A year-end report from the Commonwealth Fund highlights core, mainstream health care issues. These, in turn, show some key points of struggle in 2005.

Consumers bearing costs

“Although the increase in health insurance premiums moderated in 2004 compared with 2003, they still took a double-digit jump for the fourth straight year … far out-pacing the general inflation rate,” according to the report says. “Individuals bore more of the brunt of these increases through higher out-of-pocket costs, including increased premiums, deductibles and co-pays.” Health care activists need to report these out-of-pocket costs to drive this point home.

Uninsured growing

The number of uninsured increased to 45 million in 2003, up from 43.6 million in 2002 and a 13 percent increase from 2000. Bush’s refusal to fund any insurance program for the uninsured will dramatically increase these numbers.

Bush Medicare law

The Fund reports that one year after the passage of the Medicare Drug Bill, only 6 million of the 40 million Medicare-eligible seniors have signed up for the new program. Most of these got their coverage through their HMO coverage. The price tag for the Bush drug benefit is actually $530 billion, not the stated $400 billion. The cost is directly attributable to legislation passed by the Republican Congress that prohibits the federal government from negotiating a national drug-pricing plan similar to those in place in Europe and around the world. This will be a main area of struggle in 2005 and must be linked to the fight to save Social Security.

Drug development, approval and monitoring

The Commonwealth Fund Report stated that the Federal Food and Drug Administration came under greater scrutiny in 2004. The report was issued before the revelations on the dangers of VIOXX and similar drugs. This is definitely a point of mass struggle and can link the Bush administration to the drug cartels.

Patient safety and medical errors

Due to errors in hospitals, 44,000 to 98,000 Americans suffer deaths that could have been prevented. Little progress has been made in this disastrous situation, according to a study by Dr. Robert Wachter of the University of California San Francisco Medical Center. The quality of care issue has to be presented in a believable and effective manner. This is not an anti-worker fight, it’s a fight for more funding and greater numbers of nurses, physicians and other workers in hospitals.

State initiatives

The Fund states there was a mixed picture of state actions for health care progress. With the Republicans controlling both houses of Congress and the White House, some health policy leaders are urging greater emphasis on action at the state level.

Influenza vaccine

The Fund documents the debacle of the U.S. not being able to provide enough vaccine for those who must have it for protection from the deadly flu virus. Drug company control over production and distribution of prescription drugs is ripe for challenging.

Information technology

The Fund greets talk about increasing health information technology, but says that the talk is not backed up with enough action. IT is important to mass health care coverage, but cannot be in and of itself the solution to problems.

The value of the Commonwealth Fund’s health highlights is that its authors have their finger on the pulse of the top mainstream policymakers, the often-quoted “policy wonks.”

It doesn’t take much to identify the key issues, but as Marx said, what are you going to do about them?

Left out of the report are crucial issues such as affirmative action to rid the health system of its endemic racism; access to and expansion of health professional education; and government-sponsored research on key health problems. The struggle for a universal national health program must be kept on the front burner. With this kind of program, coalitions of labor, community, religious and other health care activists can unite and expand to fight for a people’s health approach.