HOPE Strategy Retreat Report

How We Win National Improved Medicare for All

Recommendations from Single Payer Strategy Retreat
Oakland, CA December 8-9, 2018
Sponsored by Health Over Profit for Everyone

This report describes the recommendations of an in-depth strategy analysis on how the single payer movement can win National Improved Medicare for All (NIMA). It is the result of a two-day strategy retreat held in Oakland, CA on December 8-9, 2018 at Friendly Manor, St. Mary’s Center. The retreat was organized by Health Over Profit for Everyone (HOPE), in collaboration with Women’s Economic Agenda Project (WEAP), and included people with different backgrounds in healthcare policy, poverty and welfare rights, as well as people who have provided health services as nurses and doctors to diverse populations. Key strategy decisions from the meeting are in bold throughout the report.

The Current Situation

The meeting began by reviewing the current stage of the single payer movement. Recent polls have shown that we have majority support for Medicare for all. In August 2018, the Reuters–Ipsos survey found 70 percent of voters support Medicare for all. This includes 85 percent of Democrats along with 52 percent of Republicans. A second poll in October 2018, the American Barometer conducted by Hill.TV and the HarrisX polling company, also found that 86 percent of Democrats, 52 percent of Republicans and 69 percent of independents supported Medicare for all.

The NIMA movement is in a stage of development known as “Majority Times.” This stage is the sixth stage of social movement development when we move from majority to “national consensus.” See The Movement Action Plan: A Strategic Framework Describing The Eight Stages of Successful Social Movements by Bill Moyer, 1987.  This is the stage just before success for social movements. It is important to understand where we are in the process of winning NIMA in order to create a strategy and understand our responsibilities at this stage of the movement. While we are in the final stage before winning, winning is not guaranteed. We have to build the movement and effectively respond to our opposition to ensure NIMA is enacted. NIMA will be most secure if politicians across the political spectrum are compelled to support it.

Healthcare was the top Issue in the 2018 elections. The Intercept reports the election resulted in at least 48 incoming freshman lawmakers campaigning on enacting “Medicare for All” or similar efforts to expand access to Medicare. This occurred despite efforts of the Democratic National Committee and the Democratic Congressional Campaign Caucus to discourage Medicare for all as a campaign issue.  The election is likely to add more co-sponsors to the Expanded and Improved Medicare for All Act, HR676, which is currently co-sponsored by 123 House Democrats, double the number who supported the bill in the previous legislative session. Many of those likely to run for the Democratic presidential nomination are co-sponsors of Medicare for all legislation. The movement has the opportunity to make NIMA a major issue in the political dialogue over the next two years. A goal of the movement must be to take full advantage of this opportunity and build a strong political narrative for NIMA.

The end goal of this phase of the movement is to develop national consensus around three issues:

1. There is a problem, i.e. people recognize healthcare is a crisis problem in the US.
2. The current approaches will not solve the problem, i.e. that means the current healthcare system based on commercial insurance cannot solve the problem.
3. People are open to trying new approaches, i.e. people support NIMA.

We are reaching national consensus on all of these issues.

The goal of building national consensus is to make it impossible for any elected official to oppose NIMA. In order to stay in office, politicians must support the national consensus.

Grand Strategy for the NIMA Movement

There is a consistent grand strategy for social movements that applies in all stages of transformative social movements. Each of our strategies and tactics must be measured against this grand strategy. The goals are to grow the movement, involve more people from different segments of society, especially drawing those who function to support the power structure, to increase internal solidarity and to deepen our resolve. Movements have the opposite goals regarding those in power: to shrink, divide and weaken them.

Slide from the Popular Resistance Movement School “How Social Transformation Occurs.”

In the movement for NIMA, we need to continue to expand our alliances. The strategy retreat focused on a number of key alliances. These included:

Senior Citizens: Educate seniors to understand that National Improved Medicare for All will be an improvement over current Medicare, e.g. NIMA will cover all health needs so there will be no need to purchase gap insurance. NIMA will have no out-of-pocket expenses, co-pays or deductibles. All providers will be included in NIMA so people can go to any doctor, hospital, clinic or other provider. There will be no need for Medicare Advantage or additional gap insurance. NIMA will save seniors thousands of dollars in annual health costs.

Businesses: Educate business to understand that NIMA will provide insurance to their employees at a predictable and affordable cost. There will no longer be increasing premiums from a commercial insurance industry.  Insurance coverage will not be changing and there will be no shrinking networks of providers. All providers will be included so every doctor, hospital, clinic or other health service is available to all employees. The predictable and steady cost of healthcare will enable businesses to plan for and invest in their business, such as predicting the cost of hiring new employees. A national public health insurance will allow businesses to compete domestically and internationally with other developed nations that already have public insurance. There is a growing movement to organize businesses which requires the support of the NIMA movement. See Business Initiative for Health Policy.

Medicaid Recipients: NIMA will provide people on Medicaid with better healthcare coverage as all medical needs are met and all providers are included in the system. Medicaid varies from state to state making it difficult for people to move. Medicaid requires a very low income in order to participate. This limits the ability of people to get out of poverty as increased income means they lose their health coverage. Outreach requires NIMA advocates to listen to the concerns of Medicaid recipients to ensure that improved Medicare for all provides the services they need. Medicaid recipients need to see that improved Medicare for all will improve their lives.

Youth: Some young people from middle and upper class families are able to be insured under their parents’ health insurance until they are 26 years old. After 26, they must find a way to afford insurance. Most young people are not covered by their parents health insurance and must find the means to acquire insurance or live without insurance. The current generation of youth have very high debt, especially if they went to college, and very poor prospects for good-paying jobs. Health coverage by employers is becoming less common. Medicare for all provides young people with excellent health coverage and removes the financial burden of commercial health insurance. Already 69 percent of youth aged 18 to 35 support Medicare for all.

People in Rural Areas and Other Healthcare Deserts: There is a crisis of hospitals closing in rural areas as well as in some poor, neglected urban and suburban areas. NIMA will solve these crisis situations as global budgeting of hospitals will provide the funds needed to serve these communities. The profit motive will be replaced by the public interest. The basic foundation of

NIMA recognizes that  healthcare is a human right, everybody will be in the same program and treated equally with access to all health providers. Related to that, decisions about hospital closings, and closings of departments within hospitals, are being made by the large hospital-clinic chains that are taking over the entire health system. These decisions create underserved communities, or hospital deserts, where people cannot access healthcare.  

People Using the Indian Health Service (IHS) and Veterans Administration (VA): Recipients of these government-run health services will continue to be served by the IHS and the VA but will also have access to improved Medicare. At some point, the IHS and/or VA may be merged into NIMA. It will be important to start working with recipients of these services now to understand and support the policies they determine should be included.

More broadly, single payer advocates must develop methods of starting conversations with people who are undecided or even opposed to NIMA, i.e.,  potential allies, congressional staffers, members of Congress, business lobbyists, that minimize tribalistic, partisan and defensive reactions. We should find ways to  begin such conversations that seek to identify common ground first, e.g., What do you think is causing US costs to be so high?

As we develop stronger relationships with and discuss the benefits of NIMA, national consensus will grow. In particular, we expect to see continued growth among independent and Republican voters as constituencies which are or lean Republican move to supporting NIMA. This could include seniors, veterans, rural residents and business owners.

In the “Majority Times” phase of a movement there is a specific grand strategy that a movement must follow.

Slide from the Popular Resistance Movement School “How Social Transformation Occurs.”

A primary goal is to keep the issue in the spotlight. This means people in the movement should be consistently educating the public about the issue, seizing opportunities to highlight the issue, and doing public events that show widespread support for the issue.

One great strength of NIMA is the truth is on our side. The movement can tell the truth and people will support NIMA. Everyone in the United States will have access to all healthcare providers. People in the United States will save money on healthcare expenditures because the tax to pay for NIMA will be lower than the current premiums, co-pays, deductibles and any other out-of-pocket costs. City and state governments who pay very high health insurance costs will pay much less to provide insurance to police, firefighters, teachers, sanitation workers, and http://healthoverprofit.org/tools/other government employees. NIMA will be a tremendous financial benefit to employers of all sizes, small, large and transnational. NIMA will be the first step to creating a leading healthcare system in the world.

A constant challenge during this period is to make sure the truth about NIMA is available to the public. The major strategy of the opposition will be to try and confuse people about improved Medicare for all. They will do this by using the term “Medicare” but misleading people about the policy. For example, allowing people to buy-into Medicare does not mean Medicare for all. This just creates a public option which is another insurance in an already fragmented insurance system. Adding more insurance, adds more administrative costs, bureaucracy and confusion in the system. The NIMA movement needs to develop a ‘Medicare for All Facts’ website that will be available to media, policy makers, candidates, elected officials and the movement with quick access to facts. The site should provide facts and citations for all of the key issues surrounding NIMA. For a model see Drug War Facts. This can be crowd-sourced but would benefit from having a staff person to administer the website.

Another example of confusion created by the insurance industry and policy makers who want to protect commercial insurance is Medicare Advantage. This is not Medicare, it is private insurance with all the shortcomings of private insurance. The insurance industry is making a major marketing effort to get people into Medicare Advantage programs as they see it as the way to survive a single payer system, indeed to profit from a publicly-funded system. See Medicare Advantage Dangers. Under NIMA, Medicare Advantage will not be needed because improved Medicare provides complete health coverage without any gaps in coverage. All providers are included so the network includes all doctors, hospitals, clinics and other facilities. A major goal of the NIMA movement is to ensure Medicare Advantage is not allowed to continue under NIMA.

Constant vigilance will be required to monitor for and expose industry gimmicks and disguises. For example, the use of Health Maintenance Organizations (HMO’s) and Accountable Care Organizations ( ACO’s) is a way for the insurance industry to get into the single payer system and turn it into a multi-payer system. It will require people in the movement with a detailed understanding of these gimmicks to ensure they are kept out of NIMA

Responding to the Opposition

The grand strategy in “Majority Times” requires the movement to stay flexible because as national consensus grows, those in power, i.e. elected officials, corporate media and industry, will take actions to confuse people. This requires the movement to adjust with rapid response capabilities and clear information to inoculate the public from confusion.

The actions of those who want to keep the current system are predictable and are already evident in the healthcare debate.

Slide from the Popular Resistance Movement School “How Social Transformation Occurs.”

We have seen this before. Majorities have supported single payer for many years. In two of the most recent moments when there was majority support, Democrats were able to mislead voters and throw the movement off track. See this article about weakening Medicare for all from the inside, The Healthcare Bait-and-Switch: From the Clintons to Obama and Back Again

The Clinton Health Plan of 1993, known as HillaryCare, was a response to the healthcare crisis of that era where there was majority support for single payer. Clinton threw the movement off track with HillaryCare, a so-called “universal healthcare plan,” which would have consolidated and protected the insurance industry. It promised a “healthcare security card” and required every resident of the United States to have private insurance.

The second moment was when the Democrats misdirected the majority who wanted single payer was the Affordable Care Act, known as ObamaCare, which expanded Medicaid and required people to buy private insurance. It promised affordable universal health insurance. Obama was able to divide the single payer movement with this false solution to the healthcare crisis.

After the strategy meeting a Texas federal court ruled the ACA was unconstitutional. Over the next two year, coinciding with the 2020 election campaigns, this decision will be reviewed by the Fifth Circuit Court of Appeals and the US Supreme Court. This case will present many opportunities for the single payer movement to make the point that the only solution to the US healthcare crisis is National Improved Medicare for All.

The reality is that neither the Clinton or Obama insurance-based plans would be universal, affordable or create high quality healthcare. The public needs to understand that a system based on profit with a foundation of commercial insurance will never be universal. The profit motive prevents universal coverage. A goal of the movement is to educate people that public insurance serves the public interest not investors seeking profit. A national public insurance, improved Medicare for all, is the only way to achieve universal coverage. We cannot compromise on this fundamental reality.

The Clinton and Obama experiences have made the movement more aware of the tactics used to prevent NIMA. We know the ONLY way to achieve healthcare for all is a single payer system and the movement is already calling out fake Medicare for all programs. Democrats are putting forward fake plans that sound like Medicare for all, e.g. Medicare X, Medicare Buy-In, Reducing the Age of Medicare, Medicare Extra for All. The movement is calling out these false Medicare plans and the movement must continue to rapidly respond to these false proposals.

The tactic of creating confusion with false approaches, Fake Medicare for All, was demonstrated by Democratic Majority Leader, Chuck Schumer, who told Meet the Press on December 16, 2018, “We want more people covered, everyone covered; we want better healthcare at a lower cost. People have different views as to how to get there. Many are for Medicare for All, some are for Medicare buy-in, some are Medicare over 55, some are Medicaid buy-in, some are public option,” Schumer added. “I’m going to support a plan that can pass, and that can provide the best, cheapest healthcare for all Americans.” The single payer movement must show why these other approaches will not solve the healthcare crisis in the United States.

In the Intercept, Lee Fang and Nick Surgey, reported on the plans the opposition has to defeat the movement for NIMA. See Lobbyist Documents Reveal Health Care Industry Battle Plan Against “Medicare for All.”  They report on internal strategy documents that show how the industry plans to derail NIMA. Those who profit from the present system, including pharmaceutical, insurance, and hospital lobbyists, have formed a front group, the Partnership for America’s Health Care Future, that is leading the opposition to NIMA. They seek to keep NIMA out of the political narrative of the 2020 elections, to define those who support NIMA as left-extremists, and urge people to fix the present system, not change it. The movement needs to do the opposite: Make NIMA part of the 2020 elections, show NIMA is supported by a national consensus, and demonstrate NIMA is the only step we can take to solve the healthcare crisis.

We are already hearing the lines of this industry front group from some Democrats who are focused on fixing the ACA rather than replacing it with NIMA. Indeed, the Intercept reported their front group swayed some Democrats running for office (describing Senate candidates who lost and probably would have won if they campaigned on NIMA). Interestingly, even President Obama, the author of ObamaCare/the ACA, now openly supports what he calls one of the “good new ideas,” Medicare for all. If the author of ObamaCare says we need to move on from the ACA, it is time for the Democratic Party to do so.

The arguments the industry front group believes will sway people are that NIMA ends employer-based coverage and will result in tax increases and increased government control.

These are examples of the confusion that those who profit from healthcare will use. The movement must position itself to continue to tell the truth about each of these issues, e.g. employer-based coverage is inferior to Medicare for all because NIMA gives people the choice of whatever doctor or hospital they want to go to as it includes all providers, it is less expensive because there will be no out-of-pocket expenses and taxes will be less than people are currently paying for the cost of insurance. Indeed, the movement is already calling out the false statements of the industry front group.

The industry front group plans a major advertising campaign to convince people that reforms are needed to the current insurance-based system, not “ripping apart” the “world class care” people in the US receive. The reality is healthcare in the US healthcare ranks poorly compared to other developed nations and Medicare for all builds on the healthcare system that already exists.  For Beltway Insiders, they plan to work with DC area think tanks to release studies undermining and confusing the arguments on NIMA. The movement needs tactics that continue to educate Beltway Insiders about the truth about NIMA.

We have already seen these tactics in play. For example, the recent report by the Mercatus Center at George Mason University funded by the Koch Brothers claimed Medicare for all costs $32.6 trillion over ten year but attempted to hide that this was $2.1 trillion less over 10 years than the cost of the current insurance-based system.The movement was able to respond to this phony claim and the study backfired against those opposed to NIMA. Indeed, the study was used to show that in fact Medicare for all was a huge bargain for the economy and people of the United States. And, media, like Jake Tapper of CNN, were called out for their false statements relying on the study.

The history of single payer and the current strategy of the opposition shows we cannot rely only on Democrats to put in place NIMA. The movements need to build political support across the political spectrum. As national consensus grows and more Republicans and independents join the consensus, then politicians of all parties will need to support NIMA.  

The movement should not allow itself to be defined as a Democratic Party movement. Health care impacts everyone and expanded and improved Medicare for all is good for everyone, it is good for businesses large and small and needs to be supported across the partisan divide. Based on the facts of cost savings, efficiency and high-quality coverage this should be an issue Republicans champion. President Trump supported the Canadian model of single payer before he became president and has said positive things about the single payer system in Australia while president.

The State of the Medicare for All Movement

The strategy session spent a good deal of time mapping the movement, i.e. describing the existing movement organizations and their roles. There are four roles in movements for transformational change, during “Majority Times” they have different responsibilities.

1. Reformer or Advocate: These are lobby or litigation groups that bring the movement’s concerns to people in power.These groups also provide research and educational materials to support the movement. During Majority Times, this role becomes more important than in earlier stages. It is important for these groups to recognize their power comes from the grassroots, i.e. the reason the issue is on the agenda and they have access to people in power is the movement. A key thing to avoid is becoming captured by those in power. Reformers should speak for the movement. They do not want to be put in the position where they are speaking to the movement for those in power. This is complicated when there are people in power who seem to represent the movement, e.g. Senator Bernie Sanders and Rep. Pramila Jayapal. The movement must remember even allies who are in government need to be pushed by the movement because they will receive pressure from other sources against the movements goals.
   
   
2. The Helper or Citizen: These are people who are not normally involved in activism but as national consensus is reached and the issue is on the agenda, they become active. An example, is people attending a town hall meeting with a member of Congress and speaking out for NIMA. These people show the broad consensus as people not usually politically-active are playing a role.
   
   
3. The Organizer or Change Agent: These people or organizations work to mobilize people in a strategic way toward a common objective. They build coalitions of organizations to create unity in the movement. They help the movement develop an overarching strategy and tactics to achieve NIMA. They become important as they support the work of the Reformers by providing the energized grassroots that shows elected officials they need to listen to the Reformer who lobby them.
   
   
4. The Rebel.These are people who put issues on the agenda. They demonstrate the importance of the issue through dramatic, nonviolent actions. In this stage, when a politician puts forward a false solution or weakens the proposed NIMA law, the Rebels will confront the politician to show the anger of the movement. They force issues into the public dialogue by putting a spotlight on them. A key role for the Rebels in this phase is to keep the movement from compromising on essential requirements of NIMA.

The movement for NIMA has organizations that work in each of these areas. Some organizations and individuals play multiple roles.

The strategy retreat reviewed many organizations and saw some areas where organizational  improvement is needed.

• Organizations made up of doctors, nurses and other providers are in contact with people who need healthcare. Their members are in an excellent position to build grassroots support for NIMA and national consensus. These providers could include discussion of NIMA in their conversations, provide materials to patients and refer people to movement organizations. A concentrated effort on providers playing an outreach role could greatly build, deepen and solidify grassroots.
  
  
• This relates to understanding that organizations are not just the leaders of groups but their members and grassroots supporters. Organizations need to find ways to consistently educate, involve and activate the grassroots. In addition to national consensus, movements need a mobilized portion of the population that takes action to support the cause. HOPE will organize people to be liaisons with congressional staff and elected officials. We will provide regular materials that can be shared by liaisons with congressional offices. HOPE will also create a lobby packet for the website. HOPE will also create a local organizer listserv, provide a list of local groups on the website with  geographic information, links to websites and Facebook pages and contact information for organizers.

• There is a need for better communication between organizations in the movement. We must be unified in our need for solidarity within the movement. It is especially important for organizations with differing approaches to be in communication as hearing different views creates constructive conflict that leads to each pursuing better strategies and tactics. The strategy of the opposition is to divide us. See this memo from the corporate strategy group, Stratfor, How The Corporations Defeat Social Movements. The answer to their effort to divide us is unity. A movement must not to do the work of our opponents. The NIMA movement must be unified against division.
  
  We are not calling for unity in support of NIMA as a sectarian position but rather doing so on the basis of rigorous research that shows that to cut the cost of healthcare and provide high quality care to everyone, a true single payer system is the only approach to do so. A real NIMA law is the only path because one-third of the cost of US healthcare is administrative costs created by the insurance industry. The single payer movement must be on guard to prevent the insurance industry into NIMA. This means ending Medicare Advantage not allowing HMO’s and ACO’s as well as requiring global budgets for individual hospitals. Public funding of healthcare should not be used to make investor’s wealthy which is why ending for profit, investor-owned providers is required.
  
  
• Organizations need to work together for rapid response capability as misinformation of opposition is put forward. By being united we can create an echo chamber that influences the public narrative with key focus on the elegant simplicity of single payer and how it is the ONLY solution to the healthcare crisis. We will need to constantly repeat that improved Medicare for all is affordable, indeed it is less expensive than the current system. It will save people, businesses, and governments money. The NIMA movement must consistently state that we can win and that we will win healthcare for everyone in the United States.The movement must repeat this and other key messages so they become part of the political consciousness.
  
  
• The movement needs a coordinated presence in Washington, DC involving many organizations representing different constituencies. The opposition will hire many lobbyists to oppose NIMA, we need a group of paid advocates and volunteers working with our DC advocates from across the country to support NIMA. A unified coalition mobilizing their grassroots to support advocates in Washington, DC can overcome industry lobbyists and money in politics.

Immediate Action: Preserve and Improve HR 676

An immediate top priority is to preserve and improve the Expanded and Improved Medicare for All Act, HR 676. We agree with Kay Tillow who, in the article, Improved Medicare for All means something. Don’t dilute it, makes the case for building on the existing bill without weakening it.

HR 676 is currently sponsored by two-thirds of Democrats. The lead co-sponsor is Rep. Pramila Jayapal (D-WA). She is trusted by many in Seattle as a progressive leader but there are serious concerns, even anger, that she is acting in secret to rewrite HR 676. HR 676 was created out of the work of the single payer movement, the Physicians Working Group. The movement needs to be participating in the redrafting of HR 676 so the movement can support it with its full force. Jayapal needs to understand she needs the movement in order to succeed, and the movement needs transparency and participation so it is enthusiastic about her bill.

While Jayapal has met with some people in the movement, she has refused to be transparent in sharing a draft of the revised HR 676 which she intends to introduce in early 2019. Transparency is essential. It is critically important that this bill remain the gold standard for the single payer movement.

Health Over Profit for Everyone agreed at the strategy retreat to organize an immediate campaign to demand transparency and participation in the crafting of HR 676. The bill will impact the lives of hundreds of millions of people and cannot be written in secret by a small staff and a few insiders. There are people with tremendous expertise who have worked on single payer for decades who should be consulted and involved in the drafting of HR 676.

The first step in the campaign for transparency will be an Open Letter to Rep. Jayapal requesting that the draft be made public. This letter will be published on independent media sites and delivered to her office. The letter will set a short deadline for her to respond.

At the same time, we will organize a call-in campaign to her offices requesting transparency in the process and participation of the movement in developing HR 676.

A second letter will be sent to Rep. Jayapal laying out the essentials of HR 676 that must be included in the bill as well as areas for improvement, e.g. clarity that all reproductive healthcare is included is one item from the Senate Bill that should be added to the House Bill.

If necessary, we will escalate with various protests directed at Jayapal. This will include protests in her offices in Seattle and Washington, DC. Videos of people criticizing drafting a bill with such wide ranging impact without transparency or participation by the movement and other actions.

We recognize that Rep. Jayapal is an ally inside the government. We want to work with her as an ally. However, we also recognize that everyone inside the government has other pressures that influence them. There are leaders in the Democratic Party who determine committee assignments, placement in the leadership of the party, funding for campaigns, access to polling information and other activities that can pull someone away from the movement’s goals. In addition, there are donors from corporate interests and the investor class who may be in conflict with the goals of the movement. Therefore, it is important for the movement to continue to pull leaders like Jayapal to the movement perspective.

Protecting HR 676 is the top immediate goal of the NIMA movement. A lot of anger was expressed at the retreat about the secrecy Jayapal is using. Containing that anger will only occur if she becomes transparent and uses a participatory process that listens to the movement.

High Priority: Improving S 1804

While the Senate is unlikely to move forward on The Medicare For All Act, S 1804, in the near future, it is important for that bill to be improved. It has serious shortcomings that make it unacceptable to many NIMA activists. Because of the way healthcare is financed, some refuse to call it a single payer bill. Senate Bernie Sanders (D-VT) is the lead sponsor of the Senate Bill. As with Jayapal, we consider Sanders an ally but we also recognize he has many pressures pulling him in different directions and the movement needs to move Sanders to introduce an improved version of S 1804.

The chart below compares the House and Senate bills. The shortcomings of the Senate bill are evident.

Many of the co-sponsors and Sanders himself, are likely to run for the Democratic presidential nomination in 2020. This is a tremendous opportunity to ensure that NIMA is a central issue of political debate over the next two years. It is important for all the co-sponsors to understand the essential ingredients for a successful NIMA, i.e. a new law that will be effective.

Key ingredients that are lacking include removing investor-owned for-profit providers from participating in NIMA and removing the insurance industry in all its forms, e.g. as a first step ending Medicare Advantage but also not allowing HMO’s, ACO’s and other insurance-disguised gimmicks. The bill needs to include global operating budgets for individual hospitals and other providers specifically to individual hospitals. Moreover, we should not put “global” in front of either “capital” or “operating” budget.  There are two parts to hospital budgets, the operating budget and the capital budget.

NIMA also needs to include long-term care coverage, see The No-Brainer Case for Universal Long-Term Care. People with long-term care needs cannot be excluded from the Medicare for all bill. The foundational principle of Medicare for all is “everybody in, nobody out.” People with long-term care needs cannot be left out.

We will write a letter to Sanders and all the senate co-sponsors laying out these concerns. The process of writing this letter will include reaching out to other organizations in order to build the NIMA movement. HOPE will organize call-in days to the co-sponsors to ensure they are all aware of the issues and we will build the movement around these issues, especially getting the profit out and covering long-term care to confront co-sponsors when they are on the campaign trail. Publicly funded health insurance, improved Medicare for all, cannot be used to fund the profits of investors. For-profit, investor-owned providers cannot be allowed to participate in the Medicare for all program.

If changes are not made Candidates who are co-sponsors can expect to be protested by people with long-term disabilities as well as people opposed to neoliberal capitalism on the campaign trail. This will also include protests at their offices in Washington, DC and in their state. These protests will result in photographs and videos showing candidates being protested leaving out the long-term disabled population as well as creating a healthcare program that funds their donors and other special interests. These changes are being urged in order to create a healthcare system that moves from scoring poorly compared to other developed nations, to one that serves the public interest with high-quality healthcare.

We want candidates’ support for NIMA to be a positive for their electoral campaigns but we cannot support a bill that will not work and does not include the essential ingredients for a successful single payer law. When a better bill is introduced the movement will turn to use its grassroots to increase support for the bill as well as support for the co-sponsors when they are on the campaign trail.

Short, Medium and Long Term Goals of the Campaign

At the retreat, participants developed short, medium and long-term goals for the NIMA campaign. Below is a chart of that describes the goals for the HOPE campaign.

Short term:

Goal	Action
Protect legislation	Jayapal – letter  (HCHR), make the letter public, organize action, contact other legislators, call inSanders – letter, get sign ons
AOC on Ways and Means	Statement of support for it, on website, share on social media
Outreach	Compile list of organizations as potential allies
Rapid response to events	Media Mobilizers -social media training, memes, talking points, place on website where people can get memes and talking points
Educate Congressional staffers	Single Payer Educators – find people to be liaisons, find people to help write, lobby packet on website
Organizers feel connected	Organizer listserv, list of local groups on the website, get geographic info to link with organizers, state Facebook pages

Medium term:

Goal	Action
Educate public	Speakers bureau (on HOPE website under tools), podcasts on NIMA- Humanist, Joe Sparks “MFA Explained”, script on basics of single payer, powerpoints, postcard to hand out everywhere, Andrea Witte videos
Expose profits/privatization	Privatization of Medicaid, video of stories from patients (Jody?) How much does privatization of Medicaid cost, how much they take.How policies create/sustain – 611b stuff, global budgets, private system keeps cost of drugs high.Point out that the system was created for profits.
Raise awareness of HOPE	music (Jim Page), videos, social media
HOPE as a place for activists to go	Welcome page for new activists – trusted resources, contact local groups, where to find information, simpler FAQ, fact and citations page (like drug war facts), geographic info? Update action map. One pagers for different constituencies. Leadership development of HOPE trainers and list on website with contacts.
Involve impacted people	Delineate specific changes to HR 676 that meet human rights (google doc), crowdsource improvements, IHS consultation group, Medicaid working group – thoughtful, informative pieces.
New co-sponsors	Organize meetings, conference calls with new staff (Zoom)
Impact strategy of movement	Share strategy document, speak with allies about areas of collaboration.
Impact 2020 election	Letter to candidates – what the movement means about NIMA, clearinghouse for the movement.
Republican support (voters/lawmakers)	Look at potential Republican lawmakers to target as co-sponsors

Long term:

Goal	Action
Change culture – we can win	Provide people with movement strategy education to understand how movements win. Popular Resistance School. Celebrate progress and victories.
Network of groups	Create a horizontal and broad network of groups united in the determination to achieve NIMA.