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


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.


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.


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.


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.


Dutch Fight to Take Health Care Away from Private Insurers

Holland-plus-medicalBrussels   What is the old saying? Something like, I’ve seen the future and it is in the Netherlands at least when we are talking about the inevitable fight to come someday in the United States to seize control of our national health care programs from big health care insurers. On the way between Germany and Belgium, I had the opportunity to meet with several organizers and campaigners who have built a powerful effort in Holland on this issue and are finding the response amazing with the potential to dominate the campaigns in the country’s elections in the spring of 2017.

If you were paying close attention during the health care debates in recent years over the Affordable Care Act or Obamacare, as it is known popularly, you often heard about the health care insurance scheme in the Netherlands which was better in its broad coverage of the population but, unlike many other countries, was provided by private, rather than public, insurers. Meeting with the organizers, I came to understand the situation a bit better. Everyone pays the equivalent of about one-hundred euros or $112 per month to private companies for insurance. I was fuzzy on exactly how this part works but the fact that they mentioned that much of the Dutch public’s opposition was rooted in disgust at the millions and millions spent by the insurers in advertising and promotion leads me to believe that a family chooses an insurer for their coverage.

There’s also a hammer to the head in this program along the lines of the deductibles that come under Obamacare. Everyone has coverage and everyone pays, but when they actually use the insurance, they have to come up with another 385 euros or $429. For some reason it is called an “own risk” payment, since if you don’t need to buy medicine or go to the doctor, your monthly payments are more like a healthcare tax or donation, so that when you do utilize the system, this is more like an admissions fee. Similar to the US experience with high deductibles blocking utilization under Obamacare, estimates are that 20% of the Dutch people are avoiding accessing the healthcare system, even when they need it, because they cannot afford the additional payment.

So the campaign is seeking to get rid of that payment of course, but also to move to a national healthcare fund more along the lines of the national healthcare program enjoyed by other countries. The support for their campaign has surpassed all expectations, and that’s part of what brought us together in this exciting conversation. In less than two months about 60,000 people have signed up to support the campaign either online or directly, and, amazingly, almost half of them are taking the additional step of asking for an “action” package on steps they can take in their communities to build the campaign.

With elections happening in mid-March of next year, this campaign couldn’t have been timed any better, so if it continues to build momentum in the summer, this could be the issue that dominates progressive debate at every level during the election. Meanwhile, regional meetings throughout the country are also pulling in crowds double, triple, and quadruple of organizers’ expectations, more are set coming off the summer with big demonstrations and other actions planned in the fall. They are riding the whirlwind here, and while they are doing so, as I said earlier, they are running the pilot program that organizers in the United States and elsewhere will need to be studying and copying in order to deal with many of the same issues involving national – and better – healthcare in our countries.


Is Their Hope for Obamacare?

77639392New Orleans     A federal court somewhere gave new hope to the haters that the subsidies the Affordable Care Act to lower income families might be blocked.  The Administration says they will win on appeal.  But, this is only one cloud of many in the building thunderstorm.

            Insurance companies and those that follow them are almost universally saying that there will be significant price hikes in 2017.  Others are dropping by the wayside, largely because of their own bad pricing and marketing decisions, but nothing keeps them from finger pointing as they leave.  In many ways this was predictable.  As the signature legacy of President Obama, they are smart enough to wait until his long goodbye transitions into whatever and both he and Congress are lame ducks caught in a quacking stalemate, and roll up heavy on Clinton or Trump with the fait accompli

            Clinton has flirted towards the left with a vague proposal to potentially allow people 50 or 55 years of age to “buy into” Medicare, which would expand the coverage to millions more, if they have the money.  What it would still not do is solve any of the problems that continue to weigh heavily on Obamacare.

            Drug prices have continued to rise for example.  In fact, drug profiteering still seems a winning business plan despite the problems with Valeant and profiteers. 

            Charity requirements for nonprofits are still largely more pretense than policy.  Modern Healthcare reported 7 of the 10 most profitable hospitals of the top one-hundred in the country, according to a researcher at John Hopkins, were tax exempt nonprofits.  The three most profitable for profits were all part of the HCA chain and all three were in states like Texas and Florida that have not extended coverage under Obamacare.  Nonprofits were very well represented in the top 100, including Herman Memorial which has been the target of campaigns by Local 100 United Labor Unions and community allies in Houston and Ochsner, headquartered in New Orleans, which has also been called out for its miserly charity record.

            Emergency room doctors are reporting that half or more of the patients they are seeing are coming in late and with insurance, but had delayed seeking care because of the astronomical level of their deductibles, equivalent to having no insurance at all.   Employers of lower waged workers continue to develop such minimal coverage programs with impunity.  The coming year will see an even higher level of penalties appropriated against lower income workers who are running from the cost, deductibles, and copays, but will be caught by the mandated penalties.

            The bottom line is that, like any major piece of new potentially groundbreaking, safety net legislation there are problems.  There are pieces that beg to be fixed.  Meanwhile the deadlock in Congress simply lets the sores fester and pain endure without stepping up and fixing what is broken.  Health care continues to be a political football, as politicians maintain the fiction that this is all part of the game, rather than coming to terms with the fact that for many low and moderate income families, it’s life and death.