November 19, 2017 Convention Speech

In July 2017 I filed to be a candidate for the US House of Representatives in PA-18, planning to take on entrenched Republican Tim Murphy.

Then a scandal erupted and Murphy resigned in disgrace in the autumn.  The state Democratic party announced that its committee apparatus would select a nominee for a special election to be held March 13, 2018.  A convention of committee members from the district would cast ballots on November 19, 2017 in Washington, Pennsylvania.

Although I was not the choice of the party establishment that day, I delivered a speech intended to appeal to those who were driven by the issues that matter to Democrats - and, I think, to all Americans.  I was allotted five minutes.

Here is the text of that speech:


Fellow Democrats, my name is Bob Solomon, and I am here today because Pennsylvania’s 18th Congressional District needs a new representative who will serve the people: someone who will go to that other Washington and work every day to make their lives better.

I have spent the last 32 years taking care of people who visit hospital emergency departments.  They come to see me on the worst day of their lives.  They face serious illness or injury, and I work quickly to figure out what is wrong and set them on the road to recovery.  I have done this for every patient, every day, without regard for whether they look like me, or sound like me, and without regard for whether they have the means to pay their bills.

I have also spent many days on Capitol Hill, talking to Senators and Representatives, trying to use my expertise in health policy to influence decision makers.

Now I seek to become one of those decision makers and move from helping patients one at a time to helping Americans a thousand at a time, or a million at a time.

Voters who have gathered to hear the Democratic candidates for the nomination to fill the vacant Congressional seat in the special election next March have learned what I stand for.

My public speeches and answers to questions have left no doubt, because they are brimming with the ideals that animate true Democrats, and those ideals are voiced with clarity and passion.

I make the case for voters to choose Democrat over Republican in March, and again in November, based on a clear vision, and a mission to take the Democratic platform and make it work for the people of our district, returning government to its proper role as a servant of the people.

So often we hear candidates speak not in specifics but in platitudes.  We cannot count on voters to recoil in horror from the right-wing extremist chosen by the GOP.  They want to know what we will do, and they want specifics.

I give them specifics.

I will work to achieve universal healthcare: a system in which if you are a human being on American soil, you get high-quality healthcare, and no decision about seeing a doctor or going to the hospital is tinged with the fear of financial ruin.  Two thirds of Democrats support a Medicare for All approach to solving that problem.  Independents and Republicans will join us when we stand firm for our ideals.  That is political leadership.

I will work to put this nation on a path to an energy future that relies on sources that will not run out, like wind and solar.  Democrats know this is a matter of urgency.  The fossil fuels industries are telling us we should just “Drill, baby, drill!”  Some people seem to like that message, but they will join us in planning the transition to a secure energy future, protecting the environment, and dramatically slowing climate change, when we stand firm for our ideals.  That is political leadership.

I will work for an economy in which no one who labors 40 hours a week is living in poverty, needing entitlement programs like Medicaid and food stamps just to survive, because we have a living wage.  We will work with our traditional partners in organized labor to help make that happen.

I will work to assure tax fairness for workers, not tax cuts for the wealthy.  Republicans say cutting taxes for the rich will help regular folks, too, because of the trickle-down effect.  But the rich invest money to make more money, not to spur growth or create jobs.   Basic facts tell us consumer spending drives economic growth and job creation, so the money must be given to people who will turn around and spend it.  Voters will see that the Democratic approach is the right one for hard-working Americans when we stand firm for our ideals.  That is political leadership.

I will work to assure that government regulation does what we need it to do: protect the environment, protect consumers, protect workers’ rights, and voting rights, and women’s rights, and civil liberties.  Republicans always put the words “job killing” in front of “government regulation.”  We know that is wrong.  When we stand firm for our ideals, voters will recognize that government is our servant, and that we can, and will, and must use it to protect all of us, especially the most vulnerable of our society - and to be the agent of social progress we all know it can be.  That is political leadership.

There is a national spotlight on this special election.  Reforming the way we finance healthcare is at the top of the list of priorities for many Americans.  You can send to Congress a candidate with the experience and the policy expertise to shape the debate, and the ability to lead us to solutions that work for all Americans.  You can vote to put our district on the map, and I pledge to you I will make you proud that you did.

I am Bob Solomon and I ask you to give me what matters most today: your vote.     

Medicare for All: Better, Cheaper

This phrase was used by the late Senator Edward M. (Ted) Kennedy, who advocated a system of healthcare financing for this nation that used a single payer.  The government-run Medicare program, established more than half a century ago, is not perfect, but it is well recognized as a remarkably efficient mechanism of paying for the healthcare services provided to seniors and the disabled.

Satisfaction with Medicare among seniors is high and compares favorably with what one finds among those whose health care is covered through any of the companies in the private-sector health insurance industry.

My sense of Ted Kennedy was crystallized by the speech he gave at the Democratic National Convention in 1980.  It was finely crafted and superbly delivered, and it was a grand exposition of the New Deal ideology, a political philosophy that holds out the promise of accomplishing great things by using government as an engine of social improvement.  Lyndon Johnson's Great Society also captured that vision, updated for the 1960s.

But in 1980 the American electorate had become deeply skeptical of government as a means toward the end of making America great, and it resonated with voters when Ronald Reagan told them government was the problem, not the solution.

It is time to rethink that way of looking at things when we consider the financing of healthcare.

We have money to spend on healthcare.  We give it to insurance companies, which are supposed to serve as a conduit, channeling the money to pay the doctors, hospitals, and other providers of health care to patients.  But the business model of the private health insurance industry is such that a portion of that money is not spent on health care.  Instead it is diverted to administrative costs that are substantially higher than we see for the government agency that runs Medicare and Medicaid, as well as marketing, return to investors, and lavish executive compensation.

Everywhere you look these days there are advertisements in the broadcast and print media and highway billboards saying "Aetna, I'm glad I met ya" and telling us that Cigna is in the business of caring.  Especially galling are the TV commercials for the "Medicare Advantage" plans, created to give the health insurance industry a cut of the Medicare dollar.  What was the rationale for that brilliant idea?  That private industry should be given a chance to show how it could do what Medicare does, only better.

Well, I am here to tell you this: it is not better; it is larceny.

Medicare's administrative costs are much lower, there are no investors expecting dividends, there are no executives pulling down millions, or tens of millions, of dollars each in annual compensation, and the marketing consists chiefly of little ads telling seniors to call 1-800-MEDICARE if they have questions.

Meanwhile, patients and doctors spend hours on the phone trying to get health insurance companies to pay for things they are supposed to pay for and jumping through hoops to get them to do so.

As if all this isn't reason enough to ditch the absurdly fragmented non-system we have for financing healthcare in this country, about ten percent of Americans are on the outside looking in, with no healthcare coverage at all.  They don't qualify for Medicare or Medicaid and they either are not eligible for employment-based coverage or cannot afford their share of the premium.  Some are self-employed and cannot pay the eye-popping premiums one finds in the individual market.

And many who do have coverage through the private health insurance industry struggle with copays and deductibles that are large enough to discourage them from seeking health care when they need it, because the costs will be largely or entirely out-of-pocket.

It is time to ditch the private health insurance industry.  It has had more than half a century to show that it can efficiently and effectively cover Americans whose health care is not financed through a government-run program, and it has demonstrated beyond any doubt that it is a failure.

Even for those who have been satisfied with employment-based coverage, that very satisfaction - and fear that something else won't measure up, or there will be a gap - is a barrier to changing jobs when such a move would otherwise be the right decision for career advancement.  Employment-based coverage came into existence at a time when employers were looking for ways to recruit and retain workers in an economy that was abundant in job opportunities.  Now it restricts career mobility and keeps people in jobs no longer satisfying because they cannot risk being without coverage in transition, with the cost of transitional ("COBRA") coverage being exorbitant, and fear that the next company won't cover a pre-existing condition.

We need a system that works like this: you are a human being on American soil, so you're covered. When you are born, you get a Social Security number, and you are also enrolled for healthcare.  For those of us who have already been on the planet for a while, it is easy to sign up.  If we don't take the initiative to do it ourselves, the first time we need healthcare, we get signed up on the spot.

Copays?  Deductibles?  Nope.

Copays and deductibles have two purposes.  The first is to get people to pay part of the cost of services that they already paid for when they shelled out money for premiums.  In a public system financed with public dollars, that rationale goes away, because there is no insurance company using it to boost its bottom line.  The second is to give people "skin in the game."  In other words, if you have to pay something, it will make you more sensible and responsible in your decisions about whether and when to seek health care.

There is no question that there is great variability among us in healthcare-seeking behavior.  Some of us seek professional health care for every little thing, and others do so only when they are very concerned that they have symptoms that could be something quite serious.  In my practice of emergency medicine I see people who have been in a car accident and feel fine, but they think they should come in "just to get checked out," while others are badly hurt and had to have worried friends or family badger them for many hours to persuade them to seek medical attention.

Yet there is abundant evidence that copays and deductibles discourage people from seeking health care that is very necessary, even urgently needed, as much as they are discouraged from seeking care that is of doubtful necessity.  Do we really want the 55 year old woman delaying going to the hospital for hours or days when she is having a heart attack, because the out-of-pocket cost encourages her to hope it's just indigestion?  I cannot begin to tell you how many times I have looked at an EKG and thought, "Well, no wonder the Tums didn't help."

I recently got an email from a conservative group, working to build public opposition to Medicare for All.  "Do you want government-run healthcare?" was the question it posed.

Great question, often paired with the assertion that the postal service - which we all love to ridicule - is an example of how the government cannot do anything well.

But Medicare for All is not "government-run healthcare."  If the government is paying all the bills instead of just the ones from patients currently in Medicare, Medicaid, and other government-based healthcare plans, it doesn't mean the hospital where I work, or the one in your neighborhood, or your doctor's office will be taken over by the government.  It just means they will be sending the bills to Medicare instead of to a slew of different companies, each of which has different rules and varying paperwork and employs an army of people to review claims and say, "No, we're not paying for that."

Imagine how much can be saved in costs by hospitals, doctors, and others who are dealing with one payer and one set of rules that are clearly understood by all.  And imagine a world in which patients get the care they need, and it simply gets paid for without their ever having to do anything except sign a form saying they received the healthcare being billed.

So, you may think, "No, I don't want government-run healthcare."  But you should want Medicare for All.  There is no good reason not to want it.  But the private health insurance industry will fight it with everything they have, because it will replace them.

It is time to replace them - with a system that works for all of us, and does the job right.

In fact, it is long past time.  

Charlottesville: Erasing History?

Deadly violence erupted in Charlottesville, Virginia yesterday.  White nationalist demonstrators were protesting the possible removal of a statue of Robert E. Lee, the Civil War general who led the Confederate forces.

Charlottesville is the site of the University of Virginia, the institution founded by Thomas Jefferson.  Mr. Jefferson famously said of slavery that "...this momentous question, like a fire bell in the night, awakened and filled me with terror. I considered it at once as the knell of the Union. it is hushed indeed for the moment. but this is a reprieve only, not a final sentence."

Jefferson understood what must happen to the South's "peculiar institution" of forced labor of Africans brought to the Western Hemisphere in shackles under the ghastly conditions of slave ships.

Lee, on the other hand, was one of the men who went to war to preserve that institution.

The statue in Charlottesville is of Robert E. Lee mounted in military splendor upon his magnificent steed, Traveller.  Removal of the statue, according to those who support its being left in place, is an attempt to "erase history."

I know a little something about history - and the history of the South's "peculiar institution."  I have read biographies of all the early presidents who were slaveholders, notably including the four of our first five who were from Virginia.  I have also read extensively on the political history of the decades preceding the War Between the States.

Beyond the thousands of pages I have read on the Civil War itself, my personal library includes biographies of Jefferson Davis, Robert E. Lee, and Stonewall Jackson.

I can assure you, there is no "erasing history."

But there is something to think deeply about: if we do not want to forget Robert E. Lee, how exactly do we want to remember him?  And what sort of monument would facilitate that?

We are not about to forget that Lee led the Army of Northern Virginia against the Army of the Potomac, that he matched wits on strategy and tactics with Union generals and mostly out-generaled them.  Lee's admirers would say that ultimately his cause was lost because the North had more to work with in men and materiel, and in the final analysis it proved to be a war of attrition.

But the grand monument to Robert E. Lee in the saddle on Traveller suggests admiration for what he did on the field of battle, including exactly what it was he sought to accomplish: separation of the Confederate States of America from the United States of America, and the continuance of slavery.

And I believe that a monument to Lee's quest does not belong in Charlottesville, or anywhere else in these United States.

So let us not forget Lee.  If there is to be a monument, let it show Lee together with the Union general who brought Lee's quest to its proper end.  Such statuary is depicted at the beginning of this essay, showing Lee and Grant at Appomattox Courthouse.

In the spring of 2016 exit polling told us many voters in South Carolina thought Lincoln should not have issued the Emancipation Proclamation, and we would have been better off if the South had won the Civil War.  Monuments to Robert E. Lee serve to support such beliefs.  It may very well be that the names of Confederate Generals attached to US military bases, such as Fort Bragg in North Carolina and Fort Hood in Texas, do something similar.

So let us not erase history.  But let us make thoughtful decisions about having monuments to history that reflect today's values, not the shameful dehumanizing institutions of centuries past.

Ethics in Politics: Reconstructing a Broken System

The year was 1988.  I was serving as chair of emergency medicine at a community hospital in a steel town in the Upper Ohio Valley.  A patient had a complex situation that raised issues in biomedical ethics.  The chair of family medicine was the patient's primary care doctor.  At the end of our discussion we agreed that our hospital needed an ethics committee to deliberate on such cases.  We recruited the director of the ICU, and his wife, a medical ethicist, and we formed a committee.

In the nearly three decades since I have been immersed in the study of ethics: not just biomedical and professional ethics, but the ethics of human societies.

This immersion has convinced me of many things.  One of these is that access to basic health care of high quality should belong to everyone living in American society.  Right now it doesn't.  We have an absurdly fragmented non-system for financing health care.  You can have employer-based health insurance.  You can be elderly or disabled and qualify for Medicare.  You can be impoverished and qualify for Medicaid.  You can be in the military service or a veteran and have access to care in that system.

But you can also have no coverage and no access.  The United States is virtually alone among First World nations in having a significant segment of its population in that last category.

Here is what I think the situation should be in a society with sound ethical values that are put into practice: if you are a member of our species, and you are on American soil, we take care of you when you are sick or injured.  You may worry that the world will flood America's borders with refugees desperately seeking health care, and you may want to find ways to prevent that.  But right now we have nearly 30 million Americans without health care coverage and access, and tens of millions more whose coverage and access are woefully inadequate.

Why don't we have universal health care now?  Is it because most Americans are cruel and heartless?  Is it because most of the 535 Members of Congress, our Senators and Representatives, are unethical beasts who care not a whit about the common man?

We have some among us, and some in Congress, to be sure, who care too little about the have nots of our society.  But a large part of this failure is the result of having a profit-driven health care system.

Think about it.  The most efficient way to take care of absolutely everyone would be to have a uniform system, like Medicare, that covers all Americans.  But that would eliminate the private health insurance industry, an industry that is very profitable.  It would surely clamp down on prices charged by the pharmaceutical industry - an even more profitable sector.  And those industries protect their turf by contributing to the election and re-election campaigns of the people on Capitol Hill who make these decisions.

The middle class family looking at eye-popping health insurance premiums, the struggling single mom who makes a little too much money to qualify for Medicaid, and the down-and-out homeless person living in a cardboard appliance box over a subway grate or sleeping under a bridge - these are all people with no political power because they are not part of the system of campaign financing.

These very same forces keep Members of Congress from doing the right thing in many other areas - including improving the environment and protecting consumers - because on the other side of those issues are corporations and wealthy and powerful individuals with their own agenda.  And their agenda and ours are completely different.

The member of the House of Representatives elected by the people of my congressional district is a fellow named Tim Murphy.  Over the years I have thought of Murphy as a decent and ethical fellow, even if he sometimes voted in a way that I thought was too friendly to corporations, especially those in the health insurance and pharmaceutical industries.

Then along came the American Health Care Act (AHCA) - the House version of the effort to "repeal and replace" the Affordable Care Act.  According to the best available data, the number of non-elderly people in our congressional district who would be tossed out of the Medicaid program, promptly joining the ranks of the uninsured, is 37,000 - among a population of about 700,000.

That's right: more than 5% of the population kicked off their health insurance. And Mr. Murphy voted for that.  I was shocked.  Then I realized I shouldn't be. Those 37,000 people don't make campaign contributions.  Heck, many of them probably don't even vote.

We must bring strong ethical values into our political system.  We want our elected representatives to make good decisions: decisions that are best for all of us; decisions that give us cleaner air and water, that avoid atmospheric changes that will bring calamity to global climate and acidify the oceans; decisions that protect consumers from businesses that, driven by profit, would abuse them in an unregulated free market.

I couldn't help but notice that Murphy had no Democratic opponent in 2016 or 2014.  Why should he vote anything except the Republican party line?  I thought about that question, a great deal.  And I decided I must do something to give him a reason.  I must give the voters of Pennsylvania's 18th congressional district a choice.

And so I have filed with the Federal Election Commission to be a candidate for the Democratic nomination for this seat in the House.  I have gathered smart, energetic, politically attuned people around me, people who are committed to bringing this kind of change to the system.  And, because no race for a seat in Congress can succeed without funding, I have begun raising money.  This is a grass roots campaign.  No money from the corporate world will be flowing into my campaign treasury.  There will be individual contributions and very little else. If a PAC that strongly supports universal healthcare wants to contribute, we will talk.  But I intend to serve the interests of the people, not the powerful, and that is how my campaign will be funded.

In the latter third of the 19th Century this nation attempted a Reconstruction to include in our political system people who were left out by our original Constitution: people who counted as three fifths of a person for purposes of determining a state's representation in the House but who were not themselves citizens and did not have the right to vote.  It is time for another Reconstruction, this time one that will bring back control of our government to all the people, and not only those who have the money to buy a share of it.

For more than three decades in the practice of my specialty of emergency medicine, I have been making human connections with people in crisis caused by illness or injury, from the well-to-do to the destitute, from Americans whose ancestors were among the earliest colonists to immigrants from Africa and Asia doing their best to communicate with me in very rudimentary English.  You will not find many in the halls of government who know the people of the district as I have come to know them.  I have come to know them, and I will do what is right for them in Washington, DC.

Please join me in this effort.  Give what you can, whether it's time, or money, or telling your friends about this candidate and this campaign.

Please visit the campaign's Facebook page to learn more about this candidacy.

Please visit our ActBlue page to contribute.

[The campaign website is under construction at solomon4pa18.com, but it will soon tell you all you want to know about what I am trying to do.]  

Making Health Insurance Affordable

One of the complaints about the Affordable Care Act (ACA, also known as Obamacare) is that for some people it contributed to an increase in the premiums they had to pay for health insurance.  The observation was made that they were being forced to pay for health insurance that included more "essential health benefits" than they had previously had, and that drove up premium costs.  Metaphorically, they were being forced to buy a Cadillac when they had been perfectly content with a Chevette.

Insurance is a mechanism for sharing risk.  Thus it works best when everyone participates.  If people with low risk opt out, choosing to go without insurance and take their chances, and only people at higher risk (or who are most risk-averse) are in the "risk pool," premium costs will be higher.  The people who are uninsured may get sick or hurt and require care that they then cannot afford.  Most likely that care will be provided anyway, resulting in their financial ruin, and since they will be unable to pay for it, the cost of that care must be spread among all who do buy into the risk pool.

This is the rationale for requiring everyone to play.  This was also the trade-off for getting the insurance companies to drop their exclusion of pre-existing conditions.  If you are not allowed to wait until you get sick or hurt and NEED coverage to buy it, there can be no justification for denying you coverage for a problem you already had when you bought insurance.

So, what about this "essential benefits" package?  Why do we have to do that?  Why pay for coverage we think we will never need and didn't have before?

When you buy auto insurance, there is something called "comprehensive" coverage, which covers everything other than collisions.  So if someone dumps a bucket of red paint on your white car, it's covered.  Likewise if you return to the car you parked in a high-risk neighborhood and find it perched on blocks with its wheels missing, or someone's ex-girlfriend mistook your car for that of her jerk of an ex-boyfriend and carved obscenities into most of the painted surfaces, or she took a baseball bat to the hood and fenders.  Or maybe you parked it under a tree with a limb you didn't realize was dead and which then fell onto the roof while you were in a nearby store stocking up on beer for this weekend's March Madness games.

You wouldn't think the coverage was very comprehensive if, for example, it didn't cover damage to your car caused by someone who didn't like you, and the insurance company thought you had it coming, or the policy excluded "acts of God," and the insurance company, declaring God all-powerful, used that to refuse to pay for just about anything.

So, back to health insurance.  Suppose you were presented with a long list of things that could be covered or not.  You could go through and pick all the things that you thought would be expensive and that you were unlikely to need, and leave them out, thereby lowering your premiums.  The insurance company would then do an actuarial (risk) analysis and charge you an accordingly low premium.  But maybe your assessment of your own risk was wrong, or you were just unlucky, and now you have expenses that aren't covered because of the choices you made.  You are now in the same situation you would have been in if you had been able to decide not to buy insurance at all.

To prevent this, policymakers had to decide what coverage everyone should have to buy.  Inevitably it includes something you will never need.  It may cover expenses related to pregnancy, and if you are a middle-aged widower, you may be quite correct in thinking that is coverage you will never need.  Similarly, you may not want to pay for coverage for mental illness if you have never had one and have no family history of that, but mental health problems are common, and it may be very expensive if you're wrong in your risk assessment.

But many people deride the ACA - especially the "Affordable" part of its name - if it made their premiums go up because they had to pay for coverage they never had before.

Here's a policy you can almost certainly afford: it will cover you for injuries sustained if you step on a land mine near your home in rural Iowa.  No other risks to your health are covered.  Oh, and you are on the hook for the first $10,000 in expenses, but after that the insurance policy kicks in.  I can assure you, the premiums for this coverage will be VERY affordable.  And the value of the coverage to you will be essentially nil.  This will really be the same as having no health insurance at all, unless your Iowa neighbors take a strong dislike to you and start planting landmines along the perimeter of your property.  By reputation, at least, Iowans are not like that.

The now-proposed American Health Care Act (AHCA) will allow people to buy health insurance that is much less comprehensive than under the ACA.  The appeal of lower premiums with such an approach is strong.  The AHCA's critics from the right call it "Obamacare lite."  (Tastes great, less filling, right?)  Because if it still requires you to have health insurance, it's still an unacceptable government intrusion into your life.

Until you find out that what wasn't included in your new policy is something you actually need.  Oh, no!  Why did Uncle Sam say it was OK to buy coverage that didn't include the costs of rehab after the surgery for my broken hip?  Why didn't anyone tell me I should pay for maternity benefits even though I wasn't planning ever to get pregnant because life doesn't always go as planned?

If there is an essential benefits package, that everyone pays for, then there is enough money going into the risk pool, and everyone is covered for all the things the experts say the average American may need.  That's how risk sharing works.

Maybe you think that's just too costly.  There are many other ways of reducing costs.  Skimping on coverage is the wrong approach.