The Struggle for Real: Universal Health Care Now

by Carl Sack / forum speech given in Sept. 2009

Welcome, and thank you all for coming. My name is Carl Sack, and I am a member of Socialist Action, which is sponsoring this forum. I was also active in the Northland Health Care for All Coalition while that organization existed. I have intensely studied the current health care system and proposals now on the table.

I also have a personal interest in calling for universal health care. I was born with a heart defect, and have had three open heart surgeries. When I’m about 35, I’ll need another surgery, but at the present time I am uninsured and am not sure how I would have any way to pay for it, since even if I do have insurance by then it could exclude coverage for pre-existing conditions. The procedure I’ll need costs tens if not hundreds of thousands of dollars, which I won’t be able to afford out of pocket. So unless our system changes, I could literally be dead in ten years from a treatable disorder.

That’s my story. Everyone in this room probably has their own. I want to leave plenty of time for discussion, but first let’s cover just what it is that makes our system so unjust, and what we can do about it.

The Problem

General

While we have probably all heard various statistics on the quality of U.S. health care, let’s start by reviewing some of the basics:

-The U.S. ranks #39 on the overall quality of its health care, according a 2000 report by the World Health Organization. This puts us last among developed nations, and also behind such countries as Colombia, Morocco and Costa Rica.

-The U.S. ranks last of 19 developed nations in the number of preventable deaths. 18,000 people needlessly die each year because they cannot afford adequate care.

-The U.S. ranks 29th in the rate of infant mortality, with 6.8 infant deaths per 1,000, compared to Cuba’s 6.0 infant deaths per 1,000.

-Over 47 million Americans are uninsured. (source: Robert Wood Johnson Foundation survey).

-Those who are insured often have high premiums and co-pays. An AFL-CIO survey found that 39% of Americans failed to get needed health care in 2006 due to financial barriers to access.

-Those who are insured still may be denied coverage for necessary procedures, or have their policy rescinded entirely when they need it most. A Congressional investigation found 20,000 cases of rescission among just three large insurers over a five-year period.

-In most states including Minnesota and Wisconsin, people are routinely denied medical insurance coverage on the basis of pre-existing conditions such as diabetes, cancer, or even something as benign as acne. Nationwide, a recent survey found 36% of non-elderly adults had been discriminated against based on a pre-existing condition. (My story with Blue Cross)

-In Duluth, a 2005 survey by East Hillside Patch found that 47% of households surveyed had problems obtaining medical or dental services, 51% had problems affording prescription drugs or glasses, 40% said their health needs were not met because of a lack of health care benefits. 76% of households reported their health care benefits had changed in some way over the past year.

-The cost of U.S. health care per person is over double the nearest other country, at $7,439 per person in 2007. The U.S. spends 15.3% of GDP on health care, which is expected to grow to nearly 20% by 2017 (Centers for Medicare and Medicaid Services). 31% of this expenditure is for administrative costs, according to a study published in the New England Journal of Medicine, including 5-10% that goes to profit shareholders of private insurance companies and health care facilities. This compares to 16.7% overhead in Canada overall and 1.3% overhead for Canada’s national health insurance.

Gender

Now that we have some background, let’s get back to the title of this forum, which states that universal health care is a matter of gender, race and class justice. So let’s talk about just how the present for-profit system discriminates based on gender. In 2008, the National Women’s Law Center published a report that found:

-While women having health insurance through an employer are protected by state and federal laws against gender discrimination, there are few such regulations that protect people who do not have employer-provided or public insurance and must purchase their own insurance. Approximately 7% of women have health insurance through this market, and 18% are completely uninsured. With the layoffs of the recession, more people are seeking to buy individual plans.

-Insurance companies in the individual market usually charge higher premiums for women than for men under a legal practice called gender rating. The study found “huge and arbitrary variations in each state and across the country in the difference in premiums charged to women and men.”

-It is difficult and costly for women to find health insurance that covers maternity care.

-In nine states and D.C. it is legal for insurers to reject women because they are survivors of domestic violence. Insurers can also reject women for having previously had a C-section.

-In addition to such direct practices, because of the ongoing history of employment discrimination based on gender in this country, women are more likely to work lower-paid jobs with more limited or no health insurance benefits than are men.

Race

Unlike gender discrimination, in the wake of the civil rights movement, insurance companies dropped the practice of charging different premiums based on race. But there are still more barriers for people of color to get quality medical care than for whites.

-A Dartmouth study in 2008 found that blacks with diabetes were five times more likely to have a leg amputated than whites, and black women were less likely to receive mammograms than white women.

-A 2004 National Health Survey found that 14.6% of Blacks, 16.5% of American Indians and 13.3% of Hispanics were in fair to poor health, versus 8% of Whites. Much of this is due to the economic inequalities that parallel race, but even comparing among groups with the same income, Blacks were 3-5% more likely to report fair to poor health than Whites.

-Infant mortality rates are far higher for African Americans and Native Americans than for Whites. Cancer rates are much higher for Blacks, while Indians are twice as likely to die from diabetes than Whites.

-21% of Blacks and 32% of Indians are uninsured, compared with 13% of Whites.

-On Native American reservations, the quality of health care is often much lower than elsewhere. Despite a treaty obligation dating to 1787 under which the U.S. is responsible to provide all Native Americans free health care, federal funds for the Indian Health Service have shrunk to the point where they run out mid-year. The common although tragic joke on reservations is “don’t get sick after June.” Reservation clinics are ill-equipped and understaffed, and stories of deadly rationing of care abound.

Class

As for class, those to whom money is no object do get Cadillac medical care. The rest of us, the working class and poor, are left with the crumbs and the worst impacts of rising medical costs.

-Insurance premiums have risen 6-8 times faster than average wages.

-As millions of people lose their jobs due to the recession, they also lose their health care coverage. Those who have stayed on the job have faced heavy benefit concessions to employers, especially in the area of health care coverage.

-The federal COBRA program allows people who are laid off to maintain their health insurance by paying the full premium cost of their policy. Of course, with much reduced income, most unemployed cannot afford those premiums.

-1 in 5 workers were uninsured before the recession.

-62% of all bankruptcies filed in 2007 were related to health expenses, and 80% of those filing had health insurance.

-Immediately prior to the recession, half of all home foreclosures were caused in part by a medical problem, which made the homeowner unable to afford both the medical bills and their mortgage.

-While public medical programs are especially important as a safety net in times of recession, they are the first thing to get cut by governments facing deficits. In Minnesota, General Assistance Medical Care, which provides free medical coverage to 33,000 low-income, single, childless adults, will be completely eliminated as of January, 2010 due to the Governor’s budget cuts.

The Solution

It starts with recognizing Health Care as a Human Right. In a moral sense, it is self-evident that nobody should die for lack of care, for denying care violates the axiom, “do unto others as you would have them do to you.” Practically, the lack of care for some brings the health of our entire society down, as when treatable diseases spread because some people can’t afford vaccination or prompt treatment.

The hunt for profit corrupts the entire medical system, making it palliative instead of preventive—“sick care” instead of “health care.” Because they can’t afford to see a doctor, people hold off until they face a much worse condition that requires more expensive and complicated treatment. Not only that, but there is an incentive against creating a healthy lifestyle.

In order for drug companies to make money selling new drugs, there must be a demand for the drugs. Increased sickness leads to increased demand; thus obesity, diabetes, heart disease, stress disorders, etc. are all a boon to the profit-driven market.

Obviously the U.S. Health care system is not just broken, it’s inhumane. In this there is broad general agreement; only the real right-wing nutjobs will deny change is needed. But what kind of change? This question is where sharp differences emerge.

We in Socialist Action propose a simple answer: provide every single person living in the United States free, quality health care regardless of identity, citizenship status, or income. The cost of doing this would be much lower than the present system, as the waste and duplication of the labyrinthine private market, and the profits stolen to benefit executives and shareholders, would be eliminated. Not one cent of the remaining cost should be borne by working people, but rather it should be paid by a progressive income tax on only those making far more than a living wage.

However, we socialists are also realists, and we recognize that under the present political climate, this ideal is unlikely to come to pass. So let’s take a look at what proposals currently are on the table.

While I’m talking, I am going to pass around a set of three flow charts, each a different idea for structuring health care. One shows the present system, one shows a single-payer system, and one shows the Obama plan. Take a look and decide for yourself which would be most efficient to administer.

The present proposal that comes closest to our ideal is a national single-payer health care system, as embodied by Congressional Bill HR 676, the Conyers Bill, and its Senate companion S. 703. In the absurd dialogue about health care promulgated in the corporate media, single-payer is often mixed up with socialized medicine. The two are not the same, though they can go hand in hand.

Socialized medicine would be a system similar to Great Britain’s National Health System, in which the government wholly owns and operates hospitals, clinics, and other health care facilities, and doctors and nurses get their paychecks from the government. This is like the Veteran’s Administration or public schools. This system would be ideal because it would have the fewest levels of administrative bureaucracy, resulting in the least amount of overhead cost.

By contrast, single payer is essentially a national health insurance plan, whereby everybody is enrolled and the government cuts checks to private health care facilities. Under the Conyers bill, for-profit hospitals and clinics would have to change over to not-for-profit status in order to be incorporated into the system. This is like Canada’s system, or Medicare. In an analogy with education, think charter schools.

Many of the myths and lies in the corporate media create the image that single-payer leads to cold-hearted rationing and dictatorship on the part of gray-clad government bureaucrats. While these accusations certainly apply to private insurance companies that routinely limit doctor choice and deny necessary care, under the Conyers proposal everyone would have access to whatever health care providers they chose and could not be denied coverage for any necessary procedure.

As for funding, the group Physicians for a National Health Program, which calls for a single-payer system, finds that savings in administrative costs—which would amount to more than $350 billion annually—would be more than enough to pay for a single-payer system for all Americans. Further, 60% of health care spending is already publicly financed through two tax measures: the tax credit for private health insurance, which mainly benefits wealthier people, and the Federal Employees Health Benefit Program. PNHP says, “The amount of public health spending in the U.S. is greater than the combined public and private spending of nations which provide universal comprehensive health insurance.”

The next option is the ever-changing health reform plan being pushed by President Obama and the majority of bought-and-paid-for-by-the-insurance-lobby Democrats. Those pushing Obamacare acknowledge many of the failures of the present insurance system and the toll its cost is taking on the ability of U.S. capitalists to compete on the world market. But they seek a solution that would save the struggling sectors of U.S. capitalism while doing the minimum to actually help the human beings desperately in need of access to care.

The Obama plan would actually be a boon to the private insurance industry. And why not? The insurance companies have spent $19.7 million buying politicians on both sides of the aisle so far this year—a tiny sum compared to their billions in annual profits, to be sure, but you still don’t drop that kind of dough unless you expect something major to show for it. (Source: Center for Responsive Politics).

And show it will. One of the staples of the plan is a provision requiring everyone to purchase some kind of health insurance or face a tax penalty, thus handing the insurance industry millions of new customers in a captive market. Of course, those being criminalized and punished would be lower-income people who could not afford to purchase insurance no matter what the cost. Not to worry, proponents say—the very poor would receive a government subsidy. Then again, centrist Democrats argue that the subsidy makes the price tag of the overall plan too high, so it might not be in the final version after all. Even with a subsidy, an individual mandate would neither guarantee coverage for all nor reign in administrative costs.

After a very similar mandate with a subsidy was introduced in Massachusetts in 2007, 40% of the previously uninsured remained without coverage. Many were forced to buy catastrophic policies with extremely high deductibles that made them essentially useless. Meanwhile, an agency similar to Obama’s proposed “health care exchange” was established, which added another 4.5% to administrative costs and contributed to a state budget crisis, resulting in deep cuts to the social safety net. Those who found themselves unemployed due to the recession still lost their health insurance (and had less state-funded care to rely on).

What of the much ballyhooed and maligned “Public Option?” This would ostensibly be a public health insurance program that anyone could opt into. Liberals in favor of the Obama plan argue that the Public Option would give government-run insurance a chance to compete with private insurers and showcase its effectiveness, perhaps leading toward a single-payer system sometime down the road.

However, the Public Option would merely further add to the waste and duplication already in the patchwork insurance system. Right-wingers have certainly exploited workers’ fear of losing employer-based insurance “that they like,” but there is some reality to the threat that employers could dump workers’ health benefits with the excuse that they can just sign on to the public plan. This would amount to a huge cost-shift for care away from businesses and onto the backs of working-class taxpayers. Further, the public plan would be weighted down by carrying the costs of the poorer and sicker segments of the population so private insurers could maintain their “Cadillac Care” reputation.

The ideology of the “Public Option” is one that says competition is good, that it lowers prices and creates an incentive to innovate. But PNHP has found that market-based competition is responsible for raising costs and lowering the quality of U.S. health care. When Medicare was restructured in the 1980s so that private companies could compete with the government plan for federal dollars, HMO’s began cherry-picking healthy patients and persuading them to pay extra premiums, while denying care for the sickly and dumping them back on the government rolls. This scheme ended up costing Medicare billions more annually, and led to the current funding shortage and underpayment to providers.

Rather than lowering prices overall, competition merely breeds greater bureaucracy and waste. The state of Maine has offered a “Public Option” since 2003; it only covers 10% of the previously uninsured and has not realized any lower costs in competitors’ premiums.

The Obama plan includes some market regulation measures tackling the most egregiously criminal acts of private insurers. But as long as a multi-billion dollar private insurance industry exists that can pay for hundreds of lobbyists and buy off politicians of either major party, the insurance companies will continue finding ways to deny adequate care and rob patients blind.

What can we do?

The only way to get the necessary universal health care reforms is to build a militant movement independent of either major political party.

Even some well-meaning liberals have fallen into the Obamacare trap. In the Northland Health Care for All coalition, I worked with a group of people seemingly committed to single-payer, who even went so far as to agree that the more-comprehensive-at-the-time Obama plan was “Bogus ‘Universal Health Care.’” Those days are over. If you go to the Health Care Teach-In at UMD on Wednesday evening, I guarantee you’ll hear those same individuals extol the virtues of the Public Option and discuss hypothetical political maneuverings that could get it to pass.

Even if the Public Option were a good thing, political maneuvering within the system can only run into the brick wall of Congressional Democrats bought and paid for by the health insurance lobby, or who are perhaps afraid they’ll be the latest subject of a Bill O’Reilly rant. By backing the Public Option, mainstream Liberals have spinelessly given ground to the Right, accepting a “compromise” that is really more of a cave-in.

The answer is to take to the streets and the lecture halls and blogs and passionately explain to working people why only government-run universal care—a single-payer or socialized system—can put an end to the malignant tumor that is our insurance system. The Left—including the unions, which still hold considerable power—must be united and uncompromising in our support for single-payer as the most privatized acceptable option.

Conclusion

One final word is needed on the accusations that health care reforms would constitute “socialism” in America. I am proud to call myself a socialist, and I do so because I believe that society should be founded on the basis of providing for human needs, not on the basis of greed and profit for a small minority of wealthy individuals. Privatized health care constitutes the epitome of capitalism, the epitome of runaway greed. In the words of Rolling Stone’s Matt Taibbi, the system is “a black leprosy eating away at the American experiment — a bureaucracy so insipid and mean and illogical that even our darkest criminal minds wouldn't be equal to dreaming it up on purpose.”

The proposals being debated in Congress and by mainstream media would do nothing to dismantle a capitalist industry that should never have existed in the first place, and is even bad for the rest of American capitalism. In fact, they would strengthen and prolong the leprosy. Real government-run health care is the only way to halt the death machine that is the American medical system.