1-25-06, 1:00 pm
The enemies of people’s health care are wealthy and powerful, but they have utterly failed to deliver adequate health services via the market system. This failure is dramatized every day on television, in newspaper and in the everyday lives of practically every person in the US. The health crisis reached epic proportions with last year’s Hurricanes Katrina and Wilma. Solutions to this crisis won’t arrive like a magic bullet or through divine intervention, but as a result of decades of struggle based on the demand that health care is a human right. The realization of this human right in the form of socialized medicine may seem far removed from our current disastrous private system, but we are closer than many people think.
Many current struggles highlight that nearness of a radical solution to this life and death issue, because radical solutions in health care already exist; they just are not called radical. Winning a comprehensive solution must begin with defeating the Bush administration’s health care agenda by eliminating the influence of the medical industrial complex in Congress and ending Republican control. Such a reversal will have a big impact on health care policies; and they know it.
Veterans’ Health
The first example of a far-reaching solution to the health care crisis that already exists involves one of the oldest national health systems. The Veterans’ Health Administration (VHA) system of hospitals provides full care, mental health and pharmaceuticals through government-run facilities with full-time, salaried physicians and nurses. Recently, the Bush administration’s effort to cut back and ultimately eliminate this national health program, no matter what the effect on veterans and their families, has been met by a growing struggle to save it. This struggle shows concretely that middle Americans will and do support socialized medicine despite the fact that they don’t call it that.
Every candidate for the 2006 congressional elections must be put on the spot in regard to their support for these hospitals. Doing their part in New York City, Veterans for Peace and other veterans’ organizations recently descended on a Veterans’ Health Administration hearing held to decide the fate of the Manhattan and Brooklyn VHA hospitals. At that hearing, the Democratic politicians did their part. Right-wing New York Mayor Michael Bloomberg and ultra-right Representative Vito Fossella also testified to keeping both hospitals open, breaking with the Bush agenda under pressure from veterans, medical and public health professionals and public opinion that might turn against them in upcoming elections.
These hearings are being held in other parts of the country. Supporting these veterans’ struggles can bring them into the larger fight for national health legislation.
Preventing Another Katrina
In the middle of the struggle to save and rebuild the VHA hospital system to take care of veterans, Hurricane Katrina struck. The consequences of the diversion of financial and material resources from New Orleans and other Gulf Coast communities caused by the Iraq war could not be swept under the rug. The connection between Bush’s wars and the hurricane’s devastation was not just obvious to progressives and those directly affected. Mainstream print, radio and television reporters saw that had there not been a war going on, National Guard units from those states would have been saving lives. Following Katrina, Hurricanes Rita and Wilma added to the damage.
As Katrina destroyed New Orleans’ levees, media reports focused on New Orleans Charity Hospital’s inability to care for storm victims adequately. What the media didn’t report, however, is that with enough funding public hospitals and VHA hospitals can deliver the preventive and emergency care needed before, during and after the Federal Emergency Management Agency (FEMA) involvement in any crisis. A system of public community-based clinics linked to these public hospitals would also be a key component. These hospitals and community clinics should have been and could have been made hurricane proof. The immediate and continuing failure of FEMA to include on-the-ground public hospitals, public health and anticipated medical services must be addressed by the current and incoming Congress.
Katrina challenged the public health and medical community to find a new way of looking at access to health and mental health services. The health crisis that Gulf Coast working families face following this devastation shows that the health system must no longer rely on the profit motive to provide needed health services. Just as importantly, we can’t rely on insurance or reimbursement mechanisms to take care of people. For most people outside of Congress it is obvious that a comprehensive solution is needed.
Rising to this challenge, the Center for Policy Analysis, a nonprofit organization that examines health care issues, has proposed that the crisis of major hurricanes demands a national health program that “provides universal health coverage through an accountable, responsive and cost efficient health care system for residents of Louisiana, Mississippi and Alabama, modeled on HR 3000.” (HR 3000 is the National Health Service legislation sponsored by Representative Barbara Lee and 12 other members of Congress.)
Last October, the New York Times admonished Republican Congressional leaders for doing only the minimum to provide basic health services for victims of the hurricanes. It is painfully ironic that Senate Majority Leader Bill Frist, a medical doctor, is actually leading the attack on hurricane victims. The health-for-profit ideologues of the Republican Party consistently oppose the expansion of Medicaid and Medicare programs to protect those most in need. Instead they support privatization of these federal programs to benefit Republican corporate contributors. Hospital Corporation of America, the Frist family’s for-profit hospital chain, leads on the demand for privatization and stands to gain billions. Frist’s doctor credentials ought to be revoked. Incredibly, the Bush agenda for the Gulf Coast is to continue privatization and cut-backs on Medicaid and Medicare in order to pay for the reconstruction. They are still trying to exploit hardship for profit. But their proposals are running into strong opposition.
We must act now to prevent another health care disaster. The limitations of band aid measures after a disaster have never been more apparent. Preventive emergency programs must be in place to take care of pregnant women and people in need of dialysis, diabetes drugs, oxygen and other life supporting equipment and so on. Easy to build emergency equipment, such as backup electrical systems, needs to be in place. So far, however, the Bush administration has worked hard to keep the public’s attention diverted from disaster prevention and comprehensive solutions.
The Cuban system applies the maximum available resources to protect people. This is one reason why the World Health Organization gives Cuba among the highest grades for its health care system. Given their geographic location and history of hurricanes, the Gulf Coast states have a lot in common with Cuba and could learn important lessons.
Steps Toward Comprehensive Solutions
Despite the ultra-right’s domination of the health care agenda, progressive solutions continue to be offered at the grassroots. Two recent ballot proposals in Massachusetts and Philadelphia are helping to build a movement for change and at the same time sending a message to Congress. While these initiatives would impact local communities and will influence state and local electoral campaigns, the most important effect will be to rekindle the hope for national health legislation. The Massachusetts initiative proposes a state constitutional amendment with the following language:
Upon ratification of this amendment and thereafter, it shall be the obligation and duty of the Legislature and executive officials, on behalf of the Commonwealth, to enact and implement such laws, subject to approval by the voters at a statewide election, as will ensure that no Massachusetts resident lacks comprehensive, affordable and equitably financed health insurance coverage for all medically necessary preventive, acute and chronic health care and mental health care services, prescription drugs and devices.
So far this amendment has passed the state legislature and now must be adopted by the voters. The Philadelphia initiative proposed changing the city’s charter to recognize the right of health care for everyone and to implement a plan to provide complete coverage. It was adopted by over 75 percent of the vote, and is in the process of being put into effect. Even so, Philadelphia’s health care experts noted that local efforts should not be seen as a substitute for national action, writing in their report to the city council that “[t]he generally accepted and optimal approach to achieving decent health care nationally is universal coverage. National reform is the ideal solution and will require significant changes to the financing of health care at the national level.”
New Opportunity for Activists
The Medicare Prescription Drug Improvement and Modernization Act of 2003 established the Citizens Health Care Working Group. Its subsequent implementation is giving health policy activists an opportunity to reach tens of thousands of people. This compromise portion of a generally regressive piece of legislation came from the center-right proposals of Senators Ron Wyden (D-Oregon) and Orin Hatch (R-Utah) known as the Wyden-Hatch amendment. It established, through the Government Accountability Office (GAO), a 14-member Citizens’ Health Care Working Group that would preside over a series of national community meetings to hear from everyone about the health crisis and what to do about it. To its credit, this group does not include any corporate representatives of the health care industry.
United Food and Commercial Workers’ (UFCW) union President Joe Hansen is a member of that group. In a statement released by the UFCW last November, Hansen commented on the role of this working group:
Lawmakers and policy experts need to hear directly from working people and ordinary citizens about the reality of health care in their daily lives. The Working Group’s most important task is to facilitate and encourage every American to take advantage of this unique opportunity to help lawmakers understand the views of ordinary people on how to make quality, accessible, and cost-efficient health care available to every American.
Hansen also pointed out that union members have a “first-hand knowledge of the pitfalls of our current health care system – whether soaring costs or access to quality care – and they have valid ideas for making the system work better for all Americans.”
Hansen added, “We have every intention of ensuring that their concerns and ideas receive the full weight of their due in the final recommendations prepared by the Working Group.” Last November, the Universal Health Care Action Network (Uhcan) indicated its intention to encourage its members and allies to get universal health care issues before the community meetings that the working group will hold.
The meetings are the first federally sanctioned community meetings on health care since the commission headed by Hillary Clinton’s traveled the country in 1993. The Clinton administration’s health care initiative failed because it did not take on the medical industrial complex or the ultra-right movement in Congress. That failure emboldened the right wing and its corporate financiers, which ended up with the inauguration of the 1994 Republican-controlled Congress and the implementation of the failed ideology of “managed care,” privatization and the claim that the market can solve the health crisis.
Testimony before this working group will be very different this time around. Corporate and market driven health care has failed. This fact must be driven home again and again. In this case repetition is the food for our future demands.
The progressive health care movement has to be there with the most logical and comprehensive answers. That movement must include traditional civil rights organizations that represent the interests of Black, Latino and other minority people who are routinely discriminated against by insurance carriers and providers of health service providers. Disparities of life expectancies based on race and national backgrounds must be included. Benefit, not financial contribution, based systems are more able to eliminate these differences and contribute to the fight against racism.
The structural solution must look at combining the Veterans’ Health Administration, the Philadelphia program, the existing federal system of community health and mental health centers, the Public Health Service Physicians Corps and the revitalized Medicaid, Medicare and Bureau of Indian Affairs health systems (without privatization measures). Making the public system the centerpiece makes sense, since it is not directly driven by market and profit incentives.
These recent local initiatives and upcoming nationwide community hearings will set a new tone in 2006. These experiences will be important in forcing candidates running for office in 2006 and the subsequent 2007 Congress to take up the issue of national health care from a progressive standpoint. Candidates for the 2008 presidential elections will be listening closely so that when the Republican candidate for president heralds the virtues of the US health system, as Bush did, they can be countered with an alternative, no profit, public health policy direction.
Summary
It has been said that there has never been more written about a problem with less done to correct the problem. The documentation of racism and anti-women aspects of our health care crisis is filling journals and mass media outlets. It could be said, that in the past decade, the more that is written about the health crisis, the worse the crisis seem to become. That is no longer the problem. The Bush agenda is in big trouble, and at the heart of that agenda along with the war and out of control corruption is the health care crisis. Illustrating the problem in terms of the human toll must continue. But, the issue is not just the documentation, its analysis of those events against the greed of the health, drug, financial and related industries.
All hands on deck must be our call. But, there is a cautionary note.
First and foremost the success of any national health legislative struggle must include an active labor movement. Most, if not all, health policy leaders understand that no progressive national health legislative movement can succeed without the full support of the organized labor movement. Sadly, neither the continuing affiliates and the AFL-CIO nor the breakaway CTW made any mention of national health policy necessities, even though these unions are facing increasing pressure from employers to cut back and/or eliminate negotiated health benefits. The recent demands of the auto industry to force the autoworkers’ unions to take concessions sent shock waves around all labor negotiated contracts.
But, it would be a strategic mistake to think that benefit setbacks mean that labor is ready to eliminate their negotiated labor contracts in favor of a national health plan, regardless of how progressive it may appear. Union leaders face elections and elections deal with the here and now, not future hopes.
That also means that continuing to gain local union and higher labor body support for city, state and national health care legislation (and constitutional action) is very important. Clearly, there must be a direct attempt to win labor to a national health program by assuring elected leaders that any proposal for national health care will not eliminate negotiated plans in contracts. A good example is the French national health care system. There, labor unions maintain complete control of their benefit programs (via mutuelle societies), but also fully participate in the national program. Another example might be the Canadian system which started with unions maintaining control, but then were eventually folded into the national program. The same could happen here. A US plan might allow the voluntary incorporation of their plans into the national program. For example, had there been a national health plan in place, the UAW and GM could have found an alternative to increasing worker contributions for diminished health services; they could have simply shifted to the national program.
The first step toward that approach is taking place in Pennsylvania with the “Model Bill 2005 Balanced Health Care Reform” which is a comprehensive universal bill for everyone in the state. It carries the following feature: “Parties to collective bargaining agreements with health benefits at least as generous as the Commonwealth Plan may opt out of the program.” The feature was included after consultation with the Steelworkers, the Pennsylvania AFL-CIO and a few other unions. This could be the kind of an approach that would bring labor into the national health care struggle on a meaningful level. More information can be gotten at http://ulwar.air.com/phc. The crises brought on by national disasters coupled with the on going health care crises faced by over 45 million uninsured and another 60 million with rapidly diminishing benefits, points to the necessity of on-the-ground community and hospital and mental facilities with salaried physicians and nurses ready to help. Political Affairs will maintain a scorecard of local and state initiatives and national actions and the results of the 2006 elections.
--Phil E. Benjamin is health editor for Political Affairs.
