USA Election: A Movement Can Always Beat A Machine

socmvmtcollage1New Orleans   The election was over early, just not the way many had expected. I had always argued that regardless of the polls and pundits the election was going to be close, but I had also argued that I thought Clinton would win. Now, I will have to substitute the word “thought” for “hoped.” I had always argued that I hoped Trump would be the Republican nominee because he might be the only candidate Clinton could beat. I now may have to rethink that and revise my analysis, because Trump and his unique campaign may have been the only candidate that Clinton could NOT beat.

The bottom line is pretty clear: a real movement can always beat a machine. When you have almost vastly unpopular candidates in the contest, making everything relatively equal in that regard, a genuine movement can always beat even the best financed and well-oiled machine.

As progressives, we have to understand the simple facts. With courage, this could have been us. In fact given the closeness of the contest between Bernie Sanders and Hillary Clinton for the Democratic nomination, it almost was us.

As organizers, we have to give Trump credit for his willingness to unabashedly embrace a movement and his place in it. He argued a case for the abandoned and left behind by the economy. He railed against the adverse impacts of trade and globalization. He argued for jobs for the jobless. He made a better case against Wall Street and the Washington establishment. These are all our issues. A populist is someone who puts the people first, and as unlikely as Trump was as the bearer of that message, this was our message.

The contest in coming months on the right and throughout the establishment will be to see who can best capture Trump’s heart and soul to make him fit the usual mold better. We actually need to push him on the claims he has made to deliver change to our constituency, if we want to reclaim it. We need to push the demands of huge blocks of those who will feel suddenly disenfranchised by this counterattack by the white and rural and too much of the working class: women, Latinos, and African-Americans. These are also our constituencies and Trump is vulnerable to all of them in trying to convert his movement to governance.

We know these problems and their fragility, because we have faced it repeatedly. We saw how rapidly the movement behind Obama dissipated. Trump may be a horse less easily broken to the bit, and in that space the effort is being made to corral him, we have huge opportunities, if we are able to seize them. Make no mistake this new world order in America will hurt millions if allowed to settle and concretize or be usurped by the far right, so we really don’t have much choice. This is ride-or-die time.

Disruption forces realignments. Chaos provides opportunities, but only to those moving hard and fast to take them and create change out of the turmoil. We have to engage the struggle where we find it, and Trump has now created the new conditions for engagement, and we now have to adapt quickly and organize the alternative paths for new movements to take hold and win, before the door closes and the opportunities are once again lost.

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Sorting out Obamacare Problems Now

obamacare-premium-mapAmersfoort   To the degree that the final version of the Affordable Care Act was neither fish nor fowl and represented a compromise between those that hated the entire concept and those that were trying to make the best of whatever slices of the original loaf were left, we all knew that problems were inevitable. Over the last five years we have been treated to regular and confusing reports from the battlefront, but nothing that ever fixes any problems, some of which are normal and predictable in a huge, new program. Without progress many fall out of love with Obamacare, even as more than ten million have enrolled with huge positive health impacts. Now consensus is building that any new president will have to fix the plan in the coming year, though no one seems sure about the fix or how to come to agreement on a cure.

What to do?

Some notions are almost simple-minded. One I saw said the quick fix was essentially a minor tune-up. Raise the amount of the subsidies for lower income families so that they can absorb the higher premium costs, and raise the level of the penalties to force more of the young and able into the program.

I’m all for raising the level of subsidies, if there can be agreement on that from whoever emerges as the new Congress, but raising the level of penalties is not a real solution to anything. The quick fix folks think that the fact that 260 million Americans or covered by healthcare on their jobs means no problems there, but that’s wrong too. Or, at least it isn’t the whole story.

Many penalty payers are not necessarily just the young and healthy, but also lower waged workers caught in so-called company coverage that ostensibly is offered, but because of the combination of premium cost and exorbitant, almost no-limit deductible charges, means that almost whatever the penalty level might be, it will still be cheaper than paying a premium of 9% of your pay and then having to pay many thousands of dollars in deductibles before you get any real benefit from the so-called insurance. This is really not medical insurance but catastrophe insurance, meaning if you know you need a major operation, maybe you pay. If not, you take your chances and pay the piper. Luckily, it’s taken out of your IRS tax refund, so you can pretend it hurts you less.

A lower waged worker caught in the service industry by these kinds of premium plus high deductible policies would need to be making more than $20 per hour for full-time 40-hour per week work to make it worth taking the insurance rather than paying the penalty. In some healthcare companies where we have contracts, like the service contractor giant ResCare for example, there are literally no takers out of more than 400 workers. I know people who are literally saving up for a CT scan because they don’t have insurance and are paying the penalty, making their health care “cash-on-the-barrel.” The quick, simple fix does nothing for any of these people and pretends that the United States is not dominated now by the service economy and its workforce.

The argument for a public option, a government-funded insurance of last resort, for these workers and others that can offer real competition and leverage to the private insurers makes sense, as Jacob Hacker, the political scientist and health care experts has argued. That’s still not single-payer or any kind of a system that takes private insurers out of the market, but the last years have already established that there’s no free enterprise in this marketplace. There are private insurances still waiting for subsides — $2 billion from the government – and there are regular folks getting subsidies and more that need them who are caught in the bind. Either the government needs to let workers and families caught by corporate insurance gimmicks that technically qualify under the Act, but are worthless in reality, come into the marketplace and get subsidies if qualified, or set up a public option that offers real coverage for this huge segment of the population.

The justice of raising penalties to catch the scofflaws doesn’t work when we still need a lot more mercy or stiff requirements on corporations to provide real insurance coverage.

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Organizing Props Matter in a Campaign

organizers for Netherlands national health care reform campaign against "own risk" admire their crowd magnet

organizers for Netherlands national health care reform campaign against “own risk” admire their crowd magnet

Amersfoort, Netherlands   We were meeting with the organizing team for the national healthcare campaign in Holland. The campaign has hit a deep nerve in trying to push private insurers back out of the market place and arguing that there is not a national healthcare system when huge numbers are not participating because of an “own risk” system requiring significant additional payments that are preventing people from using health insurance. Suddenly, someone opened the door of the conference room, and announced that the truck was here. In no time, any other business was deferred, as we all went down to the driveway behind the building to see the truck.

Being old school, I assumed we were all being dragooned down to help unload boxes of some sort or another from a delivery truck, but not this time. Instead we were greeted by a giant campaign prop. This was something else!

one of the organizers takes a punch at "own risk"

one of the organizers takes a punch at “own risk”

The truck was painted in the rainbow colors of the campaign with the cross signifying the health care fight. There were huge metallic letters fabricated over the bed of the old truck, an Opal Blitz, with theater lights spelling out Eigen Risico or Own Risk. When the designers started pulling stuff off the truck, I quickly realized that we hadn’t seen the half of it yet. Two more pieces were manhandled off of the truck. Once it was placed upright, it became clear it was a punching bag like one you would find at a state fair. But this one was rigged to a computer which made it much different. The operator would type your name into a computer. An IPad would spell out that “Nils is Hitting Own Risk.” When Nils took his swing, the lights began flashing on the truck spelling out the words Own Risk again, very dramatically. Meanwhile there was a camera mount aligned to the overhand bag, so that when Nils or anyone else laid a roundhouse on the bag it also took a picture. There was router and wireless connections behind the IPad structure which caught the picture matched it with the address and sent an attachment of the picture to the swinger’s email. Within minutes, Nils had an email that was a short video of him hitting the punching bag and an explosion of colors coming out.

the truck is something else

the truck is something else

What an intricate campaign prop. One of the designers told me it only took two weeks to build the contraption, as it was a lot more than that just “thinking it through.” Talk about bells and whistles. Old school carney act comes to the digital world!

If you want to win a campaign, it helps to have props for actions and rallies, and here’s one that it is easy to imagine is going to be a hit when members are working marketplaces trying to get the word out to friends and neighbors.

This was pretty much one that it is safe to say most of us “couldn’t do this at home,” but as something advancing a campaign and creating a happening in town after town, this bad boy is going to be hard to beat.

campaigners debate campaign colors and clothing

campaigners debate campaign colors and clothing

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US-Like Health Insurance System Huge Political Issue

20160830_131857Amersfoort, Netherlands   In the exactly six weeks since I visited organizers of the national health funds campaign in Holland, the campaign has continued to explode. When I first sat down with them at that time they had about 40,000 responses to their campaign with a little more than half asking for tool-kits to take more action. Now, a mere six weeks later and during the summer when the pace of action, campaigns, and seemingly everything else in Europe dissolves into holidays, the numbers had ballooned to almost 120,000 responses and close to 50,000 requests for tool-kits.

Walking into the Socialist Party of Netherlands building in Amersfoort, which is housing and managing the campaign thus far, a giant conference room is filled with tables, one after another. The first night of my visit when I walked out of the building at 8:55 PM there was a crew of 15 members walking up and down in assembly-line fashion collating the packets for mailing. When I walked in early the next morning, looking to my left at the conference room a half-dozen volunteers were still walking along the tables putting the packets together. I jokingly asked them if they had been their all-night, and they responded they were “slaves” to the task. The flipchart indicated they now had close to 50,000 packets assembled.

20160830_131905

Later in the day the head of the IT department displayed the health campaign analytics on a screen behind him. There had been a spike to 7000 unique visitors the previous day in reaction to a news conference where one of the campaign activists, a health care worker, had talked about the peril to “on risk” citizens who were paying the mandatory annual fees to the private company insurers, but were part of the 20% of the population who avoided going to hospitals at all costs in order not to pay the additional 385 euros when they actually accessed the system.

Disapproval of the plan is not only driving the campaign but increasingly becoming a central issue in the political environment of the Netherlands. In a multi-party system where there are as many as forty political parties of all shapes and sizes in this small country, positions on change to the privately directed national health plan is becoming the line of demarcation between the parties. As the campaign has grown several of the larger parties have argued that they will change the payment system and lower it in some way. The SP/N has been the most aggressive, not surprisingly given their role in supporting the campaign, in saying that the “on risk” payments should be eliminated and the system returned to its previous situation as a national health fund, and in fact caused some stir recently by saying that it would not join a future government without such a pledge. With national elections distributing parliamentary seats only a bit more than six months away, healthcare is clearly at the center of the debate just as it has been in the United States, the United Kingdom, and other countries in recent years.

Most of the meetings I have been in have been focused on how to scale up a field program that maximizes the opportunity for change on this campaign. Predictive dialers, robo-calls, large scale door knocking efforts, extensive networks of house meetings are not as common in Dutch campaigns as they are in the US and Canada, and organizers are looking to master much of this organizing methodology in coming months in order to scale the campaign sufficiently to leverage the political season to create extensive change around national healthcare in the country.

This may be a small country along the water and under sea-level, but they may make waves all over Europe with a victory on this issue.

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Where You Live Could Kill You Faster

SSM Population Health

SSM Population Health  Age-standardized annual probability of death among U.S.-born women aged 45–89 years.

New Orleans    Many of us live where we live, where work has brought us, or where family keeps us. Maybe we live where we have come to love the land or the local culture? Maybe we live where we managed to hang on to a house or bought a small piece in a patch where we thought we might want to spend lots of time someday or some summer when it was too hot, or winter when it was too cool. None of us probably include in the equation that by living one place or another we could literally be bringing reality to the expression, “I’m dying to live there!”

Sadly, studies are now emerging that go to the heart of why life expectancy has been lagging, particularly for American women, although American men are not gaining much time these days either. Looking at extensive population data, researchers are finding that discounting all other factors including wealth, employment, and marital status, where women live could mean life and death. Since where you live could also impact on issues like whether or not your state has favorable maternity and parental leave policies, this hits women particularly hard, and could take years off their lives. Social and economic scores were critical because advancing inequity where you live also is not just an issue of justice, but life itself.

In studies being published in SSM Population Health and reported by the New York Times, the residential life lottery ranks the states with the best scores as Hawaii, Nebraska, New Hampshire, North Dakota, South Dakota, and Vermont. Good news for them, but bad news for many of the rest of us, since other than Hawaii almost nobody lives in the other states on that list, and even fewer want to move there for goodness sakes. Other than Hawaii, these are also just about lily white states, which quickly brings us to the states with the worst scores and you can hear the sounds of “Dixie” playing in the background: Alabama, Florida, Louisiana, Mississippi, and New York. Huge income inequality accounts for New York being part of the New South. For women, the list was not much different. The best were Hawaii, Nebraska, North and South Dakota, and Minnesota made this list as well. Women hit hard luck in a different array of states though which included Nevada, Tennessee, Virginia, West Virginia, and Wyoming.

All of this is in spite of the creation of Medicaid and Medicare over the last 50 years, and even more recently the Affordable Care Act. Looking at the states in-and-out of Medicaid expansion didn’t solve the problem. In the worst list, only New York had expanded coverage until Louisiana just came onto the list. In the best, South Dakota and Nebraska rank high, but haven’t expanded while Nevada and West Virginia drag down even though they have.

All of which means there is no quick fix to this. It’s not a matter of just figuring out where the best hospital in your community might be. It’s got to be the pretty much the whole package of social and economic improvements to lengthen lives of both men and women.

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Obamacare is Delivering Some of the Goods in Poor States

Screen Shot 2016-08-14 at 10.37.59 AMNew Orleans   There are now some thirty states that have expanded eligibility for Medicaid under the Affordable Care Act. There are twenty states – and a lot of the Republican Congress — that are still dragging their wagons through the dirt, and, if researchers are right, putting their people under the ground as well.

Researchers connected with Harvard’s Public Health School conducted an important experiment. They surveyed people in Kentucky and Arkansas before Medicaid expansion in 2013, again after the first full year in 2014, and finally at the end of 2015 with another year under peoples’ belts. They used Texas as the so-called control state for comparison, since Texas refused to budge on the Obamacare Medicaid expansion for lower-income, working families. Bottom line: 5% more people in Arkansas and Kentucky, too very different states with different approaches on the expansion, felt that they were in “excellent” health compared to do-nothing-much Texas.

Reading about the researchers work on the Harvard Public Health website and its lead author, Dr. Benjamin Sommers, an assistant professor there, offered a good summary that goes deeper than 5%:

Sommers and colleagues surveyed approximately 9,000 low-income adults in Arkansas, Kentucky, and Texas from late 2013 to the end of 2015. The results showed that, between 2013 and 2015, the uninsured rate dropped from 42% to 14% in Arkansas and from 40% to 9% in Kentucky, compared with a much smaller change in Texas (39% to 32%). Expansion also was associated with significantly increased access to primary care, improved affordability of medications, reduced out-of-pocket spending, reduced likelihood of emergency department visits, and increased outpatient visits. Screening for diabetes, glucose testing among people with diabetes, and regular care for chronic conditions all increased significantly after expansion. Quality of care ratings improved significantly, as did the number of adults reporting excellent health.

Debate over? Of course not. Many will wonder, and wait, until larger studies, including the government’s own, provide more data on whether or not people really are healthier or just feel healthier.

Regardless, how people feel may not answer the medical questions fully, but could start to provide answers for the political questions. As we find every day, particularly in the Age of Trump, people vote on how they feel, not based on the facts of the matter. If everything were equal, politicians would see that the trend line of how people feel about their own health and Medicaid expansion is now improving annually. If it continues along these lines, politicians will start playing “duck and cover” which might mean more expansion in the twenty holdout states.

There’s a big “if” though. These same politicians would actually have to care about the poor families that are the beneficiaries of Medicaid expansion, and believe, regardless of the evidence, that they vote, and that some of these poor are their voters.

It might be easier to deliver better healthcare than to convince elected officials of the value of the poor and their votes.

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