JAN S. RODOLFO is a registered nurse in oncology at Alta Bates Summit Medical Center in Oakland, California, and is a member of the California Nurses Association/
National Nurses Organizing Committee (CNA/NNOC) Board of Directors. She spoke to ELIZABETH LALASZ about the movie Sicko and the struggle for health care for all.
YOU TRAVELED on the Sicko bus tour, along with other nurses from the CNA/NNOC and patients featured in the film, joining Michael Moore for movie premieres and rallies in several cities. What was the response?
I WAS in New York, Washington, D.C., Chicago, Pennsylvania for a press conference, and New Hampshire, so mainly on the East Coast. What was most memorable about the response was how uniform it was in every city we went to, both in terms of the nurses who turned out in each local area and the response of the audiences. In each city there was a standing ovation for the premiere; in each city you would sit in the dark with a large audience and listen to people sniff—you could tell there were numerous people around you who were weeping one moment and then laughing hysterically the next. It was a great collective experience in the theaters.
One of my favorite moments was in New Hampshire. We did a series of events that day—we did the premiere and then we did a town hall meeting of “undecided voters” with questions asked from the audience and then a press conference. The discussion in the town hall meeting was excellent, because there were people from all different political persuasions. There were people who stood up and identified themselves as Republicans, but all of whom were hitting the theme again and again that none of the candidates represented what they wanted to see happen with health-care reform. It really struck me that it’s a broad political issue—it doesn’t just fall along political party lines.
WHAT DO you think of what has happened since Sicko opened in theaters on June 29? There’s been organizing, from meetings and small protests to people gathering in churches—there seems to have been an explosion of activity around the movie, it really tapped into something.
I ABSOLUTELY agree that there’s been an explosion of activity. One of the characteristics of it has been the difficulty for pockets of people in the different localities to be in contact with each other. So I think the movement is currently characterized by everyone grappling with what are the next steps and trying to figure out what kind of health-care reform to support and who to support, but that hasn’t coalesced into a national debate of activists. It’s been largely something great that will happen in one city and then in another city, but there isn’t a connection between them.
From my sense it demonstrates the potential for a true national movement, because it’s obviously impacting and inspiring so many people in so many different places. And not just people in urban areas. My parents are moving to a small town in Wisconsin with a population of 500 or something and the town next door, Cedar Wood, was playing Sicko and the township petitioned their theater to play it and then they had meetings afterwards. A tiny town in Wisconsin!
IN MARCH, a New York Times poll showed that a majority in this country believes health care needs to be fundamentally reformed. In Sicko, Michael Moore argues for a single-payer system. This is also what the CNA/NNOC supports, along with groups like Physicians for a National Health Program (PNHP). How do you explain what a single-payer system is to people around you—what are the highlights?
THE FIRST highlight is that a single-payer system takes private insurance out of the picture. You eliminate the third party between patient and provider, which currently exists only to deny people care. You have this third party which skims 30 percent of every health-care dollar—30 percent is taken away from the bedside to make profit based on denying care. If you remove that third party, you can make health-care decisions based on what people actually need rather than based on what is profitable for the insurance companies.
It’s also comprehensive. Right now we have a very piecemeal system where you may have health insurance, but it doesn’t cover pre-existing conditions or it may not cover specific drugs that you need. You may have health care, but not have dental or vision coverage. And obviously each of these ties into each other, in terms of quality of life and being able live a life that you want to live. Single-payer is comprehensive and it takes into account that dental, vision, and prescription drugs have to come together if you are going to be able to provide true quality health care.
Single-payer health care covers everybody cradle to grave. And the fact that it covers people cradle to grave means that the largest pool of individuals possible is included in a single-payer plan, which is why it is effective at containing costs and why it becomes more efficient. It’s able to provide much more to everyone than we get now for the same amount of money in the current system. It creates the ability to negotiate cheaper drug prices based on bulk. This is why people go to Canada to get their prescription drugs because Canada is able to negotiate with drug companies on behalf of the whole country.
Another angle of this argument is the perception that government-run systems are inefficient. There are a couple things to say about that. The first thing is that private insurance companies have an incentive to be inefficient. The longer they take to pay, the more they deny a claim, the less money they ultimately have to pay out. And any patient who dies as a result of not getting coverage is not someone they are going to have to pay for any longer. If they deny ten people’s claims, even if they are covered, only two of those ten people on average will have the time and energy to fight to get paid. So insurance companies get away with keeping the money they should have paid out to cover the other eight. There’s the incentive for private insurance to be inefficient.
Whereas when you have a single-payer system, a government-run system, every individual is covered and any preventive care they can receive at any point in their life leads to fewer complications and fewer serious illnesses later on. Preventive care actually saves the system money. So if you can keep someone off of dialysis and keep their kidneys from failing by giving them a blood pressure medication, it makes sense to the system to give them the blood pressure medication.
Additionally, if you look at Medicare, which covers individuals sixty-five years and older—the population most likely to need care currently since they are the most likely to be sick—Medicare is able to take care of that complicated population for 3 percent overhead versus the 30 percent overhead that insurance companies charge. So a single-payer system is really much more efficient since all the money goes into treating patients and doing preventive care. It doesn’t go to profits. It doesn’t leave the bedside.
THERE ARE other myths about what a single-payer plan would look like, such as you wouldn’t be able to choose your own doctor or you would have to wait in long lines before receiving care.
LET’S TAKE a look at HR 676, which is the national Medicare-for-all, single-payer bill sponsored by U.S. Representatives John Conyers and Dennis Kucinich. HR 676 allows you to choose your doctor or hospital in the same way you are able to under Medicare now. So it doesn’t nationalize hospitals or doctors—they aren’t employees of the government—rather, it’s a mix of public and private providers and you choose. In theory, there is an incentive to provide the highest possible care so that doctors and hospitals attract patients and you can go anywhere in the country and choose a provider.
It is instructive to look at Canada. There is record keeping about the length of time patients wait in lines, because citizens in Canada at some point began to complain about the lines. As a result of that, they have been able to come up with solutions that have decreased the waiting times significantly.
In this country, there is no centralization of all that kind of information. So the studies that have been done about waiting times demonstrate that even people with insurance wait on average longer than they do in Canada. But in this country there is no easy means to fix this problem, whereas in Canada since the priority is to decrease the waiting times, then the system is able to accommodate that.
In France, which is another single-payer system, they have one of the shortest waiting times of the industrialized world because that system has made that a priority, including the hospices and other services that appear in Sicko.
In this country, more than 46 million people are without health insurance, many millions more are grossly underinsured, and those folks can’t even get in line. I see patients all the time in the hospital who have advanced cancers and they knew something was wrong, but they didn’t feel financially that they could be seen. So, they end up in the ER [emergency room] with something that’s no longer curable, something that’s terminal. It could have been treated had they gone in when they knew there was a problem.
HOW IS single-payer different from the universal health-care plans put in place by former Republican Governor Mitt Romney in Massachusetts and those proposals from President Bush and California Governor Arnold Schwarzenegger, as well as plans put forward by the Democratic presidential candidates?
POLITICIANS ARE looking at poll results—the same results we are looking at—and they see that people are saying they want universal health care. A growing number of people are saying they want universal health care even if it means in increase in taxes. They are looking at the polls, but they aren’t feeling the pressure of an actual movement on the ground making demands. Politicians like Schwarzenegger and Romney along with the Democratic presidential candidates are trying to figure out a way to benefit from the poll results by telling people what they want to hear without fundamentally changing the system and jeopardizing their campaign contributions.
What you have is a bunch of politicians trying to figure out how to reform health care without angering the insurance companies and damaging their profitability. What they have come up with is incremental reform, which actually throws more money into private insurance than is already there. The individual mandates in Massachusetts and what Schwarzenegger is looking at, which would require that everybody purchases health insurance, create a completely captive audience—the health insurance companies love this kind of proposal.
These programs take a bunch of public money and shift it to private health insurance companies. There’s money in California that goes largely to public-sector hospitals that provide urgent care; that money, which is part of the MediCal money would be shifted to the insurance companies. All of these types of reforms make the problem worse not better.
Politicians currently feel they can float these incremental reforms and Americans won’t know the difference. So my hope is that Sicko will educate people. Anytime a political candidate stands up in a forum and lays out their plan I hope that someone is going to get up and say, “Wait a minute, I saw this movie and insurance companies are the problem. What do you mean you are going to give insurance companies more money? What do you mean the insurance companies are going to take care of this for us?”
But right now the politicians are trying to do the minimum they can get away with for the public while maintaining their contributions. And none of the viable candidates are talking about single-payer. So it’s going to take a movement that is more of a threat to them than a loss of contributions will be to actually get that to change.
AS A registered nurse, what makes you a supporter of single-payer?
THIS IS one of the things I’ve been thinking about recently. I work on the cancer floor. One of the things I completely take for granted in taking care of cancer patients is at some point in time they talk about feeling like they are being a burden to their family and that the family would be better off if they were dead. Every patient has that conversation!
And that’s about the reality of having a terminal illness—you are likely to financially destroy your family. This is the reality of treatment in the U.S., but it is not true in the countries that have single-payer. Why should financial concerns outweigh your concerns about what’s going on with your illness? They are literally more significant to people than what is happening to them in treatment. They can’t focus on getting well, they have to focus on what kind of care can they afford.
I’m really tired of having that conversation! And I don’t think it has to be like that. At the moment, as a nurse, this is what is motivating me.
As far as working conditions go, we have long waits in the emergency rooms and many people being seen who haven’t had the opportunity to be seen by a primary physician at all. Most of whom are very sick by the time they are seen in the ER. I’ve taken care of patients who have been in the ER for forty-eight hours before they were admitted into the hospital.
I have patients who choose which medications to get filled. This is a very routine conversation that I have. Many of them don’t get any refilled because they have to pay their rent. Choosing between rent and food and medications. Or they take their medications every third day because they are trying to make their prescriptions stretch.
I’ve seen physicians prescribe medications on the basis of what they think will be reimbursed. We have situations where patients get treatment—whether as inpatients or outpatients – determined on whether they will be reimbursed and in what setting. We routinely send patients home knowing the demand on the family to provide them care is well beyond what the family can manage. This is another side of being a burden to your family. Being sent home too soon, with too many medical needs, and the family has to take care of really complicated medical needs that should be taken care of by professionals, but there’s not reimbursement for it. So you have people leaving their full-time jobs in order to take care of a sick family member, which makes the financial situation even worse.
When we—six to eight nurses and Donna and Larry Smith, whose story is featured in Sicko—were in the back of the Sicko bus, we were telling stories about health care. We each have multiple stories. It’s kind of horrifying when you get a group of health-care providers together how many of these stories you can come up with. I said something about patients who have to work full-time during their chemotherapy because otherwise they will lose their health insurance if they don’t. There’s no way they are well enough to work, but they need to figure out a way to continue to work, since they are afraid they won’t be treated if they lose their health care. I have a friend who works at Children’s Hospital in Oakland, California, who talked about how parents have to leave their kids alone in their beds in order to go to work and keep their health insurance.
And Donna, she started to cry. She said she had never thought of it this way. There was a point, after Larry had a major heart attack that she didn’t know if every time she left to go to work whether he would be alive when she came back. But she had to leave him every day—with him begging her to stay—in order to go to work for an employer she couldn’t tell she had a sick husband. She was afraid they wouldn’t keep her on because it might affect their group rates. She would sneak out on her breaks to call the intensive care unit to find out if he was still alive. And she said she felt like the worst wife in the world because she couldn’t stay. And she didn’t realize until we were talking on the bus that it wasn’t her fault.
It’s crazy, this system makes people make these kinds of decisions on a daily basis.
RECENTLY MICHAEL Moore sent out an e-mail message on his listserv titled, “Watch the movie, start a revolution.” What do you think are the next steps?
THE FIRST and most important hurdle is making sure the movement continues as Sicko eventually flies out of the public spotlight. Making sure people who are inspired by Sicko are forming groups that have a sense of organizing for the long-term, that we continue to fight for what we need. It’s about building that kind of infrastructure.
The debates around how to move forward in terms of what kind of health-care reform we need are going to play themselves out in the presidential campaign. It’s really important that the movement be able to convey to the Democratic presidential candidates, in particular, that they aren’t going to be supported unless they back single-payer health care. Right now, candidates are confident that as long as they put something forward for health-care reform the Left will back them. The movement has to able to put significant pressure on candidates around single-payer and not be subsumed into individual candidate’s campaigns. We need to not be apologizing for Democratic presidential candidates who have proposals to extend the insurance industry.
WHAT IS the role of the labor movement in the fight for single-payer?
BUILDING SUPPORT within the labor movement for HR 676 is a huge step in the right direction. We haven’t had the AFL-CIO come out for a single-payer position before and the labor movement is such a key component in winning significant reforms. There is a lot of energy starting to whip up around HR 676, so we are seeing central labor councils along with local labor federations beginning to back it along with the international unions as they react to their members’ growing demand for single-payer.
I think it needs to be said that health-care, whether for retirees or for current employees, is the main issue of contention across the country in all contract negotiations. Too many unions have made concessions on health care and bought into the idea if they make concessions on health care with their employer that somehow this will stop further concessions down the road. The reality is unions need to be demanding and out fighting for single-payer as the only option.
Any concession on health care in one workplace makes it all the easier to come after workers in other workplaces. I don’t believe the labor movement has any choice but to stand up and fight for this.
POLLS SHOW the two other big issues for people in this country are the ongoing occupation in Iraq and immigration. How do you think the health care movement can connect these issues?
I THINK it’s really important to connect the issues and I think they are organically connected. The amount of money spent on the occupation, essentially destroying another country where we have no business being, instead of providing for health care demonstrates that the issues are completely interlinked. It’s about where the money is going. Where are we willing to spend the money? And when they say single-payer is too expensive, one of the things Michael Moore likes to say is, don’t ever say single-payer is too expensive, the government has demonstrated they can come up with trillions of dollars to waste on the war.
In terms of immigration, a lot of the arguments about immigration are playing themselves out in health care, as you talk about whether or not illegal immigrants should be covered by national health care. So our movement for health care has to not duck that question and not capitulate to the Right on it. But we have to say that every human being deserves to have health care. It’s a pubic health issue. You can’t provide adequate health care to everyone as long as there are people being denied health care. Health care has nothing to do with immigration status.
I HAVE heard this fight for single-payer is equivalent right now to the fight in the 1930s to win Social Security. What do you think it will it take to ultimately win it, especially given we are up against some of the most powerful money interests in this country—the pharmaceutical and insurance companies?
I THINK it’s going to take the mass demonstrations Michael Moore illustrates in his movie when he’s looking at France. I think it going to take the kind of mass movement in this country that happened in the 1930s. The labor movement has to be involved. It’s going to take massive demonstrations to convince politicians in this country that the only way to stabilize the situation is to grant single-payer. You have to leave them no option.
It’s like any movement. You need to have a committed group of activists across the country that understand single-payer is the only solution and who are ready for when an explosion comes to lead the movement. I believe nurses will be at the center of this, given what our experiences are like every day. I think CNA will be at the center of this—we have been committed to this for a long time and we are not afraid to anger anyone.
There’s going to be a point in which public sentiment on this issue will turn to concrete action to demand it and we need to make sure at that time the movement can’t get diverted into a presidential campaign or co-opted into an incrementalist reform, but steadfastly refuses to stop fighting until we win single-payer.
