Bill Moyers Journal

by Bill Moyers

  Once again, Dr. Flowers tried to deliver her letter. This time, she and her colleague Dr. Carol Paris refused to move when security told them to, because they didn’t want to be excluded, marginalized, and ignored. They were arrested, and when I saw the pictures of them being led away, I recalled the famous words attributed to another Margaret, the anthropologist Margaret Mead: “Never doubt that a small group of thoughtful, committed individuals can change the world; indeed, it’s the only thing that ever has.”

  Margaret Flowers is a pediatrician from Maryland who worked at a rural hospital and in private practice. She is now advocating full-time for single-payer health insurance, working on Capitol Hill for the organization Physicians for a National Health Program. Channeling Glenn Beck, I think I may have startled her with my first question....

  —Bill Moyers

  Are you a Communist?

  No.

  A socialist?

  No.

  A paid agitator?

  No, I don’t get paid for what I do.

  Do you advocate the violent overthrow of the United States government?

  No, I really want our country to be the best it can be.

  So why did you get yourself arrested?

  Because what I’m advocating is in the best interests of the people instead of the corporations that are funding the political campaigns.

  Why do you say single-payer is the best? What did you learn when you were practicing that made you such a passionate advocate for single-payer?

  I went into medicine because I really do care about taking care of my patients. I chose pediatrics because I feel that if you give children a great start, a healthy start, they can carry that through the rest of their lives. And I really believed that medicine was about taking care of patients. I learned otherwise, that it was more about fighting with insurance companies and being pushed to see more and more patients. When I looked at what was going on and at what works in other places and what has worked here, what models have worked here, I saw that if we have a Medicare-for-all system, doctors can practice medicine again, the art that we train to practice.

  What do you mean by “Medicare-for-all”?

  With a Medicare-type system the administration is very simple. Medicare is very quick at reimbursing you. They don’t have a profit to make. Furthermore, the Medicare system allows patients to choose the doctor they want to go to. They don’t have an insurance company saying who’s in network and who’s not in network. So it’s universal, full choice, allowing doctors to practice medicine and patients to choose their care.

  Why weren’t you able to do the medicine you wanted to do because of our present health care system?

  It started when I was working in the rural hospital. When we admitted a patient to the hospital, the first person who would come to visit us was someone from utilization review, which is the group that interfaces with the insurance company. And they would say, “You have this many days to make this patient better. This is how many days they’ve been authorized for.” And we often found that it didn’t match the number of days that we felt the patient needed to be in the hospital. So the system puts the physician in the really uncomfortable position of debating whether you send a child home before they’re ready. Do you ask the family to bear the extra cost? We usually ended up asking the hospital to just write off the rest of the stay, if we didn’t feel that a patient was ready to go home. And then in private practice, it’s the same kind of thing. You see a patient. You determine the best treatment, and then the insurance company says, “No, they can’t have that test” or “They can’t have that medicine.” It didn’t make medical sense. It wasn’t based on the patient’s need. It was based on what the insurance companies could get away with.

  My own doctors have told me that they are constantly lobbied by industry representatives trying to sell them something that increases the profit of the industry, whether or not the doctor thinks it’s the right thing for patients. Was that your experience as well?

  Completely, yes. You have representatives coming into your office all the time, wanting to bring you lunch, gifts, tell you how great their product is. And there’s no really independent body that can tell you whether what they’re saying is true or not. When you’re practicing and so busy, it’s hard to figure that out. My friends who work in the military health system or the VA love what they do because that system actually provides them nonbiased information on what things are best for their patients.

  Nonbiased information?

  It’s an independent review that’s not done by the company that’s profiting from selling a certain device or medication. It’s a board that looks at the various products and really compares them and tells you which is better and which isn’t.

  Was there a moment when, as a pediatrician, you said, “I can’t keep doing this. I’ve got to change this system before I can really practice medicine”? Was there a eureka moment?

  There was. It happened when our office manager sat down with us in our practice and said, “Okay, if we want to keep in business, this is what you need to do. You can only see one well child a day, and the rest of the patients have to all be sick patients that you can churn through this many patients each hour.” And—

  They gave you a quota?

  Basically. And that is the model that many primary care practices use.

  One of my doctors teasingly said to me the other day, “I’ve got seven minutes for you now.”

  Right. And if your patient happens to bring up something else that’s bothering them, you have to ask them to reschedule and come back to talk about that other thing, which means they have to take more time from work and continue to carry that worry with them while they’re waiting for the next appointment. That just wasn’t why I went into medicine. I like the relationship that I have with patients. I want to take care of them. And when you build that relationship with your patient and you get to know them, you can provide the best care for them. You can’t with the way things are right now.

  You didn’t go into medicine to get arrested three times in less than nine months, either. And yet there you are in the video, being handcuffed and led away

  Yes, I never really dreamed that this was a path that I would go down. I mean, I’m a mother. I try to be a good citizen in my community. But it came to a point where this was the only way that we could be heard. We were being completely excluded, and when we tried the traditional avenues of being heard, we were just pushed aside.

  I remember. When you and several others stood up in protest during the Senate hearings on health care in May 2009, Senator Max Baucus, the chairman, had you put in handcuffs and taken away.

  They did. They did. And it was terrifying. I had never been arrested before. But I knew at that moment. I looked around the room, and I looked at the people who were sitting at the table, both the senators and the people from industry who had been invited to testify, and in my mind, I juxtaposed that with the stories and the people that I’ve met, and the doctors I’ve talked to, and I felt as if I were there on behalf of them. And I would do what I needed to do. And that I was ready for that.

  At the moment, it seemed like there might be momentum behind this single-payer Medicare-for-all movement. What happened?

  Good question. That was a big step for us, taking civil disobedience action. And when we did that, the powers that be actually did start inviting us in to have a seat at the table. Senator Kennedy’s committee contacted us. And I was the first person to testify in the Health, Education, Labor, and Pension Committee hearing. I sat next to the CEO of Aetna, which was a very interesting experience. And then when we went over to the House and spoke to the leadership there, they said, “We want your voice to be heard here.” So we actually thought we were starting to get our foot in the door. And then we had some good amendments that were introduced. They would have substituted a national single-payer system for the legislation that was moving through Congress. And then we saw all that fall apart. What we learne
d is there was a lot of control coming from the White House. They wanted to pass something. And they were concerned that if the single-payer voice was in the discussion, or if it was in any way associated with certain legislation, it would hurt their ability to pass that legislation. So they put the kibosh on us.

  The White House?

  Yes, it really came down from the top.

  Why were they able to get away with this? Several polls suggest that 60 percent or more of your fellow doctors support a single-payer option, Medicare for all. How can elected representatives refuse to hear and negotiate with that many people, so many doctors who care about this?

  They weren’t listening to us. The industry has so many lobbyists talking to the staffers and the legislators. This summer [2009] we actually brought doctors and nurses to Capitol Hill, to meet with legislators and staff and tell them what makes good sense from a health standpoint. When we tried to reach the White House to be included there—we requested meetings with the president on numerous occasions—they just said no. They wouldn’t allow us in.

  When you stood outside the White House last week, wanting to give your letter to the president, did you really think the “leader of the free world” was going to respond to a petition from a single individual standing outside his gate?

  I did make the point that I was representing the majority of the public and the majority of physicians.

  How could you make that claim?

  Because numerous polls have shown that the majority of the American public wants a national health system. When the poll actually describes what it is, a system where everybody pays in and everybody can get the care that they need, people want it, they support it. You know, I supported President Obama. I even worked the polls on Election Day, and I knocked on doors to get people out. I guess I was naive.

  Had you taken him seriously when, before his campaign, he was an advocate for single-payer?

  Yes. We knew that he understood what single-payer was. In the debates he said that he understood health care was a human right. I know that he didn’t campaign on single-payer or anything like it. But we felt that if we built the grassroots movement and showed that this is what the American people want, that he would actually, in some ways, include us. The exact opposite happened. The whole process was very tightly scripted. And very exclusive. He didn’t want us causing any trouble.

  One of the front groups for the health industry ran a full-page ad in The Washington Post this week, taking credit for killing off any public option that might include a version of single-payer in the health care reform. The ad said: “In last week’s address to the nation, he [the president] pulled the plug on the Public Option. After nearly a year as the centerpiece of his health care reform plans, amazingly he didn’t utter a word about it and hoped no one would notice.” Whose side do you think the president was on in the health care reform process the last nine months?

  This whole process was dominated by fear of the industry. I believe he was really on the side of the industries that profit from the current situation.

  What did they fear?

  These industries have such power and so much money to buy influence over members of Congress. If the politicians come out in favor of a Medicare-for-all approach, the industry instantly runs ads against them or even candidates against them. They fear not being reelected.

  If the president had sent a staff person out to invite you in for coffee last week, what would you have told him?

  I would have told him that the American people were expecting more from him, that there’s been such a huge amount of suffering in this country and so many preventable deaths. And that it’s completely unacceptable that we are the only industrialized nation that allows this to happen. And that it doesn’t have to be this way. America’s already spending more than any other country on health care, so it’s not an issue of whether we have the money. We have the resources to have one of the top health systems in the world. And why wasn’t this debate about what is best for the people? In terms of our economic recovery this is vital, because our whole health system is a drag on the economy. So why is the president excluding us? Why isn’t he letting us be at the table, when this makes complete sense from the standpoint of public health policy and economic health policy?

  He didn’t invite you in for coffee. He didn’t hear you say what you just told me. You tried to give him the letter. And when you learned that he was going to speak in Baltimore the next week, you were waiting there.

  It felt like another opportunity, yes.

  When you were arrested last Friday, were you taken to police headquarters?

  I was, with Dr. Paris.

  Handcuffed?

  We were.

  You were interviewed independently by the Secret Service?

  Yes. They wanted to make sure that we didn’t have a psychiatric history or we wished the president any harm.

  What did you tell them?

  That no, we don’t wish him any harm. In fact, if we passed a Medicare-for-all system, it would be a huge win, not just for the American people but for this administration. If you look at Tommy Douglas in Canada, the father of their health system, he was voted their national hero.

  I watched the video of your arrest. I think I heard you say to somebody: “Would you please call my husband?” Is it true he didn’t know you were out there and were going to get arrested?

  It’s true.

  Did somebody call him?

  Actually, his brother called him because he saw it on the news. And he said, “Do you know where your wife is right now?” And my husband said, “No.” I have to tell you that Dr. Paris and I weren’t sure what was going to happen that morning. We just knew that we would go down there with our banner and our letter and that hopefully we could get our message across and that hopefully they would call a staffer to take our letter. Instead, they kept telling us to move on, to go across the street, and there came a point when we looked at each other and without speaking we just knew that we were not going across the street.

  Why did you decide not to comply with their request to go across the street?

  Because it’s too important. Our message is too important. We can’t continue to be excluded anymore. We’re losing doctors from practice. People are suffering who don’t need to suffer. There’s so much preventable death. This is unacceptable.

  But you were stymied last May. You were frozen out of the months of discussion that followed, when the White House was striking deals with the health industry and the drug industry. You were out in the cold, literally and figuratively. They won’t listen. Do you really believe this is going to make any difference?

  It has to. And whether or not it does, I have to do this, because if we don’t push for this, nobody is going to push for this. And we’re going to do everything we can to build this movement and to push our country in a direction that puts us at least on par with the other industrialized nations.

  So what happens now to your movement?

  Our movement is growing. We’ll keep on growing until we get Medicare for all. We’re completely committed to doing this, and to keep moving forward on the national and the state level. One way or another, we’re going to get there.

  Looking back over the last year, what have you learned about our political process?

  I didn’t realize how broken it was. I knew that there were powerful special interests influencing the process. But I didn’t realize the degree, the depths to which they affect our political process.

  PHILIPPE SANDS

  It took an outsider to hold up a mirror to the culture of cruelty spawned by our government after 9/11. The international lawyer Philippe Sands, long a friend of America, was dumbfounded at how the Bush administration had abandoned the principles of Abraham Lincoln, who in the middle of the Civil War told his generals that “military necessity does not admit of cruelty ... nor of torture to extort confessions.”

  Philippe Sands, QC (Queen’s Counsel), is known in top legal
circles for his investigation of torture cases under such infamous dictators as Chile’s Augusto Pinochet and Liberia’s Charles Taylor. He directs the Centre on International Courts and Tribunals in London, where he closely studied the British fight against terrorists of the IRA and concluded that “coercion doesn’t work ... it extended the conflict with the IRA probably by between 15 and 20 years.” His reputation gained him access to the key officials in Washington who helped to develop the Bush-Cheney policy of “enhanced interrogation methods,” the official code for the use of cruelty in the pursuit of confession.

  The administration fought tooth and nail to keep secret the internal debates behind that policy, no doubt because many of the participants feared they could one day face prosecution for war crimes if their actions turn out to have been illegal. Some of them, however, agreed to meet with Sands. What he learned became the core of his book Torture Team. I met him when he was asked to testify before the House of Representatives Judiciary Committee, which had finally begun hearings into the culture of cruelty.

  —Bill Moyers

  Let me go right to the story of the suicide bomber in Baghdad who drove his bombing vehicle into an Iraqi police station. He had been held at Guantánamo for over three years. Pentagon records say that he had told people he wanted to kill as many Americans as he possibly could. Why give someone like that the benefit of the doubt?

  We give people the benefit of the doubt because that’s the nature of our system. We believe fundamentally in democratic values. We don’t assume guilt, we assume innocence. There are people at Guantánamo who pose a threat, undoubtedly. But there are also a great many more people who don’t pose a threat. And in those circumstances, I think using this as an example to somehow come down on the merits of the Guantánamo system is not a sensible thing to do. I think Guantánamo has been a problem, as Abu Ghraib has been a problem, because it has undermined America’s claim to moral authority in facing up to the very real challenge of terrorism. Locking them up and throwing away the key is only going to exacerbate the problem. And it’s a problem that we faced in Britain, for example, in relationship to the IRA back in the 1970s and the 1980s. That’s not the way to go.