A measuring stick

Now that President Bush has embarked on giving all Iraqis a national health program, members of Congress are finally sitting up and taking notice. “What about here?”

Of course, many trade unionists, community activists and health care professionals have been hitting on Congress to make health care a prime issue for a number of years. And the AFL-CIO rejoined the movement at the recent meeting of its Executive Council.

On the other side are the usual suspects: the insurance industry; physicians in the American Medical Association; even the drug cartels – the Medical Industrial Complex. But that hasn’t stopped them from claiming that their proposals are universal and comprehensive.

During the 1970s and early 1990s, the same level of activism took place. One of the most important activities for health activists during that time period was to establish a list of pro-people, pro-health criteria by which to judge the myriad of proposals.

The criteria are not mysterious nor are they a confusing bunch of ideas. On the contrary, they are principles that leaders of progressive health circles have agreed upon and they have proven useful in health systems in Europe, Asia and other countries.

These criteria can be summed up as follows:

Universal: All people are covered, including those without official immigration papers and international travelers.

Governance: Federal administrators cannot be left to run the system. Therefore, to make sure that the system works there must be governance that reflects those who pay for, those who use, and those who work in the health system. This requires a strong presence of the organized labor, community health and pro-people professional activists.

Full Access: Full access means all health services are included: hospitalization, physician care, mental health and psychiatric care, vision care, dental care, transportation to health services that are immediately available in their area. This is of particular importance to families in rural areas or underserved urban communities.

Guaranteed and available health services: A person may have the right to services, but there may not be hospitals or physicians available. Many proposals that claim to be universal are almost useless when there are no community health clinics and hospitals or physicians willing to accept patients in programs such as Medicare or Medicaid.

Publicly-minded professionals: No system of national health care can work without physicians, nurses, allied health professionals[physical and occupational therapists, etc.], health planners, and administrators who believe in the system. The system requires salaried physicians to guarantee continuation of health care rights.

This was not possible a few decades ago, but for over 20 years more than half of the physicians in the U.S. are already on salary. Although fee-for-service can’t be outlawed, a national health system can be built on fee-for-service medicine.

The funding for the Federal Public Health Service Corps would need to be dramatically increased to where it was a few years ago. This would set the federal tone on health services and train the next generation of health professionals. This is also the way to make sure strict affirmative action guidelines are implemented so that everyone has access to professional training.

Public health research: Federal research budget cutbacks has meant that important public health research is more and more controlled by the drug and medical supply companies. A real national health system must have a research arm to rely on.

Planning: No health system, especially in a country the size of the U.S., can be efficient and effective without an aggressive planning system that carries with it enforcement powers. From 1970 to the mid 1980s such a system existed. But that was then, and now we are stuck with the Reaganite “the market system can be the planners.” This must change. Federal tax dollars must be monitored in more ways than just for open fraud, like that that practiced by Dr. – now Senator – Bill Frist’s Hospital Corporation of America.

Put this list in your computer or your monthly planner and get ready for candidates seeking election in 2004. Insist that they outline their plans for resolving their health care crisis and measure them against this criteria. That’s called grassroots political action.

The author can be reached at pww@pww.org