Thank you, Bill [Scheuerman], for your comments and congratulations on a terrific turnout for this first annual Kaiser Permanente/National Labor College Forum.  It’s a tribute to the leadership you are bringing to this campus as well as a tribute to Kaiser Permanente and the Coalition of Kaiser Permanente Unions.

I’m wearing three official hats today — the first as Chair of the Board of Trustees of the National Labor College, the second as President of the AFL-CIO and a third as President of the Board of the Coalition of Kaiser Permanente unions.  I welcome and tip all three of those hats to all the representatives of Kaiser Permanente who are with us, to the many leaders of allied organizations who’ve joined us as well as the press, and especially to the elected officials, members and staff from so many unions from outside as well as from within the AFL-CIO.

We’ve worked hard to put together a broad program with participants from all across the union movement and your presence here today shows that when it comes to health care we stand united — thank you.

As President Scheuerman outlined, our morning program is devoted to maintaining and improving quality of care as we enter into what we hope will be the endgame in our decades-long struggle to make health care a right for all families living in our country — and not just a privilege for the wealthy or for those lucky enough to have a strong union fighting for them.

My job this morning is to lay out why quality of care is not negotiable – and I want to make sure you understand I’m not talking about negotiations with employers where we fight year-in and year-out to protect, preserve and improve employer-paid benefits.  Rather, I’m talking about negotiations that are taking place in our national political arena over the shape and substance of national health care reform and for us the words, “affordable, high-quality, health care for all” are inseparable.

We are willing to bend and flex and compromise on lots of different issues but we will not bargain for, nor will we accept, a second-class health care system.

At the AFL-CIO, we decided last year not to lock into a specific, grand scheme for national health care reform and instead adopted a set of principles to guide us in the debate.  One of those principles is guaranteed care for all through a new national program that provides choices of plans, physicians and hospitals.  Another principle is shared responsibility in financing. Yet another is the concept of “pooled risk” instead of forcing individuals to “go it alone” as individuals in the private market.  We also believe in a continuing, vital role for employer and union-sponsored benefits — something President O’Sullivan will be addressing this afternoon — and in a vital role for government not only as a funder but as a watchdog on costs, standards and fairness.

Transcending all of these principles is our insistence on what health care policy experts call “care that is high-value and patient-centered” — and what we call “quality care.”

So what does “high-value and patient-centered” mean for our members and their families — indeed for all working Americans, for the poor, for the elderly?

For a mother whose child is running a fever of 103 degrees it means not having to stand in line to get attention.

For a senior citizen with a painful hernia it means not having to wait six months for what a bureaucrat has deemed an “elective procedure.”

For a middle-aged man it can mean not being dismissed too sick and too soon after surgery for a kidney stone.

For an anxious young woman it means never being subjected to the indignity – or the danger – of having a breast removed in the morning and being sent home that same evening with an IV.

“High-value and patient-centered” also means using scientifically-proven best practices – a genuine partnership between providers and care-givers.  It means preventive medicine and chronic care regimes to keep you and your family healthy — the right to choose your own doctor, hospital, clinic or nursing home and reliable, comparative information from an independent source to help you make that choice.

When you become a patient in one of those facilities it translates into having a strong voice in the decisions affecting your care, safe staffing levels, zero tolerance for preventable errors, and the automated systems required to back it up.

You’ll hear more from George Halvorson and our morning panel about how Kaiser Permanente and its unions are pioneering programs in many of these areas and the labor movement commends all of the people who are working so hard to make Kaiser a model for national health care reform.

But we believe we must go even further to insure the highest possible quality of care — because unfortunately, not every provider is as responsible, innovative and transparent as Kaiser Permanente.  So we believe that a new national health care plan – no matter what form it takes – must include strong national standards of care and ethics for providers as well as physicians, regulations to insure safe staffing levels, dissemination of information on mistakes, and even payments to providers based on performance and quality.

These over-arching principles will require a strong federal government role – not just in financing a new, high quality system but in making sure the system delivers “high-value, patient-centered care.”  And these kinds of standards will also require an independent body like the National Institute of Medicine as an ombudsman.

As you’ll hear from Jeff Levine later this morning, if we want popular support for national health care reform, we’ll have to prove to voters that we’re going to push up quality instead of driving it down.  And we must also be mindful that the status quo is not providing the quality of care people in our country deserve — the dirty little secret of American medicine is that despite the best technology in the world, care for patients is riddled with preventable errors.

Our infant mortality and life expectancy rates compare miserably with those of other industrialized nations.  Every year in America, 80,000 people die unnecessarily from high blood pressure, diabetes and heart disease because they don’t receive proper care.  Over 180,000 patients in our hospitals die each year from avoidable medical errors and preventable infections and in this highly advanced nation of ours roughly 30 cents of every health care dollar is spent on poor quality care or administrative waste.

Those shocking statistics add to the urgency we already recognize — 47 million people without health coverage, almost 9 million of them children; millions of retirees having to choose between housing, food and prescription drugs; workers being forced out on strike to maintain employer-paid benefits; companies staggering under the weight of premiums that have doubled over the last seven years.

And here’s the real Catch-22 for us in the labor movement:  Today, unionized American businesses that provide adequate health care benefits are handicapped in the marketplace.  Their global competitors don’t have to carry health costs on their balance sheets because their countries provide universal health care and that issue hits working families right in the pocketbook — the wages of manufacturing workers in the U.S. – for example – lag behind four of our top six trading partners, while our health care costs exceed those in all six countries by an average of almost a dollar an hour.

Here at home, unionized employers — and unionized workers — face a similar disadvantage against domestic competitors who shirk their responsibilities and all of us end up essentially subsidizing non-union companies like Wal-Mart.

Recently, we learned just how hard our health care crisis is hitting unionized workers who’ve long been envied for having good health care coverage.  In January and March, more than 26,000 people took an online 2008 Health Care for America Survey sponsored by the AFL-CIO and our community affiliate, Working America.  Many of the unions and organizations represented here helped promote the survey.

Seventy-seven percent of those who answered our questionnaire were either union members or members of union families — and the results were astonishing given that most union members readily admit they are the “lucky ones” when it comes to health care benefits.

In our survey, more than a third of the respondents reported skipping medical care they needed because of costs and 25 percent said they had serious problems paying for the care they needed.

Ninety-five percent said they are concerned about being able to afford health care in the future.

Half of the respondents said they or a family member has stayed in a job they didn’t like just to keep health care benefits.  Seventy-one percent said they were worried about losing coverage if they changed jobs or lost their job.  Ninety-five percent of those who have health insurance said they are not satisfied with costs.  Sixty-two percent aren’t satisfied with quality and 94 percent of the insured said our health care system should be fundamentally changed or completely rebuilt.

Brothers and sisters, those are our members talking – your members talking – and it shatters any myth about a union card protecting your family from a health care system that is not delivering quality care at a price working families can afford. 

Union members give our health care a D-plus at best and that should be a wake up call for all of us.

The labor movement hears the urgency of the call and the good news is that many good people in the medical community, in hospitals, among employers and unions, in consumer organizations and in many branches of government are working hard to improve and guarantee high quality care for all.  We’re fortunate, of course, to have a partner like Kaiser Permanente — not just in this forum today — but in the bigger arena of debate over national health care reform.

After many years of struggle, we have a real opportunity to make health care for all a reality and we’ve intensified our efforts with a fresh campaign to educate and mobilize our members.

Our goal is to elect a Congress that will help us finally forge a plan that provides high quality, affordable, portable health care for every family in America and we are just as determined to elect a president who will champion, sign and enforce the historic legislation we need.

But we consider the elections this fall just a gateway to a greater goal of having a hand in all the work that goes into national health care reform and a voice in all the decisions that affect us and our families.

We’re starting that process now through forums like this one, through more than 300 open meetings in union halls and workplaces across our country this month alone, and through intense discussions with political candidates we’re endorsing.

We are guided in our quest for higher quality of care by the insights of labor leaders like many of you, and like Joe Hansen, president of the United Food and Commercial Workers and a leader of Change to Win, and Leo Gerard, president of the steelworkers union and a member of our AFL-CIO Executive Council, both of whom were invited to be on our program today.

Joe couldn’t be with us but he has said many times, and I quote: “Our first concern is how do we improve outcomes.  Our health care system focuses on the wrong issues and sends resources in the wrong directions.  It is more about illness than about health, and we react to disease rather than promote healthy lives.  We have to demonstrate that reform will bring an improved system, more accessible, more affordable, more effective — a health system instead of a sick system.”  Thank you, Joe.

Leo Gerard had to cancel out because he’s on limited travel after a heart problem, but if he were here today, he’d repeat what he’s told audience after audience, and I quote: “I agonize that I don’t want my generation to leave to the next generation a lower standard of living, and a lower quality of life, and more anxiety and less opportunity than I had.

“I believe fundamentally that if we don’t fix the health care system, that will be our legacy.  There are lots of things we need to fix, but if we don’t fix health care, the rest won’t happen.”

Leo, we hear you and we wish you success as you navigate your own course through our health care system – Godspeed and God bless.

A health system or a sick system?

A lower standard of living or a better life?

What will be our legacy?

Let’s find the answers and Godspeed to all of you.  Thank you very much.