The overriding health policy ideology of the Republican Party has two components: to increase profits dramatically for their politically connected health corporate friends (e.g., Senate Majority Leader Bill Frist is part owner of the largest for-profit hospital system in the US); and, to privatize all government services. These two goals mostly work together; but they come into conflict when the profits run up against voters who are angry about the price of and access to health services and prescription drugs. This took place in the recently enacted Bush Medicare legislation. It is within these contradictions that a people’s health movement can make major advances.

Analyzing Bush’s statement paints a sordid and unhappy picture that we unfortunately are living with today. 'On the critical issue of health care, our goal is to ensure that Americans can choose and afford private health care coverage that best fits their individual needs.'

Here is the crux of the problem: Republicans demand that each 'individual' must choose for him or herself. Group activity is discouraged. Individualism is the cornerstone of the private system. On the other hand, monopolies are allowed, if not encouraged among the medical industrial giants in the insurance, drug and medical supply/equipment industry. Group plans where disease prevention is more important than profit, like Group Health Plans in California and the Northwest, must be stopped at all costs. In New York City, the Health Insurance Plan of NYC (HIP) is being threatened with privatization. People are told to put their trust in the insurance carriers to get them health services.

The Republicans say they want to 'make insurance more affordable.' How do they propose to do this? The only proposal that Bush has put forward was an insipid plan for small business owners to be able to afford health insurance for their employees. 'Small businesses should be able to band together and negotiate for lower insurance rates, so they can cover more workers with health insurance – I urge you to pass Association Health Plans.'

This failed idea has been proposed in some states, but has been rejected as far too expensive. The only implementation method possible for this proposal is to subsidize small business, with taxpayer monies, so that small businesses can buy health insurance from insurance companies who charge their regular high premiums. New York Republican Governor George Pataki has played around with this idea, but his own budget people rejected it as a total waste of money. Bush’s proposed legislation for small business has a nice ring to it, but it has no chance of passage; and, he knows it.
It isn’t just small employers who can’t afford to pay the health premiums that insurance carriers are charging. A recent study by the Commonwealth Fund has found that 25 percent of workers employed by corporations of 500 or more employees do not have health insurance. This is a national crisis for which all employers are at fault, but the greed of the insurance and drug companies is at its heart. Lower-income Americans

The class and race nature of the anti-people Bush Administration is summed up with this proposal: 'I ask you to give lower-income Americans a refundable tax credit that would allow millions to buy their own basic health insurance.' It is another nice sounding phrase meant to appeal to working-class Latino and Black voters. The Bush administration does not define lower income. Throwing terms like 'lower-income' and 'refundable tax credit' around gives his message a positive tone, but in reality few working poor people, most of whom make too much to qualify for Medicaid, have enough money to buy health insurance and then file for a refund. Or, is the Bush administration planning to abolish Medicaid and put this kind of program in its place? Put nothing past the corporations vying for power in the Bush administration that would love to get their hands on the billions of dollars in Medicaid.

The Bush speech then called on technology to solve the crisis. 'By computerizing health records, we can avoid dangerous medical mistakes, reduce costs and improve care.' That’s it. See how simple solutions like this one will solve the crisis? When the Institute of Medicine reported that over 100,000 people die each year in US hospitals due to avoidable medical errors, the silence of the White House was deafening. Now, we have their response: computers.

Bush made no mention of the financial crisis in hospitals that has resulted in the unemployment of tens of thousands of nurses, salaried physicians, technicians and other highly trained, professional health personnel. No mention of the killing speed-up on physicians in training that has them working well past the hours designated by government regulations. All we have to do is computerize and life will be ok.

Attack on Medical Malpractice It didn’t take Bush long to get to the medical malpractice system. But, in this sentence, he ascribes far greater value to killing of malpractice suits: 'To protect the doctor-patient relationship, and keep good doctors doing good work, we must eliminate wasteful and frivolous medical lawsuits.'

There is no need here to point to the whole industry of lawyers and corporations making money off of mistakes made by hospitals and physicians in the health care system. Millions of dollars are going to lawyers rather than to the victims of a failing health care system. But the solution is not to kill the one existing system that can help out victims of health care mistakes. If the Bush administration was really interested in helping such victims he would guarantee that victims receive 75 percent of the jury awards; not the crumbs left after attorneys apply fees and their expenses.

Without access to legal recourse, victims of a failed health care system couldn’t reach out for help to pay their bills. Families must pay the bills after their loved one is either recuperating or dead. These bills can run into the hundreds of thousands. Bush fails to mention this aspect of the problem in his denunciations of the malpractice system. He makes no call for relief for people who lose their homes, cars and bank accounts to collection agencies, a business that is growing each day. Today hospitals, including public hospitals, are garnishing the wages of their patients who are unable to pay their bills.

In this instance the trial lawyers are right. Patient-victims must be able to seek relief in the courts. And, given the capitalist system, the costs of the unnecessary disabilities and deaths must be borne by those who caused it. It is up to those people to seek a better system of health care, a system that makes these suits unnecessary. Only a national health care system, which doesn’t charge people at the point of service and makes sure all health care is of high quality and accessible can eliminate the medical malpractice mess. A comparison with European and Canada systems makes the point. There is no medical malpractice problem in those countries. Health Savings Accounts Under the Bush Medicare plan individual 'health savings accounts' (HSA) are being pushed. HSA are supposed to 'give' to the worker (and possibly family) a sum of money at the beginning of the year to use for health services. There are different variations on this theme, but the fundamental purpose is the same. The worker gets to keep what ever is left at the end of the year. These HSA will drive cash-starved workers to forego treatments and other services.

The one major attempt at HSA was in Jersey City, New Jersey. There, the then Republican Mayor became the darling of his party, which is advocating HSA by offering and encouraging their use amongst city employees. The logic was that young people are less sick than others; they would prefer this health insurance option. Initially, younger workers there found the plan attractive until they saw the costs of starting families. On birthing costs alone, they would have spent their entire HSA. After this, there were few subscribers to the HSA and the Jersey plan was dropped almost immediately.

But, in another attempt to make HSA look good, Bush is pushing another failed idea: 'I propose that individuals who buy catastrophic health care coverage, as part of our new health saving accounts, be allowed to deduct 100 percent of the premiums from their taxes.' You can be sure that 99 percent of people listening to this proposal have no idea what Bush is talking about. Only the ideologues of individual medical saving accounts understand, and they don’t care who doesn’t.

This is the Bush health ideologues’ answer to hospital executives who are crying to have their patients’ medical bills paid in some way.

Medicare 'Reform' The unpopularity of the Medicare reform bill is deep. The Bush pollsters are finding what everyone knows. The arm-twisting and political payoffs that enabled Bush to pass the Medicare bill showed that it did not have popular support. In both the House and Senate it passed by just a few votes.

The infamous buying off of AARP did not bring senior support. On the contrary, labor, political activists and regular members are leaving AARP in droves. The hundreds of thousands of dollars that AARP used (probably paid by insurance carriers and drug companies) to advertise their decisions only dug their hole deeper. Three full-page advertisements in the New York Times, each costing at least $60,000, only showed their failure as a representative of senior citizens. In one ad, AARP explains their new support for the importation of prescription drugs and the importance of the federal government negotiation (regulation) of the price of prescription drugs.

Recently, polls have shown that there is broad opposition to the Medicare program. A Gallop poll shows over 60 percent oppose the bill completely. Even more oppose the prohibition of importing drugs from Canada and Mexico and the legislative inability of the government to negotiate the level of the price of drugs, something routinely done around the world.

No, Medicare will not be a plus in the Bush election campaign. Unity in Action The points of unity as put forward on Health Action Day by Jobs with Justice and the Universal Health Care Action Network provide every candidate a national universal health program that will get them elected: Affordable – removing all financial barriers; Cost-efficient – spending maximum monies toward patient care; Comprehensive benefits, including long-term and mental health benefits; Promotes prevention and early intervention; Eliminates disparities in access to care; Addresses special health needs and underserved rural and urban populations; Promotes quality and better health outcomes; Adequate numbers of qualified health care caregivers to guarantee timely access; Adequate and timely payments to guarantee access to providers; Fosters a strong network of facilities; Ensures continuity of care.

These points of unity are embodied in the broadest piece of legislation in Congress: H.R. 99 and S. 41 – both for Universal Health Care Access Resolution. A Note on Inclusiveness These points of unity must also be used so as to make sure the term 'universal heath care' is not used to frighten people who already have some form of health care coverage. There is a distrust of Congress amongst many people. The recent Bush Medicare law actually threatened people who already have a prescription drug benefit. Some employers saw that they could reduce their expenses for coverage under the new law. Labor-negotiated prescription drug benefits may also see reductions. This would save corporations a lot of money.

Because of this, groups that already have benefit packages worry about Congressional action, regardless of who offers the reforms, for example, veterans (through the Veterans Administration Health System), Medicare and Medicaid recipients, Native Americans in places like Alaska where they have their own medical and public health systems and the labor movement. Each group has to have assurances that their hard fought negotiated health benefits will not be lost in any national health care legislative program. An Appeal The only answer to the Bush administration’s anti-people, pro-profit health policy program is to unite to defeat it. It will require the combined power of the labor movement, the Medicare and Medicaid movements, the movements to protect and expand the Veterans Hospitals and others such as the Native American health programs to both protect their own programs and fight for health care for everyone else. Pro-people candidates running for the White House and Congress will certainly listen to this united front. Health care is a 'hot' voters issue in the 2004 elections. Support and promotion of a universal national health program for everyone is sure to bring in votes for candidates.



--Phil E. Benajmin is a member of the health commission of the Communist Party USA.