Pax Americana

198 More Sundays: Best Care Anywhere

Well, I'm not sure if this is appropriate to employ in the struggle for healthcare reform, but perhaps a kind of social intervention, Method 175. Overloading of facilities, could work:

Overloading facilities involves the deliberate increase of demands fo services far beyond their capacity, so that the operation of the institution (government department, business, social service, and so on) is slow down or paralyzed.  Such overloading may be initiated by customers, the public, or employees of the institution.  The objectives may vary and may include improved services, wage increases and political ends.

In 1965 at the Los Angeles County Hospital in California, for example, interns protesting pay policies initiated an overloading of facilities by admitting far more patients to the hospital than existing facilities could accommodate--even persons not needing hospitalization were admitted.  This was called a heal-in.  The interns' aim was to obtain a better bargaining position with the hospital administration.  The hospital was filled with patients within four days, and the action cost the city around $250,000 in increased costs.

[The Miami News reported at the time:

Representatives of resident physicians and interns at Los Angeles County General Hospital, miffed by a pay raise of less than $10 a month, said they would flood the huge facility with patients. They called it a "heal in."

County Supervisor Kenneth Hahn called it "a deliberate plan to disrupt good hospital service." Ho said a delegation of three doctors claiming to represent the 200 interns and 350 resident physicians said their strategy was to admit as many patients as possible and, at the same time, retain present patients longer.

Hospital administrators said there was a 25 per cent increase in admissions yesterday and a 40 per cent drop in discharges. The doctors had asked fot $400 monthly for interns and a sliding scale foi resident physicians from S510 to $713 a month Interns now get $330 to start and $337 after six months — plus room and board. Resident physicians receive from $435 to $645 a month.]

A similar case occurred in Massachusetts at the Boston City Hospital in 1967, where it was called an "around-the-clock heal-in."  This action was begun by 450 residents and interns at Boston City Hospital on Tuesday, May 16, 1967.  The purpose of the heal-in was to dramatize salary demands by doctors at Boston teaching hospitals; at that time the take home salary of an intern was only sixty dollars per week.  The doctors felt that it would be in violation of their oaths to go on strike, so they chose instead to practice "ultra-conservative medicine in order to overcrowd the hospital.  Dr Philip Caper, President of the House Officers' Association, said: "Everyone gets the best of care," which was ensured by having all the interns and residents work twenty-four hours a day.  "Every patient who might benefit from hospitalization will be admitted, and no-one will be discharged until he is completely well."

The heal-in was patterned after the similar action at the Los Angeles County Hospital eighteen months previously.  The Boston City Hospital doctors began their heal-in as an unannounced experiment on Saturday, with 874 patients in the hospital.  On Sunday there were 890, on Monday 924, and on Tuesday at 7am (after the main action was begun) there were 982.  An unidentified doctor stated; "With 1200 or more patients in the hospital the laundry will not be able to keep up, the kitchens will have trouble getting the food out, the X-ray and laboratory departments will be swamped, and people will begin to listen to our demands..."

By Wednesday morning there were over 1000 patients, and 1075 on Thursday.  The heal-in was supported by private doctors and house officiers at the other major Boston hospitals.  Action was taken only at Boston City Hospital because house officers there had full responsibility for medical procedure, unlike the private hospitals.

Countermeasures by the administration began Tuesday afternoon with an announcement that there were no more beds for male patients, which was disproved that evening by the admission of two more patients.  They next tried to influence the chiefs of services to override the admittances, which these doctors refused to do on the grounds that these patients were indeed getting the best of care.  The administration's final effort was to deny their competence to make salary changes.  On the evening of Thursday, May 18, they relented and promised to make salary adjustments.  The doctors ended the heal-in voluntarily that night.  Observers felt that it was a "safe, effective way of backing up demands for higher wages."

[An LTE in Psychiatric News, 2001:

I was at the time a chief resident in psychiatry on what was then a Harvard service. I recall no mention of proposed union affiliation or concern about compensation, since the vast majority of residents felt privileged to be training under such notable clinicians as Dr. Derek Denny-Brown.

At issue were deplorable conditions for patient care such as grimy, open-bay wards with water-filled grapefruit juice cans filled with cigarette butts, an absence of bed linen, and no assistants to transport patients for X-ray studies or other procedures, such that interns had to push the gurney stretchers themselves.

The city administration had turned a deaf ear to the repeated pleas of the interns and residents. The “heal-in” was a last-ditch effort to draw public attention to the plight of the patients, who were, many of whom were poor and African Americans. We were determined during the heal-in to provide superior round-the-clock care. I recall being on duty for 36 hours straight. There were no “nonpatients” admitted, as described in Dr. Avram’s article. Rather, the decision was made not to discharge patients until every outstanding laboratory or X-ray study result was on the chart—this was had also been a significant problem in the precomputer era because of an absence of lab result dispatchers.

The Boston Globe was contacted in advance, emphasizing that superior care would be provided to patients during the heal-in. Thus, there was widespread public sympathy and support for this effort.

As I recall, the patient census soared from 800 to the full 1,200-bed capacity in two days. This required that some patients seeking admission were temporarily deferred to Massachusetts Memorial and Massachusetts General, New England Medical Center, and other area hospitals.

The city of Boston finally got the message, and the necessary patient care improvements were initiated.

This was not an action taken lightly and indeed only as a last resort. The interns and residents at Boston City Hospital felt totally vindicated by these positive results.]

I wonder if, with a majority of healthcare practitioners supporting single-payer, this would be an action they could take to make a point?  Order enough expensive tests that insurance companies would have to pay out or deny, create administrative bottlenecks, etc.  Even insurance employees of conscience could assist.  Dunno.

Anyway, I've just been trying to think of other ways people involved in delivering care can get involved somewhere between sidewalk summits and civil disobedience.

ntodd

Make Us Do It

Look, letters, petitions and virtual marches are lovely.  Really, they are, so good on MoveOn et al for the effort today.

That said, let's not pretend this is what Obama needs to "make him do it."  I often cite the same apocryphal FDR story he has, and I see it's making the rounds again.  Yet people seem to forget just how this actually worked with Roosevelt:

As the nation prepared for war, African American leaders hoped that the rapidly growing defense industry would provide new opportunities for blacks. In September 1940, A. Philip Randolph, president of the Brotherhood of Sleeping Car Porters, met with President Roosevelt and urged the President to promote equal employment opportunities and to desegregate the armed forces. Although Randolph left the meeting with assurances that President Roosevelt was looking into the matter, no agreement was made.

Having failed to secure the support of the Roosevelt administration, Randolph hoped to bring his cause to the American people. For months he planned a march on Washington and gathered the support of tens of thousands of African Americans. Worried about the impact of the march, Franklin Roosevelt met with Randolph two weeks before the march was scheduled to begin and urged him to call off the march. The only way he would stop the march, A. Philip Randolph told FDR, was if President Roosevelt issued an Executive Order.  [emph mine]

On June 25, 1941 President Roosevelt issued Executive Order 8802 prohibiting discrimination in the defense industry and created the Fair Employment Practices Committee (FEPC) to monitor hiring practices. Although the military remained segregated, World War II brought about new jobs and opportunities for African Americans.

I agree with the assessment that Obama's tepid health insurance reform proposal full of GOP "ideas" represents a loser mentality.  What of our collective refusal to step up and apply real pressure on him to deliver meaningful HCR in the form of single-payer?

I submit our reliance on passive, electronic means of expression is part of our own loser mentality.  We fundamentally gave up in March when we didn't begin an aggressive, escalating strategy to support HR676.

Fortunately, we've once again got an opportunity and some good starting points.  But what's our next act and what will it take to make us do it?

ntodd

198 More Sundays: A Healthcare Revolution Without Torches And Pitchforks

Twenty-four years ago tomorrow the four-day nonviolent People Power Revolution began in the Philippines.  I find it a curious historical coincidence that Thursday--the day Obama is holding his "bipartisan" HCR summit--marks the anniversary of the people's victory over the dictator Marcos.

The spark that set it all off was a corrupt snap election called to prop up Marcos' hold on power.  All regimes require the consent of the people and crave the veneer of popular legitimacy.  The tyrant fraudulently declared victory over his opponent, Corazon Aquino (who died last August), and that was his undoing:

After the election Cory Aquino spoke to a crowd of one million people at a rally in Manila. She proposed a seven-part program of nonviolent resistance, including a one-day work stoppage and a boycott of Marcos-controlled banks, stores and newspapers. She urged people to "experiment with nonviolent forms of protest" and declared: "...if Goliath refuses to yield, we shall keep dipping into our arsenal of nonviolence and escalate our nonviolent struggle." The revolution had begun.

On February 22, 1986, Defense Minister Juan Ponce Enrile and Deputy Chief of Staff Fidel Ramos defect from the Marcos government. Enrile and Ramos barricade themselves in the Defense Ministry headquarters in Manila, along with a small group of sympathetic troops. They say they are prepared to die rather than continue supporting the corrupt Marcos regime.

The revolution employed a variety of Methods, including some I've been discussing in the context of healthcare reform: withdrawal of bank deposits, boycotts and strikes.  Success was also made possible by the mutiny of regime officials.

Of course it started with 47. Assemblies of protest or support:

Opposition to the policies or acts of an opponent, or support for certain policies, may be expressed by public assembly of a group of people at appropriate points, which are usually in some way related to the issue.  These may be, for example, government offices, courts, or prisons.  Or people may gather at some other place, such as around the statue of a hero or villain.  Depending on the particular laws and regulations and on the general degree of political conformity, such an assemblage may be either legal or illegal (if the latter, this method becomes combined with civil disobedience).

...

In Berlin in 1943...about six thousand non-Jewish wives of arrested Jews assembled outside the gate of the improvised detention center near the Gestapo headquarters demanding release of their husbands.  And in the entry for March 6, 1943, Goebbels wrote in his diary: "Unfortunately there have been a number of regrettable scenes at a Jewish home for the aged, where a large number of people gathered and in part even took sides with the Jews."

One of the most common objections when I bring up nonviolent action is that the apathetic/corrupt/rightwing media won't give us coverage, so there's no point to the exercise.  Global protests of the Iraq War are often used as proof of the folly. 

That, however, is based upon a few faulty assumptions: media doesn't cover such assemblies (yes, they do), coverage is supposed to generate sympathy/shame within the regime (it isn't necessarily), without coverage it's a tree falling in the woods (depends on the type and goal of the action).  If you consider the Filipino example, nobody was trying to somehow get Marcos to give up power simply by getting a million people to show up on TV.

The point was to rally the troops, as it were--to inspire, to encourage them to not only resist but do so nonviolently, and to demonstrate that it was a collective effort so no individual should be afraid of going alone.  It would be great if we could effect social or political change just by holding up a bunch of signs, but entrenched interests are not going to be swayed by news reports of even the largest "focus groups" without follow-up and real consequences.

That's not to say having coverage, especially positive coverage, isn't welcome.  Any channels of communication to a larger audience is helpful to the cause, of course.  But folks do tend to notice the impact of action if it's massive enough (e.g., snarled traffic, lost revenue) all by themselves, so let's not grant the media some magical powers without which we would never experience reality.

Aquino educated her audience, provided them with a strategic framework and specific tactics.  Her appeal was to the people, not her opponent.  Even had there been no media coverage of that event, she reached a million citizens directly and launched a successful revolution.

The Filipinos could have reacted completely passively, just accepting the old dictatorship and the games Marcos played in stealing the election.  Or they could have opted for violence.  Instead, they doubled their chance of victory by resisting nonviolently:

Our findings [using data on major resistance campaigns from 1900 to 2006] show that major nonviolent campaigns have achieved success 53 percent of the time, compared with 26 percent for violent resistance campaigns.

There are two reasons for this success. First, a campaign’s commitment to nonviolent methods enhances its domestic and international legitimacy and encourages more broad-based participation in the resistance, which translates into increased pressure being brought to bear on the target. Recognition of the challenge group’s grievances can translate into greater internal and external support for that group and alienation of the target regime, undermining the regime’s main sources of political, economic, and even military power.

Second, whereas governments easily justify violent counterattacks against armed insurgents, regime violence against nonviolent movements is more likely to backfire against the regime. Potentially sympathetic publics perceive violent militants as having maximalist or extremist goals beyond accommodation, but they perceive nonviolent resistance groups as less extreme, thereby enhancing their appeal and facilitating the extraction of concessions through bargaining...We assert that nonviolent resistance is a forceful alternative to political violence that can pose effective challenges to democratic and nondemocratic opponents...

There is never a guarantee of success in any endeavor, nor is there such a thing as a risk-free revolution.  Yet I'd rather use a combination of the 198 different tactics we cover here as part of a strategic nonviolence campaign than picking up the proverbial pitchforks and torches.

Just look at the odds.  Violence dramatically favors the house.  If you go with nonviolence most of the time you beat the house and walk away from the table much, much richer.

Now we're not trying to overthrow a government when it comes to healthcare, but we are rebelling against a ruthless corporatist regime that keeps us down whilst increasing its own wealth.  We can beat the insurance companies and their thralls in DC if we extrapolate from the victorious movements that rid themselves of the worst tyrants.  No need for bulldozers or airplanes, just people.

We can begin with some assemblies on the 25th to reach out, to educate our fellow citizens and elected employees in person.  We probably can't achieve reform as quickly as the Filipinos got rid of a dictator, and a few "street summits" probably won't create enough space for Congress and the President to give us the single-payer system we need, but that's okay.  You have to start somewhere.

So no more trying to come up with reasons why nothing will work, reasons why we shouldn't try.  Instead, imagine how we can make People Powered Reform happen, andlet's get to it.

ntodd

(Post at Pax Americana, Dohiyi Mir, Green Mountain Code Pink, and Daily Kos.)

Where The Rhetoric Ends

Healthcare-NOW!

Let’s make President Obama hear us loud and clear that we want Medicare for All!

The event will be followed by lobby visits to drop information to each Congressional office about the single-payer, improved Medicare-for-All solution to the health care crisis. If you can join us to lobby after the Summit, please contact Katie at [email protected] or 1-800-453-1305.

When: Wednesday, February 25th, 2010 – 9am. Please RSVP.

Where: In front of the White House on Pennsylvania Ave between 15th and 17th Sts.

Who: Patients, Nurses, and Doctors who have the solution to the Health Care Crisis.

For more information, and talking points, on the sidewalk summit, go here.

Please let us know that you’ll be there.

A number of sidewalk summits are being planned in cities across the country on the same day. Check back for more information on them as it comes in.

Um...I think it's Thursday the 25th, but whatever.  I love this planned action.

ntodd

This Protest Will Self-destruct In 10 Seconds

That's one option:

Like many people, Terry Hoskins has had troubles with his bank. But his solution to foreclosure might be unique.

Hoskins said he's been in a struggle with RiverHills Bank over his Clermont County home for nearly a decade, a struggle that was coming to an end as the bank began foreclosure proceedings on his $350,000 home."When I see I owe $160,000 on a home valued at $350,000, and someone decides they want to take it – no, I wasn't going to stand for that, so I took it down," Hoskins said.

...

The Moscow man used a bulldozer two weeks ago to level the home he'd built, and the sprawling country home is now rubble, buried under a coating of snow.

Method: 23. Destruction of own property.

I suppose one could argue this wasn't Hoskins' property since the bank technically owns it, but whatever.  Whether you're burning British cloth,draft cards or your home (okay, this guy bulldozed his and to his credit didn't then crash a plane into the bank), it's still a pretty powerful statement.

ntodd

Anthem Is Anathema

Following up on yesterday's report back from LA, I wanted to direct you to some pics taken by Matt Berkelhammer.  My top 3:

Thank you for documenting our fellow citizens' expression of outrage, Matt.  And thanks to my friend for connecting us.

Of course such acts aren't a huge intervention, but a necessary part of the escalation.  While there was a little too much emphasis on the PO for my taste--why not shift the window more and promote HR676?--I applaud the people who turned out, doing something active instead of passive, registering their dissent in the real world instead of complaining impotently online.  Would that more did the same.

ntodd

Sam's First Lobbying Experience

We left the house early today so we could meet with Congressman Welch's HCR point person in Burlington before my classes.  Third time's a charm, it seems: our previous attempts had been aborted by literal and figurative weather (snow storm first, then Ericka's being ill).

We chatted with Susan Elliot for almost a quarter hour, though a few minutes were spent oohing and aahing over our newest activist.  Last time we'd gotten together--a follow-up to our August group lobbying action--Sam still had a few weeks to cook, so it was nice to make official introductions.  The boy was his usual charming self, dressed to kill and very alert.

Anyway, we got some helpful intel from our meeting.  There is, unsurprisingly, a lot of frustration on the House side, especially amongst staff.  They worked so hard to get HR3200 out the door--flaws notwithstanding--and it's gone nowhere thanks to the Democrats' lack of 120 votes in the Senate to pass anything.

They definitely are "spinning off" as many smaller bills as they can to get whatever benefits are possible no matter what the fate of the Senate's Frankenstein monster.  A decent, albeit unsatisfying hedge from where we sit because we at least get the truly good things without the other baggage like mandates that entrench the insurance companies.

Peter's still playing it close to the vest about how he might vote on whatever comes out of the sausage machine.  Readers might recall that he--rightly, I think--didn't want to be painted into a corner with the pledge Credo/FDL wanted Members to sign. 

So it's unclear if he and other progs will stand firm or fall into the "pass something" trap, watered down PO or not.  Susan reaffirmed Peter's pro-choice stance, but it doesn't look like he'll vote against a bill that contains Stupak/Nelson language.  We expressed our concern about women being thrown under the bus, and our preference to kill the bill entirely to push HR676, which we also acknowledged is not a likely thing.  Still, you gotta weigh in.

The best news we got was that our entire Congressional delegation is working closely with Vermont Legislators on our single-payer efforts.  And it looks like stimulus monies might actually help grease the skids, though they will run out in June of 2011.  After that our health programs will be running a deficit like the rest of our state services, but there's talk of a sweetened beverage tax that will help cut down on obesity-related health problems and make up a significant bit of the anticipated shortfall.

Susan agreed that with Racine and Shumlin salivating over the Dem nomination and Governor's seat, there's a fire lit to get single-payer done here.  Racine and his committee in particular were able to punt the issue last year, hoping to leave any "reform" up to DC Democrats and their Overwhelming Yet Strangely Impotent Majority.  Now they have to deal with this since Congress has screwed the pooch and thus will be quite motivated, but we must up the pressure all the same (more on that later).

On the whole it was another positive meeting, disheartening with regard to the national scene, encouraging at the state level.  Despite the many challenges ahead, we came out of the Congressman's office feeling re-energized knowing that we've got real opportunities for change and even if we're not reading about it in the news, there is good stuff happening in the background that can bear fruit.

ntodd

Full Court Press

I tend to focus on direct action over electoral politics, but of course one way to effect change is through the normal process of campaigning and voting.  The problem in our two-party system is that the Democrats can generally count on progressive voters, if only through the fear that voting for an alternative candidate will aid the GOP.

However, we cannot be afraid to press our points and even exercise some political muscle.  Perhaps it's a dicey proposition to not support the Democratic nominee for President, but at the district level the danger is less and our efforts to chip away at the partisan duopoly can even be more successful.

So how about taking a page from the 50 State Strategy?  Enter Full Court Press:

435 Democratic Primaries 2012*

It’s quite simple.  We strongly believe in the following 5 points:

    * WPA-style jobs program — create jobs by CREATING JOBS!
    * Medicare available for all
    * Repeal Hyde Amendment, vote no on any bill with Stupak or Nelson-like language
    * Repeal DOMA, DADT, support gay marriage
    * U.S. out of Iraq and Afghanistan

They reflect the needs and desires of the Democratic Party’s progressive base.  The principles of you and me.  And yet our officials ignore them, not just as individuals, but as a party, en masse.  They try to blame individuals, if it weren’t for Stupak, if it weren’t for Nelson.  Yet the Democrats in Congress — both House and Senate — have said yes to a version of the healthcare bill that includes either the Stupak or the Nelson amendments.  They have said it is okay to throw women’s Right to Choose under the bus.

They vote funds for ongoing wars in Iraq and Afghanistan.  They are not fighting for the federal government to actually create jobs by creating jobs.  The Democratic Party has not repealed the Defense of Marriage Act or Don’t Ask, Don’t Tell, when they have had the power to do so.

SO WE TAKE THESE POINTS TO THE POLITICIANS

In every congressional district with a Democratic incumbent, we ask her or him whether she or he supports those points.  In writing.  All 5.  If they say yes, we support them.  If they do not, or if it is not a Democratic seat, we file in the Democratic congressional primary.  We get the signatures, we do the paperwork, we pay the filing fee, We run on those points.

The bottom line is to have at least one FCP candidate on the primary ballot in every district.

They're also exploring possibly fielding candidates in 2010, but the short-term goal is to make Full Court Press a "household word" this year, then in 2011 recruit candidates and building the necessary campaign support structure for 2012.

Let's assert ourselves and no longer be dominated by "centrist" hegemony.

ntodd

More Of This, Please

A citizen activist reports back in e-mail:

Calling out for Democrats in Congress to act in the next 40 days, 200 Los Angelenos rallied for health care reform in downtown on Wednesday. The rally was organized by Health Care Access with assists from labor unions and Organizing for America. It took place outside the California headquarters of Anthem Blue Cross in Los Angeles.

Anthem raised rates on nearly one million California subscribers nearly 39% last week. It sparked outrage across the state and in Washington. President Obama said the increase in premiums illustrate the future of health care costs, if Congress does not approve health care reform.

Thank you, my friend.

Hopefully we'll have some pictures later if a photog at the event comes through.

ntodd

Franking Privileges

Just got a letter from Representative Welch (composed Feb 4) in response to a letter I sent him (on Jan 27) about a letter he and several colleagues wrote to President Obama about lifting the siege of Gaza (way back on Jan 21).  The Mail, it seems, moves as slowly as Justice sometimes.

Regardless, the letter (the one our Congressman signed) is a small gesture and certainly won't tangibly change things.  Neither will any of the missives I've sent to him and other Members on myriad issues over the years, of course.  Not even what Senators Bennet, Brown, Gillibrand and Merkley wrote to Harry Reid about reconciliation and HCR will do a huge amount of good.

That's not really the point of this exercise.  Writing letters can be a significant act of dissent or declaration of intent in a variety of contexts, a starting point for escalation or a signal of continued vigilance and dedication to change.  They also can maintain relationships, not just romantic ones but political, too.

So I'm always glad when one of our Congressional delegation takes the minimal energy required to send something back to me.  Sure Welch's staff composes the letters and he just signs them (I don't think he or either of our Senators uses an autopen), but it's still an important part of the continuing interaction.

Actually, with Peter it's a bit more personal since I've spent a few years lobbying his office, getting to know him and his staff.  I do have to admit it tickles me a little that he always crosses out 'Mr Pritsky' and writes 'Todd', and appends the form letter with a little note in his chicken scratch.  Today: Thanks Todd.  Appreciate your continued leadership.

Yeah, yeah, an overstatement on his part, but it's a nice sentiment all the same and just encourages me to keep pestering him on Gaza, Afghanistan, HCR, etc.  Hmm...is he asking me to "make him do it"?

ntodd