Letter from the Chair
Senator Edward M. Kennedy died last week. I found myself glued to the television, reading every piece of coverage in the New York Times. I listened to laudatory comments from his Senate colleagues on both sides of aisle about their friend and colleague. They described how “Ted” would look for areas of agreement and then use these levers to push through legislation. A Sunday NYT editorial described him as the last “liberal,” the last of a breed that believed government should be used to protect the poor and disenfranchised. One of our colleagues said she felt “bereft” at his passing, this man with whom and for whom she had worked. I, too felt bereft, even though I never knew him.
Over the last few months since Kennedy’s diagnosis, the media have spent time trying to identify who among the Kennedy clan will be the family’s new standard bearer. I am more interested in who will be the new standard bearer for social justice in Congress. It is not enough to be a believer; there are still believers in the House and Senate. What is lost is a believer who not only has the skills to bring along members of his or her own party but who also has the skills and understanding to bring along members of the other party who believe in the vision of universal coverage. Yet, with all the accolades for “Teddy” and how he reached across the aisle for compromise in addressing much needed programs, no one in Congress has stepped forward to model those same virtues.
Eight years ago we lost Senator Paul Wellstone. Now Ted Kennedy is gone. But for the activists among us, Kennedy’s words live on: “For all those whose cares have been our concern, the work goes on, the cause endures, the hope still lives, and the dream shall never die.”
Many of our colleagues in the Medical Care Section of APHA have worked for and with these leaders and mourn their passing. This newsletter includes their reminiscences, as well as Senator Kennedy’s remarks as he accepted the Paul Wellstone Award at the 2007 Activist’s Dinner. But the time for mourning and celebration must give way to renewed energy and action. The battle for health care reform must not be lost again to a campaign of lies and misdirection. In the 1980s the catastrophic health care act was passed and then voted down, in part, due to a campaign that scared American seniors. In the '90s the Clinton health care reform effort didn’t even come to a vote due to a campaign that scared Middle America. Today, the tides that had seemed so ready for a change, so ready for real reform, are rapidly ebbing in the face of fear and mistrust by many of the potential beneficiaries of change.
If there is to be health reform, we cannot and must not be silent. Some, like Senator Kennedy, took up the mantle of social justice to carry on the work of his fallen brothers. We have other role models from within our own family who have responded to calls for justice. Let me recognize just a few: Dr. Mardge Cohen, the spouse of Dr. Gordy Schiff (past-chair of the Medical Care Section) is being honored at this year’s Activist’s Dinner for taking up the mantle for HIV/AIDS treatment for women and children in the United States and in Rwanda. Dr. Ellen Shaffer and her partner took up the mantle for World Trade and health. Ms. Nancy Stoller took up the cause of residents of Gaza who are without access to desperately needed health care. Dr. Vic Sidel and his colleague Robert Gould have taken up the mantle of peace time and time again. Dr. Arlene Ash took up the mantle of clean elections here in the United States. These are all remarkable people, remarkable because they stepped up and stepped out for what they believe is right.
More of us need to step up, in whatever way we can, whether it is using some of the personal credibility we have within our communities as providers, as teachers, as policy-makers, or as researchers. We must educate public audiences that are being given misinformation, provide objective research or literature to legislators, or just make phone calls and write letters. We must not let another opportunity to reform our health care system and to expand access to quality health care to all slip through our fingers.
“For all those whose cares have been our concern, the work goes on, the cause endures, the hope still lives, and the dream shall never die.”
This is my last letter to you all as chair of the Medical Care Section. It has been my great honor to hold this office and to have, for a time, this venue to speak to all of you.
I wish you all peace and health (paz y salud).
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Native Health Initiative
Native Health Initiative: A partnership to address inequities in health through loving service
As most of us in the Medical Care Section of APHA know, it will take much more than health care reform to address the vast inequities in health in this country; American Indian and other populations live sicker and die younger largely because of school systems, employment structures and other social determinants of health that are inadequate.
The Native Health Initiative grew out of a community-led effort, hoping to develop a different model for improving health injustices, one funded by compassion and a collective desire for improving health in Indian country. This summer, future health professionals served in tribes in North Carolina and New Mexico; along with community leaders, project mentors, and partner organizations, 6,000 volunteer hours were dedicated to the work. And monetary funding to make this all happen? $1,500.
“It is a beautiful thing to see everyone giving back to their communities, which then inspires outsiders to join in and get involved,” says Raphael Lope, NHI-NM Coordinator.
NHI’s use of loving service (the term it uses to describe the currency of Indigenous communities, where one’s relations with others are paramount to degrees held or monetary wealth) to mobilize resources to address injustices serves as a reminder that the process of our work is as important as the work itself; If programs’ process are not empowering communities, amplifying strengths, and building health from the inside out, they are unlikely to have lasting benefits, even if they show short-term results. In addition, as the oasis of funding for public health programs has dried up in the last year, we see the downside of relying strictly on monetary funding for health programming.
As NHI continues to forge new ground, including its dream to help create a new definition of global health, one that includes the United States and its marginalized populations, we look to continue to work with, learn from, and contribute to the MC Section of APHA.
If you are interested in getting involved with the Native Health Initiative, please contact Anthony (firstname.lastname@example.org) or visit our Web site, www.lovingservice.us. And for those headed to APHA’s Annual Meeting in Philadelphia, NHI plans to hold an informal meeting on Tuesday afternoon, Nov. 10, place TBD.
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Ellen Shaffer, Mona Safarty, and Others
SENATOR EDWARD KENNEDY – A PUBLIC HEALTH HERO
What follows are the remembrances of several Medical Care members who have worked with the Senator. Senator Kennedy will be missed by all who are concerned about the health and welfare of all of America’s people.
Reminiscences on Working for Senator Kennedy by Mona Sarfaty, Former Senior Health Policy Advisor
It was Jan. 15, 1987, and we were at a “Health Goals” hearing at the beginning of the new Congress. Surgeon General Koop was the lead witness. The Dirksen hearing room was standing room only, and the entire press corp was there with pooled cameras. Senator Kennedy was in the Chairman’s seat at the center of the dais and smoking a big, fat cigar. At that time, he smoked an occasional cigar. (In his reminiscence at the Memorial Service, Hatch claimed that Kennedy used to blow smoke his way just to annoy him when they strongly disagreed.) The Surgeon General would soon be in the hearing room. Awkwardly (I was very pregnant) I took my place behind him, seated just close enough so that I could pass notes or whisper a suggestion if necessary. My briefing book about the hearing was on the desk in front of him. I was disturbed to see the cigar. (I was scheduled for an induction of labor the very next day.) So I leaned forward and said, “Senator, the Surgeon General is going to be at this hearing.” He paused and looked at his cigar. He definitely understood what I was telling him. “Awww, can’t a guy have any fun,” he said while he snuffed out the cigar. I never saw him light up another cigar in the Senate. Not long after that, tobacco control legislation became one of his (and my) major initiatives.
Activism on health care has been a central focus of my adult life since my college years, even before I knew I would go to medical school. So, when opportunity knocked and I had a chance to work for Senator Edward M. Kennedy and the Health Office of the Senate HELP Committee, it felt like a privilege. Every day ('85-'92) was filled with purposeful work on behalf of many issues I cared about, especially access to medical care and a public health system that was proactive on problems like tobacco, or HIV/AIDS. One of the best things about the job was that Senator Kennedy was devoted to those issues. In the language of contemporary organizations, we had remarkable alignment on goals and objectives.
Earlier, as a family practice resident who trained at a public hospital in San Francisco, I had cared for uninsured patients who showed up at our emergency room only after being turned away by other hospitals. Since Stephanie Woolhandler and I had been part of the same inpatient team for a while, I was aware of a study she and David Himmelstein did on the problem of “dumping” uninsured patients on public hospitals. They documented the “dumping” phenomena and demonstrated that it was not a rare event. Even though Democrats were in the minority in 1985, Senator Kennedy’s health policy advisors (there were two of us at the time) were asked to develop legislative proposals for the new year. “Dumping” seemed like an egregious problem waiting to be addressed. Medicare revenue generated 40 percent of hospital budgets. Hospitals were tax exempt organizations. It seemed clear that no patients should be turned away from an emergency room because they lacked health insurance or were part of an unwelcome group.
In reality, until the next mid-term election, our chances of getting legislation through the Senate were limited. President Ronald Reagan was committed to weak government, and the Republican dominated Senate was not inclined to take action on a regulatory matter. But thanks to the unflagging commitment of Senator Kennedy to health access, and his knowledge of Senate strategy, we circumvented the political obstacles and pushed through ground-breaking health law, the Emergency Medical Treatment and Labor Act (EMTALA). EMTALA was significant at the time and remains so today. The front page headline in the Washington Post read “Emergency Room Access to Widen.” Under EMTALA, any hospital that wished to receive Medicare payment had to play by the new rules. Every patient who presented to the ER had to be evaluated and treated.
How this bill became law while the Democrats held a minority of seats in the Senate is an interesting story. Fortunately, the Democrats were in the majority in the House of Representatives. The usual route for passage of a new law was to travel through both Houses of Congress. But, there was an alternative pathway. If a bill was introduced in both Houses but reported out of Committee and passed in one House only, that bill could be added on to another bill that passed both Houses during a “Conference.” “Conference Reports” are bills that are negotiated by the two Houses. They have privileged status during debate since they are not amendable.
I conferred with the National Health Law Program about an antidumping bill and wrote specifications for it. We added childbirth labor and delivery to an initial draft. We took it to Kennedy and he took to Congressman Stark who was Chair of the House Ways and Means Committee with jurisdiction over Medicare. Stark loved the idea. They introduced it together as the “The Kennedy Stark Bill” and Stark added it to a budget reconciliation bill (COBRA) that was on a fast track. EMTALA became law. That's the way it happened.
There were many other positives points about working for Senator Kennedy. I heard Barney Frank say in his NPR interview after Senator Kennedy succumbed to brain cancer, that if Senator Kennedy was going to be at the meeting, you knew it was going to be fun. Senator Kennedy had a playful sense of humor. When we drove to the Senate offices with him from his home in the morning after toast and coffee, he would instruct his driver to weave through traffic so he could arrive earlier. If the weaving caused annoyed looks from other drivers, he would slink down in his seat and hold the newspaper up over his face. He enjoyed telling amusing stories. I was asked to drive us to the Senate in my car one morning. Senator Kennedy needed my car make and model for the attendant at the Senate garage. I had just bought a Chevy Celebrity station wagon. As we drove up to the garage, Kennedy told the attendant that he should let me in because, “she drives a celebrity.” He repeated it several times for a bigger laugh each time. There was general amusement at this.
At one of the annual holiday parties which reunited staff, one staff member said to another (an Assistant Secretary of Labor), "You know, working for Senator Kennedy was the best job you’ll ever have." She didn't respond. But I thought about that statement. It was on target for many of us.
My children were born during that same period of time and used to come over to the office in the evening after I picked them up from the Senate Employees Child Care Center. The other staff loved their inquisitive nature, their energy and their drawings. When I finally left for academia so that I could spend more time as a hands-on parent, my connection to the Health Office and EMK (as we referred to him) continued. At times there were requests for help or information about issues we knew well. At times there were issues we felt we had to weigh in on.
Senator Hatch's honest and amusing stories told at the Friday night Memorial Service in Boston about his friendly adversarial relationship with Senator Kennedy were a reflection of what Kennedy’s staff experienced on a daily basis. There was a good deal to agree about but many sources of disagreement. While Senator Hatch said Eunice Shriver would intervene when they couldn’t resolve their differences, it was Senator Kennedy who intervened for us when we couldn’t resolve differences with Hatch’s staff. Both Senators had a near instinctive feel for the ethical principles of beneficence, respect for persons, and distributive justice. They believed that human services should be available to the community and to those in need. While they were at opposite ends of the political spectrum, there was enough overlap in values that it was possible to find common ground on difficult health problems.
But at the beginning of work on every new issue, the two Senators would "agree" that they wanted to get something done that year. Issues were placed on the table, such as smoking, HIV/AIDS, access to care for persons with physical handicaps. Exactly how they were going to agree was not clear. The staff job was to figure that out. That was the challenge. At times, an up or down vote would win the day on the Committee or on the Senate floor. When staff could negotiate no further, Kennedy would negotiate. It was an advantage that Kennedy was willing to get into the details. Once into the details, there was much in every piece of legislation that was not political or ideological. Kennedy could prevail at the end because he had been willing to let his staff guide him into the details.
Senator Kennedy became a champion for an entirely new issue last year after I introduced to his current health staff a scientist who is a member of the UN International Panel on Climate Change. EMK held a hearing, and I had the privilege again of going to brief him and sitting behind him to provide additional information if needed. A provision that grew out of this hearing was placed in Senator Lieberman's Energy Bill in 2008. Once again EMK opened the door for a possible solution to a problem that concerns and confronts us. It is possible that all of us who worked for Senator Kennedy continued to feel like his staff. Perhaps it is only those of us who continued to work for the same values and goals. But that may include most of us.
Remembrances by Ellen Shaffer and CPATH
Senator Ted Kennedy was a hero for many reasons, most prominently his dogged commitment to health care reform. But he also understood that our health in the United States is linked with conditions around the globe, and that U.S. policy on trade influences both. One of the last bills Senator Kennedy co-sponsored was S.1644, introduced earlier this month by Senator Stabenow, to make sure that when it comes to trade, the United States makes public health a priority.
My organization, the Center for Policy Analysis on Trade and Health (CPATH), found strong allies in both Senators’ offices for legislation to create a new advisory committee within the Office of the U.S. Trade Representative that would serve as the voice of public health in all trade agreements. As a result of debates around the Australia Free Trade Agreement in 2004, we all realized that the pharmaceutical, tobacco, health insurance and other lobbies’ disproportionate influence on trade advisory committees benefited those industries but jeopardized health worldwide. In particular, the Australia agreement could restrict access to life saving medicines for our trade partners – and for Americans, too, because of restrictions on reimportation.
The Australia agreement passed, but when Congress took up the Peru Free Trade Agreement a few years later, they succeeded in removing some of the more egregious Intellectual Property and other provisions that would have kept needed medicines out of reach for the people of Peru.
It soon became clear that approaching each agreement was not the solution; that we should instead put health concerns on an equal footing with business interests in our trade policy more generally. Trade agreements provide a basis for altering domestic U.S. laws and policies, as well as those of our trading partners. Senator Kennedy understood that trade rules must find a balance between keeping goods and services flowing, corporations’ need for uniform and predictable rules, and the obligations of governments to protect the public’s safety and well-being.
As research CPATH has just released shows, Intellectual Property protections written into CAFTA (the Central America Free Trade Agreement) are having a catastrophic effect on Guatemala’s health system. The cash-strapped Ministry of Health is now paying up to 864% higher prices for brand name drugs than they would pay for generic alternatives. Generics – many produced by Guatemalan companies – are often barred from entering the market and even pulled from the shelves in the wake of CAFTA.
According to a contact there, because of cost-cutting efforts, she and others living with HIV/AIDS are now allotted their medications in eight-days doses, meaning they must make sometimes arduous trips to the nearest clinic four times every month. Imagine taking one day a week away from work and family obligations just to fill a prescription.
Senator Kennedy devoted the estimable efforts of his health office staff to drafting legislation for a Public Health Advisory Committee on Trade (PHACT). He was an original co- sponsor of the bill just introduced by Senator Stabenow, also long a champion on this issue. S.1644 requires that public health organizations be included on the Advisory Committee for Trade and Policy and Negotiations, and establishes a new Tier 2 Public Health Advisory Committee on Trade (PHACT). Language in the bill not only introduces balance, but also improves transparency and accountability as trade policy is developed. A similar bill is in the House, and I am hopeful that President Obama will soon sign it into law.
Ted Kennedy will be remembered as a fierce advocate for the voiceless and the powerless here at home, but many of us will also remember his principled leadership and advocacy to link our concerns at home with those of people around the world.
PAUL WELLSTONE AWARD PRESENTATION
Activist Physicians Dinner
November 4, 2007
Barry S. Levy, MD, MPH
The sponsoring organizations of this dinner have established the Paul Wellstone Award to be given annually to a U.S. Senator or Congressperson who best exemplifies the values, vision, and leadership of Paul Wellstone. As many of you know, Paul Wellstone was a two-term U.S. Senator from Minnesota whose life was devoted to promoting health, peace, and social justice. After earning his PhD in political science at the University of North Carolina, he worked as a community organizer, assisting politically disenfranchised groups. Then, for more than 10 years, he served as a professor of political science at Carleton College in Minnesota. In 1988, he was the Minnesota campaign manager for Jesse Jackson’s presidential campaign.
In 1990, and again in 1996, running from the “Democratic Wing of the Democratic Party,” Paul Wellstone was elected to the U.S. Senate, and was about to be elected to a third term at the time of his death. The Nation described him as “a progressive populist who was in solidarity with the causes of union workers, family farmers, peace activists, abortion rights campaigners, and racial and ethnic minorities.” Senator Wellstone earned wide respect from many people -- not only progressives -- for his work in health care and the environment, in labor and education, in civil rights and peace. He was a strong advocate for the rights of victims of domestic violence and people with mental health problems. He promoted and supported increased immigration. He opposed the Persian Gulf War in 1991 and, shortly before his death, opposed the Iraq Resolution, the blank check that President Bush was given in 2002 to wage war against Iraq. He was the only U.S. Senator up for re-election in 2002 who voted against that resolution.
In late October 2002, Paul Wellstone, his wife Sheila, and their daughter Marcia as well as five other people were killed in a plane crash in northern Minnesota. Paul and Sheila are survived by the sons, David and Mark Wellstone, who are aware of this award, but unfortunately could not be here this evening. David and Mark Wellstone direct Wellstone Action, which is a not-for-profit, nonpartisan organization that trains citizens and potential candidates to support progressive causes. If you want to obtain more information about Wellstone Action or to contribute to Wellstone Action, its website is www.wellstone.org.
The first Paul Wellstone Award is being presented this evening to Senator Edward Kennedy. Jay Bhatt and I would like to acknowledge several people, without whose assistance, this award would not have been possible. They are Pamela Wilson, Vic Sidel, and Caya Lewis, Kavita Patel, and Ashley Bennett of Senator Kennedy’s staff.
Jay Bhatt, MD
Forty-five years ago, a dashing young senator came into this cynical world that we term “inside the Beltway.” With both vision and progressive ideals, he challenged the special interests and status quo with vigor and thunder in the halls of Congress. Senator Kennedy, senior Democratic Senator from Massachusetts, has served in the United States Senate since 1962. When you think “health care” in Congress, you think Senator Kennedy. He is currently the second longest serving U.S. Senator.
He has demonstrated great personal courage. Like other family members, he has sought to improve the world. He too has demonstrated the resilience in the midst of tragedy, turning adversity into unselfish actions and positive growth.
Senator Kennedy passionately demonstrates the values, the vision and the leadership of Senator Wellstone, with whom he served in the U.S. Senate for 12 years. Senator Kennedy has worked throughout his career for progressive growth that we all share. He has consistently been the lead voice in advocating for universal health care, a woman’s right to control her reproductive choices, gay rights, gun control, social justice, reduction in our reliance on fossil fuels, and opposition to the Iraq War. He has also co-sponsored and supported many legislative proposals to improve education, rationalize immigration policy, protract and strengthen Social Security and Medicare, and promote peace. In the aftermath of Katrina, we were once again reminded that not all of our citizens have equal access to the American Dream -- for safe housing, a decent education, good health care, and a living wage.
Senator Kennedy has said it is a privilege to work with so many of you who continue the march of progress for these great goals. He has been an incredible advocate for many of the issues on which all of our organizations work.
We are extremely pleased to present the inaugural Paul Wellstone Award to Senator Edward Kennedy. Unfortunately, Senator Kennedy could not be with us tonight, but he taped the following remarks three nights ago.
Senator Edward M. Kennedy
Thank you for that kind introduction, and I’m very grateful for this award. It carries very special significance since it is named after an outstanding leader I was honored to have as a friend. Paul Wellstone was an extraordinary colleague in the Senate who was always determined to summon the courage to rise above rhetoric and labels and do what is in the best interest of the people, and he beckoned each one of us to do the same. On bills before the Senate, he always had a sharp eye for any special interest giveaway or other provisions that threatened the public interest. In so many ways, he was the conscience of the Senate.
I know that Paul and Sheila would be proud to be among a group of physicians who serve as the conscience of our communities. When we need people ready, willing and able to fight for health care for all Americans and who are tireless advocates for their patients, we look to you. Each of you and the organizations you represent are nation’s best –- a combination of immense intelligence and vast compassion.
We all know how much there is to do, and we wish Paul was still here to lead us. We’re all aware of social injustices being committed against the defenseless –- the parents who are forced to choose between feeding their family and paying for health care. Too many in our society refuse to agree that health care should be a basic right for all, not just an expensive privilege for the few. But we continue to believe that the extremes and the excesses of inequality can be reduced, so that every man, woman and child in America will be able to receive the quality health care they need and deserve.
I believe the tide is gradually changing. As the saying goes, people are sick and tired of being sick and tired. People are waiting to be inspired and are ready for leaders like you to reach out to them. I believe very strongly that with your passion and activism, we can unite a world that is in desperate need of our attention, and is convinced that the health of our world is something that can’t be bought, traded, or sacrificed any longer.
So I thank all of you for this award. I thank Paul Wellstone for his everlasting flame, and I thank you as well for picking up his fallen standard and holding it high again.
Rest in peace...
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A Dose of Poetry
Unbeknownst to many, Senator Kennedy loved poetry. Several years ago he read for the Academy of American Poets at
Poetry & the Creative Mind
, which is an annual fundraising benefit for the Academy of American Poets, on April 6, 2004 in Lincoln Center as part of a lineup that included Meryl Streep, Vanessa Redgrave, Wynton Marsalis, Kevin Kline, Tony Kushner, Brice Marden, Mary-Louise Parker, Diane Sawyer, Cynthia Rowley, Louis Menand and Samantha Power. One of his favorite poems was John Brown’s Body by Stephen Vincent Benét. What follows is an excerpt of his remarks, as well as the first two stanzas of the poem.
“When I was a student at Milton Academy, I was introduced to Stephen Vincent Benét and his epic Civil War poem "John Brown's Body." Benét won a Pulitzer Prize for this poem in 1929. I was immediately struck by the story, of course, but also by the strength of the meter and rhyme. My brother Jack was a young Congressman at the time, and I remember telling him about the poem.”
JOHN BROWN’S BODY
There were three stout pillars that held up all
The weight and tradition of Wingate Hall.
One was Cudjo and one was you
And the third was the mistress, Mary Lou.
Mary Lou Wingate, as slightly made
And as hard to break as a rapier-blade.
Bristol's daughter and Wingate's bride,
Never well since the last child died
But staring at pain with courteous eyes.
When the pain outwits it, the body dies,
Meanwhile the body bears the pain.
She loved her hands and they made her vain,
The tiny hands of her generation
That gathered the reins of the whole plantation;
The velvet sheathing the steel demurely
In the trained, light grip that holds so surely.
She was at work by candlelight,
She was at work in the dead of night,
Smoothing out troubles and healing schisms
And doctoring phthisics and rheumatisms,
Guiding the cooking and watching the baking,
The sewing, the soap-and-candle-making,
The brewing, the darning, the lady-daughters,
The births and deaths in the negro-quarters,
Seeing that Suke had some new, strong shoes
And Joe got a week in the calaboose,
While Dicey's Jacob escaped a whipping
And the jellybag dripped with its proper dripping,
And the shirts and estrangements were neatly mended,
And all of the tasks that never ended.
Keep up the good words and the good deeds. Peace, Linda
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