REKINDLING REFORM (NY) ON UHCAN'S SUPPORT OF INCREMENTAL REFORM AS A LEGITIMATE  PATH  TO  UHC

This discussion was intended first and foremost between Rekindling Reform NY and Project EINO about why they would honor and invite Ken Frisof to their major Fall event.  It now includes:

INITIAL CRITICISM FROM PROJECT EINO 

Friends, 

The steering committee of Rekindling Reform Alliance in NY state has circulated a detailed set of principles dealing with many features of the sort of health care system that could be serving Americans so much better with universal access to care. The principles and goals of Rekindling Reform are well thought out, clearly stated and impressive.

What is left untouched, thus far, by the alliance are the strategic aspects of obtaining a universal health care system such as the one they envision. There exists a considerable variety in strategies being proposed. To mention a few these are: work at the state level vs. the federal, grassroots work among citizens vs. focusing on health professionals, arguing for a single-payer system as the only viable economic alternative vs. being open to any solution which could create a stable genuinely universal system.

On some of these there is an indication already from Rekindling Reform of their position. Rekindling Reform is apparently not arguing from the onset that only the single-payer system should be considered. And judging from their recent events and statements they have some interest in both work on the national level and in demanding changes in their state capital. A recent mailing about a coming event in the fall, however, indicates that Rekindling Reform is not aware of another critical area of strategy and one that presents a danger to serious progress. This is the trend to include under the UHC banner, an approach which claims that continuing years (decades?) of incremental reform is a legitimate path toward achieving genuine UHC.

A major proponent of influence for this idea that eventually incremental health reforms will accumulate to the point of encompassing a UHC system has been Ken Frisof of UHCAN - a featured speaker to the Rekindling Reform fall event. This concept is: (1) a fairy tale [haven't we been working at incremental reforms nonstop for decades already?] and (2) harmful to the genuine movement for UHC. The harm comes in as it steals away support and resources, under the claim that UHCAN is already doing the grassroots work for UHC. Much worse still, this concept of incremental reforms being a path to UHC positions this major player and their resources firmly in line and supportive of the programs of the health insurance industry and the HIAA in particular, which has been our greatest opponent at every legislative effort.

Anyone who was paying attention during "Covering the Uninsured Week" last March is surely convinced at this point that the insurance industry wishes to be seen as advocating for the uninsured. What the industry is advocating for, however, is continuing and intensifying incremental health reforms -as the solution to uninsurance. New and expanded programs welded on to our patchwork system will yield them hefty additional public subsidies to cover the individuals they haven't already opted to cherry pick (the elderly, the disabled, the chronically ill, the poor). Any individual or national organization working explicitly to pursue incremental health reforms AS A PATH TO UHC is corrupting the hard work of people in many states doing responsible grassroots UHC work and confusing the public into supporting the central positions of the insurance industry.

Finally, let me reiterate, as I always do that Project EINO is not and has never argued that incremental health reforms are harmful, or that all such work should cease. What we are opposed to is pretending that incremental health reforms will ever yield UHC. This concept is ahistorical and untenable. When UHCAN or Ken Frisof argue this, it is also deceitful because they claim, after all, to be the universal health care action network. Following several years of our public criticism, Ken Frisof has not in the least moderated or backed off from this position. In fact he has refused to allow discussion of this point even at their own annual convention among UHCAN supporters themselves.

It is critical that Rekindling Reform rethink its invitation to Ken Frisof and steer clear of endorsing incremental reforms as a legitimate path to UHC.

There are several documents posted at www.EverybodyInNobodyOut.org relevant to this strategic issue and to the controversy with UHCAN specifically. Click on "Uniquely EINO" from main menu, there are several relevant links from that page. Also click on "Editorials" and select the Jeoff Gordon's "We have waited for incremental health reform too long". There is also a discussion thread on incremental reforms as an approach to UHC. Search our archived news headlines on "covering the uninsured" week for many examples of insurance industry position. Also check out the free pamphlet (Acrobat) "Grassroots Organizing for UHC" available by clicking on "For Downloading" from main menu.

UHCAN'S FIRST RESPONSE TO EINO'S CRITICISM (may 30)

Dear Dennis,

The wonderful Indian writer, Arundhati Roy, describes words as "the skin around my ideas." I am frustrated trying to find the right words, feeling that my words don't do justice to the ideas stuggling for life therein. But I really don't understand how you developed the notion from whatever words of mine you have seen that I support the straw man position you charge me with. If you would be kind enough to find them in my writings, I would be most appreciative.

My position is best described in the following paragraphs that I have used in a number of documents over the past six months.

The failure of managed care to contain costs and expand access is forcing politicians to take a new look at health care. The prevailing wisdom has been that access expansions must continue to be piecemeal, in small enough increments to fit into tight budgets.

There are three problems with this approach. First, a bruising political battle is usually necessary for each piecemeal advance, delaying for years consideration of the next advance. Second, piecemeal measures fail to engage the passions of those who see universal coverage as a justice issue. Third, by not creating structural reform, piecemeal measures make fair and effective cost control less likely to be achieved.

If any of us thinks that we will be successful only working with those who think exactly the way we do, we will doom ourselves forever to irrelevance. Tolerance of diversity of opinion among activists is to be sought, not fought. If you consider me your enemy, you must have a very small circle of friends.

Before you make historical assertions, I think you need to study your history a little better. Canada's universal health care system started as explicitly two-tiered and took more than a decade to become a single tier. While in some ways it is now single payer and single tier, private health spending in that nation is 28% of total spending, more than the average of OECD nations. Health systems evolve, sometimes for the better, sometimes for the worse.

I wish you success in your work and openmindedness in your heart.

Ken

PROJECT EINO ANSWERS UHCAN'S QUESTIONS  (june 2)

Ken ,

I am quite willing to continue this dialogue with you. I consider it a public dialogue between the director of Project EINO and the director of UHCAN (admittedly there is no listing of staff at your website, or your exact title there that I can find).

My criticisms are based on your support for incremental health reform (IHR). I have been criticizing UHCAN on exactly this basis relentlessly for several years now. These views of yours having to do with "true IHR" are most clearly represented on your website page  The other part of your response to me yesterday had to do with the history of UHC evolving rather than embraced as a new principle for organizing health care access. Specifically you cited an example of Canada where you say the system was first two-tier for 10 years, then single-payer one-tier. Let me first continue the dialogue about IHR and then later ask you for a little clarification as to what you are referring by this historical example from Canada.

Your distinction between piecemeal and IHR (or what you call "true IHR") is artificial, is without substance and introduces unproductive confusion into the movement for UHC. There is no real distinction, except that you would like to be able to name certain categories or ways of expanding our current system to qualify as a legitimate approach to UHC by defining this new concept of "true IHR".

1) artificial - you have invented a usage of "true IHR" (t-IHR) which is not what most folks active in health care policy understand by the term. Rather than meaning by increments now, it means (for you at least and those who share your new language) increments which are not by whole age group or section of the country (but not by your definition any other whole classes of population, or do we have to ask you about each population sector as the need arises)? And if anyone outside of UHCAN talks about IHR and doesn't say "true IHR" or t-IHR then post-Frisof's Definition, we should assume they are talking about regular IHR or t-IHR?

2) without substance - its not that it's a difficult concept, but rather inherently confusing rather than helpful or illuminating. You offer no rationale for why just these two cases should be considered t-IHR. Why could not a program for all state employees of 50 states be t-IHR? Why could not covering all women be t-IHR? Why could not improving medicare to really full medical coverage for 65+ seniors be t-IHR (rather than lowering the age)? Why could not adding in certain classes (or all) of disabled to an improved medicaid be t-IHR? Why could not full coverage for a certain type of care (say long term care in a nursing home) added to basic medicare be t-IHR? What's special about the two categories Ken Frisof has permitted?

3) unproductive confusion - besides being artificial and having no substance (worse still) your new definition of t-IHR introduces very harmful confusions into the dedicated work going on for UHC and is contributing to faltering steps in some states trying to get organized. There are two ways in which you are damaging the progress of UHC with this confusion. First, it is ridiculous and very harmful to define all state UHC work as IHR. There is no basis for this. You should read the history of the struggle for "universal" or "common education" as it was called in its time (much of this history is available at the EINO website). Like universal education, UHC can and will in all probability be applied first at the state level. It is no less UHC if it follows all of the principles of being universal. It is highly damaging to be telling activists around the country that state work is all IHR or all t-IHR (besides being not true). Its damaging even if some of them know what you mean by your t-IHR. Many of the people more recently coming into the movement, however, think that the only real UHC work is national - (a view you apparently share?). And yet you promote UHCAN as the major network for state UHC work - you don't think that's harmful? And then Project EINO gets accused by UHCAN staff and supporters for OUR lack of respect for unity within the UHC movement?

Second, it is very damaging to pretend that the difference between UHC work and IHR work is so trivial and arbitrary (that you can just invent your categories). There are some fundamental differences in the nature of the work, of which no one at UHCAN seems to be in the least cognizant, but which seem clear enough to anyone working as staff, activist or supporter of any of the state IHR groups. In a nutshell the difference is UHC work does not involve discussing individual programs, expanding them, fighting cutbacks struggling line-by-line each year through budgets. UHC work is, rather, mainly involved in looking at the "global health care budget" of a state or nation (global here means the "entire thing" not the planet) and at the same time looking at the "entire set of health care needs of the population". UHC work develops a plan, educates about a solution, provides the data that demonstrates the feasibility, for meeting all of those needs given the "global budget". UHC work (and almost never IHR or t-IHR work) involves looking at the many cost-savings in a UHC system. IHR work (or t-IHR work) involves convincing legislators to add an additional program or expansion to the current system and this always needs additional taxes or funding. In the "real world" of state grassroots organizing the difference in what we do day-to-day, how we work with legislators and supporters, what sort of actions we plan, even what kinds of things we stress to the media (when we get the chance) are almost entirely different (UHC work vs. IHR work). Your t-IHR and work towards t-IHR is all solidly in the other camp and is not UHC work, but you do manage to confuse enough potential UHC activists to really slow our progress.

As for the second part of your note to me about the Canadian history and that UHC evolved there, I would also like to respond to that. Please just tell me which ten years you are referring to as the "two-tier" system that was tried? Are you talking about 1961 to 1968? 1970 to 1984? 1947 to 1955? I really can't tell from my history what you have in mind.

Dennis Lazof

BRIEF FIRST RESPONSE FROM REKINDLING REFORM (LOUIS LEVITT) ON EINO CRITICISM

Thank you for your comments concerning the Statement of Principles promulgated by Rekindling Reform. Please note that these principles were included in the January 2003 issue of the American Journal of Public Health, an issue completely devoted to universal health care. Two of our members, Dr. Oliver Fein and Dr. Anne-Emanuelle Birn were the issue editors.

Our mission statement defines our purpose as stimulating debate and discussion as to how our country can best provide quality health care for all. We seem to have to done this with the exchange of views between yourself and Dr. Frishof.

We desire to encourage the development of a consensus among reform-minded groups as how this goal can be achieved. We believe we are contributing to such a consensus by encouraging the presentation of the ideas of key organizations, public officials and health policy experts.

Dr. Louis Levitt

Professor Emeritus, Yeshiva University, Wurzweiler School of Social Work Member, Steering Committee, REKINDLING REFORM

PROJECT EINO RESPONDS TO REKINDLING REFORM'S LOUIS LEVITT.

Louis ,

Thank you for your response. I certainly appreciate that Rekindling Reform has some very insightful and dedicated people at the helm and also that there is virtue in promoting dialogue among all potential supporters and allies in the struggle for universal health care.

The problem is that most people involved in UHC work and probably most of your own supporters would agree that it is pretty late in the game to still be discussing whether incremental health reforms are a legitimate path toward real universal health care. Haven't we already had 60 years of incremental reform? Isn't that a pretty fair description of the status quo? Why elevate individuals to being the "leaders of the key organizations" who are working toward convincing us that working on incremental health reforms are the most "realistic" way to achieve UHC?

Giving a platform for THAT discussion at this point in the history of our movement, denies the last 60 years of our experience, gives support to what is clearly the line of the insurance industry (our main opponents) and sets the stage for an unproductive "season of dialogue" leading up to the 2004 elections. I am asking you and the steering committee to consider this choice carefully, reconsider your offer to Ken Frisof and poll your supporters about where they want the discussion to be next fall.

As of the afternoon of June 6, I have not really received a substantial response from any one at UHCAN. There has been no attempt yet to answer any of my specific criticisms. So far, there has just been general denial and an attempt to substitute the concept of unity for the concept of thinking profoundly about where we are trying to go. Hence, I don't really agree that Rekindling Reform has begun any sort of useful dialogue between UHCAN and Project EINO. I sincerely do hope that I will hear from them soon with specific answers to my criticisms, but as far as I know Rekindling Reform hasn't even asked UHCAN of Ken Frisof to respond, have you?

For ease of reference the entire discussion has been posted at www.EverybodyInNobodyOut.org click on "Discussion Threads" from the main menu, then first selection is this discussion.

It is precisely because of the caliber of the people involved in Rekindling Reform that I doubt that it could really be their thoughtful intention to be leading our movement backwards towards decades more of incremental reform at this point.

Respectfully,

Dennis Lazof
Director Project EINO

UHCAN's RECORD, FROM RACHEL DEGOLIA MAY 29

Dennis:

I was surprised and disappointed to see this message from you ­ it was forwarded to me by one of our board members. I'd like to respond to some of the misinformation it contains.

I've pasted below a brief summary of what we've been sending out to UHCAN members regarding our recent accomplishments and action priorities for 2003. I think our record speaks for itself.

UHCAN has always stood for genuine universal health care and we support all efforts to achieve it, whether on the state or national level. There are going to be honest differences among advocates as to the best way to make it happen here - the politics are complicated and difficult with huge investments by very powerful forces in keeping any reform from succeeding. We can't afford to fall out among ourselves such as happened in the early '90s. There aren't enough of us when we do stand together!

UHCAN's main mission is to support the grassroots organizations that will make universal health care happen here and different states are pursuing different approaches. We need the federal government to support their efforts if any are to succeed. And we have to get the goal of health care for all to be on the agenda in Congress for that to happen -- that's what the Health Care Access Resolution is about -- the first step. We also have to make sure that the social safety net and public health programs we do have are not destroyed. This is where UHCAN is focusing our efforts right now and we do believe this will help move our country toward universal health care.

I find it hard to believe that people who are on the same side in the kind of battle royal we are in right now to try to realize a fundamental human right against great odds could speak of each other in this manner.

Rachel

RACHEL DEGOLIA ASKS FOR RESPONSE TO HER INITIAL REPLY

Dennis:

I don't know why you never received the responses Ken and I both sent when we were first forwarded your original email by other who received them -- neither of us were on your undisclosed recipient list. I've pasted our responses below. This last message of yours was also forwarded to us by someone else, not sent directly to us by you. Dialogue is more productive if we speak directly to each other rather than through third parties, which is what we are trying to do with you.

Rachel

PROJECT EINO ANSWERS RACHEL DEGOLIA.

Rachel,

I think its clear that I addressed my original criticism to UHC activists in NY, supporters and potential supporters of Rekindling Reform. I was asking them to reconsider their invitation to Ken Frisof for the fall event as a featured speaker. I was certain that everyone at UHCAN would soon see my letter, and so you did within 2 days that it was first sent. Nonetheless it was not primarily addressed to UHCAN.

Yes, I certainly did receive the "responses" from you and Ken. Ken's I responded to within a few days (and sent it to him directly). He had clearly stated what he was confused about and had asked for certain clarifications which I provided. Both his note to me (in full) and my response to him were emailed to the list serves and posted for any interested activist to read or refer to. Your "response" warranted no posting or response as you merely stated that UHCAN does not have to answer such criticisms - that UHCAN's record speaks adequately for itself. I of course dispute both your interpretation of the UHCAN record and the idea that it could substitute for discussing points of strategy with other activists. Since your letter was so trivial I didn't originally post it, but since you seem to be requiring that, I have now posted it with the rest of the dialogue - even though it seems completely irrelevant to the questions I have raised.

So there you have it. We're still waiting to hear answers to any specifics from you, Ken or anyone else at UHCAN. We are NOT willing to limit this discussion to a private one between UHCAN and Project EINO as you have suggested. The time for that has passed as we first brought these criticisms to UHCAN's attention some 4 years ago and since Ken has refused to discuss these issues even with his own alienated UHCAN supporters at your national conventions as recently as a few weeks ago. The only reason there is any hope they might finally get addressed now, is that you might be interested that Rekindling Reform and other state organizations hear the defense of your ideas. I'll make sure that you and Ken both receive any copies of future responses.

Dennis Lazof
Director, Project EINO

UHCAN REFUSES TO DISCUSS STRATEGY OR PRINCIPLES

As of June 17th there was no response to any of the detailed criticisms of March 27 or June 2.  On the morning of June 17 Project EINO received a one line email from Dr. Frisof (in its entirety):

"I am not sure there is any benefit in continuing this dialogue.  I wish you luck in your future endeavors."

PROJECT EINO ON THE NEED FOR AN OPEN DISCUSSION OF PRINCIPLES

Friends,

It has now been three weeks since Project EINO criticized the Rekindling Reform decision to honor Dr. Frisof at their fall event. It is 19 days since we received acknowledgement from UHCAN that the criticism had arrived there as well. Today we received this one line note back from Dr. Frisof (in its entirety):

"I am not sure there is any benefit in continuing this dialogue. I wish you luck in your future endeavors."

We will not repeat here the criticisms detailed on May 27, nor the more detailed explanation sent out on June 2 aftert Dr. Frisof asked Project EINO in his earlier note to point out to him exactly where in his writings he makes the assertions we had targeted. He also claimed that it was Project EINO which had a poor handle on the history in Canada (I asked him what "ten years" of history he was referring to in his example), but the international comparison he hoped to use in supporting his strategy, like his absurd redefinition for the phrase "incremental reform" is not worth discussing, nor is there apparently any point in using the basic terminology responsibly from the UHCAN standpoint. The unedited "discourse" is posted on this page.

During these last three weeks Project EINO has received several messages in support of our criticism, several from activists in NY state and several from other activists in the Northeastern US. Indeed, Project EINO would not have issued the original criticism had we not been hearing about frustrations on this issue from several long-standing UHCAN supporters, who had reported a complete unwillingness of Dr. Frisof or UHCAN to allow these issues to be publicly discussed (even at their own meetings with their own members and supporters).

The one officer of the Rekindling Reform Steering Committee who responded to Project EINO thus far (Dr. Levitt) wrote that he was glad that some discussion was going on. In fact, no discussion has been going on, although that was precisely Project EINO's intention. Clearly now, UHCAN has nothing to say either to their own members and supporters, nor to their critics, nor to Rekindling Reform nor to the interested American public. Project EINO received one note from Ms. DeGolia which expressed her "disappointment" in us and which stated that UHCAN does not need to discuss this issue (their record of activities is sufficient) and one earlier letter from Dr. Frisof reiterating the claim of being committed to UHC. But that's it for discussion. As for the last three and a half years during which we have persisted in these same criticisms without publicly forcing the issue with any state organization, UHCAN's choice is steadfast - refusal to discuss such issues ever, anywhere.

Is it enough to repeat slogans of "Health Care for All" while one works according to a strategy that is supported and endorsed by the insurance industry and which is aimed specifically (by the insurance industry) at increasing further the public subsidization of insurance industry profits, egregious salaries and unnecessary marketing/administration costs? While Americans already pay twice per capita what industrialized Europe pays for health care (and Europe covers all its people), is it really adequate for an alliance like Rekindling Reform to work on improving our patchwork system by raising the public costs further and still leaving people outside the system for decades to come? That is, after all, what Ken Frisof and UHCAN are all about, for incremental health reforms touted as a legitimate path (or "the only feasible path") to UHC just continues the budgetary struggles, the program expansions and contractions that have been ongoing for 30 or 40 years. Remember that the Health Insurance Association of America is also repeating these same slogans. Most UHC activists around the nation seem to have noticed this during the "Covering the Uninsured Week" into which the HIAA pumped millions of dollars and professional PR work. During that week we all witnessed the industry's intention of becoming broadly recognized as the legitimate voice advocating for UHC in our country.

As we approach this critical time when health care costs and coverage have emerged as the foremost issues in the American public's mind, when with the coming primary season ideas are most discussed and most easily influenced, is it really Rekindling Reform's concept that we activists should be discussing the viability of proceeding down the same road of patching our system with incremental reforms? And that we should continue heaping honors upon the main proponent of just this idea, recognizing UHCAN (de facto) as a leading voice? Even though he is totally disinterested in supporting his own assertions when they are challenged, or discussing any strategy fundamentals with others in the movement?

Why should Rekindling Reform throw away the most favorable set of circumstances for real fundamental reform to have appeared during the last 70 years?

PLEASE if you are involved at all with Rekindling Reform, or live in NY and are concerned with where we are heading, please write their steering committee on this issue and urge them to reconsider their invitation to Dr. Frisof. They need to hear from you directly. We would hope that Rekindling Reform would demonstrate some interest in discussing key strategy at least within their own alliance, if not with the broader UHC movement.

Dennis Lazof, Ph.D.
Director, Project EINO

A CALL FOR ENDING DEVISIVE DIATRIBE, M. Livingston

Dear Dennis Lazof,

I am a longtime PNHP activist and PNHP-NY Board member, a proud UHCAN! member, and a member of the Rekindling Reform Steering Committee. I have been following your communications over the last several weeks, and have found them without exception to be unpleasant, unhelpful and unworthy of a true single-payer supporter. By casting aspersions at Ken Frisof, a tireless longtime universal health care activist whose position may not always precisely mirror one's own, you not only do nothing to further our cause of true single-payer national health care, but weaken and divide our movement, thus strengthening the enemy, which is goodness knows too damn powerful already. I implore you to cease and desist from this destructive diatribe.

Peace,

Martha Livingston

Project EINO: RESPONSE TO M. LIVINGSTON

Dear Martha Livingston,

It seems to me that PNHP is very much against the road of incremental health reforms (IHR). In fact recent notes from their national President Don McCanne on the topic demonstrate that he is much more critical than I or Project EINO is of IHR. He agrees with Project EINO about the dishonesty of claiming to be working for UHC if one argues that we can get there via IHR, but goes a step further in attacking the value of working for IHR even for immediate necessity or a few quick-fixes (a position EINO has never taken).

A quick look over the PNHP website yielded many examples wherein it was stated that IHR must certainly be discredited as a legitimate road to UHC. Below (under the **) I supply you with the links to just four of those pages and a few excerpts.

I am truly very sorry to ever alienate any people like yourself who are dedicated and concerned with uninsurance, underinsurance and the suffering they cause. I have tried to avoid any personal attack in my criticism of UHCAN positions. What I do not understand is how you, as a PNHP activist, can think that legitimizing incremental health reforms as a feasible method of achieving UHC is something that dedicated activists should include in our movement and with which we need to unify. Should we also unify with HIAA (insurance industry lobby) in "fighting uninsurance" (again by adding IHR)? How can you think this does not "strengthen our enemy which is too damn powerful already" as you put it so well?

Most importantly, I cannot understand why anyone really dedicated with bringing the nation towards UHC would support any organization in their refusal to discuss their own published principles and the basis for those principles. Why should any ONE (Ken Frisof or Dennis Lazof) be able to invent an all new definition for "incremental reform" and then pronounce that this is "true IHR" and that it unlike all other normally referred to IHR actually does represent work toward UHC? And no other activists or organizations are even permitted to question that individual how they came up with this new private language?

All of us at Project EINO remain sincerely interested in your opinion. And are hoping that you will answer some of these questions. We would like to understand better your position and place the highest value on open discussion among interested parties. Be assured, to our minds, we are strongly dedicated to the effort of broadly unifying the UHC movement, but we do believe that honesty and open discussion are always part of building unity.

Respectfully,

Dennis Lazof, PhD
Executive Director, Project EINO

**
        CLICK HERE FOR LINK AT PNHP.ORG 

When [Joel Miller] says, "We must move towards a health system in which every American has health insurance coverage," is he endorsing "incremental" change? He must know, and we know, that unless we have universal coverage -- and not just tweaking this group or that group to increase the number of insured Americans -- none of what he's advocating for will happen. Risk avoidance will not go away. Profit-seeking and high administrative costs will continue. The most vulnerable will continue to be the most vulnerable. Costs will not be controlled.

So why doesn't he...and the organization he represents...finally come out and say it? We need one risk pool with everybody in and nobody out.

**
      CLICK HERE FOR LINK AT PNHP.ORG 

The mantra is "incremental steps" -- not because incrementalism is the right approach but because it is viewed as the only politically viable one. All the evidence, however, says that it's the wrong approach and that it won't work. Incrementalism won't work, because the problems are systemic. Reducing the ranks of the uninsured by a million or 2 million is a short-term victory in human terms. But adding them into a broken health care system is a long-term strategy doomed to fail.

The American Academy of Family Physicians has taken a giant step forward in expanding the national discourse on health care reform. AAFP recognizes that "politically viable" incremental steps fail to meet the goals of universality and equitable funding.

**
    CLICK HERE FOR LINK AT PNHP.ORG 

Advocates of universal health insurance need to reject the proposition that their goals can be achieved through a series of incremental steps. When the concept of incrementalism first began appearing in the political science literature in the United States, the model was the Social Security Act, which began in 1935 in quite a limited form.

This is an old political debate, but whatever the advocates of universal health insurance have been doing for the last 30 or 35 years, it obviously hasn't worked very well. There is very little to lose from trying something different. One of the different things that might be tried is to determine in very broad terms what the goals and principles of universal health insurance are by deciding on a set of defining ethical and moral principles and insisting that those goals and objectives be part of every conversation until they are achieved. Perhaps the "Rekindling Reform" initiative will help shape such goals and principles for universal health insurance.

The January issue of the American Journal of Public Health is dedicated to "Rekindling Health Care Reform."

**
  CLICK HERE FOR LINK AT PNHP.ORG 

If we leave intact the present system, with its wasteful fragmentation, billing, underwriting, and insurance company profits, there is only one big place to reap savings - by withholding more care as nonessential and by avoiding the sick.

The best solution here is national health insurance. We already have it for one segment of the population, through Medicare. The program is easy to understand, and even fits on a bumper sticker: "Medicare for all."

Face it: Even incremental proposals by Democrats will be attacked as too costly and entailing too much government. They might as well do it right.

MARK HANNAY OF UHCAN, REKINDLING REFORM STEERING COMMITTEE AND METRO NY HEALTH CARE FOR ALL SPEAKS OUT

Dear Dennis,

I'm afraid you very much misunderstand the nature of the events the Rekindling Reform project is planning for the fall. At the core of RR's program has been various series of educational lectures and seminars, focusing on the policy and programmatic aspects of health care reform and national health care programs. RR's impetus has been based largely (though not exclusively) in the academic and health professional/policy communities here in the greater NYC area, and it has consciously NOT (for the time being) chosen to promote any particular policy options, but rather to focus on a set of principles to guide fundamental reform here in the U.S., as published in the January 2003 edition of the American Journal of Public Health, and use them to explore policy options for the U.S. in depth with both policymakers and activists.

RR's first lecture series in Winter-Spring 2002 focused on national health systems in Canada, the UK, France, and Germany, and recent reform efforts within those programs, and what lessons they have for the U.S. In 2003, RR launched new two series of lectures, one focusing on presidential candidates (in conjunction with the Wagner School of Public Administration at NY Univ.), and a second focusing on health care policy concerns for next steps toward reform here in the U.S. To date, the latter series has included presentations by John Sheils of the Lewin Group (on costing out multi-payer v. single payer models), Prof. Theda Skocpol of Harvard University 9on lessons from the Clinton era), and an upcoming one with Lynn Williams of the Steelworkers Union (on labor's internal concerns about health care reform.) RR's Fall-Winter 2003 series continues in that vein, to include lectures/seminars led by Ken Frisof of UHCAN (on State-Federal partnership models), Richard Kirsch of Citizen Action of NY (on pay or play models), Cathy Shoen of the Commonwealth Fund (on multi-payer programs), and a yet to be confirmed speaker on single-payer systems. In no case is RR honoring any one of the above persons in any way.

By way of an aside, my own personal understanding is that UHCAN believes that there may be several methods to achieve health care for all in the United States (e.g., state-based or national programs), according to principles of social justice. While some policy options are clearly ruled in or ruled out using such principles, and some are clearly superior to others (e.g., single-payer and NHS models vs. tax credit ones), the experience of other nations clearly shows there are several ways to technically achieve just, workable, national health care programs. Some may be more economically efficient than others perhaps, but various nations' programs are often as much (if not more) creatures of practical politics as clearly-superior policy goals, for better or worse. But all share the commitment to comprehensive, quality, affordable health care for all and deliver on it! in some socially-just fashion. The decision to act is, at base, political.

Indeed, UHCAN believes that the critical priority for achieving health care for all in the U.S. at the moment is the achievement of a political consensus and commitment to act in a socially-just manner on fundamental reform leading to national, universal health care (hence, the emergence of the Health Care Access Resolution in Congress, S. Con. Res. 42, H. Con. Res. 99.) UHCAN shares the concern that often many so-called "incrementalist" strategies come up short in that regard. Because UHCAN is also a network of both state/local health care justice coalitions and national organizations with a commitment to universal health care, we do work to develop strategies and policies to promote health care reform at both state and national levels (such as the so-called "Federal-State" partnership.) But rest assured, UHCAN is far from "incrementalist" or "status quo" in character bold, decisive action is needed now more than ever! And RR shares that perspective.

I hope this clarifies matters for you. I'd appreciate it if you'd share my thoughts with those who have received your previous correspondences both about the Rekindling Reform project and UHCAN.

In the future, I'd urge you to check with RR's and UHCAN's leaders before making and broadcasting statements that are incorrect or inaccurate. While we all may have policy differences from time to time and they can and should be debated (as Dr. Lou Levitt encourages), I hope you and all others understand the strategic importance of collegiality and support for all of us who are on the same side (which we are), fighting hard (against formidable odds) for health care for all, and that we all appreciate the destructiveness of so-called "circular firing" squad strategies, out of which the vested special interests (who are the REAL cause of health care injustice and who are our REAL, SHARED enemies), celebrate and exploit our self-inflicted divisiveness for their own further gain and power.

Sincerely,

Mark Hannay
Director, Metro New York Health Care for All Campaign
Steering Committee member, Rekindling Reform
Vice-chair, Universal Health Care Action Network (UHCAN)
(212) 925-1829

PROJECT EINO RESPONDS TO MARK HANNAY

Mark,

Conversations with several people involved with Rekindling Reform had led me to believe that RR-NY was a group that was interested in UHC activism and in the goals of getting UHC legislation both in Albany and Washington DC. It was a surprise to me that some of the steering committee consider it to be more of an academic debating forum. Definitely, if this is the concept of the steering committee then a good part of what I have written is irrelevant (not the criticisms of UHCAN but the expectations of RR-NY). However, the Rekindling Reform website does state that the alliance is trying to develop "a set of principles and goals to help guide and define the group's efforts for comprehensive health care reform in the United States", so maybe you need to change that?. Your website seems to indicate that the group does indeed intend to lead some sort of effort towards "reform" (which is later specified as UHC specifically) at some point, so I will continue addressing myself to RR-NY as if you were interested in activism.

Have read the original criticism of the invitation to Dr. Frisof (May 27) and further explanation (June 2)? If so, then you realize that the dialogue we're having is not about NHS vs. a mixed UHC system or SP vs. maintaining some limited role for private insurance. That would be a totally separate discussion you may or may not want to have with, for example, some of your PNHP supporters. I don't know why you bring that up in this context. The only reason I mentioned PNHP in the recent note to M. Livingston was that she brought up her PNHP activism in explaining her commitment and acceptance of incremental health reform. Nor have we brought up, or have we any interest in an evaluation of the record of UHCAN action, which you again bring up again although we already clearly stated (to Rachel deGolia) that we had no interest in that question.

The ONLY strategy element that Project EINO has brought up and the only one upon which we asked the RR-NY steering committee to reconsider the Frisof invitation, was the element of incremental health reform (IHR) being a legitimate path to UHC. On this point your answer to us seems to be that concerned activists should "rest assured that UHCAN is not incrementalist". How can we do that while UHCAN, itself, states quite clearly that they support incremental health reform as a legitimate path to UHC (see June 2 EINO response to Ken Frisof). Note also that Dr. Frisof did not care to dispute what was stated on UHCAN's webpages. Nor do you dispute it. Have those webpages been renounced now?

In the detailed criticism Project EINO wrote and sent out (June 2) at Dr. Frisof's request, we stated exactly what is wrong and harmful about UHCAN legitimizing incremental health reform as a path to UHC. Not a single word of what we wrote has been criticized or countered by anyone at UHCAN or at RR-NY to this date. Maybe you or another colleague at RR-NY should respond to our one real point, rather than dragging in all these irrelevancies about UHCAN's record, resting assured and needing to unify. Why is it so terrible that Project EINO or any group of activists involved in UHC work should want to know how they support their assertions? And if they have created "new language" that is artificial, without substance and unproductively confusing (as we explained in detail, June 2 letter) why exactly does RR-NY want to help UHCAN promulgate those ideas, even while UHCAN itself cannot or will not even attempt to support their statements?

We differ strongly on your preference for conducting these discussions privately, between colleagues and quietly so as not to upset anyone or "divide the UHC movement". These criticisms, as we pointed out already, were made more than four years ago, they have been brought up as recently as the last UHCAN national conference - they have always been dismissed without discussion and the individuals bringing them up for discussion have not been treated very politely I might add. I can't understand the virtue now in having a closed private discussion on a topic so many activists are interested in (many who may disagree with Project EINO). Does UHCAN stand by and support what it has had posted on its website for 5+ years, or not? And why can't they defend it and discuss it with other activists? I really don't get this at all. And why should state UHC supporters in NY or any other state be "resting assured" of anything about any UHC organization that has such obvious contradictions in position and which they are steadfastly against discussing publicly?

Everyone loves to write about "unifying the UHC movement" but you can't unify when there is dishonesty and no will for open discussion. "Unifying the movement" is like "supporting our troops" its a meaningless slogan because we all believe in these concepts, believing in these does not excuse us from discussing and understanding the real and difficult issues. If you had read our June 2 letter you would have seen that we too very specifically addressed the issue of what is harming and setting the movement back and this is OUR overriding concern as well. Please answer some of the points we made and leave the slogans aside. We're still waiting for even one point we made to be criticized or countered. Please show us where our reasoning is faulty!

Respectfully,

Dennis Lazof
Director, Projector EINO

BOLSHEVIK DIATRIBES AND THE REQUEST FOR AN OPEN DISCUSSION ON ONE POINT OF UHCANS PRINCIPLES

Dear Mr. Lazof --

Eighty-some-odd years ago eastern European social reformers expended huge amounts of energy arguing among themselves, sometimes even settling their deeply felt differences through the overly physical but definitely final act of assassination. From today's vantage point, however, it matters little whether who among the Bolsheviks, Menshevik, Trotskyites, et. al. were correct. The entire socialist movement of which they all considered themselves the vanguard has become totally marginalized. All of their blustering and theorizing has, in the end, come to naught.

Your mean-spirited attempts to widen the rifts between those few Americans who care enough about reforming our health care system remind me of nothing so much as of the seemingly perennial carping among lefties which has traditionally sapped the progressive movement of much of its energy. Come off it, will you?

As a long-time member of UHCAN, I can testify that most of its members agree that a single-payer system is our best hope. I also believe that UHCAN's leadership holds the same view. Who besides yourself has declared that UHCAN is working for incremental reform and opposes a systemic, comprehensive solution? And what's all the garbage about "Rekindling Reform" and its supposed marriage to UHCAN? You seem to have invented these constructs simply to declare PNHP and other single-payer advocates the victors in some non-existent war.

Is it incrementalism to try to defend elements of our existing inadequate system from attack? Who gets hurt by asking for better benefits while trying to spread the word about how the real problem with American health care is its delivery system's fragmented, profiteering structure? And if none of us talked about anything but how great a universal government insurance program would be, do you really believe that this would hasten the advent of that great day when the dream becomes reality? After all, the plutocrats who rule our great nation care little for the hopes and desires of regular people, especially now that they've learned how big money can be used to influence voters, or, worse, disregard them.

Get real, Mr. Lazof. And stop wasting everyone's time (as well as your own) with such pointless diatribe. Calling UHCAN names will do little to achieve Medicare for All, or whatever you want to call that perfect program. You surely must have better things to do than to pollute cyberspace with your own brand of Spam.

Sincerely,

John Glasel

PROJECT EINO RESPONDES TO J.GLASEL

Dear Mr. Glasel,

What exactly Mr. Glasel is the connection between asking UHCAN and Rekindling Reform to discuss openly the statements, arguments and creative new definitions on their webpages and Bolshevism or Trotskyites? Your just mean to call me a red? You are saying that "I consider myself the "vanguard", I "bluster and theorize meaninglessly"? My call for open discussion of one specific point of strategy is "perennial carping" "traditional among lefties", my words "sap the progressive movement of energy" and then you call ME mean-spirited? I don't see anywhere that I have attacked Ken Frisof personally or anyone else in anything I have written or posted. But you consider it totally illegitimate for an UHC activist to ask for discussion of core ideas that a supposed leading UHC organization has had posted and disseminated widely for the last 5 years? Seems to me that Bolshevism had something to do with the lack of open discussion.

And still in your note you don't even bother trying to address the one core issue - why should Rekindling Reform (RR-NY) embrace the idea that UHC will be arrived at through additional years of incremental reforms? Is that what their members really want them to be discussing in the fall and promoting? That is what UHCAN argues at their website, is it not? No one denies that - not even you. But it is a terrible, awful mean-spirited (lefty bolshevik) thing to ask for an open discussion, right?

Sumner M. Rosen and Judith Davidoff wrote today that they would like to know what supports this tenet of UHCAN's philosophy. They are supporters of RR-NY and they deserve some civility and open, fair discussion. Joe Kane of the Long Island Coalition for a National Health Plan (a RR-NY supporter) also wrote in a few days ago that he thought there was some merit to our criticism of the idea that incremental health reforms will bring about UHC one day. I have a list of at least a dozen senior health policy experts from around the country who are of the same opinion. But why should I give you their names - I guess you consider them all lefties or Reds anyway right? Project EINO believes that even if one of your supporters is interested in this discussion it should happen and openly. So you cannot believe that any RR-NY supporters want to know how UHCAN supports these statements?

And please don't try and confuse the issue. Project EINO has NEVER stated, nor do I personally even believe that there is anything wrong with pursuing incremental reforms in health care!! People have immediate needs, they are suffering now and I understand trying to meet those needs this year and next. But it is dishonest and deceitful to claim that pursuing incremental health reforms is ever going to bring us a step closer to UHC. That's the point. Its the ONLY point we have made. If you and UHCAN were truly worried about "spamming" of the mailboxes - then you could just answer that one question after 3 weeks of this dialogue and stop dragging in every thing under the sun as an excuse not to answer it. FYI only Ken Frisof and one other person, so far, has asked to be removed from this discussion.

Dennis Lazof

FINAL NOTE TO DIALOGUE WITH REKINDLING REFORM

This is a final note to the recent dialogue with Rekindling Reform NY's steering committee and supporters about the invitation to UHCAN's Ken Frisof for the RR-NY fall event. It is written primarily for the benefit of the many individuals who have written supportive messages to Project EINO, at least supportive of the idea of having an open dialogue on the subject of incremental health reform.

UHCAN's page http://www.uhcan.org/files/strategies/incremental.html 

remains unchanged. It still concludes:

"Universal coverage through a single piece of federal legislation is not likely in the near future. It is important to build towards it through solid increments rather than through unreliable piecemeal measures."

Note that our June 2 note specifically argued against any sensible meaning for their piecemeal vs. incremental distinction - and in more than 4 weeks UHCAN never cared to write an argument in support of their concepts, or against our detailed criticism. As far as we know, the Rekindling Reform Steering Committee is not reconsidering their invitation to Ken Frisof. So what did we accomplish with this controversy and criticism?

1. Some pressure was applied to the RR-NY steering committee on the issue of including the UHCAN concept of incremental health reforms being able to lead to UHC. Discussion of this will undoubtedly continue and, perhaps, at some later time the steering committee can be influenced to take up this criticism in earnest.

2. Awareness has been raised within the RR-NY membership that UHCAN supports and incremental approach to UHC. Over time more supporters will come to understand the consequences of supporting this key feature of the insurance industry's strategy.

3. Awareness has also been raised that some steering committee members consider RR-NY to be directed more strongly along the lines of an "academic debating society" than an organization with "principles and goals to help guide and define the group s efforts for comprehensive health care reform in the United States" (quote from RR-NY webpage on goals). Of course, an activist organization has to know what its committed to and what it is trying to accomplish.

4. Awareness has also been raised that UHCAN and certain elements within RR-NY are disinclined from discussing difficult strategic considerations and elements of basic principles, especially in a forum open to public scrutiny.

Project EINO received as many supportive statements on our criticism and the dialogue, as we received statements attacking us for criticizing UHCAN and the RR-NY decision to honor Ken Frisof.

We hope that each of you will take an active role in RR-NY and let the steering committee hear your views on the organization's: openness to discussions with the membership and on its willingness to take on difficult subjects such as how broad of an inclusion to make of "forces within the UHC movement" (insurance industry also claims to speak for the uninsured, remember).

Project EINO would hope, of course, that someday RR-NY will evolve into a unique organization dedicated to fighting for UHC and excluding the status quo which for decades has sought to correct our patchwork health care system through incremental change. It would be wonderful to welcome RR-NY to the 17 autonomous state UHC organizations doing this work from coast to coast (see our homepage). 

Best wishes, Dennis Lazof, Director Project EINO