FAMILIES USA DAY 3 LUNCHEON CLOSING PLENARY JANUARY 24, 2015 PAGE 1

Size: px

Start display at page:

Download "FAMILIES USA DAY 3 LUNCHEON CLOSING PLENARY JANUARY 24, 2015 PAGE 1"

Horace Green
5 years ago
Views:

1 PAGE 1 RON POLLACK: Well the voice of God finally has the right gender. [applause] So this is our closing session. And I am delighted with who s going to be our speaker at this closing session. John McDonough is probably well known to all of you. I think the best way to describe John is he s a renaissance activist. John has distinguished himself, both in academia, in public policy, and as an advocate. John is currently a professor of public health practice at the Harvard School of Public Health. He s the director of the Harvard School of Public Health Center for Executive and Continuing Professional Education. John has done other distinguishing things in academic life. He was the Joan H. Tish Distinguished Fellow in Public Health at Hunter College in New York City. And he taught at the Heller School at Brandeis University. But we know John in other capacities as well. Most recently, John played a very important critical role with respect to the development of the Affordable Care Act when Senator Kennedy asked him to join the Senate Help Committee. And he played an instrumental role in the crafting and the promotion of the Affordable Care Act. John comes to that responsibility with enormous background, because when John was the head of Healthcare for All in Massachusetts, that s where we passed the first really significant legislation that could serve as an example of what we could do at the federal level. And so John was asked by Senator Kennedy, from the experience in Massachusetts, to provide similar guidance to the development of the Affordable Care Act. John has many articles in Health Affairs and the New England Journal of Medicine. He has written three books, Inside National Health Reform, is probably one of the only books that really is substantive, substantive, substantive. Goes over each of the key parts of the Affordable Care Act. He s written a book on A Legislator s Stories of Government and Health Care, and another on Interests, Ideas and Deregulation: The Fate of Hospital Rate Setting.

2 PAGE 2 So please welcome Board member of Families USA, a really thoughtful activist, John McDonough. [applause] JOHN McDONOUGH: Whoa, this is what it looks like from up here, huh? So I asked Jeff Kirsch[?], I said, What does he mean, renaissance activist? And Jeff looked at me and he said, You're old. [laughter] I listened to Ron sort of describe my résumé. And I just think, man, that guy just can't hold down a job, can he? Anyway, thank you for sticking around. Thank you for being here. Thanks for being part of this conference. This has been a really energizing experience to just listen and participate and be a part of it. So, so much has been said in the past several days. I've been here since Wednesday with the preconference. And I thought what I would do in this final talk, which I will make mercifully brief, is to provide four images that I'm taking away from here, and give those to you, and hope that, out of the four, maybe at least one of them will stick with you, going forward out of here. And I hope that these are helpful. So let me just go through these four images. So image one, the first image I will carry with me, came from moderating the panel on Thursday about the use of data and measurement to advance the Medicaid expansion cost. And, as I sat at the front, listening to Regan Hunt from Kentucky Voice for Health and Jim Carnes from Alabama Arise, to listen to the extraordinary progress that has been made in Kentucky, which, of course, is only the second most successful state in the nation with ACA expansion. The leading state is actually Arkansas. And then, listening to Jim talk about how Alabama, which had been viewed as one of the bulwark states against Medicaid expansion, how they are already seeing a shifting of the tide, a significant change in the way that their governor is now talking about the ACA expansions and Medicaid. And I think to myself, I think, Wow, you know, it is game on all over this land. It is happening everywhere.

3 PAGE 3 [applause] I have to ask-- oh, this is different. [laughter] Are any of our friends from Mississippi still in the room? Okay. So to provide a little bit of a counter to that image, I would invite you all to Google Kaiser Health News and Mississippi. And you ll get a story that was put up on the Kaiser New Service and reprinted in Politico from just this past Monday on the implementation of ObamaCare in Mississippi. And, unlike the accounts from Alabama and Georgia and Arkansas and other states, it s not nearly as good. The headline says, it s called, How ObamaCare Went South in Mississippi. And here is just one graph from that article. The first year of the Affordable Care Act in Mississippi was, by almost every measure, an unmitigated disaster. In a state stricken by diabetes, heart disease, obesity, and the highest infant mortality rate in the nation, President Barack Obama s landmark healthcare law has barely registered, leaving the country s poorest and perhaps most segregated state trapped in severe and intractable healthcare crisis. And so it provides a balance to the wonderful accounts that we ve heard of the successes in some states of how much more we have to do, and how our work is so much not done, how much more we have to go. But it does make me think about the U.S. Supreme Court decision that made the Medicaid expansion an option for states as opposed to mandatory. And let me be clear-- and I use this word advisedly-- I hated the part of the Supreme Court decision that made the title to Medicaid expansion an option. I thought it was callous. It was the Supreme Court acting as a death panel. Because, make no mistake, people will die, and are dying, because of that decision. At the same time, I have to admit that there's something good and important happening because of it. Because of that decision in state after state after state, where expansions are happening, where the conversation is opening up, it is advocates and it is the advocacy community that is in the lead. You are leading your states. You are creating a compelling and vitally important conversation about our healthcare future as a nation. And when expansion happens in Alabama,

4 PAGE 4 in Mississippi, in all 50 states, when it happens, it will be because the people in those states came together and made it happen. It started there. And that s where it will come from. And I have to think that that is something very important for healthcare, for health, for the health future in those states. I also think it actually has the potential to be even more important, in terms of changing the nature of the dialogue and the civic conversation in those states, because it is requiring a level of empowerment and of people standing up and finding their voices and expressing them in different ways, that I think is going to be very important. And I think, in the end of the day, when we are through this process, we have different projections for how long it will take. My projection is, by 2020, I think all 50 states will be part of the Medicaid expansion. I hope it s sooner than that. It could be later. Remember, it took about 17 years for the final state to join the Medicaid program originally. That was Arizona, which didn t join it until 1982, 17 years after Medicaid was created in But I think there's something really important here. And, as much as I dislike the decision, I like the action. I like the activism. And I like how there is a new conversation, a new dialogue going on in these states. So that s the first image, the image of Medicaid and what's happening in this mosaic across the country, particularly in the states that are still in the thick of the fight to make the expansions happen. The second image I have from this conversation is forward-looking. And it s not pretty. And it s the image of, not too far from here, the United States Capitol in the fall, in September and October. And there is a word for the image that I see coming. And I can't use it in polite company. [laughter] So I have some synonyms-- train wreck, calamity. Here is the definition I found of the word that I can't mention. A chaotic situation where everything seems to go wrong. It is often caused by incompetence, communication failure, or a complex environment. Okay, what am I talking about? So this fall, September or October, we may well see a healthcare policy mashup in Congress of historic proportions. And what are the ingredients? If the Supreme

5 PAGE 5 Court in King v. Burwell goes the wrong way, I know we re not supposed to say that. But, if it does, we will be having a massive political process in trying to maintain, sustain some kind of subsidy structure in the wake of an adverse ruling. That s number one. Number two, we can already see the efforts by the new Republican majorities, Paul Ryan in particular as well as others, to injure the Medicaid program by installing per capita caps all over the country. We re also seeing, potentially, the need to prevent a calamitous cut in Medicare physician payment, in Medicare Part B, because of something called SGR, or the Sustainable Growth Rate. That s coming to a cliff on March 31 st. And it s entirely possible there will be a six month delay that will put it into the fall sweepstakes. We see the urgent need, of course, to reauthorized CHIP. And we all hope that will happen in February or March and no further. And it is not inconceivable that could also be kicked forward until the fall. And then we see all the other parts of the Affordable Care Act that our opponents would love to eliminate or at least weaken or wound, the individual and employer mandates, the subsidies, the medical device tax, on and on so much. I also think, when I think of this, I think of the key architects of the ACA, who are no longer with us-- Ted Kennedy, Max Baucus, Chris Dodd, Tom Harkin, Henry Waxman, Bill Miller, John Dingell, so many others. And I do wonder, I wonder who is going to be-- who are going to be our new champions? Who is going to stand up and be the key articulate, courageous, indefatigable defender of the achievements that we ve made? We clearly have some folks. We know we have Nancy Pelosi and Harry Reid are still there. Patty Murray, who is the new ranking member on the Help Committee, was very involved in the crafting of the ACA, and we hope will play a leading role. Ron Widen on Senate Finance, Frank Pallone on Energy and Commerce, Richard Neal from Massachusetts on House Ways and Means. Chris Van Hollen on Budget. But we have a whole new generation of leaders on this issue that we need to develop, sustain, support, advance, and promote, if we re going to come out of this fall event alive, because it is

6 PAGE 6 quite consequential for all of us. So that s a second image that I come away with, are the challenges that we face coming to us, not so far away at all. The third image I have is an image I have in this room right now, and an image that has just struck me during the course of this conference, starting back to Wednesday when I was here. And, in many ways, it actually resembles and reflects what s going on in Congress right now. One of the most enduring images I will take away from this are the younger faces, the younger voices, who are all around this room, who are still here now, today, three days into this. Pick your number under age 25, under age 30, under age 35, under age 40, I'm renaissance. So I'm over the hill, one way or another. But there are so many. And that is an enduring, critically important strength of our health justice movement here in the United States, that we have folks who have been in this struggle, in this fight, in this effort for 20, 30, 40 years, some people longer than that. And this movement is changing all the time. The older generation that has been carrying this fight for so long, we are getting replaced. We are transitioning to a new younger generation who will take this movement in new and exciting directions that I and my other folks from the renaissance cohort cannot even imagine. I see it in the young staff in Families USA. I see it in our allied organizations like Community Catalyst. I see it in the state advocacy organizations all over the nation. I see it in my own institution, at the Harvard School of Public Health. It s now the Harvard Chan School of Public Health. That s another story I ll tell you about. A new generation, feeling your power, sensing the need to take higher levels of responsibility, hungering to make a difference, determined to protect what we have won and not to be satisfied there. And to continue to move forward, to move on, to achieve all of the dimensions of healthcare justice that we need. What a site. What a joy. What satisfaction it is to see all of you here participating in increasingly important leadership roles. So here is my final image. And this may freak you out a bit, but just

7 PAGE 7 hang in with me. It involves a text, a book, that was written about 1400 years ago. The book is called The Way of the Bodhisattva. How many of you have read it? A few people have. Okay. All right. It was composed sometime around the year 700 A.D. by an Indian Buddhist monk. His name was Shantideva. A Bodhisattva, by the way, is defined as a spiritual warrior who longs to alleviate his and her own and others suffering. So, if you would, for a moment, consider this a room of Bodhisattvas, all of you. And I would like to read for you just one four-line verse from The Way, easily digestible. It s not like Shakespeare or something like that. Just listen to this. To cover all the earth with sheets of hide, where could such amounts of skin be found? But simply wrap some leather round your feet, and it s as if all the world has been covered. Let me read that again. To cover all the earth with sheets of hide, where could such amounts of skin be found? But simply wrap some leather round your feet, and it s as if all the world has been covered. So, as we all know, there's not enough hide to cover every injustice in American society. Unfortunately, there's not even enough hide right now to cover every injustice relating to health and healthcare in our nation. And, at the same time, we, everyone in this room, is hoping so many of our fellow citizens and immigrant fellows, helping them every day, by helping to wrap their feet, one at a time. I think of this verse. I can't help thinking of the passions so many of us hold, for some kind of a single payer national healthcare system. That seems so much like the challenge of wrapping our entire country with sheets of hide, at least in our excessively materialistic era in the society, it seems like a bridge so far away. So what are we doing instead? We are wrapping leather around the feet of as many people in need as we can, as fast as possible. At least for now, our problems can't and won't be solved by

8 PAGE 8 eliminating each and every outer cause, as much as we might want to. But we can much better protect ourselves. And we can much better protect others by continuing our work together, by continuing to strive, by continuing to push on, by never letting any bad news-- and I mean any bad news get us down or discourage us because we pick ourselves up, we dust ourselves off, we start all over again. We keep going, because that s what this movement demands of all of us. So congratulations to all of you for what we have achieved. We have so much more to do. You know, this fight is never over until you die. And then it goes on without you. [laughter] Right? Okay. I'm feeling time, right. [laughter] But I am so energized to be with all of you. I am excited. I am optimistic for what's ahead of us. And so let s go forward for another fantastic year. And I look forward to seeing you all here again in 12 months. Thank you. [applause] RON POLLACK: Thank you so much, John. I'm reminded by the Si Kahn song, People like you help people like me carry on. Thank you. Thank you very much. I want to, as we get to the close of this conference, I want to thank some people. There are a lot of people, frankly, who helped to make this happen. I want to, if you don t mind, I want to pick out first two people who played an extraordinary role in organizing the conference. One person you ve seen a number of times during the course of the last bunch of days, Patrick Willard, who is our field director. [applause] I don t know, Patrick, whether you feel you had the benefit or the problem of not having seen previous conferences. But I think this conference has been really good. And you ve led a wonderful team. Thank you very much. Then there's sort of the mainstay about all of these conferences. I probably don t even have to mention her name, but of course I have to. She s the blood, guts and tears of our operations, and has played such a critical role throughout the years with respect to the way that we operate at Families USA and these annual conferences, this being the 20 th. I think you all know who I

9 PAGE 9 mean, Regina Wise. [applause] If Regina didn t exist, we d have to try to invent her. And that would not be an easy task. So thank you so much, Regina. In the past, I've gone through the list of all the different staff people who are involved. And, if I do that again, we ll be close to the health action conference in [laughter] So let me just thank the staff. There are so many staff people who really work hard at this. Can I ask staff people to stand? [applause] It is one of the great pleasures in life to be able to work with people who are just extraordinary, wonderful, and who are inspiring with boundless energy. So I want to thank all of you for coming to this health action conference. We only ask one thing of you, that you come back next year. And in between, you do a lot of work. [laughter] We still have a lot of work to do. We ve got some threats. We ve got some opportunities. But I remember five years ago, when the Affordable Care Act was pending, and there was this election in John s state and Phil and Kate s state of Massachusetts, that scared the living hmm out of us. And we were terribly worried about the fate of the Affordable Care Act. We needed 60 votes in the United States Senate to pass the Affordable Care Act. And we just lost the 60 th vote, passing of Ted Kennedy, and an election that didn t quite work out the way many of us had hoped. And we had 59 votes. But we still had the determination to go forward. And we found a way to do it. And we will continue to find a way to do it. Yes, we need to be worried about what the Supreme Court is going to do during oral argument on March 4 th and its decision in June. But we will ultimately prevail, because we have to prevail. And we have moved so far forward, it s a very different situation today to take something away that now exists, as opposed to providing it for the first time.

10 PAGE 10 We prevailed before. And we will prevail again. And, with all of your energy, and with all of your creativity, we re going to make a much better healthcare system that is really going to be responsive to the needs of people across the country. So thank you for coming. But thank you even more for the wonderful work that you do when you go back to your communities. We at Families USA look forward to working with you in the year ahead. And we hope to see you again. Thank you very much. [applause] END

Edited lightly for readability and clarity.

Rep. Chris Collins Interview Conducted by Howard Owens The Batavian July 26, 2017 Edited lightly for readability and clarity. Q. It's been since July 5th that we talked and there has been all this hold