U.S. health care: Crisis, solutions, action plan

The United Steel Workers of America (USWA) hosted a national forum on the health care crisis at its headquarters in Pittsburgh on April 27. James English, secretary-treasurer of the USWA, set the stage for the forum, pointing to a Census Bureau report showing that 41.4 million people lacked health insurance in 2001. (As we go to press, the Congressional Budget Office has said that nearly 60 million may be without health insurance in the U.S. at some point during each year.)

English spoke to a standing room only crowd of union and community activists – ordinary people coming together in common cause, recognizing the crisis, finding its causes, and working to come up solutions and an action plan.

The struggle around solving the crisis in the U.S. health care system promises to be one of the defining struggles in 2003 and for the 2004 elections.

We reprint here excerpts of English’s remarks, along with excerpts from other speeches presented at the meeting.

– The editors





A crisis needs action

By James English

According to the National Academy of Sciences, being uninsured for even a year diminishes a person’s general health; that lack of health insurance leads to delayed diagnoses, life-threatening complications and ultimately 18,000 premature deaths each year. Lack of insurance translates into 600 premature breast cancer deaths, 1,400 deaths among HIV-infected patients, and 1,400 premature deaths due to under-treated hypertension.

Many of [the uninsured] are children whose parents cannot afford health insurance but do not qualify for Medicare. And they include a disproportionate number of African Americans, Latinos, American Indians and Alaskan Natives.

A study by the Steelworkers union indicates that manufacturing companies spend some $6.83/hr. to provide health insurance for their employees, compared to $2.10/hr. in Canada. Small wonder, then, that Canadian business leaders support Canada’s government-run health care system, or that 30 of Ontario’s largest employers said they would be happy to pay higher taxes for a national prescription drug plan.

So what can we do about the problem?

Number one: Don’t get side tracked by phony issues. Solving the medical malpractice insurance problem needs to be dealt with – but it will not solve the health insurance problem.

Second, we should not just dismiss partial solutions. The problems are enormous – we may have to proceed in steps rather than in leaps.

Three, stay informed. And while you’re at it, check the positions of the candidates.

Next: Stir up the pot. Write letters. Attend rallies. Talk to your neighbors. The presidential campaign affords a valuable opportunity to push the envelope.

The problems that we face are enormous. No one should kid themselves about that. Our job is to find a way to get our message out so that those running for any and all elected office are forced to deal with this issue.

James English is secretary-treasurer of the USWA.





People ask: ‘Where’s the plan?’

By Rep. Dennis J. Kucinich

It’s a sad commentary that Washington can find money for a trillion-dollar tax cut but not for universal health care. They were able to spend $65 million for the first installment on war against Iraq—but no money for universal health care.

Martin Luther King, Jr. said it all: “Of all the inequalities, injustice in health care is the most shocking and inhumane.”

When South Africa broke the shackles of apartheid and it wrote a Constitution saying, “Everyone has a right to health care services.”

It is time to break the shackles of a system that has turned managed care into managed money. Health care is a matter of human dignity and of the common good. A government that derives its legitimacy from armed force while the health needs of its people are weighed and found wanting, needs to be stirred by conscience and by action.

This is our challenge and let it be our philosophy: to repair the health of our nation, to establish health care as a human right, and to create a single-payer universal health care system.

People ask: “Where’s the plan?” Well, there is a plan – one sponsored by myself, Congressman John Conyers (D-Mich.) and Congressman James McDermott (D-Wash.), and 21 others. It’s called Medicare for All (HR-676) and it creates a single-payer universal health care plan.

It guarantees access to health care to everyone. It guarantees a universal standard of best-quality medical care and lower costs. It will expand Medicare benefits to cover all medically necessary procedures – and eliminate private insurance. Other government programs like Medicaid would be subsumed under Medicare for All. All private health facilities would be converted to non-profit status.

Medicare for All would cost the same $2.2 trillion we now spend on health care every year. We start with existing annual government spending of $852.5 billion. We would maintain existing federal, state and local revenues from health-related programs – another $194 billion – with the exception of the revenues that now come from the health premiums of employees of the federal government.

Another $440 billion would come from a payroll tax of 6.6 percent on all public and private employers, nearly two percent less than the average 8.5 percent employers now pay for employee health insurance.

There would be no deductibles – another $200 billion saved.

Under Medicare for All, we would close loopholes that allow employers to deduct the cost of heath insurance when paying income taxes – and save another $230 billion.

We could generate significant cost savings by consolidating administrative costs in a situation where these costs go as high as 18 percent under our present system, compared to three percent for Medicare and Medicaid.

HR-676 would save as much as $180 billion through bulk purchase of prescription drugs.

But people will say, “There’s still gotta be money.” That’s right. We’ll stop the administration’s tax cuts and put those dollars in places that are productive for society: health care, education, job programs and protecting Social Security.

In order to get money for guaranteed health care, we could cancel the national missile defense system – and save $100 billion over ten years. We could still have a strong defense by canceling sophisticated weaponries that don’t work. But one thing for sure: we’re not going to have national health care if we pursue the policies of perpetual war and endless tax cuts.

The call for universal health care is a call to the conscience of America. It is the issue that can define who we are as a people. If we demand that everyone who seeks the Democratic nomination take an unqualified position on universal, single-payer health care, if we demand that we get profit and corporate control out of the health care system. If we demand that, we will help shape the future for the American people.

Don’t let anyone tell you we cannot do this. Don’t let anyone tell you we must wait longer. The time for waiting is over. The time for action is now: 2003 is the year to start and 2004 will be the year to deliver.

Dennis J. Kucinich is the Democratic congressman for Ohio’s 10th Congressional District.





It’s high time we get it done

By Jonathan Ross

The United States has a long history of efforts to establish some form of national health care, beginning with President Theodore Roosevelt’s proposed a national health insurance system in 1911. He’d visited Germany where the Kaiser set it up put it in place to keep the Socialists away.

The Commission of Costs of Medical Care was set up in 1927 and delivered their report in 1932 and that called for tax-based financing, highly trained personnel, and specialty care centralized in high quality care facilities.

These ideas were incorporated in the Wagner Health Act of 1937. Just when President Franklin Roosevelt was willing to take it up, we had a war that changed everything. Prior to World War II, a smattering of people had their health care attached to a job and that’s where we ended up and have been ever since. Our challenge was – and is – is to get out from under that system.

So in 1960 John Kennedy said he wanted a national health insurance program, modeled after the Medicaid system. While doctors may not want it, the family package is wonderful. It covers hospitals, doctors, nursing homes, drugs, rehabilitation care – it’s an excellent, extensive and comprehensive package.

We’d all be lucky if we had that package. And you know what? We can all have that package, because that’s what Mr. Conyers and Mr. Kucinich are focused on. They are going to use Medicare for their

model because people know that Medicare works – that that you can’t lie to them about it.

So, what happened in the Great Society of the administrations of Presidents John Kennedy and Lyndon Johnson? We got Medicare and we got Medicaid.

So then we got President Bill Clinton, who wanted to do deal with health care at the national level. Trouble is, he made a deal with the devil – he made a deal with the big insurers. He told them, “Look, I’ll turn everybody over to you. Just cover everybody.” Pretty soon the Harry and Louise ads popped out and that was the end of that.

Let’s talk principles: That’s the first thing we have to do when we talk to people. We should ask questions like what they think the health care system should be built on.

They want cost control? We’ve got to talk about that because if we can’t control costs, it isn’t going to work. Dick Gephardt is talking about $251 billion extra dollars. It’s not going to fly. Clinton wanted $100 billion. It didn’t fly. So we’ve got to make sure there’s built-in cost control.

Do you want insurance companies trumping your doctor and hospital? It’s bad enough to be sick. It’s even worse to have some damned bureaucrat telling your doctors what they may or may not do.

There must be improvement and assurance built into the system. That means public accountability to get rid of the frauds and cheats.

So here we are again. And the question is, Why are we in this room?

Our answer is simple: Because it’s high time that we get it done. We’re here because, as the Kaiser Family Foundation says, 92 percent of Americans think the present Congress needs to deal with full medical care insurance.

Doctors take an oath to serve patients, to do no harm. The guys who run the insurance companies haven’t taken any oath. The law says their duty is to their stockholders, not to their patients, and to make as much money as they can for their stockholders. We can change that—this meeting today is another step in that direction.

Jonathan Ross, M.D., is past president of Physicians for a National Health Program.





It works in Canada

By Lynn Williams

In America you are trying to get a national health plan. In Canada, we’re trying to save one. We’ve been attacked by the same people – the insurance companies and the right-wingers – and the same budget-cutting drives in both countries. And the battle is continuous.

So we’ve been struggling and fighting with them. But they have made inroads – there has been some deterioration in the system. But it finally it came to the point where the government appointed a Royal Commission to study the health care system.

The outpouring from the people was overwhelming. When it came time for the commission to make its report, it had to report that the Canadian people want their health care system. They want it fixed. They want the money put back into it so it can be run decently. So the government put millions of dollars in the budget to help finance the system and we’re on the way to getting it back in place.

There’s another very interesting fact. Over the years these people would attack the system from every conceivable angle. But no political party ever went to the people with a program to get rid of a public health care system.

Now a few words about how the system works. General practitioners are the gatekeepers of the system. I have a choice of specialists through the GP. I go to them. I show them my card. I sign in and that’s the end of it. Consider what happened to my daughter when she had her last child. When she left the hospital she had one bill to pay – the cost of a long-distance call to her sister. That’s it.

I once lived in the United States and now I’m back in Canada. I’ll confess: I miss several things from the U.S. But I don’t miss the horror stories in the U.S. papers about health care – horror stories about families having to pay rent for nursing homes, about choosing between medical care and food, about going bankrupt because of high medical bills. We don’t see these stories in Canadian papers. Under the health care system in Canada, they just don’t exist.

Lynn Williams is president of Steelworkers Organization of Active Retirees.