welcome, everybody. let's thank the first unitarian church for welcoming us here this evening. church steps up and stands out and steps up for equal rights and social justice, and we want to thank them for that. i think we should thank comes blumenauer for holding this congressman blumenauer for holding this event. we think this is a major step toward to have this forum to talk about where we would like to go, and how you can get involved to move toward this goal. let me outline the plan and i will get out of the way. we have some major national and local experts on this issue about health reform who can help us understand these terms like single-payer, medicare for all. and help us understand the national landscape and then known -- and the local landscape in the state. they will be introduced in turn. will endbefore 7:00, of that part of the program and have questions and answers. , whatwho have questions we will do is there will be people with microphones up top and down below, and when you ask a question we will feel them at -- willlists will ask answer them as best they can. i will moderate. c-span is here, so willie will try to they on time, and hopefully they will turn the cameras around and show that the audience here -- the audience is here while the speakers are speaking. congressman blumenauer? [applause] representative blumenauer: thank you, paul. thank you, t.j. i cannot think of a better place to have this conversation. over the course of the last 10 months, they have been unlike we have ever seen. in fact, we have had several of these conversations right here in this church. but the last 10 years have been an intense period of political upsets, challenging basic assumptions, watching our problems get worse while fundamental assumptions about halt -- about how to solve them, the question. because of the near meltdown of the company, the fierce tea turmoil, theal chaos of the last 10 months, i think we are in addition to date to put the pieces together with a different kind of coalition surrounding solutions that are supported by a much broader cross-section of the public. likeld describe issues transportation or food and farm policy, but the area that i truly think offers the greatest opportunity is health care, and that is why we are here. ironically, much of the thanks stars start toe align goes to trump, the tea party, and republican recklessness. over the last 10 weeks, america is not just getting a national civics lesson, that it is getting a graduate education in health care. now, president obama governs basically slightly left of center and was quite moderate in most of his tactics, notwithstanding the flaming rhetoric that was directed towards him. for the first five years he was in power, you really tried to avoid stark partisan differences. he did work hard to engage republicans. i watched him. and he made compromises. some of which i disagreed with at the time on taxes, infrastructure, and the economic recovery. this instinct to bring people together to take the middle ground was no more clearly on display than with his approach to health care, where he combined market accommodation with some of the powerful interests in congress and the pharmaceutical industry and other special interest and a request for republican cooperation that i do not think was ever really in the cards. we were certainly not helped by some in congress, some of my blue dog colleagues in the house and in the senate, senator max baucus, trying to lowering the sights to be over modest in our aspirations, and we lost a lot of time to thousand night. and ultimately did not gain anything for that trade up. had ted kennedy not died in office, this would have looked much difference, a stronger affordable care act, it still a sub optimal compromise. while it is worth acknowledging the past and at some point over hall,t the goose call -- we can speculate on what happened and why, but our purpose is not to dwell on where we were, to move on to the opportunities that are afforded to us now. the irony is that we're in a better position to begin implementation of a much that are solution. the affordable care act did achieve significant advances -- expansion of coverage, introduction of some concepts that ultimately set the stage for improvements to the american health care, a lot of the pilot projects that are involved now -- but i think we will be moving past this foundation towards a single-payer or a medicare for all or a medicaid -- [applause] [cheers] representative blumenauer: or medicaid for more. candidate care -- i am less concerned about what we call it then moving in that direction. the bottom line is america still pays far more than anyone in the averageouble the oecd for health care in rich countries. and while we all acknowledge that people get some of the finest health care in the world, that is not what the average american gets. chambers thehouse last time the president of the united states claimed we had the finest health care in the world. that was 2002, and it was not accurate then. the reality is that most americans do not get the finest health care in the world. americans on average get sick more often, we take longer to for the, we die sooner privilege of paying twice as much. in some areas, our record orders on third. world.l -- third paternal health has been given a lot of attention. uprightse wally the and services, but medical services are singularly difficult for consumers to be able to navigate to comparison shop and understand the dynamics. need the most critical, expensive, and invasive services when we are least likely to be able to process the information. when we or a loved one is sick of our judgment may be clouded, and it relates to items that are spectacularly complex. seldom are the incentives aligned properly with the providers and patients. there are some exceptions and there are some exciting models, some great innovation, some of which is going on in this community. but in the main, the american health care system is still volumetwo-volume -- to overvalued. now, americans may not fully understand -- [indiscernible] representative blumenauer: i am getting all choked up. support continue to medicare. increasingly, as result of what has been going on in congress, they appreciate the value of medicaid, which provides health care for more americans than any other program. there are opportunities to supplement them with private insurance, but they were, they hold costs down. administrative costs for medicare and medicaid are a fraction of traditional fee for service. they are better outcomes with lower cost and higher satisfaction. brokennald trump's campaign promises, the naked attack on medicaid expansion through the affordable care act, and the attack on medicare solvency have brought this into sharp relief for a majority of americans. republicans are in retreat, and donald trump is on the defensive, and not just about russia. we are going to spend time this evening exploring in greater detail single-payer options, philosophy, and mechanics. we begin the keynote this evening from tr reid whose book made a profound impact on those of uswe begin the keynote this evening from tr in the middle oe affordable care legislation, the healing of america. it is a fabulous tale of how he schlepped his bum shoulder around the world to encounter different approaches to medicine and wildly different approaches to paying for it. the next four years, republicans will control the administration. it's not just hospital and obamacare, but health care reform. they focused instead on lowering costs and denying care. that is their approach. republicans will be in charge of congress, attempting to reconcile this mean-spirited approach with an america that is pushing back. fighting to save medicaid, medicare, and elements of the affordable care act that are working for many americans. not yet a majority, but a strong segment of the population is becoming increasingly engaged and aware on health care. the landscape is changing. i'm excited about how engaged the public is and the opportunities there are two not just protect the affordable care act but build on it and move forward. the american government was famously not built to be efficient. mission accomplished. [laughter] are innumerable opportunities, checks and balances, to interfere with public policy and prevent what the public may want. there needs to be an informed public opinion and engaged constituency, and we need to build on the consensus that is emerging from the people who work in the health care space. i want to give a shout out to at men and women who work providing health care in this country. [applause] nurses, doctors, hospitals, the profession, the whole range of people, the emergency transport -- i have been involved with the political process for a long time, and i've never quite seen an entire sector of the economy where people have come together a well intended but not perfect piece of legislation work. people have rolled up their sleeves and moved forward. encouraged byy the areas of consensus and progress. as of the areas being seen one area of potential is changing that value proposition, value instead of volume, cooperating. they see light at the end of the tunnel, and they will not be served by the continuing battles in washington, d.c. all of these people in the health care space have different competing interests, values, economic, philosophical, but they have been united in rejecting the republicans' assa ult on these protections. [applause] the signal is being sent that no one is going to be steamrolled when it comes to health care. opportunities to broaden public awareness and develop initiatives that we can build on. looking at the big picture is necessary to achieving these smaller steps. i think transformational change is possible for quicker than people recognize. there is something happening around the country. 20 years from now, there will be a single-payer system of some variation. i think it could be 10 years. sooner,ould happen , butding on what we all do first, we must know what the various single-payer concepts entail,at they would how best to get there. ,re there intermediate steps dealing with the fact that republicans are in charge of congress for the next 20 months yet go i have high hopes for november of 2018. [applause] there is this administration for .nother 44 months we've got an opportunity to be .ble to move things forward the public is not going to stand for republicans pricing lower income seniors out of the health care market. they are not going to countenance this assault on , and i think there's an opportunity to be able to engage them in these steps, these strategies. what do we do going forward? tr reid is the best person we could have this evening to get us going. i mentioned what he did with his bum shoulder. mess,test book, a fine 15, about thepril i think there's another bestseller here for congress. he's got a great knack. leadership of an unsuccessful but important single-payer campaign in colorado last year. [applause] he is insightful. boil analytic, and he can it down in terms that are so simple, even a member of congress can understand it. i'm going to shut up. i'm going to sit down and welcome to the podium tom reed. [applause] >> thank you very much, congressman. i am delighted to be here. i love coming to portland. i really like oregon. i've never liked pumping my own today, boy, i was flying in this morning before the rain started. mt. hood was out there spectacularly next to the airplane. i was like, boy, these people must be lucky. as a person interested in health policy who has this nutty idea that a decent society should provide health care for everybody -- [applause] view hasho holds that to have respect for organ. here's what you've got. you have a bunch of troublemakers and rabble-rousers, applecart upsetters, doctors, nurses, members of congress, rabble-rousers who refuse to our absurdly fragmented, ridiculously expensive, and in equitable health care system. your rabble-rousers for decades have been fighting to do something better about health care, and there's a long list of people in this state who have been national leaders. are you are out to -- allowed to say something good about john kitzhaber in this room? [applause] it was remarkable to see what he did, and he still has the right idea. we ought to listen to him. the leaders of health care for all oregon have been national leaders in this program. [applause] the oregon chapter of physicians for a national health program, one of the best in old country. [applause] there's a group of oregon physicians who call themselves the mad as hell doctors. [applause] they went around the country delivering this message. the nurses have been leaders. earl blumenauer is a leader in this field. there's something about oregon where people have decided, why don't we find a way to provide high-quality health care to everybody at a reasonable cost? a bunch of radicals. i'm telling you. i'm happy to come here. i'm a little daunted coming to oregon, because i'm a coloradan. i'm a proud coloradan, and we feel a sense of competition. oregon, because i'm a coloradan. last time i was here, i was bragging. i said, you guys have ducks and beavers. we have buffalo and rams. somebody said, our docs igor buffalo for lunch, which is true. [laughter] ing have thunder rivers, rich forests, great cities, fruitful plains. that, but youof also have a notion. it seems unfair to me. the last time i was here, i did the 4t trail. it's fabulous. [applause] it's a train, trail, tram, and trolley. is that it? me, wise portland ian told go west to east, and it's free. if you go the other way, you have to pay. i did it. it's fabulous. ek.ac ust a great half day in the middle of a great american city, you are in this thick forest. we don't have that in denver. i wish we did. took met off, dr. metz to flaming spanish coffee. we don't have that in denver either. [laughter] my assignment tonight is to take us out of portland, take us out oregon, the united states, take a rapid trip around the world to see other countries like us. there are about 35 of them in the world depending on how you define democracy. what do they do? one way of looking at it, most important, the answer is pretty simple. the other countries like us. all the other developed democracies on the planet have decided to provide health care for everybody. all of them do it. health care for all. [applause] all their citizens, all their foreign residents, legal or illegal, foreign correspondents like me and my family. that is the fundamental rule. there is only one industrialized democracy that does not provide health care for everybody. that is the world's richest country, the united states of america. which up with obamacare, was in advance but not perfect. got to 28.5 million people without health insurance. that was a milestone considered good. now it's clear they want to take us backward. we want to go back to 50 million people without health insurance if they get their way. to me, this is a national disgrace. it's wrong. we should not do that. a decent democracy ought to provide health care for everybody. the united states is a rich, compassionate, decent country. we should provide health care for everybody. we should, and we could. i know we could, because all the other countries like us do it. if anybody needs to leave early, i can reduce my argument to a bumper sticker -- are you ready? if france can do it, the united states can do it. that's the whole thing right there. [applause] as i said, that is the simple part. you make this fundamental commitment -- if you live in our country and need health care, we are going to provide it. it gets more complicated when we talk about how they do it. there are many different ways to do this. agree onich countries the destination, a formal health care for everybody, but they disagree on the route to get the re. earl didn't give me much time, so i don't have a lot of time to go through them. there is a book on the topic. some countries do it with one single-payer, and that system works great. i lived in great britain. my family got great health care from the national health service. we didn't have to wait that long. britain covers everybody, 62 million brits, another 12 million foreigners or aliens in their country, foreign correspondents. they have better health statistics than we do and spent 44% as much per capita through the single-payer system. other countries have multi-planar systems. japan covers everybody, fabulous health outcomes. 3200 different payers. germany, 220 different payers. those multi-payer systems worked in a way -- the economists call it and all payer system.there are 3200 different insurance thes, but they all have same rule and same form and pay the same feed to the doctor. they work like single-payer. that is the model that works. there are different approaches to how to do it. some countries, britain for example, say, you should never pay a doctor bill. they paid through high taxes. it pays for health care for everybody, but it is expensive. playcountries want you to -- pay for everything. in france, they make you pay. , andurrent fee is 23 euros the insurance company pays you back the same day. they have a rule -- does anybody have that in america? the insurance company pays it the same day? that is the rule in france. so you knowu to pay you have a valuable service and there were costs involved. what i'm getting that is, there are different routes to that destination, but they all agree on what we ought to do. why? i went around the world and asked health ministers and doctors, why do you do this? why do you provide health care for everybody? the most common answer i got was, why don't you? [laughter] they kind of feel this smug superiority. america, we are richer. we are stronger. we have the biggest navy, but they give everybody health care. they have a right to feel superior. they've done it, and we haven't. why would you do this? there are several things. one thing that is obvious, if you cut health -- provide health care for everybody, it saves lives. if you believe in protecting human life -- [applause] in the united states at the moment, we have 28 million people uninsured, and according to the national academy of sciences, at that level of uninsurance, 22,000 of our fellow americans die every year of treatable diseases because they cannot see a doctor. that is happening every single day in the world's richest country. it's a disgrace. why do we let that happen? do you know how many brits die of treatable diseases because they cannot see a doctor? zero france? zero. netherlands?? zero. if you cover everybody, it saves lives. here's the second point. guess what? if you cover everybody, it saves money. it's cheaper. [applause] this was our argument in colorado when we were arguing for universal health care. yes, it costs less, and it's true. members of congress said, that counterintuitive. i'm going to cover more people and spend less? absolutely. you want proof? go to any of the 15 countries in my book. they cover everybody, they had better health outcomes, and they spent half as much. why? one major reason is that doctors ctor --e mad as hell do if you can spot that illness early, if the person with a vague pain in her abdomen can afford to go to the doctor and get it treated and she -- he finds an infection, that is treatable. that is a $100 treatment. in america, she can't go to the doctor, and four weeks later, she has the -- has a burst of pendants. money --ow we send save money, by covering people. you spend less if you cover everybody. those are practical reasons. the real reason all the other countries like us have committed to providing health care for everybody, it's pretty simple. it's the right thing to do. [applause] other countries see it as a moral imperative. doggone it, we've got to care for our neighbors when they are sick. fromcountries, this comes religious motivation. someone told me when i was doing ins work around the world, the first book of our judeo-christian bible, and asks a fundamental human question -- keeper?brother's all the following books of the old and new testament answer that question, yes. yes. i am obliged to care for the least of my brethren. that is a fundamental human obligation, and if we don't do it when they are sick, we are not meeting our basic moral duty as human beings and fellow citizens. why would you want to live in a country where 22000 and neighbors die unnecessary deaths because they could not see a dr.? who would want that? when i went around the world and said, why do you do this, i got this blank look. isn't it obvious? i asked this question, and she is french. she said, you americans, you say everyone is created equal. it's ridiculous, she says. beautiful.ome are some have a sense of fashion. she said, once you are sick, everyone is equal. once you are sick, we are going to treat everyone equally. another key point i want to make. guess what? health care is not free. health care is inordinately expensive in all rich countries. it is worse here. we pay vastly more than everybody else for the same treatment, same drug, but in all countries, it's a fundamentally large part of their spending. in america, we spending 18% of our gdp. that is one out ofthat is one o0 we spend on health care, but other countries are at 12%,that0 we spend on health care, but other countries are at 12%, 13% of gdp, 11% for some. that is more than they spend on their military. it is more than they spend on pensions. it's a fundamentally huge amount of money. their fundamental belief is, everyone should be covered. here is what goes along with that. everyone should pay. covered, everybody pays, except the poorest people. the theory is, they will get back to work and start paying. it may be that they paid her taxes. it may lead that everyone is mandated to have an insurance policy. but healtho-pays, care is not free, and they cannot provide it for free. in other countries, they refer to this as a matter of personal responsibility. if you are living person, you are going to run up health care bills, and you need a responsibility to pay some part that. that. the reason i want to emphasize this is, if you look at the so-called american health care act, the republican health care plan, ryan care, trumpcare -- someone in oregon told me it should be called waldencare. [applause] [laughter] that goes the other direction. that takes away the concept of personal responsibility. remember ronald reagan complaining for welfare queens who wanted something for nothing? that seems to be the republican standard. let's give people something for nothing. paul ryan, the champion of the health care act, said, americans should have the free choice to decide whether or not to have health insurance. they should have the free choice to be irresponsible. what happens when one of those americans, a young mom who has made the free choice not to have health insurance, what happens when she gets in a car wreck with two kids in the back seat? by the time you have an ambulance, a couple weeks in the emergency room, you are looking at seven figures worth of health care, and if she is not insured, we are still going to provide her care. we are not going to let that mom and her kids to i, but the hospital is going to have to provide that care. it is worsethey are going to pas to the rest of us. this is paul ryan's notion of free choice. you go without health insurance and stick the bill on everybody else. been said that this american health care act should be called the freedom -- freeloaders relief act of 2017, because it says, don't worry about paying your own bills. don't worry about health insurance. just go to the emergency room, and we will stick the bill on everybody else. this seems wrong to me. this seems un-republican. barack obama's bill, as the it had somesaid, serious problems, but at least that president had the courage to tell americans to be responsible to pay their own bills. now we have a president who says, stick it on others. that is a fundamental problem with the american health care act. no other country in the world would do it that way. they know it is expensive, and they want everybody who can afford to to pay. that seems pretty basic to me. how are we going to do it? how are we going to get there in the united states? if the republican plan passes, we are going backwards. we are going to have fewer people insured. that seems long to me. how are we going to do it? we are going to do this state by state. states, three states, we will find a way to provide health care for everybody, and neighbors will copy it. if we can do it in colorado, new mexico would have to do it. if you did it in oregon, washington would do it the next week. [laughter] way, but we is a tried to do this in colorado. we had a plan called colorado care, which we did get on the ballot. it came to us from a group of dreamers and idealists who came up with the plan to provide health care for everybody in colorado. i had written a book on this topic. they came to me and said, why don't you be chairman? i said, you are nuts. to get on the ballot in colorado, you need 97,000 signatures. we got 167,000 when we told people what we were doing. [applause] we learned some lessons. one lessonwe learned some lesso. one lesson is, don't hire me to be the chairman. we lost. we lost pretty badly. insurance companies, for some reason, did not like our plan. that meant they couldn't keep raising their rates 20% per year. they spent $8 million to defeat us. we raised $825,000 and got creamed. the wording of the amendment really matters. when you put this on your ballot in oregon, here's what we had -- we had a ballot, the wording written by the secretary of state, and it said, shall we raise taxes $25 billion to - -right there, i think we lost it. [laughter] we tried to fight that, but we couldn't. we achieved a lot. we definitely found that we couldn't find anybody in colorado or anybody in any insurance company who will defend the current system. every one of them agree that the current health care system is no good. just about everybody agreed when they were asked, should we provide health care for everybody, over 90% of coloradans a said yes, and when they saw that wi-fi billion dollars, they were a little skeptical. -- the $25 billion, they were a little skeptical. when we lost, we went around the state to talk to the people who worked for us, and 66,000 coloradans signed up to keep working for universal health care. i think we are going to do it. aye been to oregon, i've seen what hcho and pnap and all the others and members of the legislature are working on to get this done in oregon. i hope you do it. i hope you do it. but i hope we do it first. you know, we're the buffalos and the rams here. so what i always say when i come to oregon, and i mean it, is, i'm from colorado. we beat you to marijuana. we'll beat you to medicine. [applause] mr. >> thank you so much. thanks to all of you for being here. let me now introduce sam metz, he's a recently retired anesthesiologist, a founding member of the portland chapter, and a tireless worker for universal health care and single payer. there's no one i know that's more attentive to the tail and yet able to summarize things so we can all understand them. so sam, why don't you tell us. [applause] sam: that was a polite word for my personality, i think. we are in a historic building. in 2011, oregon's first large single payer conference was held right here in this building, in this sanctuary, the guest speaker, the keynote speaker was representative john conyers of michigan. [applause] the author of h.r. 676, america's expanded and improved medicare for all bill. that's our national single payer bill. he was also, by the way, introduced by the indefatigable dr. gorman at that time. representative blumenauer's endorsement of h.r. 6 6, the national single payer plan, is momentous for many reasons. one of which is, it helps move the national conversation about health care reform from, should we repeal, repair, or replace the affordable care act, to what kind of health care system do we want and how do we get it? what we want is not easy but it's simple. we want access to our families to health care that's independent of our credit rating at the time we need care. we want our costs to go down and it doesn't matter whether we call it taxes or premiums or out of pocket payments, it's all our money. want the total amount to be more. excuse me. less. we want it to be less than we pay now. which is pretty easy. no one else pays more. lastly, we want better outcomes. a don't want to know that if family member becomes pregnant, there are 59 other nations where she and her baby have a better chance of surviving the pregnancy. better care to more people for less money. pretty simple. how do we get it? tom reid eloquently describes it in his book, "the healing of america." every other industrialized country provides better care to more people for less money than we do. the only thing they have in common you heard about some of the variety the only characteristic all those countries have in common is universal care. universal care means, as you heard, everyone participates in a prepaid health care plan. nobody can be excluded, nobody can opt out. second, every policy covers treatable diseases. you won't die because you picked the wrong policy. finally, every patient can see every physician. physician payment is based on value of service, not on the insurance of the patient. in insurance speak, that's one risk pool, one set of benefits, one network. universal care isn't a goal. it's the first critical step in providing better care to more people for less money. we might be able to do that. we might be able to provide better care to more people for less money without universal care but we would be the first country in recorded history to achieve it. could be that neanderthals did it but forgot to scribble on the side of the cave. meanwhile, oregon has not been idle. there are not enough seats up here for all of the oregon legislators who support single payer health care in oregon. we are -- [applause] we are fortunate to have two leading lights of this movement in oregon. one is state representative alyssa kinney guyer. she is chair of the house human services committee. a member of the house health care committee. she was vice chair for two years. in 2015, she co-sponsored h.b. 2828 which helped to fund oregon's first state sponsored study of universal care and she is a co-sponsor of s.b. 1046 which is oregon's statewide single payer bill. somehow in all of those years of public service she got a masters of public health. i think that's pretty admirable. we also have state senator michael dembro. [applause] in 2011, then representative den breaux introduced his -- democrat bro introduced his -- representative dembro introduced his single payer bill. now he's in the senate and this year he introduced once again the statewide single payer bill which has 33 co-sponsors. [applause] one out of every three oregon legislators is a co-sponsor of the senator's bill. please now welcome to the podium, representative kenny guyer and state senator dembro. thank you. [applause] kimmy: i want to add my thanks first to earl for hosting this event and the incredible site you're put -- fight you're putting up back there in washington, d.c., we have your back and we're so grateful for everything you do. how -- and i want to say hon in order i am to be up here with tom reed who has been -- who has done so much work with the doctors who have been at the forefront of the legislative battle. we have a couple of legislators who are here, senator lou frederick, stand up. [applause] and i believe representative representative mall strom is here. -- malstrom is here. right? back there she's a nurse active with single payer and i know a lot of you in the audience have been involved for a listening time. as a member of the health care committee and also chair of human services and housing and on the early childhood and family support committee, i really deal with a lot of the most vulnerable populations and we know that health care is so critical to having a thriving society. we are so -- so frustrated by our current system. i think we've done some very innote vay -- innovative things in oregon with our c.c.o., coordinated care programs, integrating mental health, dental health, really trying to be more preventive, trying to take care of housing and social determinants of health. it's only a piece of the population. people are going in and out of that system all the time. if you've got a woman with breast cancer, you can have access to it up to 185%, normally you're at 138%. if you have kids they're on it up to 300%. if you are undocumented woman you can have it while you're pregnant only, it ends at birth. if you are a a pregnant woman you can have it, normally up to 138% of poverty line but if you're pregnant you can -- and you're a documented person and you're up to 185%, you can have it while you're pregnant but two months later. it is ridiculous. people are part time. they get a few more hour, they're no longer eligible have to get off the care they've been given from a doctor and join a private payer who may not accept the same -- may not accept your insurance. so this churning back and forth affects the quality of care people have and relationships with their provider. the other thing it is most people because the average amount of stay in a job is seven years and you may switch employers and get on a difference health insurance provider you may again lose your provider but also you typically, our insurance companies are not putting emphasis on preventive policies because they know they're only going to have you for a sench amount of years that drives us crazy. the administrative costs of course, which tom mentioned, are ridiculous in our system. look, what other country has so many different fragmented systems. we have government-proided -- provided health care through the v.a., the private payer system, and then public payer with paying private providers with public sector but even in that we've got medicare with a policy at the federal level, medicaid where we do more policies at the local, at the state level. it is real illinois hard to provide policies that have any kind of coherence at all when you've got so many different players. we have in oregon tried to do innovative things. first we included undocumented women. we're trying now to cover all kids, 17.5,000 children who are undock youmented. we tried covering copa, the compact or free associations of three pacific island nations whose citizens are allowed to live here because we bombed their islands and created a lot of health concerns. they are allowed to live here legally but cannot get onto medicaid is we've done a premium insurance assistance plan for them. we tried to cover the people who are eliminated from medicaid through the five-year bar, if you're legally here as an immigrant, you're not allowed to have medicaid for the first five years. we try the basic health care. we've been put our finger in the hole. pharmaceuticals we have a bill that says no up with should pay more than $100 for their pharmaceuticals and insurance is going to have to pick up the cost but if the cost goes over the cost of the top five, the ice in the top five oecb, -- oecd, the 35 or so industrialized countries, if our pharmaceutical price go over the average cost for -- in those top five, not bottom five but top five countries then the pharmaceutical companies would have to rebate, give a rebate to the insurance companies and we're having a hard time doing that in oregon. guess why? we're a small market. people are like, well, they can -- how do they keep the costs down in france and switzerland and england and those places? well, that's because they can negotiate because they're single payer. they have a bigger, they have a bigger negotiating. so all kinds of ways in which this has been really frustrating. i just want to say how honored i am that my state senator has been such a champion on bringing single payer to the capitol. he started this in 2011, had nine people. i came into the legislateture in 2012, my first session, and has joined forces, i'm honored to have worked on this we have a long way to go but we have made a lot of progress and he'll tell you about that. [applause] >> thank you, alyssa, and earl for setting this up, tom for coming all the way. i first met tom in the summer with en ebbett me that colorado would get the single payer before oregon. that was a bet i really feel bad about losing. would have liked to have -- i really would have liked them to pass it. but we'll see. we'll see about next time. but most of all i want to thank you all for being here, for coming here. as tom mentioned, oregon has been working on health care quality, health care access, health care reform for many, many years. and i recognize a lot of people in this room, how many of you were working on this issue 10 years ago? yeah. look at that. a number of people. tom mentioned the doctors, i first got involved with this issue through jobs with justice, a single payer tax court, all sorts of eem have been working on this for a long time. and you know, i remember back to 2009 when obamacare, the affordable care act was being discussed and many of us were hoping that a single payer program would get into that. into that program. then we were hope, at least the public option can get into this program. it didn't. but one thing that did get into the affordable care act, and that's thanks again, there are a few people in this room who joined me in meeting with our own senator ron wyden who made sure there was a provision put into the affordable care act that would allow states to go their own way. that would allow states to create their own single payer systems after 2017. guess what? boy, 2017 seemed so far away back then in 2010. but here we are. we have a lot of work yet to go on this issue. a state program is going to require a huge organizing effort. i'll get back to that in a moment. we have been introducing refinements, variations of what we call the health care for all oregon act. with each biennium. it started with nine sponsors that became 15. that became 24. that became 30. now we're at 33. but i will say that because -- although it sometimes seems like legislators are in here for life a lot of them do move on and do other things. all the e to include sponsors that have -- all the legislators who have signed on to this program, there are i'm sure close to 50 if not over 50e which really is something. we have yet to crack the partisan divide. i'm waiting for the day we get our first republican. i know that there are hcao crazies out there putting a lot of pressure on their representatives and senators out in the more rural parts of the state to get them to do that going that is what it's to take. sam mentioned we, through work in 2015, then finalized in -- work done in 2013, then finalized in 015, there was money far study done by rand corporation looking at the best way to finance health care here in oregon. they looked at four different models. they looked at the affordable care act that is the status quo, we thought, at the time. now of course we weren't anticipating that even that would be under -- in jeopardy. it included a public option that would be sold on the exchange with private insurance. it included a very high deductible plan financed through a sales tax. and it included the health care or all oregon program. what it decided, after the research that was done and the analysis of that research, you won't be surprised to learn that the health care for all oregon act would provide the highest quality care for the greatest number of people. is that a surprise to anyone? no. that's what a single payer plan will do. and it would do that in a way that was the most efficient in terms of keeping administrative costs down. and it would do it in a way that could, by providing large pools of users, could be much more demanding in terms of its negotiations with pharmaceuticals. and other providers. and so that was the good side. on the downside, it did -- they did point out challenges. and a lot of those challenges were connected to the fact that we don't have a national program. right. because for us to move forward with single payer, we would have to get waivers from the federal government in a number of areas, for those of you who really know this stuff, erisa, medicare, you know if we want a pool that includes everyone, that has to deal with people who are employed in self-employment -- self-employed kinds of concepts, we have to get waivers to do all those things. clearly where we are now would be -- with the trump administration that is going to be a real challenge. having a national program, we would also, you know, the nding of it would be a lot easier because it would be spread out over a lot more people. but what the rand study did show was that we could, as i easier mentioned, provide the best health care to the most people at the most affordable price in that we would -- it would cost us no more than we as a state are currently paying for health care. but it would do it in a different way. instead of looking at premiums and deductibles and all sorts of out of pocket expenses and all those wages that are not going into salary because they have to go into -- into benefits, you add all that up together, we could be doing this much mproved system here in oregon. and so that is what we will continue to work on. one of the lessons, i think, of the obama -- i'm sorry of the demise of the obama administration, of the trump administration, is that a lot of this, whether we're talking about health care or climate change whether we're talking about you name it, a lot of the work is going to have to happen at the local level. at the state level and actually at the very local level. but also i would say at the regional level. some interesting things are going on, as many of you know, in california right now. california is making support for single payer a sort of, you know, a marker for democrats down there. you know. which side are you on? kind of thing. o it's very -- yeah. and so what we have to be thinking about doing as we're preparing for our election here oregon to put single payer on the ballot, which right now is looking like the year 2020, ok, how can we partner with washington? so that they get it on their ballot in 2020? how do we partner with colorado, so they get it on their ballot in 2020? so that all those insurance dollars are going to get spread out. right? [applause] because otherwise they're going to pick us off state by state. and let me say, if california can do it, it's going to make it so much easier for the rest of us. right? because as many of you know, you put california together with oregon and washington and you've got the world's sixth largest economy. that's mainly thanks to oregon, of course. yeah. in order for us to get there, it's going to require, as i mentioned before, just really massive organizing. and i want to thank our friends healthcareforalloregon. hcao. we're going to have to get support from a million oregonians. our job is going to be to get the legislature to refer this measure to the ballot so the wording, as tom mentioned, is the right wording, so that the timing is the right timing. that it's our legislative generated initiative that the voters will support. but it will take a million voters to say yes. so that means everyone in this room is going to have to get 10 of their friends to support it. and they're going to have to get 10 of their friends. and yes, it's not just betsy devos' family that can follow the amway model. so can we. we are going to do that and we will pass this with the state. it's not just about us. i, this year, received my own single payer card. i reached that golden age. so i'm on single -- i will be on single payer. medicare for all. but this is not just for us. this is for our children, this is for the future. this is for all americans. thank you for your support. [applause] representative dembro and kelly guyer. looking out in this group it occurs to me that persistence and hope are the two things that this collaboration is about and has been about. so betty johnson, betty? would you stand up for a minute. [applause] thank you. and betty is persistent. i met her in 2001 or 2002. i know students for national health program are here. there's some of them right up here. stand up. [applause] hey are hope, right? you couldn't talk about it. it was literally, explicitly excluded. i was going to talk about, just mention it. today it's a major part of the national conversation all over the country. [applause] so i think betty's example has shown us, we need to be in it for the long haul. we need to keep up, as senator dembrow said we need to sign up with hcao and keep the momentum going. with that, i want to open the forum for questions. it's a public forum. we should have someone from representative blumenauer's office with a microphone, someone there with a microphone, someone here with a microphone. we have people with microphones. the news is, just to make sure we get some questions, there's a free copy of the book, "the healing of america" to those who ask a question. i'll try to be fair and -- you had your hand up right away. here's a microphone. >> first of all i want to say, thank you representative blumenauer for hosting this event. kevin fish, mental health consumer organization. i want to say some of the things we find, we struggle, approximately one million people in oregon are on medicaid. 750,000 people plus are on medicare. when we have a hearing related to medicaid and medicaid customers, we have a really difficult time getting a critical mass. if we have a hearing about housing and landlords, we don't have a problem with that. if we have a hearing about medicaid and medicare for all, we have a whole bunch of aarp members. where do we get the folks that are receiving medicaid, how do we get them engaged in this debate? i think they could benefit from it. thank you very much for your time and where is my free book? [laughter] >> what i mentioned about this national conversation about dicaid has been really transformational. i've been in this business a long time. there's been more articles published, more news accounts, there's been more attention focused. and frankly we're doing a better job of communicating how medicaid is so tide to the overall system. the 74 million people, it's not just nerms of the income, this is the majority of people in nursing homes. the role that it plays particularly for disabled children. what's happening in our prisons. which have been de facto mental health treatment underfinanced and strained, but we've been able to use medicaid funding to be able to improve those ervices. it is happening but i must say, i thank my republican colleagues, wherthain talking about pulling the plug, adding 14 million more people to the uninsured ranks, literally in the next year, and then putting us on a downward spiral with edicaid. it's getting people's attention. i think we all need to be more effective in terms of bringing it home to what difference it make it is to individual families. how it's tied into so many other areas of education, of corrections, of special needs. senior services. it's phenomenal how little people appreciate all of the implications. but i think it's happening and i appreciate your being a part of the conversation. we welcome opportunities to continue locally focusing on medicaid specifically to talk about those interrelationships. i'm speaking tomorrow morning on a forum that's dealing with mental health and i will be making the point. how important it is to be able to deal with this area. but we welcome opportunities to expand it and welcome suggestions that any of you may have. [applause] >> i just want to say quickly that one of the things that attract nose single payer is health estigmatizes care. people who -- you know, if everyone -- if health care is a human right and everyone has access to it, then no one is better or worse than someone else. you know. people who are on medicare -- [applause] they don't feel there's a negative stigma to being on medicare. they might wish they were 10 or 20 years younger but that's for other reasons. but somebody who is on medicaid there is a negative stigma about it and there should not be. there must not be. [applause] >> you sir, over there in the corner. >> thank you all for coming. would i be wrong in thinking that wall street and wealthy insurance companies are going to be adversarial with regard to single payer because of the financial ramifications? >> anyone want to respond to vested interests? >> one of the reasons it's hard to change health care is because there are big winners in the current system. that would be private insurance companies, big pharma and for-profit hospital companies. they're doing great and therefore they resist change. my feeling is, we could come up with a system that would leave some room for the insurance companies to do business. for example, medicare for all, if you set a basic floor of coverage that everybody in america gets then the insurers can sell their supplemental plans and they're doing beautifully on medicare supplements. they're doing fine. i think there might be a way to work out that we provide a basic system of health care for everybody and then let the insurers sell whatever they can sell as supplemental. this is what happens in france. everybody has a national health insurance plan and then everybody has a private insurance plan on top of it. it's actually cheaper than insurance in america. but those work together and the insurers then are required to agree on who pays which bill. so i think we could offer the insurance industries something. talk to any -- i made a movie about health insurance in america. guess what, every health insurance executive i talked to said they want to see everyone covered. if it's true this would be a way and they could still do some business. i think it's workable. >> you're raising, i think a very important strategic point, and i agree with what tom is saying. for instance, we didn't have to cut such a sweet deal with the pharmaceutical industry. in this country right now, we . ve this crazy pricing system we have crazy competition for stuff advertising, i don't know if you listen to disclaimers on the advertising, it scares the dickens out of me that they're on the television ads. but the majority of prescriptions in this country are -- that are prescribed are not filled. in fact, when we were dealing act and affordable care arguing to the con trare -- and arguing to the country, there was a standard&poor's analysis that expanding act and coverager prices would enable them to be profitable because there's a lot of people who could benefit from these pharmaceutical therapies. that don't do it because they forego the cost. then you've got bureaucracy and all these other items. i mean, being thoughtful and strategic, there is a way for most of the players to make a living. it's just that we don't have to have the inefficiencies, the inequities, and the gaps. and you're asking a question that we ought to think about, because what we've done with medicare advantage gives an opportunity for being able to supplement it but we have to be rigorous, to make sure it's properly implemented but done right it can actually help. i'm working now on kidney health. i am just appalled at --, -- we spend 1% of the federal budget on dialysis. we do a terrible job of dealing with transplantation. we don't help people who don't doe nate kidneys. i mean -- who donate kid mis. not pay them for it but help them with expenses and recovery. we have dialysis patients trapped three days a week, four hours at a time, and then they go off to have other medical appointments when they have some of the most fragile conditions in america. why can't we figure out a way to be able to get more value out of that time? so i think there are ways that we can provide better care and let people do something that adds value but don't have things like we're faced with the pharmaceutical industry now. [applause] >> sir. hold on one second, we've got a microphone for you. -- 'd like to >> can't hear you. >> strategies and tactics. you said that the republicans are not coming on board. it seems to me essential to get the republicans to come on board. how do we convince them? what do the politicians say to people with a lot of ex--- what do people with a lot of experience say in terms of being .ble to convince them >> who wants to speak to tactics? sam? >> the question about wringing on republicans, all elected officials love more than anything else to be re-elected. and the pressure that they will feel comes from us in the room. doesn't matter whether your representative is -- what party they're from. use your weapon of mass destruction. you take your pen and you write them. you say, this health care system has failed me. my family. my clients. my business. my community. i want everybody to have health care. and free. i want you to make it happen. signed, your voting constituent. p.s., let's have coffee and tell me how you're going to do this. doesn't matter what party. send that letter, they will respond. >> i would just add quickly that i think that the reports are really important because right now we need to get businesses on board. that's one of the, you know, close partnerships with republicans. when you read the reports about how much money business is spending on premiums, trying to help their employees get health insurance in a very expensive system, and when employees don't have adequate health care, it's not integrated health care, how much loss in productivity they have, i think those are the kinds of things that are going to be convincing. i think dewe do have the right policy it's just that we're single payer -- it's just the words single payer scared people off. i think we're starting to come around to, if obamacare had its flaws and the new trumpcare has its flaws, you kind of keep coming back to, well, all of these flaws point increasingly to a single payer system. i hope that rationale will help also in addition to constituent pressure. will get some republicans on board. >> thank you. p in the back there. excuse me. i wanted to ask in regards to getting republicans on this, we all know that prevention is cheaper than trying to fix the problem down the road. and t.r. reid, this is -- this question is for you. are there any studies that show these other countries are more productive than us because they have better health care? i know you can't exactly compare dollars to pounds or whatever, but is there a way to maybe pull republicans into this by showing if we're a more healthy country, we're more productive and we're more economically viable? >> yes, i think that ought to be a winning argument. as a matter of fact if you look at the drain on the national economy of spending one of six dollars on health care, when other countries do better spending one of eight or 10, that ought to be a powerful argument. i think in tactical terms, does anybody buy this? i think the moral imperative ought to work with conservatives. if you're pro-life, you should be pro-health care. [applause] >> anybody want to followup to that? >> when i go around the country, i mean, it's the national academy of sciences, it's not i who says that 22,000 americans die every year. it's the institute of medicine, national academy of sciences. when i say that, people say, that's crap. couldn't be right. your numbers are wrong. no, it's true. and if people realized, if republican, democrats knew how cruel our system was, wouldn't they feel a moral imperative to fix it. i think the productivity argument is a good argument. i still believe the winning argument for universal health care is the moral imperative to care for our neighbors. but i wouldn't give up on the economic argument. >> because, we, our companies compete all over the world. they bear the burden for over half the health care costs as part that their competitors in germany , in france, in japan, all these other countries, don't have that problem. at a time when we're actually watching unemployment drop. this is a good thing. but people are concerned about people in the work force. a healthy work force makes a difference. and i think prevention does save money. this is a business advantage. if one state gets this right, they will actually have a competitive advantage in the work space. so i think we just -- use all of these arguments to try and connect people. i think there are -- have been some voices in the business community that have not been as engaged as they could be in terms of defending their own interests. > sir, in the green. >> i sat on the medical board of directors for an international medical foundation several years ago and we had this age-old fight since 1963 about the cost of medication. i suffer from a genetic disorder that was costing me $2,000 a week in medicine. i'm off that medication since 11 years. i talked to a medical convention about two weeks ago and the same medication now costs $17,000 a week. what are we doing to get medicare to negotiate prices like the v.a. does? the rest of the world is doing this. they negotiate prices with the drug companies. why do we not do the same thing? [applause] >> this was the battle we had, recall, in 2004. where my republican colleagues made it illegal for the federal government to negotiate. the largest consumer of pharmaceutical goods in the world cannot negotiate on behalf of medicare recipients. we've seen that it makes a difference for the v.a. we've got to change the law. but this is something that the rapacious behavior on the part of some of these companies, and the fact that this is something we ought to be able to agree with donald trump on who said the federal government should be able to negotiate, there are some openings here. but you're right. it's immoral that the federal government can't behave the way that other employers and governments do. >> i've got one right here and then right here. ma'am? yeah. you've had your hand up for a long time. >> hi. thank you all for being here. so i'm curious. when we talk about a single payer system or all-payer system, would we include extended family leave for mothers, fathers in that? do other countries include those costs in that system? i'm a young woman, want to start a family someday and right now my employer doesn't have to pay me when i take time off to have time with the child. >> extended family leave, where does that fit in? >> it goes well together. >> i don't know if there are any countries that combine those. certainly every other country, industrial country in the world does offer that. i don't know that they do it as part of their single payer system or their health care or universal health care system but they certainly all offer it. and we do have a bill right now in the legislature called family, which is the family and medical leave insurance act. that is partially paid by employer, partially paid by employee in order to provide ve, kind of leave, paid lea not fully paid but it pays a higher percent. the less you make, the higher percent of your salary you would make. it's up to 16 weeksve, not after pregnancy. that bill deserves a lot of support. it's sitting in house rules right now. [applause] >> you, sir. >> so i agree with what she's saying that the way to get to the representative to make them afraid of re-election is to get to them but the problem is you're speaking, what better setting here for speaking to the choir, for preaching to the choir than a church here. and that's what you're doing. the problem is getting to these people in the red districts. i've done some experiments where i've called some of them. i called mitch mcconnell's office. they won't listen to you if you're not a constituent. so the question is, how do we get to the representatives in the red districts and make them afraid for re-election if they don't pay attention to the logic that has been so beautifully set ut here. >> let me say something, then i'll turn to earl. i think the big challenge, i think the real potential for an organization like health care for all oregon, is in reaching every part of the state. members of health care for all oregon have relatives, they know people, they have co-workers. everywhere all around the state. we -- there are active chapters, i know down in the medford-ash lin area and some other parts of the state. that's where the organizing has to happen. and then once they build that kind of heft, that pressure on their representatives will be irresistible. >> what about nationwide? >> we have in the front row some of the portland's nasty women. [applause] the pla cards you see all over the city -- the placards you see all over the city there it is. in fact, we had a gathering right here a couple of weeks ago. what we are finding in the aftermath of some of the political turmoil and upset is that people are asking that precise question and they are working to connect to other parts of the country. sister districts. people are talking about being able to extend their networks to family, friends, people who are co-religionists, members of their alumni association. finding ways to amplify the oice of people who share their concerns, who are in parts of the country that look red. but care deeply about the future of the country, who care about health care who care about justice. who care about environmental protection and lead in the drinking water. and i am just astounded at what is happening in our community in the last four months where people are organizing, they're -- i've lost track of all the it's -- bad r -- -- women. there are there's been truly an outpouring they're connected in interesting ways and spending time being more specific about what they can do to extend their voice and the connectivity. and that is, i will tell you, making a difference. that's one of the reasons that you watched the sand get in the gears on the repeal of the affordable care act. and why the republican bill is in real trouble in the senate. these people are doing that. they're making a difference. i hope each of us is thinking about, you know, our brother-in-law in wyoming, or you know, somebody you know in fossil, oregon. this is a dynamic that is -- i am seeing it make a difference in congress. on a daily basis. >> we have time for one more. congressman blumenauer wants to close in a few minutes. the young woman in the corner has had her hand up for a very long time. go ahead. >> thank you so much. you know, we've got a lot of great brains in the room and i'm sure a lot of you have terrific networks and i continue to think that it's not out of the rem of the possible -- the elm of the possible that we could just trick trump into talking about it some more. embarrass him, compel him, trick him, whatever. i i really think he's the way to get it out to the most ears at this time. so think about that. >> all right, one more question. you, sir. i apologize to all those who had your hand up but i didn't get to you. >> i was a vermont resident for four years. i know that vermonters would have been insufferable if they'd actually managed to beat oregon and colorado to single payer and there was a really good run made at it a couple of years ago, i was sad to see that ultimately fail. i was wondering from those of you who have been strategically involved in this for a while, what lessons can we take away from the sort of fiasco of single pay for the vermont collapsing? >> i'm going to turn that over to our speakers but the first lesson was, we stole the symbol, health care the human right with rosie the riveter, that's their symbol. they came here and told us about it and we took that. what other lessons can we learn from vermont? >> i argue that vermont is not that relevant to oregon and colorado, washington, because it's 600,000 people, half of them work outside of this the state. they have very old population. and it was just too expensive for them to do it with that group. it's just not a big enough risk pool. oregon, how many people? four million. we're at 5.5 million. that's a big enough risk pool for insurance to work in oregon -- and i mean, vermont wasn't. now, vermont is talking to maine and new hampshire about a tristate plan. that would give them 4.5 million, the three of them. that might work because all those vermonters work in -- over in new hampshire. so i felt, everybody raised that. you know. didn't work in vermont. of all places. but it's not a good risk pool. whereas your state, our state are big enough for a risk pool to work. but it may be that the message is we ought to do this regionally. so the west coast states can do it. and the rocky mountain states can do it. maybe michigan, ohio, an indiana could do it together. or something. that may be the message for how it works. i'd love -- i love this idea that all the states put it on the ballot in 2020. and make the insurance companies decide where to fight. [applause] >> thank you. you don't need more speeches. i just want to thank everybody for making the investment this evening to be here. tom, for joining us. [applause] it's great to have michael and alyssa who are carrying a number of battles on in se lem. we appreciate, after a long day coming here and being part of he focus, to have paul and sam pounding away, focused. and eloquent. it helps. but mostly the ideas that are bubbling here. is anyone coming away with an idea or two you hadn't thought about? anybody get some new information? i think the notion being in it for the long haul, the stakes are very high. we've got short term battles in washington, d.c. that we're going to fight. we've got some long-term challenges that we need to undertake. but having an opportunity to continue percolating, organizing, encouraging, and reinforcing makes a huge, huge difference. i know having people like you that i get to represent makes it easier for me to crawl on a plane to go back to washington every week. and i want to thank you very, very much. [applause] >> thank congressman blumenauer once again. let's let him know we're going to be there behind him all the way. [applause] >> congress returns from the memorial day recess this week. the senate on monday, 3:00 p.m. eastern. senators will consider a resolution commemorating the 15th anniversary of the reunification of jerusalem with a vote scheduled for 5:30. the house returns tuesday, with a legislative session opening at 2:00 p.m. eastern. the main bill on next week's tonight in the house -- on c-span, author salman rushdie and others discuss the rise of so-called fake news. and the state of the media. ere's a preview. >> we come up with occasions when the press got it horribly wrong. and we can equally come up with the opposite, you know, when the press did a national service, getting things right. that people were trying to conceal. which only because it's the most famous, watergate comes to mind. but i think we're living dnd i think part of the reason for this is that the mainstream media have been financially impoverished and there are fewer working journalists. and larger and larger numbers of opinions -- opinion people filling up the spaces with -- which reporters used to fill. in there's more opinion and less hard digging. that's the problem. but it seems to me that we live in a changed situation. we live in a situation where on his first day in office, the president of the united states declared war on the news media. and declared them to be his enemy. and afterwards expanded that thought to make them the enemy of the people. a term which stalin would recognize. you know. i'm sure that mr. trump is unfamiliar with it but he may have heard of stalin and if hasn't, steve bannon has. if you're in a situation where the most powerful authority in the land declares the news media to be not only his personal adversary but also the enemy of the american people, that's a change situation. >> that discuss was part of a day-long event hosted by the ethics center and bart college in april. we'll announcer: c-span where history unfolds daily. in 1979, c-span was created as a public service by america's cable television companies. and is brought to you today by your cable or satellite provider. for the next hour, a book tv exclusive. our cities tour visits redding, california, to learn more about its unique history and literary life, for six years now we've traveled to u.s. cities bringing the book scene to our viewers. you can watch more of our visits at c-span.org/citiestour. >> i grew up as a son of a game warden and so the first -- my teenage years i spent a lot of time riding on patrol with my dad and i had all these great adventures working with him as well