. We see many who believe in health care reform and the advantages of a single payer solution skeptical about its political feasibility. Doctors and administrators beholden to their corporate employers recognize the soundness of publically funded universal health care also known as single payer, but deny it because of their dependence on the status quo. The elimination of the meme that true reform is unrealistic or politically infeasible must be the keystone of our campaign strategy. We know that some progressive representatives and senators in the legislature refuse to display leadership on health care reform because of this cynicism. We must disabuse them of this false conceit by demonstrating that the people in every corner of this state believe in, deserve and will fight for justice in all spheres of public life. To do so, it is essential to rebut the notion that government is the cause of all our problems and privatization is the solution. We may be flexible in adapting our language, messaging and attitudes to varying conditions across regions and demographics of the state, but we will not compromise on the principles of programs that incorporate our shared values.
The fulfillment of these aims requires that we build a movement which will overcome the powerful, wealthy forces oppressing us as was done in the civil rights, women’s and gay revolution and, will be done for immigrant rights. To have predicted the achievements of these movements that seemed impossible a short time ago would have been called unrealistic. I remember Southern politicians admonishing the civil rights leaders to go slow. Now, even some Democrats in Congress offer to compromise with the Republicans to delay the implementation of Obamacare for a year, in which 47,000 people without access to health care will die of treatable causes. Still we are denied the fulfillment of our dream for justice. The dream is real, but we have to wake up to realize it. That means creating a loud, visible presence of activist organizers in a network covering every county, district, town and rural outpost of the state, not just in the liberal metropolitan enclaves. With the reach and strength of our members, we can inoculate our constituencies against the distortions and lies that the wealthy stakeholders will use to manipulate, threaten and buy off the public.
The time for us to act is now. The opposition has mounted a wall of massive resistance against the Affordable Care Act, just as the Southern Democrats did against school integration over 50 years ago. They are forcing the administration to respond with an expensive advertising campaign to promote the exchange. Insurance companies will spend a billion dollars to encourage people to sign up, adding to their already too high administrative costs. We must be ready to spread the word about real reform to every citizen in every part of the state. We can cover Oregon with the truth.
This is a challenging task and I have no doubt that we are equal to it. When I think about the morality of our campaign, I don’t think about the achievement of the rights we deserve. I think about the moral force that confronts us as individuals and community which makes it incumbent upon us to do our utmost to fulfill the promise. Citizenship is not about prerogatives, but obligation and duty.
This is a timeline of how our strategic goals will be implemented.
The results of the finance study must be presented to the Legislature by Nov. 1st 2014. Beginning now, the Legislative Strategy calls for interviews with all Legislators to engage them on The Plan for Health Care for all Oregon and to assess their level of support. In the 2014 campaign season, HCAO will interview candidates. Among the questions put to the legislators will be whether they agree to advance the recommendations of the finance study. Representative Dembrow has alluded to his plans for reintroduction of the bill to create health care for all Oregon. Depending upon our efforts on its behalf through lobbying, rallies, letter writing and a media campaign it will pass in 2015. Then, upon determining whether to sponsor a ballot initiative or support a referral from the legislature for a vote by the public on the measure, we will have a year to mount a petition or get-out-the-vote campaign rivaling the scope of elections to statewide office in 2016. Assuming it passes, we will request waivers from the federal government in 2017.
To accomplish all this, we must build a massive, grass roots movement of volunteer activists to carry the message to the legislature and to the people across the state with a force which can withstand and overcome the power of the vested interests of medical profiteers. Our data base of such individuals has grown to over 7000 across this statewide movement. We are growing it through house parties, tabling at community events and forums. We ask all of you to step forward, fill out the volunteer activist forms in your packets and respond to the call when you are asked for your service. Commit to your member organizations and regional chapters to work in unison with the statewide organization to achieve our common goal. The opposition is well financed and sophisticated. We have the wealth and wisdom of the people and the power of righteousness.