Guaranteed Healthcare

Ezekiel J. Emanuel chooses to assign liberals with controlling costs in
health care, when he should be waving his finger at the health care
sector. When “skyrocketed” health care costs come up, profit never makes
it into the discussion or calculations.

Although many may think today that we have always had employer-sponsored health insurance (ESI) in this country, that is not the case. While some companies offered coverage in the 1930s, the basic concept gained momentum only after the start of World War II. The war effort required a rapid buildup of industrial capacity in the face of a severe labor shortage as many men went off to war. Employers needed a healthy workforce, and needed to compete for workers. Federal wage and price controls made it difficult for them to offer higher pay, so that ESI became an important recruitment tool. Employers were helped by an IRS ruling that made their costs of ESI tax-deductible;  these benefits also were not taxable for employees. (Somers, AR, Somers, HM. Health and Health Care: Policies in Perspectives. Germantown, MD. Aspen Systems Corporation, 1977, pp 109-11)

We saw in our last post how the intensifying class war in America over the last 30 years has hollowed out the middle class and led to the widest gap between the haves and have nots in our country’s history. In this Second Gilded Age, the right has been winning the war by its promotion of deregulated markets and its attacks on government, thereby sacrificing the public interest to the benefit of the politically elite and the few at the top. In this new landscape, Social Darwinism increasingly prevails—sink or swim, take care of yourself, don’t expect any ‘handouts’.

As the Great Recession rolls on after three years, without signs of relief on the horizon, a growing army of many millions of Americans is finding it impossible to gain access to necessary health care that is affordable. Meanwhile, class warfare is gaining intensity with a widening gulf between the left and right over the major issues of the day, including the future of U.S. health care. As political gridlock continues, the battlefield is littered with many preventable deaths, many lives wounded by the ravages of untreated or under-treated disease, and growing stress in affected families.

Under the theory of moral hazard, it is postulated that insured people overuse health care services and that patients themselves are a leading cause of health care inflation. If they would just have more “skin in the game” through enough cost-sharing (co-payments, deductibles and other restrictions), it is assumed that costs could be reined in.

As the last three posts have shown, the primary care infrastructure of the U.S. health care system is crumbling, overrun by specialization, sub-specialization and market forces. As a result, access to primary care is not available to a growing part of our population, costs go up as value, quality and outcomes of care go down, and any accountability within the market-based system remains out of reach. The “reform” legislation of 2009 cannot be expected to alleviate these fundamental problems, “building” as they do on our present flawed system of financing and delivering health care. Since all incremental efforts to reverse these trends have failed, we need more fundamental approaches.

Up to the middle of the last century, most Americans could count on good access to generalist primary care physicians with the training and commitment to evaluate and treat their medical problems, whatever they might be. Those days are long gone. The ratio of generalist physicians to specialists in this country reversed from about 80:20 percent in 1930 to 20:80 percent in 1970. Since then we have seen the generalist tradition being carried on by family physicians, general internists, general pediatricians, and osteopathic physicians, but their aggregate numbers today are no more than 30 percent. And that number is falling fast as more medical graduates seek out the higher pay and more attractive life styles of the non-primary care specialties.

Yesterday’s blog post by John Goodman and Thomas Saving of the National Center for Policy Analysis (NCPA) is the latest in an avalanche of unfounded assertions and distortions that have characterized the writings from this center for many years. The Dallas-based NCPA, established in 1983, describes itself as a “nonpartisan public policy research organization, with the goal to develop and promote private alternatives to government regulation and control, solving problems by relying on the strength of the competitive, entrepreneurial private sector” (its website). This latest post puts forward, without context and with cherry-picked references, carefully selected statements that might seem to some to support their case—that deregulated markets will solve all of our health care problems. It would take a very long paper, or a number of papers, to respond to the many unfounded claims in their latest post.

Amidst all the crises confronting our country today—ranging from the deficit, rising unemployment and underemployment, mistrust of legislators and the government—there is another major crisis: the continued deterioration of primary care that threatens to break up the very foundation of U.S. health care. Underreported and widely misunderstood, the continued decline of primary care results in uncontrollable inflation of health care costs, decreased access to necessary care, increasing fragmentation and depersonalization of care, and unacceptable quality and outcomes of care. As health care costs spiral out of sight and consume an ever-increasing part of the country’s GDP, this trend, unless reversed, can destabilize and eventually bankrupt our health care system, and perhaps even our country.

When the nurses come to Washington, D.C., next week, there will be other advocates and activists for social justice seeking support for some of the same issues and bills.  The vision NNU’s leaders and members have for a more just nation in which Main Street issues matter – like good jobs, education, healthcare, and a healthy environment – is a vision that embraces many issues our allies share and are working to support.

This is an action that takes just moments to complete, but has the potential to change the future. 

A petition drive has been launched by several groups, asking the Senate Democratic Caucus to support the DNC Afghanistan Withdrawal Resolution and Sanders’ American Health Security Act of 2011 (S.915).  To sign the letter,  http://www.pdamerica.org/forms/sign/Sign-Letter-Senate-Democratic-Ca].

This letter will be distributed to the members of the Senate Democratic Caucus on June 7, as part of the National Nurses United  June 7 Rally and Lobby Day. (If you can’t make it to DC for the rally and lobby day, then please mark your calendars for the June 7 National Call-in Day, and find more information on that here: http://capwiz.com/pdamerica/issues/alert/?alertid=48701501].

Many of our allies in the progressive movement have endorsed and signed this letter—we hope you’ll join them.  [Sign here http://www.pdamerica.org/forms/sign/Sign-Letter-Senate-Democratic-Ca].

Our allies have a goal to gather at least 25,000 signatures between now and midnight, June 5.  [Click here to sign http://www.pdamerica.org/forms/sign/Sign-Letter-Senate-Democratic-Ca], and then please post this to your Facebook page and forward this email to your likeminded friends and family members.

Tim Carpenter, of the Progressive Democrats of America, noted, “Bin Laden is dead; the Afghanistan mission is accomplished. It is time to bring our troops and war dollars home and start addressing the very real hardships facing Americans, including providing comprehensive healthcare for all and the spiraling costs of healthcare.”

By Donna Smith

After this past weekend of horrific storms and tornadoes, it was clearly appropriate for our elected officials to declare a federal disaster in some areas.  With the designation comes some federal money and help for the storm-ravaged areas and residents.  Few would quarrel with our government stepping up and stepping in when so many lives and so many livelihoods have been damaged and lost.  It is the right thing to do, and some suffering will be mitigated.

Check out this great video by www.MadAsHellInAmerica.com and then take a moment to share it on Facebook, Twitter, and with friends. Afterall, everyone in America deserves Guaranteed Healthcare.

By Donna Smith

I’m up for some political behavior modification work.  How about we support and reinforce the elected officials who do what we want to see happen and stop giving power to those who act in ways we do not wish repeated?

I think Vermont has it right.  When their state House members passed a very inclusive and progressive measure to provide healthcare to all Vermonters, that is what humanitarian effort looks like.  Providing access to healthcare for all is much more humanity-friendly than dropping bombs, I think.

Read about it here:  http://www.boston.com/news/local/vermont/articles/2011/03/24/vt_house_resumes_debate_on_health_care_bill/

So, for me, dropping bombs and allowing people to suffer in other less overtly violent ways are undesirable political behaviors and I will not reinforce them.  Providing access to healthcare and promoting peace is something I like and want to see more of in the future.  I want to see a lot more peace and a lot better healthcare access, so I want to reinforce those elected officials who make those things happen.

Staring today, for me, my political effort and advocacy goes even more pointedly toward reinforcing behavior like that of the elected officials in Vermont who understand that warfare on ones own citizens, even if it is economic warfare and class warfare and healthcare warfare, is not desirable behavior and will not be rewarded. 

I think I’ll find a way today to very concretely reward at least one of the Vermont elected officials who acted so appropriately on behalf of us all.  Wish we could get lots of people to do that and send a powerful, positive and behavior-modifying message.  It used to work when I was parenting; maybe it’s worth a shot now.  Peace.  On Vermont.

By Donna Smith

Today, I heard the news.  President Obama supports the Wyden-Brown amendment allowing states to innovate on healthcare reform.  You’ll have to pardon some of us while we readjust the mirrors.

Just 20 brief months ago, I recall the trepidation and trauma that surrounded allowing the U.S. House of Representatives Education and Labor committee to even take a vote on what was then known as the “Kucinich amendment.”  The amendment would have provided a path to waivers of some of the federal restrictions and requirements that keep states from implementing state-based single-payer healthcare plans or other kinds of health reform under the new law.  At the time, text messages were flying back and forth from all the President’s men to all of the members of Congressman Miller’s committee to keep the flock in line – no one was supposed to vote for the Kucinich amendment.

It passed anyway.  It was the only piece of health reform legislation of any kind that passed with bi-partisan support during the rough and tumble debate of 2009-2010.  Republicans hated single-payer possibilities but voted for the Kucinich amendment as a states’ rights issue; Democrats voted for it if they thought their state might pass something better that the current federal bill, maybe even single-payer legislation.   Some Democrats fought against it because they thought it was an affront to the President’s bill.  But in a remarkable moment of sensibility, the amendment passed only to be stripped from the final bill to keep the President happy and more secure in his path to passage of his larger bill.